September 4   2015, Friday
eMedinewS
editorial
Dark Chocolate good for the heart
Dr KK Aggarwal Dark chocolate is thought to promote relaxed arteries, also have biochemical effects that may discourage atherosclerosis suggests a report published in the March 2014 issue of the FASEB Journal.

In a randomized, double–blind study, eating dark chocolate—acutely and over weeks—not only improved objective measures of endovascular function, it also improved biochemical markers that reflect leukocyte activation, inflammation, and other signs of atherogenesis.

Changes in endothelial function were reflected in improved flow–mediated dilation (FMD), blood pressure, and augmentation index, while "changes in leukocyte–cell counts, plasma cytokines, and leukocyte adherence markers after chocolate consumption point toward a less–activated state of cellular adherence and, hence, a less atherogenic milieu, according to the authors, led by Dr Diederik Esser (Top Institute Food and Nutrition and Wageningen University, the Netherlands).
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eMedipics
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Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
News
Psychiatry
Two small studies failed to detect any functional improvement from the use of intranasal oxytocin (multiple brands) in patients with schizophrenia, even when coupled with social skills training, suggests new research. The findings were presented at the 28th European College of Neuropsychopharmacology (ECNP) Congress.

Oncology
Venom belonging to the Brazilian social wasp Polybia paulista contains the antimicrobial peptide Polybia-MP1 (MP1), which has been demonstrated to inhibit multiple forms of cancerous cells such as prostate cancer, bladder cancer and multidrug-resistant leukemic cells, suggests a new study published in Biophysical Journal.

Gastroenterology
Nutrition

The British Dietetic Association (BDA) have released a new version of their policy regarding gluten-free foods on prescription to coincide with new celiac disease guidelines produced by the National Institute for Health and Care Excellence (NICE). The updated policy states that a gluten-free diet is the only treatment for celiac disease and therefore warrants the continued provision of gluten-free staples on prescription.

Obstetrics and Gynecology
Plastic Surgery

For women undergoing hysterectomy, removal of hanging abdominal fat and skin--a cosmetic procedure called panniculectomy--can be performed at the same surgery without increasing the risk of complications, suggested a study published in the September issue of Plastic and Reconstructive Surgery.

Hepatology
New research suggests that cirrhosis at first diagnosis and antibodies for the soluble liver antigen/liver pancreas antigen (SLA/LP) are major risk factors for poor short- and long-term outcome in patients with autoimmune hepatitis. The results were published in Hepatology.
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Cardiology eMedinewS
  • PROMPT (Post–Myocardial Infarction Remodeling Prevention Therapy): Participants randomized to receive a cardiac resynchronization therapy defibrillator (CRT-D) with LV pacing alone or with right ventricular (RV) pacing had no significant differences in remodeling 18 months later, the primary end point, compared with those who didn't receive any implant. No differences in secondary end points, which included mortality or HF hospitalization were observed.
  • BELIEF: In patients with persistent, recurrent atrial fibrillation (AF), performing electrical isolation of the left atrial appendage (LAA) as well standard catheter ablation and pulmonary-vein isolation may increase the chance of success. However, two experts have also cautioned that it is too soon to recommend LAA isolation for all patients with persistent, recurrent AF.
  • PLATFORM (Prospective Longitudinal Trial of FFRCT: Outcome and Resource Impacts): The use of CT followed by a fractional flow reserve (FFR) calculation in stable coronary artery disease patients scheduled for a planned invasive catheterization was associated with a reduction in the percentage of patients in whom no obstructive disease was identified during the coronary angiography. For those who underwent planned invasive diagnostic angiography without FFRCT, 73% of patients in the "usual-care" arm had no obstructive disease compared with just 12% of patients who underwent diagnostic angiography based on information from the FFRCT test.
  • ABSORB Japan and ABSORB STEMI TROFI II: Absorb everolimus-eluting, bioresorbable vascular scaffold is at least as good as the everolimus-eluting Xience stent, but there is still no evidence of superiority -- a disappointment for many who had hoped bioabsorbable technology would rapidly prove itself superior.
Pediatrics eMedinewS
Pediatrics
Psychiatry
Genetics

Combining chromosome microarray analysis and whole exome sequencing may benefit children suspected of having autism spectrum disorder by revealing genetic mutations potentially linked to autism spectrum disorder, suggests a new study published September 1 in JAMA.

Pediatrics
Addiction

Given the high prevalence of binge drinking among adolescents, parents and pediatricians should talk to children about the dangers of alcohol use from the age of 9 years, suggested a clinical report from the American Academy of Pediatrics, published in the journal Pediatrics.
Pulmonary Embolism
The most common symptoms in patients with pulmonary embolism were identified in the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) study. They include:
  • Dyspnea at rest or with exertion (73 percent)
  • Pleuritic pain (44 percent)
  • Cough (37 percent)
  • Orthopnea (28 percent)
  • Calf or thigh pain and/or swelling (44 percent)
  • Wheezing (21 percent)
  • Hemoptysis (13 percent)
Dr KK Spiritual Blog
Why is there a ritual or tradition of offering food to God before eating?

This is a Vedic reminder to oneself that one should eat only those foods that are offered to God. Each time you offer food to God, it is a reminder to you to change your decision and choices. For example, alcohol, tobacco, onion, garlic, radish, etc. are not offered to God. If they are part of your food, there are chances that you will not consume these food items, if you observe this ritual.

Over a period of time people have stopped following this ritual and now eat some foods, which cannot be offered to God in all their 21 meals during a week. This is the reason why the incidence of lifestyle diseases is increasing in the community.
Scientific awareness on personal hygiene and prevention from obesity among school going children, N P CO. ED. Sr. Sec. School, Kali Bari Lane, Havlock Square, New Delhi-3-8-15
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Make Sure
Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.
Reaction: Oh my God! Why was additional insulin given?
Lesson: Make sure that the insulin dose is correctly calculated. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.
Dr Good Dr Bad
Situation: A patient with chronic kidney disease (CKD) wanted a cardiology consult.
Dr Bad: It’s not needed.
Dr Good: You should get it done.
Lesson: Chronic renal dysfunction alone is an independent risk factor for the development of coronary artery disease, and for more severe coronary heart disease.

(Copyright IJCP)
eIMA Quiz
What percentage of your diet should fat make up?

A. About 10 percent of your daily calories.
B. About 20 percent of your daily calories.
C. About 30 percent of your daily calories.
D. About 40 percent of your daily calories.
E. There is no recommended amount of fat; you should strive to eat as little of it as possible.

Yesterday’s Mind Teaser: All are precancerous for carcinoma colon except

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

Answer for Yesterday’s Mind Teaser: d. Carotene

Answers received from: Dr K Raju, Dr Poonam Chablani, Dr Shangarpawar, Dr Azhar Almas, Dr K V Sarma, Dr G Madhusudhan, Dr B R Bhatnagar, Daivadheenam Jella, Dr Raghvendra Chakurkar, Dr Avtar Krishan.

Answer for 2nd September Mind Teaser: c) It is related to duration of ulcerative colitis.

Correct 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.
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Rabies News (Dr A K Gupta)
Can the IM and ID routes of vaccination be used interchangeably?

It is recommended by many internationally reputed experts that the phenomenon of mixing of IM and ID schedules is not to be practiced and must be avoided as far as possible.
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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
A World Heart Day initiative

Creating Heart Healthy Homes

It is the World HeartMonth and the theme for the upcoming World Heart Day is ‘Creating heart-healthy environments’. Given that we live in a country, which is soon to become the heart disease Capital of the world, each one of us must work towards making their homes heart-friendly. Making even just a few changes can help reduce your own and your family's risk of heart disease and stroke.

Heart disease is reversible if lifestyle modifications are made in a timely manner. Nine potentially modifiable risk factors of heart attacks 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%, 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, “Inculcating heart healthy practices within one’s home can go a long way in reducing the incidence of cardiovascular disease in India. Children should be taught about the ill effects of smoking, the benefits of consuming a healthy diet and regularly exercising from the very onset. Parents play an extremely important role in influencing the choices their children make in their future. If they regularly smoke at their homes and live high-stress and inactive lives, their children are more likely to do the same."

A few ways in which each one of us can make their homes heart friendly are:
  • Stock your home with healthy food options.
  • Limit the consumption of junk or pre-packed food that are often high in sugar, fat, and salt.
  • Incorporate fresh fruits and vegetables in your meals and reduce sweet cravings by swapping sweet treats with mango or other sweet fruits.
  • Prepare healthy yet creative lunch at home and for your child’s school tiffin.
  • Ban smoking in your home, this will not only improve your health but also your children's health and discourage them from picking up the habit in the first place. Quitting smoking is a great way to be a positive role model for your children.
  • Be active, limit the number of hours spent watching TV or playing games on various electronic gadgets.
  • Organize outdoor activities such as cycling, hiking or simply playing in the garden.
  • Recognize your CVD risk.
  • Visit a health professional who can measure your blood pressure, cholesterol and glucose levels, weight and body mass index, and advice you on your risk.
  • Once you know your CVD risk, you can make a specific plan to improve your heart health and your healthcare professional can also advise on appropriate treatment options where necessary.
eIMA News
Increasing maternity leave from three months to eight months: For comments
In terms of running essential service particularly Hospitals where majority of the staff are female. Such long leave will make effective patient care difficult. Such long leaves normally attract termination of service of the employee and against existing labour Laws.

IMA cannot approve or support this proposal. Although IMA support women rights and women empowerment. Husband also can do babysitting and need not be the responsibility of women alone. This proposal in fact goes against women empowerment.

Prof. Dr. A. Marthanda Pillai
National President,
Indian Medical Association.
Tobacco control
The health ministry had set a deadline of April 1 to increase the size of pictorial warnings on packs of tobacco products. A notification to this effect was also issued allowing time to manufacturers to prepare for the implementation. However, following interim recommendations by a Parliamentary Committee on Subordinate Legislation examining the proposed amendments to the Cigarettes and Other Tobacco Products Act, 2008, the ministry had put the final notification for the implementation on hold. The committee had sought more time to do stakeholder consultation and submit its final report to the health ministry.

IMA also reacted and sent its recommendations against the views of the Parliamentary Committee. The government has also failed to indicate a deadline for the committee to submit its recommendation or to say how long the ministry will wait before issuing its final order.

The agriculture ministry has also given its consent to the proposal for larger pictorial warnings.
News
  • Mortality among patients who experience the condition known as takotsubo cardiomyopathy is comparable with that of acute coronary artery syndrome, and women are nine times more likely than men to experience the condition. Widely known as "broken-heart syndrome" or by many other names including "widowhood disease," takotsubo cardiomyopathy causes the heart to contract abnormally and to take an unusual shape while doing so. "Takotsubo" is a Japanese word for an octopus trap that resembles the heart's shape during the abnormal contracture. (Medpage Today)
  • A new analysis of the IMPROVE-IT trial found no significant increase in the rate of new onset diabetes in patients taking ezetimibe. In the study, new onset diabetes was defined as the initiation of a diabetes drug or two consecutive fasting glucose levels of 7 mmol/L or higher.
  • ICU physicians and patient surrogates rarely spoke about the patient's religion or spirituality, but when they did, surrogates were more likely to broach the topic. Of 457 surrogate decision makers, 77.6% said religion or spirituality was fairly or very important in their life (JAMA Internal Medicine)
  • The US Food and Drug Administration (FDA) has put five distributors of pure powdered caffeine on notice that their products are potentially dangerous. Caffeine in its powdered form is very potent. A teaspoon has the same amount of caffeine in it as about 28 cups of regular coffee. Consume too much caffeine and you can end up with a rapid or dangerously erratic heartbeat, seizures or even death, according to the FDA.
  • The US FDA approved Varubi (rolapitant) to prevent delayed phase chemotherapy-induced nausea and vomiting.
  • Children treated with amoxicillin for strep throat may return to school the next day without putting other children at risk for contracting the illness, suggests a study published online August 20 in the Pediatric Infectious Disease Journal.
  • The US FDA has approved a labeling update for ceftaroline fosamil (Teflaro, Allergan) used to treat adults with acute bacterial skin and skin structure infections (ABSSSI) and community-acquired bacterial pneumonia (CABP). The updated label includes new data on efficacy in patients with ABSSSI with baseline Staphylococcus aureus bacteremia and allows for a shorter intravenous (IV) infusion time.
How active are you?
  • < 2,500 steps/day (sedentary – basal activity)
  • 2,500–4,999 steps/day (limited activity)
  • 5,000–7,499 steps/day (low active)
  • 7,500–9,999 steps/day (somewhat active)
  • 10,000–12,499 steps/day (active)
  • ≥12,500 steps/day (highly active)
Health Ministry geared up to address Dengue in the country
Shri B P Sharma, Secretary, Ministry of Health & Family Welfare stated here today that the Ministry is geared up to address the recent spurt in number of Dengue cases in Delhi and other states. The Minister for Health & Family Welfare, Shri J P Nadda has been personally reviewing the status of Dengue in the country, he stated. In addition several meetings have been taken with Municipal Bodies, Delhi Government officials, Delhi Cantonment Board and MS/Directors of Central Government hospitals in Delhi to review the situation and preparedness to address and manage Dengue and not allow it to escalate. Shri Sharma has asked the National Vector Borne Disease Control Programme (NVBDCP) of the Health Ministry, Delhi Government and the Municipal Corporations to coordinate their IEC activities towards this end.

Secretary (HFW) also said that all four serotypes (1, 2, 3 & 4) of Dengue were isolated from time to time from various States in India. The report of serotype presently circulating in Delhi is awaited. The process of identification is underway at AIIMS and the result is expected within a week, he stated. He also informed that in 2015, though more cases have been reported than 2014 till 31st August, deaths have been comparatively less. Also, due to intermittent monsoon Dengue vector breeding is rampant in both residential and non-residential areas.

Secretary (HFW) has also written to Secretary (Urban Development) to allow access to several unoccupied buildings and rooftops of buildings for checking breeding. He has also urged CPWD to undertake special measures for vector control in construction sites, basements, roof tops and unused flats/buildings.

Breeding surveillance of all premises of the central government hospitals is being carried out to ensure that they are free of any vector breeding. Adequate stocks of NS1 and IgM testing kits to detect cases of Dengue are available with identified 514 sentinel surveillance hospitals and apex referral labs. The list along with the treatment guidelines is available at the Ministry’s website.

Central teams from the Ministry of Health & Family Welfare have visited high endemic states which have reported large number of cases, to provide technical guidance to the states to combat the situation.

The Ministry has also undertaken intensive targeted multi-media IEC activities to create mass awareness among the communities for prevention and control of Dengue. (Source: Press Information Bureau)
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Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

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Inspirational Story
Addiction to Worry

Carole started counseling with me because she was depressed. She had been ill with chronic fatigue syndrome for a long time and believed her depression was due to this. In the course of our work together, she became aware that her depression was actually coming from her negative thinking – Carole was a constant worrier. Many words out of her mouth centered on her concerns that something bad might happen. "What if I never get well?" "What if my husband gets sick?" "What if I run out of money?" (Carole and her husband ran a very successful business and there was no indication that it would not go on being successful). "What if my son gets into drugs?" "What if my kids don’t get into good colleges?" "What if someone breaks into the house?"

Her worry was not only causing her depression, but was also contributing to her illness, if not actually causing it. Her worry caused so much stress in her body that her immune system could not do its job of keeping her well. Yet even the awareness that her worry was causing her depression and possibly even her illness did not stop Carole from worrying. She was addicted to it. She was unconsciously addicted to the sense of control that worry gave her.

I understood this well because I come from a long line of worriers. My grandmother’s whole life was about worrying. She lived with us as I was growing up and I don’t remember ever seeing her without a look of worry on her face. Same is with my mother – constant worry. Of course, I picked up on it and also became a worrier. However, unlike my mother and grandmother, who worried daily until the day they died, I decided I didn’t want to live that way. The turning point came for me the day my husband and I were going to the beach and I started to worry that the house would burn down and my children would die. I became so upset from the worry that we had to turn around and come home. I knew then that I had to do something about it.

As I started to examine the cause of worry, I realized that worriers believe that worry will stop bad things from happening. My mother worried her whole life and none of the bad things she worried about ever happened. She concluded that nothing bad happened because she worried! She really believed that she could control things with her worry. My father, however, never worried about anything, and nothing bad ever happened to him either. My mother believed that nothing bad happened to my father because of her worry! She really believed until the day she died (from heart problems that may have been due to her constant worry) that if she stopped worrying, everything would fall apart. My father is still alive at 92, even without her worrying about him!

It is not easy to stop worrying when you have been practicing worrying for most of your life. In order for me to stop worrying, I needed to recognize that the belief that worry has control over outcomes is a complete illusion. I needed to see that, not only is worry a waste of time, but that it can have grave negative consequences on health and well–being. Once I understood this, I was able to notice the stomach clenching that occurred whenever I worried and stop the thought that was causing the stress.

Carole is in the process of learning this. She sees that her worry makes her feel very anxious and depressed. She sees that when she doesn’t worry, she is not nearly as fatigued as when she allows her addiction to worry to take over. She sees that when she stays in the moment rather than projecting into the future, she feels much better. The key for Carole in stopping worrying is in accepting that worry does not give her control.

Giving up the illusion of control that worry gives us is not easy for anyone who worries. Yet there is an interesting paradox regarding worry. I have found that when I am in the present moment, I have a much better chance of making choices that support my highest good than when I’m stuck thinking about the future. Rather than giving us control, worry prevents us from being present enough to make loving choices for ourselves and others. Worrying actually ends up giving us less control rather than more!
Quote of the Day
Strength of a character isn't always about how much you can handle before you break. It’s also about how much you can handle after you've been broken. Robert Tew
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Reader Response
Respected Sir, Congratulations and great appreciation for the strong and very genuine points included in the agenda to improve rural health system. Good package and facilities and more than one doctor will also hold doctors who go abroad for jobs. Regards: Dr Sofiya Ansari
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Wellness Blog
Fever

Fever does not always mean presence of infection. There are many situations where there may be fever without infection and hence needs no antibiotics.
  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti-psychotic drugs.
  • Hyperthermia may not respond to anti–fever drugs.
  • When fever is more than 41.5°C, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of the thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.
IMA Humor
Under the wagon

A farm boy accidentally overturned his wagonload of wheat on the road. The farmer that lived nearby came to investigate.

"Hey, Willis," he called out, "forget your troubles for a while and come and have dinner with us. Then I’ll help you overturn the wagon."

"That’s very nice of you," Willis answered, "but I don’t think Dad would like me to."

"Aw, come on, son!" the farmer insisted.

"Well, OK," the boy finally agreed, "but Dad won’t like it."

After a hearty dinner, Willis thanked the host. "I feel a lot better now, but I know Dad’s going to be real upset." "Don’t be silly!" said the neighbor. "By the way, where is he?"

"Under the wagon," replied Willis.
Over 50 doctors attended the IMA Rise & Shine CME on Vitamin D deficiency in Trivandrum
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