April 5  2015, Sunday
All about depression
Dr KK Aggarwal
  • Depression is a major public health problem as a leading predictor of functional disability and mortality.
  • Optimal depression treatment improves outcome for most patients.
  • Most adults with clinical significant depression never see a mental health professional but they often visit a primary care physician.
  • A physician, who is not a psychiatrist, misses the diagnosis of the depression 50% of times.
  • All depressed patients must be enquired specifically about suicidal ideations.
  • Suicidal ideation is a medical emergency.
  • Risk factors for suicide are known psychiatric disorders, medical illness, prior history of suicidal attempts, or family history of attempted suicide.
  • Demographic reasons include older age, male gender, marital status (widowed or separated) and living alone.
  • World over about 1 million people commit suicide every year.
  • Seventy–nine percent of patients who commit suicide contact their primary care provider in the last one year before their death and only one–third contact their mental health service provider.
  • Twice as many suicidal victims had contacted with their primary care provider as against the mental health provider in the last month before suicide.
  • Suicide is the 10th leading cause of death worldwide and account for 1.2% of all deaths.
  • In the US, the suicidal rate is 10.5 per 100,000 people.
  • In the US, incidence of suicide is increasing in middle aged adults.
  • There are 10–40 non–fatal suicide attempts for every one completed suicide.
  • The majority of suicides completed in US are accomplished with firearm (57%); the second leading method of suicide in US is hanging for men and poisoning in women.
  • Patients with prior history of attempted suicide are 5–6 times more likely to make another attempt.
  • Fifty percent of successful victims have made prior attempts.
  • One of every 100 suicidal attempt survivors will die by suicide within one year of the first attempt.
  • The risk of suicide increases with increase in age; however, younger and adolescents attempt suicide more than the older.
  • Females attempt suicide more frequently than males but males are successful three times more often.
  • The highest suicidal rate is amongst those individuals who are unmarried followed by widowed, separated, divorced, married without children and married with children in descending order.
  • Living alone increases the risk of suicide.
  • Unemployed and unskilled patients are at higher risk of suicide than those who are employed.
  • A recent sense of failure may lead to higher risk.
  • Clinicians are at higher risk of suicide.
  • The suicidal rate in male clinicians is 1.41 and in female clinicians it is 2.27.
  • Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts.
  • The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration.
  • Management of a suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow up.
  • Major risk for suicidal attempts is in psychiatric disorders, hopelessness and prior suicidal attempts or threats.
  • High impulsivity or alcohol or other substance abuse increase the risk.

IMA-GFATM RNTCP PPM Annual Review National Workshop (29th March 2015)
  • The US Preventive Services Task Force (USPSTF) has concluded there is insufficient evidence to recommend screening for thyroid dysfunction in adults who are not pregnant and who are asymptomatic, reports an article published online March 23 in the Annals of Internal Medicine.
  • A minimally invasive aesthetic treatment that uses cold thermal injury to block the impulse control of motor nerves leading to temporary muscle relaxation and a reduction in dynamic wrinkles seems to be the potential new treatment for facial wrinkles, reported a study presented at the American Academy of Dermatology 73rd Annual Meeting.
  • When smokers quit, their metabolism improves, suggests new research presented at ENDO 2015, the annual meeting of the Endocrine Society.
  • Prostate artery embolization appears to be a safe and effective alternative to more traditional treatments for benign prostatic hyperplasia, suggest two new studies presented at the European Association of Urology 30th Annual Congress.
  • Urine concentrations of two tumor-specific proteins may have significant potential for detecting renal cell carcinoma (RCC) in some patients, reported a new study published online in JAMA Oncology.
Dr KK Spiritual Blog
Why can the body be revived even after hours of death in hypothermia?
  • It is a well–known phenomenon that cardiopulmonary resuscitation (CPR) is not successful if the body temperature is less than 35°C.
  • In hypothermic deaths, a person can be revived even after hours of cardiac arrest. Once the body temperature is brought back to normal, only them CPR will be effective.
  • This would mean that consciousness gets frozen and does not leave the body when the temperature is below 35°C.
  • This forms the basis for induced hypothermia after death to revive the brain.
  • Modern science is silent about this mechanism but the ancient Indian literature talks about it in great detail. As per Chandogya Upanishad (6.15.1), the process of death takes time and is a sequential process.
  • First, the motor indriyas organs (Karma Indriyas) stop functioning followed by sensory indriya organs (Gnanaindriyas) followed by cessation of pana or respiration.
  • Once this happens, the frozen sensory organs, motor organs, manas (mind, body, memory and ego) and prana have to get dissolved in Tej and then leave the body, which means presence of Tej is the most important factor for consciousness to leave the body.
  • In modern science, Tej would be governed by the body temperature. That means if the body temperature is low, the motor and sensory indriyas and manas Product (Vritti) will find no heat or Tej to dissolve and come out of the body.
  • Therefore, till the body temperature (Tej) is brought back to normal, the indriyas will seize to function but still be revivable.
  • This process may take upto 48 minutes in presence of Tej and there is no time limit if Tej is absent.
  • A clinically dead person with cardiac arrest therefore will have absent functioning of Manas organs, sensory organs, mind, intellect, memory and ego with no respiration but yet revivable back to life.
Beneficiaries of Sameer Malik Heart Care Foundation Fund
Cardiology eMedinewS
  • The results of a new study suggest that there is a paradoxical relationship between calcification of the coronary artery and atheroma volume among individuals treated with statin therapy. In the analysis, statins, specifically high-intensity statin therapy, actually promoted coronary calcification despite regressing the volume of coronary atheroma. (Medscape)
  • Compared with stopping dual antiplatelet therapy (DAPT) at 12 months, extending therapy to 30 months reduced the risk of stent thrombosis and MI but also increased the risk of mild to moderate bleeding in patients who had a coronary stent implanted, whether this followed an initial MI or stable angina, reported a new study published in the Journal of the American College of Cardiology.
Pediatrics eMedinewS
  • Pimecrolimus 1% cream (PIM) or topical corticosteroids (TCS) are safe for the long-term management of mild to moderate atopic dermatitis (AD) in infants, suggests a new study published online March 23 in Pediatrics.
  • Most deaths in children with cerebral malaria may be due to increased brain volume leading to raised intracranial pressure, suggests new research published online in The New England Journal of Medicine.
Quote of the Day
Heart tells the eyes "See less, because you see and I suffer lot".
Eyes replied, "Feel less because you feel and I cry a lot".
Make Sure
Situation: A patient died after receiving penicillin injection.
Reaction: Oh my God! Why was anaphylaxis not suspected?
Lesson: Make sure that each time a patient is given penicillin injection, anti-anaphylaxis measures are available.
Dr Good Dr Bad
Situation:A 40-year-old male developed dyspnea for the first time in life. 
Dr. Bad: It is an attack of asthma.
Dr. Good: Get an ECG done.
Lesson: First onset of breathlessness after the age of 40, unless proved otherwise, is cardiac in nature.
(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
Inspirational Story

Nothing is as painful, as unforgiveness to the soul; a heart that's torn asunder, with forgiveness becomes whole.

A single kind word spoken means more than countless words; the three words, "I forgive you," Are all that need be heard.

To a soul that has been wounded, like a healing, cooling balm; Forgiveness soothes and comforts, till at last the soul is calm.

For the soul that seeks forgiveness, when forgiveness can't be found; it struggles vainly every day, to hear that simple sound.

The power in those three kind words can heal a heart that's broken; But that heart cannot begin to heal, As long as words remain unspoken.

Compassion in its purest sense, Reside in those three words; the three words, "I forgive you," Are all that need be heard.

eMedi Quiz
The buffering capacity of a buffer is maximum at pH equal to:

1. 0.5pKa.
2. pKa
3. pKa+1
4. 2pKa

Yesterday’s Mind Teaser: In a patient with a tumor in superior mediastinum compressing the superior vena cava, all the following veins would serve as alternate pathways for the blood to return to the right atrium, except:

1. Lateral thoracic vein.
2. Internal thoracic vein.
3. Hemiazygos vein.
4. Vertebral venous plexus.

Answer for yesterday’s Mind Teaser: : 4. Vertebral venous plexus.
Correct Answers received from: : Dr. Poonam Chablani, Raju Kuppusamy, Kala Sarma, Daivadheenam Jella, Dr G Madhusudhan, Dr Avtar Krishan
Answer for 3rd April Mind Teaser:2. Propionyl CoA.
Correct Answers receives: : Daivadheenam Jella, Dr Avtar Krishan, Dr G Madhusudhan, Viswanatha Sarma, Daivadheenam Jella, Dr Poonam Chablani
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
Sonal Namaste
When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet.
Facts about Tuberculosis (TB)
How is TB diagnosed under RNTCP?
  • Under the Revised National TB Control Programme (RNTCP) patients who have cough for 2 weeks or more (with or without other symptoms) are suspected to be suffering from pulmonary TB. Such patients are called TB suspects.
  • TB suspects are referred to the nearest Designated Microscopy centre (DMC) for sputum examination.
  • There are over 12,800 such DMCs located in public, NGOs and private health facilities across the country.   
  • Two sputum samples from the TB suspects are examined for TB bacteria at the DMC by a test called smear microscopy. If TB bacteria are seen in the test, the patient is diagnosed as a ‘smear-positive pulmonary TB case’ and started on treatment.   
  • In case the smear microscopy does not show any TB bacteria, the patient is given antibiotics for 2 weeks. If the patient’s symptoms do not resolve, a repeat sputum examination is done.  If the repeat examination is also negative, a chest x-ray is done. If the chest x-ray is suggestive of TB, the patient is diagnosed as a ‘smear-negative TB case’ and started on treatment.
  • Patients suspected to be suffering from extra-pulmonary TB are referred to the secondary and tertiary care health facilities for necessary tests like FNAC (Fine Needle Aspiration Cytology) etc. to confirm the diagnosis.
Pharmacist to answer patients' queries for free

NEW DELHI, April 3, 2015, DHNS:

If you want extra information on the medicines prescribed to you by a doctor, you can now consult a pharmacist for free at the Indian Medical Association headquarters in ITO here.

The Indian Medical Association has started free consultation for patients. A pharmacist will be available for eight hours every day who can advise patients on when the medicine needs to be taken or on drug reaction in individual cases.

The pharmacist will also be able to guide patients on duration of the treatment. Patients can also discuss the possible side effects of the medicines and how to report these to doctors in future.

“Currently, one pharmacist is available at the headquarters. The idea is to give patients more information about medicines prescribed by doctors. The pharmacist can respond to queries like how the patient is reacting to the drug,” said Dr K K Aggarwal, Honorary Secretary General,?IMA.

The IMA will expand the project at a later stage so that more patients can be accommodated.

In government hospitals, patients are often at loss to understand how to go about the medicines with doctors having little time during rush hours. The IMA is now planning to send circulars to government hospitals so that doctors can send patients here for free consultation.

Hoardings will also be put to make people aware of the consultation available at the IMA?House, said Dr Aggarwal.

Meanwhile, the IMA is also likely to start free OPD in the headquarters in a month. Besides free consultation, needy patients will also be provided medicines at a subsidised rates

Tobacco Debate


A controversy broke out on Thursday (April 2) over remarks by 'beedi' baron and a parliamentary committee member from BJP Shyam Charan Gupta suggesting "nil" effect of smoking, evoking sharp reaction from Opposition parties which sought his removal from the panel. "I can produce a lot of people in front of you who are chain smokers of beedi and till date they have had no disease, no cancer... You get diabetes due to eating sugar, rice, potatoes. Why don't you write warnings for all these things as well," said Gupta, a Lok Sabha MP from Allahabad. His remarks were criticised by Opposition parties including Congress, SP and CPI-M which alleged that there was a "conflict of interest" as Gupta was in tobacco trade and also a member of Parliamentary Committee of Subordinate Legislation looking into the rules regarding tobacco sale in the country. Terming Gupta's inclusion as a member in the committee as "grossly unethical", Congress spokesperson Sanjay Jha said, "...Here you have an elected MP, who sits on a panel and clearly does not make disclosures. If he is running a Rs 250 crore worth of business (beedi)... The conflict of interest is culpable."

Jha further said, "You do not have to be a genius or a Sherlock Holmes to find out that what is the vested interest that he is definitely trying to pursue at the legislative level. This is the kind of risk that as a country we are getting to exposed on account of a very unethical Parliamentarian." Significantly, Gupta remarks came barely days after the panel head Dilip Gandhi's statement that there was no Indian study to confirm that tobacco use leads to cancer, leaving the government embarrassed and rival parties and the medical fraternity gunning for him. Gupta, a member of the same panel, had reportedly told the committee that beedis have "nil" harmful effect and had also suggested that the government should make a distinction between smoked and chewed tobacco as he believes that the former was not as harmful. Defending Gupta, Gandhi said he was not the only one in the tobacco trade.

In a debate moderated by TIMES NOW's Editor-in-Chief Arnab Goswami, panelists -- GVL Narasimha Rao, National Spokesperson, BJP; Dr Ajoy Kumar, Spokesperson, Congress; Dinesh Trivedi, MP, Lok Sabha & Fmr MoS, Health & Family Welfare; Dr K K Aggarwal, Senior National Vice President, IMA; Dr K Srinath Reddy, President, Public Health Foundation of India and Navika Kumar, Political Editor -- discuss the issue -- everyone knew, nobody did anything?

Members of IMA Kamarhati cordially invite you to attend the World Heath Day Program " Seminar on Food Safety" on 07 Apr'15, Tuesday at 4pm at IMA Hall, 1, Ambica Charan Mukherjee Road, Belgharia, Kolkata-56 ( besides CSTC Belghoria depot on Nilgaunge Road)

With Regards

Dr. PK Pandit, President IMA Kamarhati Branch 

AGA Issues New Endoscope Safety Recommendations
Janis C. Kelly: Medscape

After recent outbreaks of drug-resistant and sometimes fatal infections after endoscopic retrograde cholangiopancreatography (ERCP), the US Food and Drug Administration (FDA) and device manufacturers have issued warnings and updated instructions on cleaning the equipment. Now, the American Gastroenterological Association (AGA) has published best-practice recommendations for physicians using endoscopes.
AGA Recommendations for Physicians Using Endoscopes
In the new recommendations, published online March 23, the AGA recommends physicians:
  • treat all elevator-channel endoscopes the same, including both fine-needle aspiration echoendoscopes (endoscopic ultrasound) and duodenoscopes;
  • continue to follow the recently enhanced manufacturer reprocessing guidelines;
  • track elevator-channel endoscopes by patient and by device serial number to facilitate retrospective identification in case of infection;
  • use a two-phase infection surveillance program that tracks all patients who have had a procedure with an elevator-channel endoscope and periodically collect culture surveillance of all elevator-channel endoscopes — a positive culture should trigger a review of reprocessing techniques;
  • use a standard device reprocessing training program and require reprocessing staff to demonstrate competency every 6 months; and immediately contact the Centers for Disease Control and Prevention to aid in investigation of any suspected breach or infection.
The Indian Medical Association (IMA) has strongly condemned the attempt to give a 'backdoor entry' for those from other streams of healthcare to get trained in modern medicine. IMA office-bearers have met health minister V S Sivakumar and health secretary K Ellangovan to register their protest and demanded immediate withdrawal of the order. The state had decided to give Ayurveda and Homoeopathy graduates training in modern medicine in the health service department hospitals. The director of health service had informed the government that practitioners of modern medicine would be against the decision. It is dangerous to allow people inside the labour rooms or operation theatres in the name of training, added Dr A V Jayakrishnan, Secretary, IMA. It is a violation of the Medical Council of India norms and Supreme Court directive, said state president of KGMOA Dr E P Mohanan.
Wellness Blog
Cholesterol tips released

Blood lipid levels may exhibit mild seasonal variation with a drop in the summer and total cholesterol level peaking in the winter. The variation can be up to 5 mg/dL.

Serum total and HDL–cholesterol can be measured in fasting or non–fasting individuals. There are only small clinically insignificant differences in these values when measured in the fasting or non–fasting state.

The total cholesterol can vary by 4 to 11 percent within an individual due to multiple factors including stress, minor illness and posture. Values may also vary between different laboratories, with data suggesting that a single measurement of serum cholesterol can vary as much as 14 percent. Therefore in an individual with "true" serum cholesterol concentration of 200 mg/dL the range of expected values is 172 to 228 mg/dL.

More than one measurement of total cholesterol should therefore be obtained when treatment considerations demand a precise determination. Measurement of serum HDL–C and triglycerides may demonstrate even greater variability.

A standard serum lipid profile consists of total cholesterol, triglycerides, and HDL–cholesterol. Lipid profile should be performed after 12 to 14 hours of fasting to minimize the influence of postprandial hyperlipidemia. One can use either plasma or serum specimen. The serum cholesterol is approximately 3 percent lower than the plasma value.
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IMA Humor
Where’s the toast I asked for?

An elderly husband and wife visit their doctor when they begin forgetting little things. Their doctor tells them that many people find it useful to write themselves little notes.

When they get home, the wife says, "Dear, will you please go to the kitchen and get me a dish of ice cream? And maybe write that down so you won’t forget?"

"Nonsense," says the husband, "I can remember a dish of ice cream."

"Well," says the wife, "I’d also like some strawberries and whipped cream on it."

"My memory’s not all that bad," says the husband. "No problem – a dish of ice cream with strawberries and whipped cream. I don’t need to write it down."

He goes into the kitchen; his wife hears pots and pans banging around. The husband finally emerges from the kitchen and presents his wife with a plate of bacon and eggs.

She looks at the plate and asks, "Hey, where’s the toast I asked for?"
ESI Medical Colleges Not To Get Closed
ESI management has ultimately decided not to shut down its medical colleges.

IMA has been fighting for the cause of 1300 ESI medical students. IMA had written to the President of India, Prime Minister, Health Minister and Labor Minister in this regard. IMA also raised the issue with MCI & Members of Parliament.
“It's a victory of medical profession,” said Dr A Marthanda Pillai, National President, Indian Medical Association and Padma Shri Awardee Dr K K Aggarwal, President of Heart Care Foundation of India and the Honorary Secretary General of Indian Medical Association.

There was no reason for the government to have allowed closure of medical colleges when there is already a shortage of medical seats.

As per this new decision, ESIC would continue with the already running three Medical Colleges at Karnataka, Chennai, and Kolkata and one Dental College at Delhi. Ongoing PG courses would also continue on similar lines. However, ESIC will not undertake any more Medical Education Projects. ESIC will focus on its core function of providing social security to insured persons.

Eight more medical Colleges are under construction.

The core function of ESIC is to provide medical benefit to the insured persons under the ESI Scheme. The ESI Corporation in its 163rd meeting took a decision to exit from Medical Education and, a decision in this regard was communicated to all concerned in January, 2015. This decision had fully protected the interest of student and most of other stakeholders. However, the students continued to have some apprehensions in this regard. Several representations from Member of Parliaments, present of students, public representatives and general public were received. In the 164th meeting of the Corporation also, it was reiterated that the interests of the students as well as the insured Persons should be protected. Therefore, a revised Circular was issued that ESIC would continue to admit students at its already running four Medical Colleges and one Dental College.

ESIC is continuing its efforts to transfer other Medical College projects to state Governments concerned. If they do not take up the project then effort will be made to run these Medical Colleges under PPP Model etc.

In Faridabad, Hyderabad and Coimbatore, the State Governments may run these Medical Colleges with attached Hospitals as ESI Hospital. In case a favorable response from these State Governments is not received, ESIC would run these Medical Colleges either in PPP model or in its own.

In Gulbarga, the Medical College is running under a tie-up arrangement with the State Government Hospital. The ESIC shall continue to admit students at the Medical College. The State Government has been requested to take over this college. If the response of the State Government is not favorable, ESIC would examine to run the college in PPP mode.

The colleges at Mandi, Alwar, Paripally and Patna are targeted to be taken over by the state Government. If the response of the State Government is not favorable, ESIC would examine to run these institutions in PPP model, failing which the assets may be divested.

One of the important conditions of transfer of Medical Colleges is that the ESI insured persons should continue to get treatment in these hospitals in cashless manner.

The proposed ESIC Medical College project in Basai Darapur, Delhi, would be, modified into a Centre of Excellence for proving enhanced secondary care as well as Super Speciality Treatment facility for ESI beneficiaries.

ESIC will neither set up any other Medical College nor any other new Medical Education Institution.
Rabies News (Dr A K Gupta)
What are the common side effects of intra–dermal rabies vaccination?

Cell culture vaccines have proved to be remarkably safe and free of significant adverse events. However, mild symptoms of pain, erythema, irritation or swelling at the intradermal injection sites occur in 3–92% of patients. The most frequent symptom is local irritation in 7–64% of vaccines. Generalized symptoms reported by 3–14% of recipients include headache, fever and influenza–like illness. Transient macular, papular and urticarial rashes are occasionally seen. All these adverse effects are mild, transient and self limiting and rarely call for the use of antihistamines and analgesics.