May 5  2015, Tuesday
Physical illness can trigger depression
Dr KK Aggarwal If you have depression, a thorough physical exam and careful medical history should be evaluated to pinpoint a physical source of the problem for an appropriate treatment.

In depression not only look for what’s going on in the mind and brain but also check what’s going on in the body. Many medical problems are linked to mood disturbances.

Over fifty percent of heart attack survivors and those with cancer report feeling depressed. Depression is also linked to diabetes, Parkinson’s and other chronic conditions.

Depression too can affect the course of a physical disease. Depression is linked with slower recovery from a heart attack and an increased risk for future heart trouble.

Thyroid disorders also affect mood. Overactive thyroid can cause mania and under active thyroid can cause depression. Other medical conditions associated with mood disorders include certain neurological conditions (multiple sclerosis, Parkinson’s disease, Alzheimer’s), other hormonal imbalances, and lack of vitamin B12.
Workshop on control of NCD & Tobacco at Indore. An inspiring lecture given by Dr KK Aggarwal – Dr Dilip Acharya Chairman IMA National Cancer & Tobacco Control Committee.
Official Launch
Shri Shripad Yesso Naik
Union Minister of State, Ministry of Health & Family Welfare
Dreaming up a Healthy Billion:
The right pathways for universal healthcare
Shivinder Mohan Singh
Executive Vice President,
Fortis Healthcare
KG Ananthakrishnan
Vice President and Managing Director, MSD India
Shobana Kamineni
Executive Vice Chairperson,
Apollo Hospitals
Girindre Beeharry
Country Director, India, Bill &
Melinda Gates Foundation
Dr. KK Aggarwal
Honorary Secretary General, IMA
President, Heart Care Foundation of India
Rajendra Pratap Gupta
Public Policy Expert
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  • There is a link between consumption of sweetened milk drinks and type 2 diabetes, indicating that efforts to reduce intake of sugar–sweetened beverages (SSBs) should be extended to include milkshakes and flavored milk. In the study, type 2 diabetes risk per serving per day was of 1.21 for soft drinks, 1.22 for sweetened–milk beverages, and 1.22 for artificially sweetened drinks, but there were null associations for sweetened tea and coffee (0.98) and for fruit juice (1.01).
  • Nonalcoholic fatty liver disease progression is accompanied by increases in the rates of cardiovascular disease burden and mortality, suggests new research presented at the International Liver Congress 2015.
  • Thirty days after the most recent confirmed case of Ebola in Liberia, a woman likely contracted the disease through unprotected vaginal sex with an Ebola survivor, reports an article published online May 1 in the Morbidity and Mortality Weekly Report. This suggests that the Ebola virus appears to persist in the seminal fluid of convalescent men much longer than previously recognized.
  • With food, seeing it is eating it, a new study published April 28 in the International Journal of Obesity suggests. People who keep food in plain sight around the house are more likely to be obese, while low self-esteem is another risk factor.
  • Nipple-sparing mastectomy is as oncologically safe as skin-sparing mastectomies or modified radical mastectomies in carefully selected women with early–stage breast cancer, suggest the findings from a meta–analysis presented at the American Society of Breast Surgeons (ASBS) 16th Annual Meeting.
Dr KK Spiritual Blog
Shiksha and Sabhyata

Suno, Samjho, Jaano and Karo is the mantra for education and involves not only hearing but listening and understanding and converting understanding into wisdom by doing it practically.

One of the components of education is etiquettes or manners which can be at every level of education. In older era, Rajkumars or princes were sent to Gurukuls for formal education including that of warriorship. They were also sent to Gharanas/Kothas to learn tehzeeb the Lucknawi way where they were taught how to talk to each other and respect others. Their language in typically Lucknawi style used to be ‘we’ oriented and not ‘I’ oriented. Today’s education is more oriented towards ‘I–ness’ or ego and not towards the soul or respect.

In our student days, we were taught that a senior is a senior and needs to be respected. Even today, when we meet our teachers, we take blessings by touching their feet but today’s students believe in shaking hands or saying ‘hi’. There is more and more commercial touch in the teacher–student relationship of today.
Ego makes one rude and arrogant with a mentality full of Rajas and Tamas. Road rage, gang rapes, murders, violence, terrorism are all examples of not learning etiquettes at the right time.
Case of the day
Coronary dissection with high platelet count

A 50-year-old man was admitted with first onset left shoulder and arm discomfort. He had strong family history of premature coronary artery disease and dyslipidemia. In 2003 he underwent CAG for syncope, which revealed luminal irregularities and no significant coronary artery disease. Echo showed regional wall motion abnormalities. Follow-up CAG revealed left anterior descending artery proximal and mid dissection and a long area of dissection in the first diagonal branch. Lab tests showed significant platelet elevation. Ultrasound of the abdomen revealed moderate splenomegaly. The enlarged spleen, positive JAK2 study, and persistently elevated platelet count confirmed the diagnosis of essential thrombocythemia.

Lesson: High platelet counts in essential thrombocythemia can predispose individuals to vascular dysfunction and damage, which may contribute to coronary artery dissection.
(Source: Mali P, Muduganti S, Buddemeier KJ. WMJ. 2015 Feb:114(1):26-9).
Cardiology eMedinewS
  • New data from a large international registry of thrombolysis in stroke suggest that tissue plasminogen activator (tPA, alteplase) is safe to use in patients with very severe strokes. The data were presented at the European Stroke Organisation (ESO) Conference 2015.
  • Two new studies presented at the American Heart Association's Quality of Care and Outcomes Research 2015 Scientific Sessions have associated left ventricular assist devices with poorer health and cognitive function in some patients with advanced heart failure.
Pediatrics eMedinewS
  • The number of infants born with neonatal abstinence syndrome has increased in recent years, and more newborns are suffering from withdrawal symptoms from drugs they were exposed to in the womb, suggests a new study published online in the New England Journal of Medicine.
  • Data accumulated from a national classroom survey of Swedish 12- and 15-year-olds suggest that family break-up is bad for children's psychosomatic health, but that the particular domestic arrangements agreed by parents after a split may make some difference to their kids' wellbeing. Kids under joint custody had fewer problems than those cared for by sole custody. The findings are published in the Journal of Epidemiology & Community Health.
Make Sure
Situation: An adult undergoing bronchoscopic biopsy developed infective endocarditis.
Reaction: Oh my God! Why was IE prophylaxis not given?
Lesson: Make sure that all procedures of the respiratory tract that involve incision or biopsy of the respiratory mucosa include IE prophylaxis.
Dr Good Dr Bad
Situation: A patient with painful diabetic neuropathy came with postural hypotension.
Dr Bad: The two are unrelated conditions.
Dr Good: It is due to autonomic dysfunction.
Lesson: Painful diabetic neuropathy is associated with significantly greater autonomic dysfunction than painless diabetic neuropathy. The greater autonomic dysfunction seen in painful diabetic peripheral neuropathy may reflect more predominant small fiber involvement and also adds to the growing evidence of its role in the pathophysiology of painful diabetic polyneuropathy.
(Copyright IJCP)
Wellness Blog
Anger can be a trigger for Heart Attack or Stroke

A flash of anger may precipitate heart attack or stroke in susceptible individuals within two hours of anger episode as per a systematic review showed by Murray Mittleman, Dr PH, of the Harvard School of Public Health, and colleagues in the European Heart Journal.

The relative risks estimated in this meta–analysis indicate that there is a higher risk of cardiovascular events after outbursts of anger among individuals at risk of a cardiovascular event, but because each episode may be infrequent and the effect period is transient, the net absolute impact on disease burden is extremely low. However, with increasing frequency of anger episodes, these transient effects may accumulate, leading to a larger clinical impact.

In pooled results of four of the studies, the risk of MI or acute coronary syndrome was 4.74–fold higher in the hours after an outburst. One study evaluated intracranial hemorrhage and showed that the risk was higher in the hour after a bout of anger.

Mediated through increases in circulating catecholamines, increased myocardial oxygen demand, coronary vasospasm, and increased platelet aggregability, anger can cause transient ischemia, disruption of vulnerable plaques, and increased thrombotic potential.
eMedi Quiz
All of the following are examples of traction epiphysis, except:

1. Mastoid process.
2. Tubercles of humerus.
3. Trochanters of femur.
4. Condyles of tibia.

Yesterday’s Mind Teaser: The nerve commonly damaged during McBurney's incision is:

3.11th Thoracic.
4.10th thoracic.

Answer for yesterday’s Mind Teaser: 2.Iliohypogastric.
Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K Raju, Daivadheenam Jella, Dr Shangarpawar, Dr KC Sharma, Dr KV Sarma, Dr G Madhusudhan.
Answer for 3rd May Mind Teaser: 4. Inferior mesenteric vein
Correct Answers received: Daivadheenam Jella, Dr Shangarpawar, Dr Pandit Hantodkar, Dr Poonam Chablani, Dr KV Sarma, Dr K Raju, Dr Madhusudhan G.
Rabies News (Dr A K Gupta)
Is there any dietary restriction during PEP?

It is advisable to abstain from alcoholic drinks during the course of rabies vaccination as it may affect the immune response.
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
Breaking News: Abducted Dr. R. B. Choudhary from Gumla is found dead. Agitation and Road jam were being done. Urgent meeting of core committee at 7:30 PM yesterday and a joint meeting of JHASA & IMA Jharkhand will be held today at 3:00 PM. Dr Pradeep Kumar Singh– Secretary, IMA Jharkhand State, Mob–09431389436; Dr B.P.Kashyap– Joint Secretary, IMA Jharkhand State, Mob– 09431174937
ACP Highlights 2014s Top Studies
  1. Spironolactone did not significantly reduce cardiovascular death, aborted cardiac arrest, or heart failure hospitalization in patients with heart failure and preserved ejection fraction, found the international TOPCAT trial. However, patients in some countries –– including the US –– saw benefit.
  2. Several trials with the PCSK9 inhibitor evolocumab showed reduced LDL cholesterol levels in patients with hyperlipidemia, though clinical outcomes were not evaluated.
  3. Transcatheter aortic valve replacement with an expandable balloon reduced mortality in patients with severe aortic stenosis and a high risk for death after surgery compared with open aortic valve surgery.
  4. Compared with warfarin, a percutaneous left atrial appendage closure device in patients with nonvalvular atrial fibrillation had similar rates of cardiovascular death, stroke, or systemic embolism, results of the PROTECT AF unblinded randomized trial indicated.
  5. A Mediterranean–style diet supplemented with extra–virgin olive oil was linked to lower rates of new–onset diabetes compared with a Mediterranean–style diet plus mixed nuts or a low–fat diet. Participants were primarily older whites living in Spain, which could limit generalizability.
(Source: Medpage Today)
Over 75% of doctors have faced violence at work, study finds
Sushmi Dey, TNN | May 4, 2015, 04.57 AM IST

New Delhi: Those who save lives are themselves at risk. More than 75% of doctors across the country have faced at least some form of violence, initial findings of an ongoing study by the Indian Medical Association (IMA) have revealed.

Doctors faced maximum violence when providing emergency services, with as many as 48.8% of such incidents reported from intensive care units (ICUs) or after a patient had undergone surgery, the study said. Relatives and attendants of patients were often found guilty of such actions. According to the findings, data of the past five years showed that escorts of patients committed 68.33% of the violence.

However, experts said the findings did not reflect the actual situation as not all cases were reported. The gravity of the problem is much more. "All cases of violence are not reported. Doctors often understand the situation of relatives who are in distress and do not report such cases. Mostly, those cases are reported where the doctor feels serious threat of life or has already faced so," IMA secretary general Dr KK Aggarwal said.

Violence against doctors varies from physical assault to threatening behaviour to mere verbal abuse. While most incidents of violence were found to have occurred during visiting hours and peak hours, when doctors are busy and visitors are around, the study found that doctors and paramedical staff also had to face rage while transporting serious patients to hospital.

"The transport time is very crucial. This is also a kind of emergency service and relatives of patients are nervous and under stress. Any delay or even an unintended negligence results in huge rage and anger among the patient’s escorts," the head of emergency services in a leading private hospital said.

While IMA is advocating a stringent law at the Centre to address the situation, doctors and healthcare experts say there is a strong need for counselling of relatives and escorts of patients.

Doctors need to keep patients and their relatives in the loop from the very beginning. "Patients should be told the truth, about the adverse effects and also given the choice of alternative treatment," Dr Talat Halim, director, trauma and emergency at Fortis Hospital, said. He added that medical practitioners needed to show empathy with patients as well as their escorts, who are often in distress when in hospital.

Experts also pointed out the need to streamline processes in hospitals and at other healthcare delivery centres. For instance, a lot of violence–related cases happen when the patient passes away. While hospitals insist on clearing payments before handing over the body, distressed escorts often get into fights in such situations. Experts said such processes needed to be streamlined and handled by non–medical people.

The trend of violence against doctors is also on the rise in China. In 2006, around 5,500 medical workers were injured by patients or their relatives. However, in 2010, such cases increased to 17,000.
Names of IMA Members of Violence Against Doctors Committee
Team IMA Haryana would hereby like to intimate you the names and contact details of the IMA members of Violence Against Doctors Modification Committee. These are as follows:
S. No.
Mobile Number
Dr. Neeraj Nagpal
Dr. Dhirender Soni
Dr. V. K. Bhatia
Dr. Prashant Tyagi
Dr. Shailesh Tomar
Dr. Neeraj Nagpal will be the Chairman of this committee.

Names of IMA Haryana Members of PCPNDT Act Modification Committee
S. No.
Mobile Number
Dr. I. S. Yadav
Dr. Satish Chugh
Dr. Deepak Bhatia
Dr. Urmila Yadav
Dr. Prabhjot Kaur
Dr. V. K. Bhatia
Sonal Namaste
CDC guidelines advise use of a plain (nonantimicrobial) soap with water for routine hand washing.
IMA forms grievance cells to resolve complaints against docs
Free Press Journal

Indore: The Indian Medical Association (IMA) has started a grievance cell in every district to hear complaints against doctors and suggest ways to resolve them. The IMA made the move to make clear its stand against the cuts, commission and other lucrative offers to the doctors.

IMA General Secretary Padma Shri Dr KK Aggarwal told Free Press, "We have started a grievance cell at every district and the President and Secretary of the concerned chapters, are the member of that grievance cell."

He was speaking on the sidelines of a workshop on Non Communicable Diseases and Tobacco organised by IMA, Indore Chapter.

Dr Aggarwal, who is a member of MCI’s Ethical Committee, said that a few guilty doctors in drug trials, are not the face of whole doctor fraternity. "Stern action has been taken against the doctors who were found guilty in violating the norms of the ethics committee."

The IMA general secretary said that government’s attitude towards the medical profession is suffocating the doctors. It should devise ways to improve their working conditions, he said.

On prevention and control of cardiovascular diseases, he said, "The rate of cardiovascular diseases are increasing drastically and mainly in the age group of 30–40 years. These diseases are curable, but the reason for increment of these diseases is the changing lifestyle. People turned inactive leading to CVD."

He further added the example of wild animals and said that as they are active, they do not suffer from CVD but an animal in laboratory does.

The general secretary of IMA also gave a formula of 80 minutes for stress management and for being healthy.

"People should adopt the formula of 80 minutes of remain healthy in always, ie. always keep your blood pressure below 80, walk 80 minutes in a week with 80 steps per minutes, keep the noise pollution below 80 decibel and if you consume alcohol than do not take it more than 80 gms in a week," Dr Aggarwal said.

Head of Department of Liver Transplant in Sir Ganga Ram Hospital, New Delhi Padma Shri Dr Saumitra Rawat also participated in the conference and put light on the alarming situation of liver cases in the nation.

He also expressed his concern over the fast changing life style and said that the changes are major reason for the increase in number of cases of liver diseases.

IMA comments

1. I was a member of MCI ethics committee and IMA has asked all branches to make grievance cell
Inspirational Story
The Story of a Woodcutter

Once upon a time, a very strong woodcutter asked for a job in a timber merchant and he got it. The pay was really good and so was the work condition. For those reasons, the woodcutter was determined to do his best.

His boss gave him an axe and showed him the area where he supposed to work. The first day, the woodcutter brought 18 trees. "Congratulations," the boss said. "Go on that way!"

Very motivated by the boss words, the woodcutter tried harder the next day, but he could only bring 15 trees. The third day he tried even harder, but he could only bring 10 trees. Day after day he was bringing less and less trees.

"I must be losing my strength", the woodcutter thought. He went to the boss and apologized, saying that he could not understand what was going on. "When was the last time you sharpened your axe?" the boss asked. "Sharpen? I had no time to sharpen my axe. I have been very busy trying to cut trees…"

Reflection: Our lives are like that. We sometimes get so busy that we don’t take time to sharpen the "axe". In today’s world, it seems that everyone is busier than ever, but less happy that ever.

Why is that? Could it be that we have forgotten how to stay "sharp"? There’s nothing wrong with activity and hard work. But we should not get so busy that we neglect the truly important things in life, like our personal life, taking time to get close to our Creator, giving more time for our family, taking time to read etc.

We all need time to relax, to think and meditate, to learn and grow. If we don’t take the time to sharpen the "axe", we will become dull and lose our effectiveness.
Quote of the Day
It is strange that those we miss the most are those we take for granted. Sir John Betjeman
IMA in Social Media 28291 likes 45557 likes 1192 likes

Twitter @IndianMedAssn 935 followers
Reader Response
  • Dear Editor, Think about it: Is it not too much hype about heart attacks? TOI is rabble–rousing! One has to die of "cardiorespiratory arrest" since brain death is rarely accepted as "final". So obviously, statistically it will be the largest group of cause of death. Dr Hemang D Koppikar
  • IMA Leads in the health awareness camps with full zeal. It is when real practical participation is concerned, things sometimes go wrong. I tried my level best to deliver a small hands on practical training for "TB Notification by private doctors", to my fellow colleagues at District Solan, H.P., in a planned function to mark world TB Day celebration, but despite all my efforts not even a single doctor from the District turned up. How else can we rope in private fellow colleagues in the fight against TB. Let’s start thinking now. Dr Ajay Kumar Singh
  • Team IMA at Nepal: Please note the needs: Gynecologist (Only Females), Internal Medicine, Pediatrician and General Physician. May be able to stay only for next 7 days only. Dr. Ashok Gupta
IMA Videos
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IMA Humor
Absent—minded professor

One of the world’s greatest scientists was also recognized as the original absent–minded professor. One day, on board a train, he was unable to find his ticket. The conductor said, "Take it easy. You’ll find it."

When the conductor returned, the professor still couldn’t find the ticket. The conductor, recognizing the famous scientist, said, "I’m sure you bought a ticket. Forget about it."

"You’re very kind," the professor said, "but I must find it, otherwise I won’t know where to get off."
IMA Releases Asthma White Paper
One should not ignore the first attack of asthma after the age of 40 and either cough or acidity may be the only signs of asthma, says the Asthma White Paper released by IMA on the occasion of World Asthma Day.

Elaborating on this, Padma Shri Awardees, Dr A Marthanda Pillai National President Indian Medical Association and Dr KK Aggarwal Honorary Secretary General IMA, said that if asthma is not controlled, it may be fatal. The following 20 points were also released on the occasion.
  1. Do not ignore the first attack of asthma after the age of 40, it may be of heart in origin.
  2. All wheeze is not asthma and all asthmatics do not wheeze.
  3. Only cough may be a sign of asthma.
  4. If you are able to speak a sentence during an asthma attack, you do not have severe asthma.
  5. If you get an attack of asthma more than twice in the night in a month or more than twice during day time in a week, you need continuous asthma treatment
  6. All asthmatics should be questioned about symptoms triggered by common inhaled allergens, at home, day care, school, or work
  7. Indoor allergens, such as dust mites, animal danders, molds, mice and cockroaches, are of particular importance.
  8. Food allergy rarely causes isolated asthma symptoms, although wheezing and cough can be symptoms of food-induced anaphylaxis.
  9. Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) may trigger symptoms of asthma in about 3-5% adult asthmatic patients. Asthmatic patients with nasal polyps have a higher incidence of aspirin-exacerbated respiratory disease. Aspirin-sensitive asthma is uncommon in children.
  10. Non-selective beta-blockers, even in the very small amounts that are absorbed systemically from topical eye drops, can trigger severe attacks of asthma. Selective beta-1 blockers can also aggravate asthma in some patients, especially at higher doses.
  11. Gastric reflux is common among patients with asthma. The prevalence of the gastroesophageal reflux among patients with asthma ranges from 30-90%. Look for asthma symptoms after eating certain foods (e.g., high fat food, chocolate, peppermint, caffeine, alcohol).
  12. Well-controlled asthma means daytime symptoms no more than twice per week and night-time symptoms no more than twice per month.
  13. Exercise-induced asthma is asthma that occurs after exercise in many asthmatic patients. All patients with asthma, when exercising, should have a rapid-acting beta-agonist drug available for relief of asthma symptoms. In well-controlled asthmatic patients, but who frequently have asthma symptoms with exercise, prophylactic use of a rapid-acting beta-agonist about 10 minutes prior to exercise is recommended. Avoiding exercise in cold, dry air can also reduce the stimulus for exercise-induced asthma. Oral theophylline and oral beta agonists are minimally effective or ineffective for exercise-induced asthma.
  14. All asthmatics should buy an asthma meter (peak flow meter) and keep it above 60% of normal range.
  15. Inhalers are better than oral drugs.
  16. Inhaled irritants include tobacco smoke, wood smoke from stoves or fireplaces, strong perfumes and odors, chlorine-based cleaning products and air pollutants. Patients should be cognizant of avoiding irritants and avoid exertion outdoors on days when levels of air pollution are high.
  17. Annual administration of influenza vaccine is recommended for patients with asthma as they are particularly at risk for complications of influenza infection. But, vaccination does not reduce the number or severity of asthma exacerbations during the influenza season. Physicians should ensure that patients understand this distinction.
  18. Administration of pneumococcal vaccination is recommended for all those adults whose asthma is severe enough to require controller medication and for children with asthma who require chronic treatment with oral steroids.
  19. Sulfite compounds are used in the food industry to prevent discoloration. Significant and reproducible exacerbations may occur after ingestion of sulfite-treated foods and beverages, such as beer, wine, processed potatoes, dried fruit, sauerkraut, or shrimp.
  20. Near-fatal and fatal asthma exacerbations may occur in patients with mild, moderate, or severe asthma and the course may be either slow or rapid in onset. A recent history suggestive of poor asthma control or any prior history of endotracheal intubation and mechanical ventilation for asthma should alert the physician that the patient is at high-risk for near-fatal asthma exacerbations. Other factors include long duration of asthma, poor adherence to medical therapy, systemic glucocorticoid dependence, psychosocial problems, aspirin/NSAID sensitivity, cigarette smoke exposure, prior hospitalization for asthma and aeroallergen exposure in sensitized individuals.