June 5  2015, Friday
Is Caffeine Good For The Health?
Dr KK Aggarwal
  • Caffeine is the most consumed stimulant in the world,
  • It is consumed in the form of coffee and tea.
  • At present there is no scientific data for promoting or discouraging coffee and/or tea consumption in the daily diet.
  • Short term benefits include mental alertness and improved athletic performance.
  • Short term adverse effects including headache, anxiety, tremors, and insomnia.
  • Long term adverse affects include generalized anxiety disorder and substance abuse disorders.
  • Long–term benefits are dose–dependent. Caffeine is associated with a reduced risk of Parkinson disease, Alzheimer disease, alcoholic cirrhosis, and gout. Both caffeinated and decaffeinated coffee are also associated with a lower risk of type 2 diabetes.
  • Heavy coffee intake may trigger coronary and arrhythmic events in susceptible individuals, although coffee intake is not considered a long–term risk factor for myocardial disease.
  • Most studies show a modest inverse relationship between coffee consumption and all–cause mortality.
  • Caffeine withdrawal is a well–documented clinical syndrome with headache being the most common symptom. (Source: Uptodate)
This World Health Day, the Indian Medical Association commits to making food safety a priority within its Swachh Bharat Swasth Bharat program
  • Co-administration of calcitriol and denosumab is beneficial in chronic kidney disease patients on dialysis who have low bone mass and secondary hyperparathyroidism, suggests a new study published online in the Journal of Clinical Endocrinology & Metabolism.
  • improve cognition but does improve some mood symptoms, suggests a study published online June 2 in PLOS Medicine.
  • Menopausal hormone therapy (MHT) for up to 4 years after the last menstrual period may not
  • A single dose of an FDA-approved intravenous nutrition source may significantly reduce the toxicity and increase the bioavailability of platinum-based cancer drugs, suggests a study published in Scientific Reports
  • A new study suggests that an enzyme involved in protecting the body from pathogens - cyclic GMP-AMP synthase (cGAS) - senses Mycobacterium tuberculosis (TB). The study, published in Cell Host and Microbe, exhibited that the enzyme is essential for defense against the tuberculosis bacteria.
  • Patients with rheumatoid arthritis (RA) have an increased risk for herpes zoster, especially with increasing age, but the only immunomodulating medication that contributes to the risk is prednisone, suggests a large observational study published online in Arthritis Care and Research.
  • The adjusted hazard ratio for breast cancer among 107,337 women on calcium channel blockers was 0.96 when compared with 165,815 women not taking these agents (95% CI 0.90-1.03), a nonsignificant difference, said Sara Soldera, MD, of McGill University Health Center in Montreal, and colleagues.
  • Patients with rheumatoid arthritis (RA) have an elevated risk for herpes zoster, particularly with increasing age, but the only immunomodulating medication that contributes to the risk is prednisone doses above 7.5 mg/day, according to Dimitrios Pappas, MD, of Columbia University in New York City, and colleagues (Arthritis Care and Research.)
  • Alcohol use disorder, or AUD, is the medical diagnosis for problem drinking that causes mild to severe distress or harm. A new study supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, reports that nearly one-third of adults in the United States have an AUD at some time in their lives, but only about 20 percent seek AUD treatment. The study also reveals a significant increase in AUDs over the last decade. The new findings are reported online today in the journal JAMA Psychiatry.
Dr KK Spiritual Blog
Relieve stress by changing the interpretation

Stress is the reaction of the body or the mind to the interpretation of a known situation. Stress management, therefore, involves either changing the situation, changing the interpretation or taming the body the yogic way in such a way that stress does not affect the body.

Every situation has two sides. Change of interpretation means looking at the other side of the situation. It is something like half glass of water, which can be interpreted as half empty or half full.

Studies have shown that anger, hostility and aggression are the new risk factors for heart disease. Even recall of anger has been reported to precipitate a heart attack.

Many studies have shown that when doctors talk positive in front of unconscious patients in ICU, their outcome is better than those in whose presence if doctors talk negative.

The best way to practice spiritual medicine is to experience silence in the thoughts, speech and action. Simply walking in the nature with silence in the mind and experiencing the sounds of nature can be as effective as 20 minutes of meditation. He said that 20 minutes of meditation provides the same physiological parameters as that of seven hours of deep sleep.
Cardiology eMedinewS
  • In the Veteran's Affairs Diabetes Trial (VADT) of older men with poor glycemic control, those who were randomized to receive about 5 years of intensive vs standard glycemic therapy had a lower incidence of cardiovascular events, but no improved survival during a median 9.8-year follow-up, suggest new findings published in the New England Journal of Medicine.
  • New research suggests that digoxin does not increase all-cause death, irrespective of dose, persistence of use, or underlying heart failure, but only after taking into account differences in patient characteristics. The data were presented at the Heart Failure Congress 2015 of the European Society of Cardiology Heart Failure Association.
Pediatrics eMedinewS
  • Rates of some adverse events more than double following routine immunization of extremely low-birth-weight (ELBW) infants, suggests a multicenter retrospective study published online in JAMA Pediatrics.
  • The US Food and Drug Administration (FDA) has approved extended-release topiramate as an initial monotherapy in patients as young as 2 years with partial-onset seizures or primary generalized tonic-clonic seizures.
Make Sure
Situation: A patient of gross ascites presented with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make sure to evaluate the patient thoroughly and only moderately tap the ascitic fluid since overenthusiastic tapping can be life–threatening.
Dr Good Dr Bad
Situation: A 36–year–old executive used to take 5 pegs of alcohol once a week.

Dr Bad: Continue it.

Dr Good: Either stop it or just take one peg a day.

Lesson: The French habit of drinking wine almost daily is less taxing to the heart than the Irish custom of downing an equivalent amount of beer on one or two nights a week, which confers a higher risk, according to a study published in the British Medical Journal (BMJ. 2010 Nov 23;341:c6077).

(Copyright IJCP)
Inspirational Story
The Rebellion against the Stomach

Once a man had a dream in which his hands and feet and mouth and brain all began to rebel against his stomach.

"You good–for–nothing sluggard!" the hands said. "We work all day long, sawing and hammering and lifting and carrying. By evening we’re covered with blisters and scratches, and our joints ache, and we’re covered with dirt. And meanwhile you just sit there, hogging all the food."

"We agree!" cried the feet. "Think how sore we get, walking back and forth all day long. And you just stuff yourself full, you greedy pig, so that you’re that much heavier to carry about."

"That’s right!" whined the mouth. "Where do you think all that food you love comes from? I’m the one who has to chew it all up, and as soon as I’m finished you suck it all down for yourself. Do you call that fair?"

"And what about me?" called the brain. "Do you think its easy being up here, having to think about where your next meal is going to come from? And yet I get nothing at all for my pains." And one by one the parts of the body joined the complaint against the stomach, which didn’t say anything at all.

"I have an idea," the brain finally announced. "Let’s all rebel against the lazy belly, and stop working for it." "Superb idea!" all the other members and organs agreed. "We’ll teach you how important we are, you pig. Then maybe you'll do a little work of your own."

So they all stopped working. The hands refused to do lifting and carrying. The feet refused to walk. The mouth promised not to chew or swallow a single bite. And the brain swore it wouldn’t come up with any more bright ideas. At first the stomach growled a bit, as it always did when it was hungry. But after a while it was quiet.

Then, to the dreaming man’s surprise, he found he could not walk. He could not grasp anything in his hand. He could not even open his mouth. And he suddenly began to feel rather ill. The dream seemed to go on for several days. As each day passed, the man felt worse and worse. "This rebellion had better not last much longer," he thought to himself, "or I’ll starve."

Meanwhile, the hands and feet and mouth and brain just lay there, getting weaker and weaker. At first they roused themselves just enough to taunt the stomach every once in a while, but before long they didn't even have the energy for that.

Finally the man heard a faint voice coming from the direction of his feet. "It could be that we were wrong," they were saying. "We suppose the stomach might have been working in own way all along." "I was just thinking the same thing," murmured the brain. "It’s true that he's been getting all the food. But it seems he's been sending most of it right back to us."

"We might as well admit our error," the mouth said. "The stomach has just as much work to do as the hands and feet and brain and teeth." "Then let’s get back to work," they cried together. And at that the man woke up.

To his relief, he discovered his feet could walk again. His hands could grasp, his mouth could chew, and his brain could now think clearly. He began to feel much better.

"Well, there’s a lesson for me," he thought as he filled his stomach at breakfast. "Either we all work together, or nothing works at all."
Wellness Blog
First Aid in Burns
  • Patients with severe thermal burns are at significant risk of death and major morbidity.
  • Look for evidence of respiratory distress and smoke inhalation injury, a common cause of death in the acute burn victim.
  • Laryngeal edema can develop suddenly and unexpectedly.
  • Burn depth and size determine fluid resuscitation and the need for transfer.
  • Vascular collapse from burn shock is a critical component.
  • Rapid, aggressive fluid resuscitation to reconstitute intravascular volume and maintain end–organ perfusion is crucial.
  • The fluid requirement during the initial 24 hours of treatment is 4 mL/kg of body weight for each percent of total body surface area burned, given IV. Superficial burns are excluded from this calculation. One–half of the calculated fluid need is given in the first 8 hours, and the remaining half is given over the subsequent 16 hours.
  • Monitor urine output is important.
  • Hourly urine output should be maintained at 0.5 mL/kg in adults.
  • Carbon monoxide and cyanide: Burn patients may be exposed to carbon monoxide, requiring immediate treatment with high–flow oxygen.
  • Cool and clean wounds, but avoid inducing hypothermia.
  • Remove any jewelry and any hot or burned clothing and obvious debris not densely adherent to the skin.
  • Irrigation with cool water may be used.
  • Topical antibiotics are applied to all non superficial burns.
  • Give opioids (morphine) to treat pain and give tetanus prophylaxis.
eMedinewS Humor
The Absent–Minded Professor

An absent-minded professor was moving to a new house further along the same street. His wife knew that he was prone to forgetting things and so she wrote down the new address on a piece of paper he went off to college. She handed him the paper and the key to the new house and reminded him not to go back the old address.

That morning, one of his student asked him a complex question and the professor wrote the answer down on the back of the slip of paper. This student asked whether he could keep the paper.

Forgetting what was on the other side, the professor said, "Certainly."

In the evening, he returned out of habit to the old house, tried the key and could not get in. Realizing his mistake, he search in his pockets for the slip of paper with the new address, but off course there was no sign of it. So he wandered along the street and the stop the first personable–looking lad whom he saw.

"Excuse me, I’m Professor Galbraith. You would not happen to know where I live, would you?"
eMedi Quiz
An enzyme involved in the catabolism of fructose to pyruvate in the liver is:

1. Glyceraldehyde-3-phosphate dehydrogenase.
2. Phosphoglucomutase.
3. Lactate dehydrogenase.
4. Glucokinase.

Yesterday’s Mind Teaser: Olfleck's phenomenon is seen due to which component?

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

Answer for yesterday’s Mind Teaser: c. Nail psoriasis

Correct Answers received from: Sharavana S, Dr Poonam Chablani, Dr G Madhusudhan, Dr K C Sharma, Daivadheenam Jella, Tukaram Pagad.

Answer for 3rd June Mind Teaser: b. Medina-Ramirez reaction

Correct Answers received: Tukaram Pagad, Dr K V 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
IMA relief efforts for Nepal Earthquake victims
Dr K K Aggarwal, Honorary Secretary General IMA

When we heard about the Nepal Earthquake incidence, we at IMA HQs immediately decided to help the victims of Nepal earthquake. Under the leadership of our National President Padma Shri Awardee Dr A Marthanda Pillai, a group of 13 doctors led by Padma Shri Awardee Dr Ashok Kumar was sent to Nepal.

Heart Care Foundation of India, a national NGO, joined IMA in this cause and its Senior Board Member Mr Harsh Garg, an industrialist, coordinated all the local arrangements at Nepal through DIG Police.

The IMA team stayed in Nepal for a week and treated over 1500 patients, performed complicated surgeries and saved one person from developing gangrene.

In the meantime, the Health ministry of Nepal wrote to us saying that they did not need any more medical teams; hence, our team was withdrawn.

In between, we contacted Dr Anjani Kumar Jha, President and Dr Mukti Ramshrestha, General Secretary, respectively of the Nepal Medical Association and they requested us to supply medicines. Due permissions were taken from respective Health Ministries and Indian Ambassador to Nepal for transfer of necessary drugs.

Udyog Development Foundation led by Shri Amitav Joyprakash Choudhury joined the movement of HCFI & IMA and medicines over Rs. 42 lakhs (Nepalese currency) were collected and dispatched, courtesy Indigo Airlines.

On 27th May, Dr Pillai, myself, along with Dr Chetan Patel, Chairman, Disaster Cell, IMA and Shri Amitav Joyprakash Choudhury reached Nepal to assess the actual situation.

At the airport, we had meetings with the President and Secretary of Nepal Medical Association. We also met Shri Ranjit Rae, Ambassador of India to Nepal and we were told that we could only work through Nepal Medical Association or the Nepal Govt. We were also told that Govt. of India had donated over 4 lakhs Tarpaulin tents including vans, money and food material to Nepal.

Next we addressed a Press Conference which was organized in Tarpaulin tent with no branding as a make shift reporters club.

We also met Dr Senendra Upreti, Director General Health Sciences and Shri Shanta Badure Shrestha, Health Secretary and Shri Khagraj Adhikari, Minister of Health & Population, Govt. of Nepal. All help was offered to them by IMA through Nepal Medical Association.

We then went to various affected areas and also interviewed many victims, local leaders and families. We were shocked to see the extent of the disaster but we were happy to see the enormous efforts to rehabilitate the victims of the earthquake.

We could differentiate the efforts of China from that of India. They were visible everywhere. The Chinese tents were made of a better quality material and displayed the name of the country prominently. In one area, out of the 40 tents that were put up, only 10 tents were Chinese but had prominent display of their branding in the front and visible from the main road.

When we spoke to the people of Nepal, they were of the opinion that it was only the Chinese Govt. which was helping the Nepal victims. When we talked about the help from the Govt. of India, their answers were in the negative.

In Bhaktapur, a nearby district of Kathmandu, we saw a rehab tent of 1700 people. They were all living in 40 tents. In this area, Indian branding was not visible. Only visible branding was of China tents.

To help victims of post-traumatic stress disorder (PTSD), the Chinese mission had organized a 2-hour Musical Therapy programme.

We also saw meals being prepared by the local Nepalese people. On enquiring, they informed us that the raw materials for lunch were sponsored by China.

We interviewed a person from noodles Company who said that for Rs.14,000/-, they were providing 2000 bunches of ready-made noodles for these people, which meant for a total value of less than 5 lakhs, 2000 people were sponsored for lunch by China for over a month. I personally believe in the philosophy "Jo Dikhta Hai, Woh Bikta Hai" / "Jangal main mor Nacha, sabne dekha" (not kisne dekha).

If you are a true believer of Vedanta, it is okay to do charity and not talk about it. But today, the trend is that while it is important to do charity, it is equally important to make it visible.

In contrast to India where most of us probably believe in “Guptdaan” or secret charity, China was visible in showing its charity towards the people of Nepal Earthquake.

Our day ended with a meeting with the office bearers of Nepal Medical Association where they requested us to donate a Van to them, which IMA hopes to provide but not in Indian Vedanta way; the van will carry the IMA branding on it.
Prescribing of Generic Medicines (Under Gadget Notification)
MCI has proposed for amendments in Chapter-1-B – Duties and responsibilities of the Physician in general, Clause 1.5 – Use of Generic names of drugs:-

“Every physician should, prescribe drugs with generic names legible and in capital letters and he/she shall ensure that there is a rational prescription and use of drugs”.

Secretary (HFW) has proposed the following:-

“Every physician should, prescribe drugs with generic names legible and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs”.
IMA Swachh Bahrat Swasth Bharat Movement
  • Elevated blood lead levels means greater than or equal to 10 mcg/dL for adults.
  • Most lead exposure is occupational, associated with manufacturing and/or renovation, paint removal, and construction trades
  • Gastrointestinal absorption is the main route of lead exposure in children, the respiratory tract is the main route in adults.
  • Lead is a toxic metal with a relatively short half-life in blood, but a half-life of decades in the bones.
  • It can affect many biologic systems once absorbed into the blood stream.
  • Acute clinical manifestations of lead toxicity are varied but include abdominal pain ("lead colic"), joint/muscle aches, short-term memory problems, difficulty concentrating, irritability, anemia (sometimes accompanied by basophilic stippling on blood smear), and nephropathy.
  • Chronic clinical manifestations can be non-specific and similar to acute exposure but can also include continued decline in neurocognitive function, lead nephropathy, hypertension, and increased risk of all-cause/cardiovascular mortality.
  • Blood lead level remains the mainstay of diagnosing lead toxicity.
  • Bone lead concentration measured by x-ray fluorescence is a rapid, noninvasive measurement of lead in bone
  • In most cases of mildly elevated lead levels (>20 mcg/dL), removal of the patient from the exposure may be the only therapy indicated.
  • Chelation should be considered for patients with blood lead levels >80 mcg/dL
Surgical site infections not covered under CGHS reimbursement policy
F.No.2-1/2012/CGHS/VC/CGHS(P): Dated the 1st August, 2013:

Subject: Clarification regarding admissible non-admissible items under CGHS.

e) Package rates envisage up to a maximum duration of indoor treatment as follows: 12 days for Specialized (Super Specialties) treatment; 7 days for other Major Surgeries; 3 days for Laparoscopic surgeries/normal deliveries; and 1 day for day care / Minor (OPO) surgeries.

However, if the beneficiary has to stay in the hospital for his /her recovery for a period more than the period covered in package rate, in exceptional cases, supported by relevant medical records and certified as such by hospital, the additional reimbursement shall be limited to accommodation charges as per entitlement, investigations charges at approved rates, and doctors visit charges (not more than 2 visits per day per visit by specialists / consultants) and cost of medicines for additional stay).

No additional charge on account of extended period of stay shall be allowed if that extension is due to infection on the consequences of surgical procedure or due to any improper proceed.
Hospital Acquired Infections may mean medical negligence also
Avoidable hospital acquired infections may involve medical negligence. HAI are infections that occur after 48 hours after admission.

As per CDC 100,000 patients died of HAI in 2002. Over 20 lac people become ill as a result of HAI annually.

In March of this year, the CDC reported that 200 Americans still die daily as a result of HAI.

Staff members who failed to observe sanitary hand hygiene passed many of these infec¬tions from patient to patient.

Until 2004, hospitals were not required to inform the public of spread of infection. Since that time, many states have required hospitals to report their infection rates to the public.

In the case of hand washing, the hospital that does not enforce firm infection control policies may be liable and may be found negligent.

A recent article in the New England Journal of Medicine found that, in 2011, after obtaining data from 183 US Hospitals pneumonia and surgical site infections were the most prevalent hospital infections accounting for 22% with blood stream infections comprising 11%

Organisms involved are clostridum difficile and Methicillin-resistant staph

It has become easier to link a particular infec¬tion to a facility by sequencing the genome of the organism.

Risk factors include length of stay, severity of illness and immunity of the patient, cleanliness of the hospital, use of antibiotics policy and infection control measures.
Medicare also does not cover hospital acquired infection
The CMS (Centers for Medicare and Medicaid Services') exercised its authority under section 5001(c) of the DRA by announcing that Medicare will no longer pay the extra cost of treating the following categories of conditions that occur while the patient is in the hospital: Surgical site infection after bariatric surgery for obesity, certain orthopedic procedures, and bypass surgery (mediastinitis); Vascular-catheter associated infection; Catheter-associated urinary tract infection etc.
Sonal Namaste
How to wash your hands

It's generally best to wash your hands with soap and water. Follow these simple steps:
  • Wet your hands with running water — either warm or cold.
  • Apply liquid, bar or powder soap.
  • Lather well.
  • Rub your hands vigorously for at least 20 seconds. Remember to scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails.
  • Rinse well.
  • Dry your hands with a clean or disposable towel or air dryer.
  • If possible, use a towel or your elbow to turn off the faucet.
Quote of the Day
I never could have done what I have done without the habits of punctuality, order, and diligence, without the determination to concentrate myself on one subject at a time. Charles Dickens
IMA in Social Media
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http://imahq.blogspot.com/ www.ima-ams.org
Reader Response
Sir ji, Total tobacco ban ke liye kuchh karo na!!: regards: Dr Manoj Sharma
IMA Videos
News on Maps
Press Release
IMA demands the Govt. for withdrawal of Fast Food Product “Maggi” with immediate effect

IMA has requested the Ministry of Health and Family Welfare (MoHFW), Govt. of India to instruct the withdrawal of fast food product “Maggi” from the market till it is given a clearance by the investigative agencies.

National President, IMA, Padmashri Awardee, Prof (Dr) A Marthanda Pillai and Honorary Secretary General, IMA, Padmashri Awardee, Dr K K Aggarwal said that in a letter written to the Ministry, IMA has demanded that the Government should take pro-active measures by appointing an investigative FDA agency to test the samples of the above product and suspend the sale of batches of “Maggi” in question till the clearance is received from the investigative agency.

IMA has demanded from the Government that the investigating agency must be able to differentiate whether a particular batch of the product was adulterated or the whole of the product was adulterated.It is the duty of the Government to ensure that the general public receives quality food in the market.

Encl: A copy of the above letter by IMA to the Government

IMA/HSG/C-3/ June 4, 2015

Shri J.P. Nadda,
Hon’ble Minister of Health & Family Welfare
Ministry of Health & Family Welfare,
Govt. of India, A-Wing, 346-A, Nirman Bhawan,
New Delhi

Respected Sir,

Greetings from Indian Medical Association !

Various media reports regarding Maggi which is having high level of lead and MSG are disturbiung and needs immediate attention.

IMA would like that the Ministry of Health & Family Welfare to intervene in this matter at the earliest in view of confirmation of such report from different States simultaneously.

It is suggested that batches of Maggi should be withdrawn from the Indian market with immediate effect. Marketing of Maggi should be allowed only after getting clearance from investigative agencies.

IMA feels that Government should take action immediately as delay in such decisions may invite/force administrative orders from the Honble High Court/Supreme Court of India.

Kindly acknowledge the action taken in this regard.

With kind regards,

Yours sincerely,

Dr. A. Marthanda Pillai       Dr K K Aggarwal
Padma Shri Awardee,          Padma Shri,
National President             National Science Communication                                             & Dr B C Roy National Awardee                                             President,
                                            Heart Care Foundation of India
                                            Honorary Secretary General
Rabies News (Dr A K Gupta)
  • Study of passive immunity in the prevention of rabies discusses the advances in passive immunoprophylaxis, most notably the shift from the recommended polyclonal human or equine immunoglobulin to monoclonal antibody therapies. The first rabies–specific monoclonal antibodies are undergoing clinical trials, so passive immunization might finally become an accessible, affordable, and routinely used part of global health practices for rabies.
  • A report on use of a reduced (4–dose) vaccine schedule for post exposure prophylaxis to prevent human rabies summarized new recommendation and updates previous recommendations of the Advisory Committee on Immunization Practices (ACIP) for post exposure prophylaxis (PEP) to prevent human rabies.
  • Human rabies can be very effectively prevented, and animal control is an important component in reducing the public health risk to humans. Dog rabies can be eliminated by well established control methods and routine dog rabies vaccination programs.