April 6 2015, Monday
editorial
4 ways to put off joint replacement
Dr KK Aggarwal
  • Lose weight: For every extra pound you carry, you put about three pounds of additional pressure on your knees and multiply the pressure on your hips by six. If you have arthritis, losing just 15 pounds can cut your knee pain in half. If you do eventually need a joint replaced, losing weight beforehand can reduce your risk of having complications from surgery. Swimming, walking, or riding a stationary bike are the way to go.
  • Take care when using your joints: By standing up straight instead of slouching you can protect the joints in your neck, hips, and knees. Also use the proper technique when lifting or carrying anything heavy. If any activity hurts, stop doing it right away.
  • Try nonsurgical approaches before turning to surgery: Treatment with steroid injections is one approach. Benefits can last anywhere from 4 to 6 months — however, it doesn’t work for everyone. Viscosupplementation involves injecting a lubricating fluid into damaged knee joints to treat osteoarthritis.
  • Get pain relief: Use NSAIDS. There is also some evidence that the dietary supplement glucosamine chondroitin can lead to subtle improvements in arthritis pain. "It doesn’t rebuild joints, but it does seem to help with the pain.
If you can’t escape from joint pain even while at rest, your pain is only relieved by narcotic medications, or your function is severely compromised, it’s time to consider a joint replacement.
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Health Talk-cum-Health Walk during Rahgiri, D-Block, Radial Road 4, Inner Circle, Connaught Place, New Delhi. The function was organized by Delhi Medical Association and NDMC jointly with Heart Care Foundation of India, Indian Medical Association and Indian Oil.
News
  • A new study has stated that being male is associated with worse memory and lower hippocampal volume throughout middle and old age in cognitively normal individuals. The findings are published online in JAMA Neurology.
  • Screening for prostate cancer using MRI and a lower prostate-specific antigen (PSA) threshold could result in fewer men needing biopsies with no compromise to cancer detection rates, suggests a pilot study presented at the European Association of Urology 30th Annual Congress.
  • Among patients with symptomatic intracranial arterial stenosis, the use of a balloon-expandable stent was associated with worse outcomes than medical therapy alone, reported the VISSIT (Vitesse Intracranial Stent Study for Ischemic Stroke Therapy) study. The study results were published in JAMA.
  • Most patients with lumbosacral radiculopathy have gluteal trigger points (GTrP), suggests a new study. The findings suggest that treating these trigger points could help ease pain in these patients. The findings are published in the American Journal of Physical Medicine & Rehabilitation.
  • Natamycin treatment of mycotic corneal ulcers improves vision-related quality of life, compared with voriconazole treatment, suggests the Mycotic Ulcer Treatment Trial I (MUTT I). The data are published online in JAMA Ophthalmology.
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Dr KK Spiritual Blog
The Seven Dhatus in Ayurveda

As per Ayurveda physiology, food is Brahman and contains the same consciousness as in us and this consciousness is the essence of any food.

Any food digested is converted into three portions, the gross undigested food is converted into waste (feces); the middle one is converted in one of the Dhatus and the subtlest form gets converted into ojas or the immunity.

As per standard Ayurveda, food once eaten is converted into the first Dhatu i.e. Rasa. Once the formation of Rasa is complete, the remaining is converted into Rakta (blood).The left over essence of food makes Mamsa (muscles), the leftover of which makes (Medha (adipose tissue) and so on to form Asthi (Bone), Majja (bone marrow) and Shukra (sperm/ova).

As per this physiology, the second Dhatu will only form once the first Dhatu is of good quality and so on and at any step in Dhatu, if not formed properly, subsequent Dhatu will also show defective formation.

For example, defective Dhatu at the stage of Asthi (bone) will have normal plasma (blood), muscle and adipose tissue but may have an impaired immunity/sperm/bone marrow. Similarly, defective Dhatu at the level of bone marrow may have only impaired immunity with no impairment of other Dhatus. On the other hand, impairment of Dhatus at the level of plasma or blood will involve all other Dhatus in sickness. Isolated disorders of Shukra may have no involvement of other Dhatus at all.

This Ayurveda principle can help us to answer many yet unanswered questions in modern allopathy. Like – why in typhoid fever all the organs are involved and why in azoospermia no other organ is involved.

Upanishads talk about formation of Dhatus in much more detail. According to them, different types of foods make different types of Dhatus. Fiery foods like oil and ghee are responsible for formation of Karmendriyan (part of shukra), bone and bone marrow (Dhatu).

The earthy foods are responsible for formation of Gnanandriyan and Manas (shukra) and muscle (flesh) and water in food is responsible for formation of Rasa and Rakta (plasma and blood) and Pran (Shukra).

This means that every different type of food would make different types of Dhatus and a balanced food with a combination of fire, water and earth will only be responsible for formation of shukra, immunity or the essence.
Cardiology eMedinewS
  • Adding two non-invasive imaging tests to traditional cardiovascular disease risk factor assessment more precisely predicts a healthy patient's future risk of heart attack, stroke, or premature death, suggests a study published in the Journal of the American College of Cardiology (JACC).
  • The U.S. Food and Drug Administration has approved the Impella 2.5 System, a miniature blood pump system designed to help certain patients maintain stable heart function and circulation during certain high-risk percutaneous coronary intervention (HRPCI) procedures, such as balloon angioplasty and stenting, which re-open coronary arteries that are narrowed or blocked due to severe coronary artery disease (CAD).
Pediatrics eMedinewS
  • Children whose early childhood is spent in a home with siblings, which serves as a marker for exposure to microbes early in life, tend to be at lower risk of developing juvenile idiopathic arthritis (JIA), suggests an Australian study published online in Arthritis and Rheumatology.
  • Adolescent patients who need scoliosis surgery may benefit most from going to a hospital that performs a high volume of the procedures, suggests new research from NYU Langone spine surgeons presented at the American Academy of Orthopaedic Surgeons 2015 Annual Meeting.
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Make Sure
Situation: : A patient on ACE inhibitor developed angioedema.

Reaction: Oh my God! Why was ACE inhibitor continued?

Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).
Events
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Dr Good Dr Bad
Situation: A heart patient wanted to know if he could meditate under a pyramid.

Dr Bad: You cannot do it. 

Dr Good: Go ahead. 

Lesson: The effect of meditation under a pyramid as twice as strong as meditating outside the pyramid.

(Copyright IJCP)
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Quote of the Day
It is wise to direct your anger towards problems – not people; to focus your energies on answers – not excuses. William Ward
Rabies News (Dr A K Gupta)
What is IM pre–exposure vaccination schedule?

The regimen is three IM injections on days 0, 7 and 28.
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
Reader Response
Dear Sir, very informative news. Regards: Dr Priya

Congratulation Team IMA for the Grand Victory. Dr Surajit Ghosh. Past Sr Vice President IMA
Sonal Namaste
Liquid, bar, leaflet or powdered forms of plain soap are acceptable when washing hands with soap and water. When bar soap is used, small bars of soap and soap racks that facilitate drainage should be used
Facts about Tuberculosis (TB)
How is TB treated under RNTCP?
 
  • Under RNTCP, the treatment is available free of cost at all government and identified private and NGO health facilities called as DOT centers. There are about 4 lakh such DOT centers in the country.
  • Once the diagnosis of TB is confirmed, the patient is treated with a standardized regimen which is based on past history of treatment for TB.
  • The regimen is given in 2 phases: Intensive phase (IP) and Continuation phase (CP) 
  • ‘New TB patients’ i.e. patients who have never been treated for TB in the past (both pulmonary and extrapulmonary) are treated for 6 months with the following regimen: Cap Rifampicin, Tab Isoniazid, Tab Pyrazinamide and Tab Ethambutol for 2 months i.e. IP followed by Cap Rifampicin and Tab Isoniazid for 4 months i.e. CP.
  • ‘Re-treatment patients’ i.e. patients who have taken treatment for TB in the past are treated for 8 months with the following regimen: Inj Streptomycin, Cap Rifampicin, Tab Isoniazid,   Tab Pyrazinamide and Tab Ethambutol for 2 months followed by Cap Rifampicin, Tab Isoniazid, Tab Pyrazinamide and Tab Ethambutol for 1 month (IP) followed by Cap Rifampicin, Tab Isoniazid and Tab Ethambutol for 5 months (CP).
  • All drugs are given on an intermittent basis i.e. given thrice a week on alternate days, under the supervision of a DOT provider
  • Each patient is allocated a “Patient wise drug box’ kept with the DOT provider.
IMA NEWS
Doctors ring alarm bells over rise in food allergy cases
NEW DELHI, April 4, 2015

With little awareness on food allergy, doctors are now seeing more patients suffering from it. Poor lifestyle, especially reliance on outside food among youngsters is the primary reason behind the increasing number of food allergy cases.

There has been at least 15-20 per cent increase in food allergy cases over the last two years, said doctors. Though food allergy is common among all age groups, those in the age-group of 20-30 years remains the most vulnerable.

Consuming food with high amount of preservatives or outside food is common among this age-group.

With World Health Day around next week and its theme being “food safety”, doctors said little attention is given to food allergies.

“Preservatives in food is one of the factors that leads to food allergies among young people. Those in their 20s also rely heavily on outside food so the incidence of allergy cases is more in this age-group. Often, it becomes difficult to diagnose food allergy cases in patients,” said Dr Atul Gogia, Consultant, Internal Medicine, Sir Ganga Ram Hospital.

The common symptoms in food allergy cases are rashes, skin lesion, itching, abdominal pain and loose motion, among others. If the problems persist over a period of time, it becomes more difficult for doctors to trace the cause of the allergy.

In some cases, the manifestation is immediate like severe itching, breathlessness and choking.

“People with asthma can suffer from severe form of food allergies, especially if they consume high-risk food items. Peanuts, shellfish, sesame, prawns, mushroom fall in the high-risk category. We have seen several deaths in extreme cases of allergy due to food items in this category,” said Dr K K Aggarwal, Honorary, Secretary General, Indian Medical Association.

“It is necessary that people are made aware of the consequences of food allergies,” added the doctor.

Medical emergency
“Patients suffering from asthma or with a history of food allergies should carry epinephrine injections which can come handy in case of a medical emergency,” said Dr Aggarwal.

Though food allergies are common, people often fail to trace the cause as the same food item might not have caused allergy before.

So a patient often delays going to a doctor.

“While some people are aware of the allergies from certain food items, others do not realise it as the same food item might not have caused any reaction before. Currently, it is easier to diagnose food allergy cases as tests are available. However, such tests should be conducted in restricted cases and only under the supervision of doctors,” said Dr Suranjit Chatterjee, Senior Consultant, Internal Medicine, Indraprastha Apollo Hospitals.
Inspirational Story
Family

 I ran into a stranger as he passed by, "Oh excuse me please," was my reply. He said, "Please excuse me too; I wasn’t watching for you." We were very polite, this stranger and I. We went on our way saying good–bye.

But at home a difference is told, how we treat our loved ones, young and old. Later that day, cooking the evening meal, my son stood beside me very still. As I turned, I nearly knocked him down. "Move out of the way," I said with a frown. He walked away, his little heartbroken. I didn't realize how harshly I’d spoken.

While I lay awake in bed, God’s still small voice came to me and said, "While dealing with a stranger, common courtesy you use, but the children you love, you seem to abuse. Go and look on the kitchen floor, you’ll find some flowers there by the door. Those are the flowers he brought for you. He picked them himself: pink, yellow and blue. He stood very quietly not to spoil the surprise, and you never saw the tears that filled his little eyes."

By this time, I felt very small, and now my tears began to fall. I quietly went and knelt by his bed, "Wake up, little one, wake up," I said. "Are these the flowers you picked for me?" He smiled, "I found ‘them, out by the tree. I picked ‘them because they’re pretty like you. I knew you’d like ‘them, especially the blue."

I said, "Son, I’m very sorry for the way I acted today; I shouldn’t have yelled at you that way." He said, "Oh, Mom, that’s okay. I love you anyway." I said, "Son, I love you too, and I do like the flowers, especially the blue."

Are you aware that if we died tomorrow, the company that we are working for could easily replace us in a matter of days? But the family we left behind will feel the loss for the rest of their lives. And come to think of it, we pour ourselves more into work than to our own family – an unwise investment indeed, don't you think?

So what is behind the story? Do you know what the word FAMILY means?

FAMILY = (F) ATHER (A) ND (M) OTHER, (I) (L) OVE (Y) OU!
Wellness Blog
Alternative Therapies Lower BP

A group of experts has reviewed all the existing studies and concluded that there are indeed alternative treatments for lowering blood pressure – with aerobic exercise leading the pack as far as strong evidence goes.

Other alternative treatments – namely isometric handgrip and dynamic resistance exercises and guided breathing – also got high grades when it came to reducing high blood pressure in some patients, according to a scientific statement from the American Heart Association published in the journal Hypertension.

"The evidence is not as strong for transcendental meditation and acupuncture, but they may help as well," said co–senior author Sanjay Rajagopalan, MD, professor of cardiovascular medicine at Ohio State University School of Medicine in Columbus.

For the report, an expert panel headed by the University of Michigan’s Robert D. Brook, MD, reviewed 1,000 studies published from 2006 to 2011. They divided the studies into three major classes of alternative treatments: behavioral therapies, noninvasive procedures and devices, and exercise. The panel did not review dietary and herbal treatments. Based on the level of evidence, they gave each an "A," "B," or "C" recommendation –– with "A" being the highest –– for implementation into clinical practice.

The panel found:
  • Exercise–based regimens did the best overall, with dynamic aerobic exercises getting an "A" class of recommendation, with a level of evidence of I, the highest possible.
  • Dynamic resistance exercises got a "B" and isometric handgrip exercises got a "C" grade, with levels of evidence of IIA and IIB, respectively.
  • Still, 4 weeks of isometric hand grip exercises resulted in some of the most impressive improvements in several studies –– a 10% drop in systolic and diastolic blood pressure. However, isometric exercise should be avoided among people with severely uncontrolled hypertension (180/110 mm Hg or higher).
  • As for noninvasive procedures or devices, device–guided breathing got a "B" with level II evidence. Device–guided slow breathing proved most effective in lowering blood pressure when performed for 15–minute sessions three to four times a week. Acupuncture also got a "B," but its level of evidence was III, meaning no benefit.
  • Among behavioral techniques, transcendental meditation and biofeedback both received "B" grades, with IIBs for levels of evidence. Yoga got a C, with level of evidence of III, or no benefit, as did other meditation techniques.
  • The alternative approaches that work reduce systolic blood pressure by only 2 to 10 mm Hg; whereas standard doses of a blood pressure–lowering drug reduce systolic blood pressure by about 10 to 15 mm Hg.
  • Alternative approaches are best for patients with blood pressure levels over 120/80 mm Hg who can’t tolerate or don’t respond well to standard medications.
Do not eat leftover food of more than two hours
Inaugurating the Health Talk-cum-Health Walk during Rahgiri, D-Block, Radial Road 4, Inner Circle, Connaught Place, New Delhi, Mrs Meenakshi Lekhi, Member of Parliament, said that all food handlers should be compulsorily examined for health fitness once in a year.

Addressing the gathering Padmashri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA and President Heart care Foundation of India said when eating food in a function, one should avoid eating salad and curd, as there are chances that they may lying there for more than 2 hours unused. The correct temperature for food to remain healthy is between 5 and 60 degrees. One should see to it that vegetables and fruits are not washed in water in a container; they have to be washed in running water. The function was organised by Delhi Medical Association and NDMC jointly with Heart Care Foundation of India, Indian Medical Association and Indian Oil.

Addressing the gathering, Dr. Ajay Lekhi, President, DMA and Dr P K Sharma, MOH, New Delhi Municipal Corporation in a joint statement said that eating non-veg food can be unhygienic if the meat is not cut into pieces in a hygienic way or if raw meat is shared with the site of cooked food.

IMA in a statement said that when there is a doubt about hygiene, bananas and oranges are better than eating apples.

IMA also emphasized about Safe Water. IMA statement said that boiled water will kill the harmful organisms but it may not kill some of the spores and dissolved impurities. However boiled water or chlorine water are the best alternative if pure hygienic filter water is not available.

IMA statement further said that natural fast food is good for health provided we understand the definition of fast food. Boiled Milk, bananas, oranges, dry fruits and washed vegetables are the best natural fast foods. On the contrary, artificial un-natural fast food, which is junk food, is injurious to health.
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Tech support: "Okay Colin, let’s press the control and escape keys at the same time. That brings up a task list in the middle of the screen. Now type the letter "P" to bring up the Program Manager."
Customer: I don’t have a P.
Tech support: On your keyboard, Colin.
Customer: What do you mean?
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Customer: I’M NOT GOING TO DO THAT!!
eMedi Quiz
Which of the following is present intracellularly in muscle cells?

1. Insulin.
2. Corticosteroid.
3. Epinephrine.
4. Glucagon.



Yesterday’s Mind Teaser: The buffering capacity of a buffer is maximum at pH equal to:

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

Answer for yesterday’s Mind Teaser:: 2. pKa

Correct Answers received from: Dr Poonam Chablani, Raju Kuppusamy, Dr Kala Sarma, Daivadheenam Jella, Dr G Madhusudhan, Dr Avtar Krishan

Answer for 4th April Mind Teaser:: 4. Vertebral venous plexus.

Correct Answers receives:: Dr Poonam Chablani, Raju Kuppusamy, Dr Kala Sarma, Daivadheenam Jella, Dr G Madhusudhan, Dr Avtar Krishan
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