August 6  2015, Thursday
eMedinewS
editorial
Non–alcoholic Fatty Liver Disease Independently Predicts Prediabetes
Dr KK AggarwalNon–alcoholic fatty liver disease has been linked to increased risk for developing type 2 diabetes. A study published in the journal Liver International 2013;33(9):1406–1412 evaluated the independent role of NAFLD in predicting the development of pre–DM in a 7–year prospective follow-up of healthy volunteers.

A prospective cohort of a subsample of the Israeli National Health Survey evaluated at baseline and after 7 years by identical protocols. Metabolic parameters and ultrasonographic evidence of NAFLD were evaluated in 213 subjects, without known liver disease or history of alcohol abuse. Exclusion criteria were pre–DM at the baseline survey. Steatosis was quantified by ultrasound with the hepatorenal ultrasound index (HRI).

The study included 141 volunteers (mean age 48.78 ± 9.68, 24.82% with NAFLD) without pre–DM/DM at baseline. Both NAFLD on regular US (OR=2.93, 1.02–8.41 95%CI) and HRI (OR=7.87, 1.83–33.82) were independent predictors for the development of pre–DM, adjusting for age, gender, BMI, family history of DM, baseline insulin, adiponectin and glucose. Further adjustment for physical activity and dietary intake did not weaken the association. Furthermore, NAFLD was a stronger predictor for pre–DM than the metabolic syndrome. Subjects with both NAFLD and glucose =89 had 93.3% incidence rate of pre–DM.

The study concluded that non–alcoholic fatty liver disease is a strong and independent risk factor for pre–DM in the general adult population; thus, NAFLD patients should be classified as a population at risk.
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In cardiac arrest call 102 or 100
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News
Geriatrics
Official guidelines should set lower exercise targets for people older than 60 years than for younger adults, suggests a meta-analysis published online August 3 in the British Journal of Sports Medicine.

Psychiatry
Obstetrics and Gynecology

Treating psychiatric disorders in pregnant women with commonly used antidepressants (selective serotonin reuptake inhibitors or SSRIs) lowers the risk of several pregnancy complications including preterm birth and Cesarean section. But, use of this medication is also associated with an increased risk of neonatal problems, reported a new study published in the American Journal of Psychiatry.

Gastroenterology
Octreotide long-acting release therapy (OctLAR) improves symptoms and slows progression in patients with polycystic liver disease, suggests new research published online in Mayo Clinic Proceedings.

Obstetrics and Gynecology
Sacrospinous hysteropexy offers a uterus-preserving alternative for treating uterine prolapse, suggests new research published online in BMJ. The study revealed that women can avoid hysterectomy and opt for uterus preservation when uterine prolapse needs to be surgically corrected.

Pulmonary Medicine
Patients with moderate to severe chronic obstructive pulmonary disease (COPD) experienced significant reduction in lung function for up to 5 years after discontinuing long-term inhaled corticosteroid (ICS) treatment, suggested a new study published in the journal Chest.
Cardiology eMedinewS
  • A new review based on data from four large contemporary trials of patients with atrial fibrillation (AF) has shed light on the incidence, risk factors, and morbidity of extracranial systemic embolic events, a less common but often lethal outcome. The findings were published in Circulation.
  • Ignoring social factors such as education, income, and living environment could wipe out the progress achieved in curbing deaths due to heart disease and stroke, suggested the American Heart Association (AHA) in a statement published online August 3 in Circulation.
Pediatrics eMedinewS
Pediatrics
Neurology

Kids with traumatic brain injury (TBI) have more lapses in attention and longer reaction times than children who suffer trauma to other parts of the body, suggests new research published online August 3 in Pediatrics.

Pediatrics
Psychiatry

Street youth who were abused or neglected in childhood are more likely to attempt suicide, suggested a new study published online August 3 in Pediatrics.
Dr KK Spiritual Blog
Lord Krishna - The Great Teacher and Healer

Lord Krishna was a great teacher and a healer. He gave perfect counseling to Arjuna when he was in the state of acute anxiety, confusion, indecisiveness and depression. His supreme knowledge, skills and understanding of human relationship were responsible for convincing Arjuna that he has to perform his duty, regardless of who his opponents are.

There are basic principles to be learnt from the teachings of Bhagavad Gita to get, if one wants, to the right state of mental and physical strength.
  • The 1st principle is listen, listen and listen. In the first chapter of Bhagavad Gita, Krishna only listened to Arjuna. One must learn to listen to others. Out of 18 counseling sessions (the 18 chapters of Gita), one full session was devoted only to listening to Arjuna. Fifty percent of the emotion of a person is out once he has spoken to the Healer about his or her problems.
  • The 2nd principle is to remain non-judgmental while listening. This is beautifully described in Chapter 2 shloka 10. While listening, Krishna did not show any signs of anger to Arjuna even at those extremely difficult moments. On the contrary, He kept on smiling and listened patiently. This is another avenue where most of the healthcare workers fail in their relationship with the patients. We (doctors) sometimes become annoyed with the patients because they narrate unrelated details of their health problems. We need to understand and appreciate their predicaments.
  • The 3rd principle is that every answer should be validated by reasoning. Throughout 18 counseling sessions between Arjuna and Krishna incorporating 700 question and answers, Krishna gave proper reasoning, either experiential or based on sound logic. He never forced Arjuna to believe in what He was saying without getting convinced about it.
  • The 4th principle is that of reassurance. Krishna re-assures Arjuna on two occasions. Firstly, when he said that “I’ll appear whenever there is adharma” meaning thereby that whenever there is injustice someone will come and set it right. As a Healer, the doctor should convincingly say that “wherever there is a disease I will be there”. In Chapter 18 shloka 65, Krishna says that anyone who takes conscious decision and interprets things with full devotion, there is no reason why he or she should not become happy or healthy. He again assures Arjuna that he is going to be successful.
  • The 5th principle is depicted in the last shloka of Gita (18.78), which summarizes the importance of a good doctor-patient (teacher-student) relationship where Sanjay says to Dhritrashtra that when there is a Healer like Krishna and a patient like Arjuna, there is no reason why there will not be a victory.
Make Sure
Situation: A diabetic hypertensive was denied a beta–blocker because of the traditional teaching.
Reaction: Oh my God! You should have used nebivolol
Lesson: Make sure that diabetics are not denied beta–blockers when indicated. Nebivolol has no side effect on glucose metabolism unlike atenolol.
Dr Good Dr Bad
Situation: A diabetic with A1c 6% had a BP of 130/88 mmHg.
Dr Bad: This is very good control of diabetes.
Dr Good: This is very good control but we also need to control BP.
Lesson: Cardiovascular morbidity can only be reduced with aggressive management of hypertension, cholesterol (LDL <100 mg/dL) and aspirin (75–150 mg/day) in patients with or at high risk for cardiovascular disease.

(Copyright IJCP)
eMedi Quiz
Which of the following is not a good approach to managing stress?

A. Talking directly to the person who is causing the stress.
B. Giving yourself a treat, like comfort food or a cocktail.
C. Accepting that there are things beyond your control.
D. Trying cognitive-behavioral therapy to learn new coping skills.
E. Working out regularly.

Yesterday’s Mind Teaser: Do women have more headaches than men?

A. No, they get equal numbers.
B. Yes, but not that many more.
C. Yes, and the headaches are more severe.
D. Yes, but men tend to get more painful kinds that last longer.
E. None of the above.

Answer for yesterday’s Mind Teaser: C. Yes, and the headaches are more severe.

Correct Answers received from: Dr Avtar Krishan, Dr Jayashree Sen & Dr Bitaan Sen, Dr G Madhusudhan, Dr Jainendra Upadhyay, Dr K V Sarma, Dr Poonam Chablani, Dr G Madhusudhan, Dr K Raju.

Answer for 3rd August Mind Teaser: 2. Ulnar

Correct Answers received: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K Raju.
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Rabies News (Dr A K Gupta)
What is the cause of death in a rabid animal?

Death in rabid animal is due to progressive paralysis.
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CPR 10
Total CPR since 1st November 2012 – 113241 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
SMS of the Day: IMA Rise & Shine Breastfeeding week
Best slogan so far "maine apni maa ka pahele ghante ka doodh piya hai, dam hai to aaja"

Live webcast tomorrow

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ICON 2015
NEWS
  • Treatment with alefaceptan (Amevive, Astellas), an immunosuppressant drug formerly used for psoriasis, may have led to preservation of insulin-producing beta-cell function at 1 year after treatment cessation in patients with newly diagnosed type 1 diabetes, suggests a follow-up analysis from the Inducing Remission in New-Onset Type 1 Diabetes With Alefacept (T1DAL) study. The study was published July 21 in the Journal of Clinical Investigation. (Medscape)
  • The use of a "routine" early invasive strategy for patients with non-ST-segment-elevation ACS (NSTE-ACS) may be no better than a more conservative approach when it comes to improving very long-term clinical outcomes, suggests new research. Follow-up from the third Randomized Intervention Trial of Unstable Angina (RITA-3), which included 1810 patients from England and Scotland, showed no significant differences in all-cause or CV deaths at 10 years postprocedure between those who were routinely managed with ateriography plus revascularization as indicated and those who underwent a more selective strategy of symptom-driven arteriography and revascularization (Medscape)
  • Patients with precancerous gastric lesions face an increased risk of developing gastric cancer that increases dramatically with increasing severity of the lesion, say Swedish scientists. The findings underscore the importance of patient surveillance. The study was published online July 27 in the BMJ.(Medscape)
  • Lonafarnib, a novel oral treatment for chronic hepatitis D virus infection, reduces viral replication and is safe and well tolerated, according to an early trial. (Medscape]
  • The US Food and Drug Administration (FDA) has approved two new drugs for hepatitis C, one for genotype 3 and the other for genotype 4.
  • The first medication is a combination of ombitasvir, paritaprevir, and ritonavir (Technivie, AbbVie) in a tablet for use with ribavirin in adult patients with hepatitis C virus (HCV) genotype 4 infection without scarring and cirrhosis.
  • The NS5A replication complex inhibitor daclatasvir (Daklinza, Bristol-Myers Squibb) also cleared the FDA today for use with sofosbuvir (Sovaldi, Gilead Sciences) to treat HCV genotype 3 infection. (Medscape)
Inspirational Story
What Kind of Employee are you?

Employee "A" in a company walked up to his manager and asked what my job is for the day? The manager took "A" to the bank of a river and asked him to cross the river and reach the other side of the bank. "A" completed this task successfully and reported back to the manager about the completion of the task assigned. The manager smiled and said "GOOD JOB".

Next day Employee "B" reported to the same manager and asked him the job for the day. The manager assigned the same task as above to this person also. The Employee "B" before starting the task saw Employee "C" struggling in the river to reach the other side of the bank. He realized that "C" has the same task.

Now "B" not only crossed the river but also helped "C" to cross the river. "B" reported back to the manager and the manager smiled and said "VERY GOOD JOB".

The following day Employee "Q" reported to the same manager and asked him the job for the day. The manager assigned the same task again. Employee "Q" before starting the work did some home work and realized "A", "B" &"C" had all done this task before. He met them and understood how they performed. He realized that there is a need for a guide and training for doing this task. He first sat and wrote down the procedure for crossing the river; he documented the common mistakes people made, and tricks to do the task efficiently and effortlessly. Using the methodology he had written down, he crossed the river and reported back to the manager along with documented procedure and training material. The manger said "Q" you have done an "EXCELLENT JOB".

The following day Employee "O" reported to the manager and asked him the job for the day. The manager assigned the same task again. "O" studied the procedure written down by "Q" and sat and thought about the whole task. He realized that the company was spending lot of money in getting this task completed. He decided not to cross the river, but sat and designed and implemented a bridge across the river and went back to his manager and said, "You no longer need to assign this task to any one". The manager smiled and said "Outstanding job ‘O’. I am very proud of you."

What is the difference between A, B, Q & O?

Many a times in life we get tasks to be done at home, at office, at play.

Most of us end up doing what is expected out of us. Do we feel happy? Most probably yes. We would be often disappointed when the recognition is not meeting our expectation.

Let us compare ourselves with "B". Helping someone else with the problem often improves our own skills. There is an old proverb (I do not know the author) "learn to teach and teach to learn". From a company point of view "B" has demonstrated much better skills than "A" since one more task for the company is completed.

"Q" created knowledge base for the team. More often than not, we do the task assigned to us without checking history. Learning from other’s mistake is the best way to improve efficiency. This knowledge creation for the team is of immense help. Re–usability reduces cost there by increases productivity of the team. "Q" demonstrated good "team–player" skills.

Now to the outstanding person, "O" made the task irrelevant; he created a Permanent Asset to the team.

If you notice B, Q and O all have demonstrated "team performance" over and above individual performance; they have also demonstrated a very invaluable characteristic known as "INITIATIVE".

Initiative pays off everywhere whether at work or at personal life. If you have initiative you will succeed. Initiative is a continual process and it never ends. This is because this year’s achievement is next year's task. You cannot use the same success story every year.

The story provides an instance of performance, whereas measurement needs to be spread across at least 6–12 months. Consequently performance should be consistent and evenly spread. Out–of–Box thinkers are always premium and that is what everyone constantly looks out for. Initiative, Out–of–Box thinking and commitment are the stepping stone to success.
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  • Sir, this is fantastic. First of its kind to have impact on people. Great work: Dr J Lele
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  • Amazing display...The activity is the response to the good and embracing leadership...We are proud of you, our leaders. Appreciation to all those who celebrated Drs Day. Dr LVK Moorthy
Wellness Blog
Sangat and smoking

Sewa, Simran and Sangat are the three principles of life as per the most Vedic literature. Even Adi Shankaracharya described Sangat as the main force for living a spiritual life.

Sangat is the company of people you live with. Living in the company of good people makes one good and the reverse is also true.

The same is now being proved in the allopathic context. A study published in the New England Journal of Medicine has shown that when one person quits smoking, than others are likely to follow. One person quitting can cause a ripple effect, making others more likely to kick the habit.
  1. If your spouse stops smoking, you are 67 percent less likely to continue smoking.
  2. If your friend kicks the habit, it’s about 36 percent less likely that you’ll be smoking.
  3. When a sibling gives up cigarettes, your risk of smoking decreases by 25 percent.
  4. Your risk of smoking drops by 34 percent if a co–worker in a small office quits smoking. It is sort of like watching dominoes. If one falls, it very quickly causes others to fall.
We should treat people in groups, rather than as individuals. Friends and family need to be involved. If you want to quit, try to get close friends and family to quit as well.

Quitting smoking may have the side benefit of improving social well–being, just as it improves physical health.
IMA Humor
A woman customer called the Canon help desk with a problem with her printer.

Tech support: Are you running it under windows?

Customer: "No, my desk is next to the door, but that is a good point. The man sitting in the cubicle next to me is under a window, and his printer is working fine."
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Press Release
No certificate is required to do CPR

Under Good Samaritan Law and under IPC Section 92, any member of the public can and should attempt Hands only CPR as a bystanders whenever he come across a patient with cardiac arrest. No formal training or certificate is required to do Hands only CPR said Padma Shri Awardee Dr. A. Marthanda Pillai, National President and Padma Shri Awardee Dr K K Aggarwal, Hony. Secretary General, IMA in a joint statement.

Hands only CPR should be compulsorily taught to relatives of the heart patients, security persons, school children & teachers etc.

In case of Witnessed cardiac arrest, the bystanders should continue doing Hands only CPR till the medical facilities are available including availability of DC Electric Shock.