September 6   2015, Sunday
eMedinewS
editorial
Do not replace saturated fats with refined carbohydrates: white sugar, white rice and white maida may be more harmful
Dr KK Aggarwal It is incorrect to say eat less fat; the message instead should be eat more fresh fruits and vegetables.

White advocating low–fat diets it is easier for patients to understand advice given in terms of foods e.g., "Eat more fresh fruit" rather than in terms of nutrients e.g. "Reduce your intake of fat to less than 30 percent of your total energy intake."

The message to reduce fat has been translated by food manufacturers and consumers into a potentially harmful set of food choices.

Instead of replacing high–fat foods with naturally low–fat foods with other benefits, such as fruits, vegetables, legumes, and whole grain foods, consumers have often increased their consumption of low–fat or "fat–free" varieties of naturally high–fat foods, such as fat–free snack or junk foods. The result is an increase in refined carbohydrates, which lower good HDL–cholesterol levels with a possible increase in the incidence of type 2 diabetes and obesity, and failure to gain the benefits of more low-fat foods.
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Happy Birthday Dr K K Aggarwal
News
Neurology
Psychiatry

High-dose unilateral electroconvulsive therapy (ECT) is as effective as the more conventional bitemporal approach and is associated with fewer cognitive effects, especially autobiographic memory, the most controversial side effect associated with ECT, suggested a randomized comparison of the two modes presented at the 28th European College of Neuropsychopharmacology (ECNP) Congress.

Oncology
Transplantation

A common drug, voriconazole, often prescribed to treat fungal infections in lung transplant recipients could also increase the risk of skin cancer and death in these patients, suggests a new study published in the American Journal of Transplantation.

Nephrology
A previously unknown protein - transmembrane and immunoglobulin containing 1 (TMIGD1) - involved in protecting kidney epithelial cells from injury, could be a novel target for restoring kidney function from various forms of kidney disease, suggests new research published online in the American Journal of Pathology.

Obstetrics and Gynecology
A new study of more than 300 women suggests that exposure to certain phthalates - substances commonly used in food packaging, personal-care and other everyday products - could be associated with miscarriage, mostly between 5 and 13 weeks of pregnancy. The results from the study are published in the journal Environmental Science & Technology.

Psychiatry
Two new studies indicate that feeling sadness may actually change how we perceive color, specifically, in identifying colors on the blue-yellow axis. The research is published in Psychological Science, a journal of the Association for Psychological Science.
IMA,IJCP,HCFI
Happy Birthday, Dr KK Aggarwal
  • Dear Sir, Vanakkam, May Lord Shri Krishna bless you with a year full of happiness and life full of Bliss. May He grant you many more healthy happy returns of the day. Best regards: LVK Moorthy
  • Happy prosperous cheerful healthy birthday to Dr K K Agarwal. Wishing him all success in life. Dr Rajiv Garg
  • Happy Birthday to Dr Krishna Kumar Agarwal. Swapan Samanta, Prof. Ophthalmology, Burdwan Medical College, Burdwan
  • Dear Dr K K Aggarwal, Happy Birthday, born on the day of Janmashtami, the most auspicious day. May God bless you in accomplishing whatever you cherish for. Very best wishes. S Dwivedi
  • Dear Dr KK, I am sure you are fully recovered by now… Enjoy your Birthday and Birthday of Lord Krishna. Let Lord Krishna shower His choicest Blessings to you on this auspicious day of Krishnashtami to you on your Birthday. Wish you many happy returns of the day. Wish you happy birthday. Dr D Dwarakanatha Reddy.
  • May your birthday and everyday be filled with the warmth of sunshine, the happiness of smiles, the sounds of laughter, the feeling of love and the sharing of good cheers. Happy Birthday dear Krishan. Kusum & Mohan
  • Respected Dr KK Aggarwal, Happy birthday wishes to you on 5th of September & many many more to come. All the Best to you & your family. Regards, Dr R R Saigal.
  • Dear Dr KK Aggarwal sahib, wishing you happy birthday, and many happy returns of the day. God is kind enough to take care of you. We all wish and pray for your healthy and sound health in future. With regards: Dr Manjul Mehta
  • Dear Sir, Words fall short at times like this. Birthdays are an opportunity for us to tell people how we appreciate them in our lives. I have tried to think of a way to express my respect for you but my words fall short. All I can say is that if I can be the kind of example in someone else’s life that you have been for me, I will be a happy person. I sincerely thank you and hope you have a great birthday. Ritu Sinha
  • Sir ji, Happy birthday to you. Dr Pawan Gupta and Dr Neeraj Gupta
  • Many happy returns Dr K K Aggarwal Sir. Wish you a long and prosperous life. Thanking you, Prof. Dr Shivkumar S Utture
  • Most Revered Dr KK Aggarwal Sir, On behalf of IMA Haryana, I take this opportunity to send you our cherished wishes on your Birthday. May the Almighty bestow upon you all his benediction and benevolence. Very recently, you had a tryst with the most dreaded pulmonary embolism, which was diagnosed by your own clinical acumen. Surely, eyes see what the mind knows. We have heaved a sigh of relief and thanked God for the miraculous recovery. You are absolutely correct when you say that good wishes of well-wishes always get converted into heavenly blessings. Wishes of the entire IMA Family are always around you like a shield. We are yet to see a man, as learned, as enlightened, as conscientious, as meticulous and as dedicated to IMA as Dr KK Aggarwal, our beloved Hony. Secretary General, IMA Headquarters. We pray to the Almighty to provide him long, healthy, fruitful and happy life. “Twam Jeev Shardaa Shatam. Pashyem Shardaa Shatam Pravravaam Shardaa Shatam, Shrinuyaam Shardaa Shatam Deenasyaam Shardaa Shatam, Bhooyashch Shardaa Shataat.” Dr Anil Goyal
  • Respected Sir, Wish you many, many returns of the day & best wishes; long live IMA under your Leadership: Dr Amit Goyal.
  • Many many happy returns of the day Dr K K Agarwal: Dr Kiran Pandey
  • Happy Birthday: Ravi Wankhedkar
  • Happy Teachers' Day & Happy Birthday. Ratan Kaul
  • Dear Dr KK Aggarwal, I read your mail. You are doing wonderful job along with team IMA. I wish you happy birthday in advance. Your recovery is a miracle, sir. Thank you for sharing the information. Wish you good health and happiness Sir. Happy festival to you, your family and team IMA Happy Sri Krishna Janmashtami. We conducted a CME on vitamin D under IMA Rise and Shine. Thank you for all the support and encouragement. Regards: Dr Pushpa R Lengade
  • Sir, wish you many, many happy returns of the day. God bless you with good health. Long live IMA & Dr Agrawal. Dr Mahendra
  • Happy Birthday dear Dr K K Aggarwal. It is great that it falls on Teachers’ Day. You are a born leader and teacher. Congratulations, Dr Mohanan.
  • KK, wish you many, many happy returns of the day. Happy birthday: Dr Surajit Ghosh.
  • Dear Sir, Wishing you a very happy birthday. Dr Chandan
  • Happy Birthday Sir :) Regards: Jeet Bhati
  • Dear Dr Agarwalji, Wishing you a very happy birthday and many more happy returns of this wonderful day! Wishing you health, wealth and prosperity! You have been an inspiration to one and all. Regards, Dr Anand Dalvi
  • HAPPY BITHDAY TO DR.K.K.AGARWAL.from Dr.Sharad lakhotia
  • Dear Sir, Happy Birthday to you on this special Janamasthami which happened after your day of birth to today. Really A day of and for Krishana. Thanks and regards.Dr. Ramesh Kumar Goyal
  • Happy Birthday to respected DR KKA. DR SURESH THAKER and Dr Gayatri Thaker
  • Respected sir, On behalf of IMA Amravati branch Maharashtra I wish a very happy and memorable birthday.Regards, Dr. Dinesh B. Thakare
  • Dear K K Aggarwal Sir, Wish u happy birthday. May Lord Krishna bestow upon u good & radiant health for many-many years to come. Dr SC Joshi.
  • HAPPY BIRTHDAY to most respected and dynamic national leader of Indian Medical Association. Padma Shri Dr KK Aggarwal sir..!!Thanks, Regards: Dr MN Thareja.
  • Happy birthday and wishing u early recovery. God blessed us with your rebirth. We are fortunate to have such a great leader like you. Dr. Shiv Dutta Gupta
  • Boss Great Day. Dr A Maitra Malda.
  • Happy Birthday to Dr Krishna Kumar Aggarwal, Hon. Secretary General, IMA HQ
  • Many Many Happy returns of the day dear Sir, May God shower the choicest blessings of the Earth on you. Regards: Dr Vinod Shah
  • Dear K K Aggarwal Sir, Wish u happy birthday & good radiant health Dr S K Joshi, Past President (2013 - 14), IMA Mumbai West Branch
  • To Dr Krishna Kumar Aggarwal, Hon. Secretary General, IMA HQ. Happy Birthday and wishes for long healthy Active cheerful life. Dr Krishna Parate, Chairman NPPS
  • Dear Dr. K. K. Aggarwal, Many Many Happy Returns of the Day. May your Birthday be filled with joy and happiness and may all your dreams and wishes come true. From: Dr. T.C. Rathod, President, Dr. Suhas Pingle, Hon. State Secretary, Dr. Jayesh Lele, President Elect
  • Resp Sir, Many many happy returns of the day, On this auspicious day of Janmashtami May Lord Krishna bless with long journey of Life with full of ur all colours, WE ALL are  THANKFUL FOR VISIONARY AND DYNAMIC Leader as a Teacher And Head Of family. Regards: DR  Jayesh sheth
  • K K wish you many many happy returns of the day. Happy birthday: Dr Surajit Ghosh
  • Dear Sir, Wishing You a Very Happy Birthday: Dr Chandan
  • Dear Sirs, We wish our NP Dr Marthanda Pillai and our HSG. Dr KK, many more happy returns of the day and wish them long life and prosperity to serve IMA and the public as well. That is why ALMIGHTY GOD realised and informed IMA Team that HE is with him. We thank GOD for HIS magnanimity. My birthday is also on Janmashtami day. Long live IMA. Yours sincerely, Dr RM Krishnan
Birthday Greetings received from:
Hemant, Dr Sunil Prakash, Shubham Pandey, Charu Aggarwal, Dr Dinesh Negi, Satish Goel, Vandana, Dr SS Aggarwal, Dr Shiv Chopra, Rajendra Gupta, Charu Aggarwal, Dr Dubey, Dr Uday Kakroo, Rita Chopra, Dr Deepak Lahoti, Rohit Goyal, Kunal Khaneja, Dr Duchan, Dr A K Dewan, Dr M Naik, Sumit Chugh, Dr Pooja, Dr Ajoy Kumar Singh, Dr Ujjwal Sengupta, Dr V K Monga, Dr Jeyeh Lale, Dr Anita Madhu Kant, Dr Akhil Nikita Saksena, Dr Rajesh Poonam Mishra, Dr B B Wadhwa, Dr Anil Goyal, Dr Samaram, Dr Asim Sarkar, Piyush Goell, Dr N L Aggarwal, Chandra, Vinu, Rajiv Endlaw, Ambrish Mithal, Dr Mirtunjay Singh, Meena, Sanjay, Dr Neelam Mohan, Shailender Bharti, Dr Rajeev Chopra, Rajender Goyal, Tanuja, Sanjeev, Venu, Dr Ashutosh, Dr Aroop Bhattacharya, Rajesh Chetan, Dr Surinder H Singh, Dr Alex, Dr S N Gupta, Dr Jagdish Sobti, K Sareen, Gudia, Shambhu, Manoj Bhatt, Naresh, R N Tandon, K V Babu, Dr Arul Rhaj, Avtar Krishan, Ritu, Jaju family, Dr Sukhindo Roy, Dr J B Patel, Gurvinder Kaur, Dr Anupam Sethi Malhotra, R K Sharma, Dheeraj, DD Bhatia, Sapna, Dr K Jayaram, Dr Halbe Arun, Dr Sreharee, Dr ML Gupta, Rajesh Mittal, Ravi and Meena, Rajat, Gurvinder Kaur, Gurleen, Dr Satish Mehta, Dr Sehwas, Mohinder Desai, Gaurav Ahuja, Dr Raj Bakoria, Priyanka, Ashima Chopra, Dr Vijay Sudhir Grover, Dinesh, Dr Tulsi, Sanjeev Sheely Batra, Dr Manoj Kumar, Dr AMS Rathod, Brij Mohan Tewari, Dr Meenu, Dr S K Satija, Dr Pankaj Gulati, Saurabh Aggarwal, Shivani Sandeep Garg, Dr Ajay Kumar, Bimla Jhalani, Simmi, Dr MP Gandhi, Shiv Mishra, Rakhee, Manoj Gautam, Vinita Tyagi, Dr Archna, Meetu, Hema Gulati, Mohan Khandelwal, Dr Virna Mishra, Dr AK Kansal, Dr Anial Goyal, Dr M Abbas, Dr Swaraj Nnaik, Dr Danny Naik, Dr Praveen Bhatia, Dr Dharam Prakash, Dr Howzi Kapadia, Vikas Kapoor, Komal, Anil Wadhwa
Cardiology eMedinewS
European Society of Cardiology (ESC) 2015 Congress Update
  • Combining two diuretics, amiloride and hydrochlorothiazide (HCTZ), results in a significant reduction in blood pressure, more so than when each drug is used alone, and has the beneficial effect of neutralizing undesirable changes in blood glucose and potassium, suggested the results of the PATHWAY3 trial.
  • In a study of women aged 45 years and younger, diabetes produced a six times higher risk of heart attack. Additionally, smoking was a stronger risk than older age in women.
  • DOPPLER-CIP (Determining Optimal Non-Invasive Parameters for the Prediction of Left Ventricular Morphologic and Functional Remodeling in Chronic Ischemic Patients): Patients with stable CAD commonly undergo cardiac remodeling, and surprisingly, this remodeling often occurs in patients with small left ventricles and thick walls
Pediatrics eMedinewS
Pediatrics
Obesity

New research suggests that household food insecurity, defined as lacking access to food for an active, healthy life, dramatically increases the likelihood of metabolic diseases in children, with many showing chronic disease markers before they graduate from high school. The study is published in the Journal of the American Osteopathic Association.

Pediatrics
Diabetes
Ophthalmology

A new study has found that the occurrence of advanced forms of a diabetic eye disease remains low among children living with diabetes, thus recommending that most children with type 1 diabetes delay annual diabetic retinopathy screenings until age 15, or 5 years after their diabetes diagnosis, whichever occurs later. The findings are published online in Ophthalmology.
Pulmonary Embolism
PERC rule for pulmonary embolism

It is a tool that rules out pulmonary embolism (PE) and is an alternate to sensitive D-dimer testing in patients with a low-probability assessment for PE. The PERC rule is best used in patients who present to the emergency department (ED) with dyspnea or chest pain, in whom the gestalt estimate pre-test probability for PE is less than 15%. It is not meant for risk stratification.

The PERC rule has 8 criteria:
  • Age <50 years
  • Heart rate <100 beats/minute
  • Oxyhemoglobin saturation ≥95%
  • No hemoptysis
  • No estrogen use
  • No prior DVT or PE
  • No unilateral leg swelling
  • No surgery/trauma requiring hospitalization within the prior 4 weeks
In patients with a low probability of PE who fulfill all the above 8 criteria, the likelihood of PE is low and no further testing is required.
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 had to perform his duty, regardless of who his opponents were.

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 to listen, listen and listen. In the first chapter of Bhagavad Gita, Krishna only listened when Arjuna spoke. 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 the 18 counseling sessions between Arjuna and Krishna that included 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.
Inauguration ceremony, Best Practices in Cardiology 2015 - Rhythm to revival series
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Make Sure
Situation: A terminally ill patient who developed bed sores was prescribed only systemic antibiotics.
Reaction: Also change the position of the patient frequently and keep the skin clean and dry.
Lesson: Make sure that a patient with bed sore is also advised good nursing care and maintenance of skin hygiene, along with topical antibiotics.
Dr Good Dr Bad
Situation: A 24-year-old male was suspected to have a renal stone
Dr Bad: Go for MRI
Dr Good: Go for ultrasound test
Lesson: In suspected nephrolithiasis, non-contrast helical computerized tomography and ultrasonography are the tests of choice. In patients for whom there is a high clinical suspicion for nephrolithiasis and a low clinical suspicion for an alternative serious diagnosis, ultrasonography leads to less radiation exposure than CT and equivalent overall outcomes (N Engl J Med. 2014 Sep 18;371(12):1100-10).

(Copyright IJCP)
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CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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Deadly dengue strains in city
Durgesh Nandan Jha, TNN | Sep 5, 2015

New Delhi: A preliminary test report by AIIMS suggests two of the most virulent strains of dengue-type II and type IV-are circulating in Delhi this year.

"Our report is based on preliminary data from the first lot of nine acute-phase serum samples (collected within 10 days of disease onset) of suspected cases," said an official of microbiology department, AIIMS.

AIIMS' virology laboratory of the microbiology department, which is an apex laboratory of the National Vector Borne Disease Control Programme for dengue and chikungunya, isolated dengue viruses from six out of nine samples, and identified type II virus in four samples and type IV in two other samples.

Dengue strains are of four types. Type I causes classic dengue fever, type II leads to haemorrhagic fever with shock, dengue III causes fever without shock and dengue IV causes fever without shock or profound shock.

"Type II and IV are the most virulent forms of dengue. We have not seen so many critically-ill patients though. It may be because previous exposure to the viruses has lessened its impact," said Dr Navin Dang, consultant microbiologist and director of Dang's Laboratory in south Delhi.

Dr Ekta Gupta, associate professor at ILBS, said a larger study may be required to find out the predominant strain. "In the past few years, research shows, multiple strains of the dengue virus are present in a community," she said.

This year Delhi has reported more than 830 dengue cases so far and two deaths have been reported. On Friday, some of the AIIMS staff held protests on the campus over the death of a child due to the disease.

Experts said dengue, which assumed an epidemic form in 1996, followed by outbreaks in 2003, 2005 and 2006 in the capital, has become hyper-endemic-a disease that is constantly present at a high incidence and/or prevalence rate and affects all age-groups equally. "It could be due to the rapidly growing population, increasing urbanization and lack of an effective vaccine and vector control programmes," said an expert. (Source: Times of India)
Right to Mental Health is a human right
05 September, 2015

A day-long Meeting of State Health Secretaries on Mental Healthcare, organized by the National Human rights Commission concluded in New Delhi today. Mr. Justice Cyriac Joseph, Acting Chairperson, NHRC in his concluding remarks said that Right to Mental Health is a human right and the Centre and the State Governments have a Constitutional obligation to protect and promote this human right. He also said that given the general inhibition of the people in visiting Mental Healthcare hospitals, it would be perhaps more appropriate that the Governments considered opening a Psychiatric Wing in the existing District Hospitals instead of focusing on setting up Specialized Psychiatric or Mental Healthcare Hospitals.

Earlier, the Union Health Secretary, Mr. Bhanu Pratap Sharma said that the Centre will be upgrading more institutions as 'Centers of Excellence' for Mental Healthcare. The new Mental Health Bill will be placed before Parliament in the coming Winter Session. He said that the feedback available with the Union Health & Family Ministry is that the States were not submitting the Utilization Certificate of funds to release them. However, he will get reviewed the problems, if any, in this regard. On the key issue of funds from the Centre to the States and non-utilization of the same by them, it was felt that whereas the States needed to use them and submit Utilization Certificates, the Centre will ensure timely release of more funds for Mental Healthcare. Some of the other important suggestions were as follows:
  1. Psychiatry must be made compulsory for all Under-Graduate students to meet the shortage of doctors in Mental Healthcare.
  2. All General Medical Practitioners must be provided training on basic Mental Healthcare.
  3. The medical staff put on duty in Mental Healthcare should have a specialized training.
  4. Train civil servants regarding the District Mental Health Programme to help them integrate it with National Rural Health Mission and other flagship programmes having a health component such as ICDS.
  5. Innovate and fine tune the District Mental Health Programme while applying it in urban areas.
  6. Strengthen the NGO support base in Mental Healthcare.
  7. Develop clear guidelines on salaries of various categories of Mental Healthcare professionals and ensure regular disbursement of funds for that purpose.
  8. The rehabilitation mechanism under District Mental Health Programme requires to be strengthened.
  9. Livelihood of the cured persons must be linked to their treatment.
  10. States and UTs must consider learning and adopting the good practices of each other in the Mental Healthcare.
  11. District Mental Health Programme must be fine tuned to pay special attention to the issues of homeless mentally-ill persons.
In the morning, the NHRC Acting Chairperson, Mr. Justice Cyriac Joseph, in his Inaugural Address said that having a new law on Mental Healthcare may be useful but we have already enough laws. The real problem is not the absence of a law but the failure to implement the existing ones. Intellectually, we are concerned about the attention, the Mental Healthcare should receive but that does not take us to change of mindsets, attitude and change of heart. The NGOs' role in the rehabilitation of mentally-ill patients needs to be recognized and encouraged by the Governments to address this serious concern.

Mr. S.N. Mohanty, Secretary General, NHRC gave an insight into the efforts made by the Commission towards improvement of Mental Healthcare and said that the Commission is of the firm view that its guidelines and recommendations will give positive results. Mr. Anshu Prakash, Joint Secretary, Union Ministry of Health & Family Welfare said that the Centre is paying a focused attention towards Mental Health issue. The National Mental Health Programme (NMHP) is not receiving the due attention from the States. They need to set targets and fix responsibilities to ensure that there is affirmative action on improving the Mental Healthcare. He said that the huge shortage of human resources, including medical and para-medical staff, lack of infrastructure and general awareness about the Mental Health continues to remain a problem. Nobody talks of co-morbidity of Mental Health with other diseases, which cannot be handled alone either by a psychiatrist or a psychologist without inter-sectoral coordination. Inter-Ministerial as well as institutional cooperation is also very important for addressing the Mental Health issues. Private sector must contribute in building infrastructure and medical students while doing MBBS should be exposed to this subject.

The participants included, among others, NHRC Members, Mr. Justice D. Murugesan and Mr. S.C. Sinha, senior officers, Special Rapporteurs, State Health Secretaries, Mental Health experts and academicians, Heads of Mental Health Institutions and civil society representatives. (Source:
http://www.merinews.com/article/right-to-mental-health-is-a-human-right/15909367.shtml)
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Inspirational Story
The Tale of Two Pebbles

Many years ago in a small Indian village, a farmer had the misfortune of owing a large sum of money to a village moneylender. The moneylender, who was old and ugly, fancied the farmer’s beautiful daughter. So he proposed a bargain. He said he would forgo the farmer’s debt if he could marry his daughter.

Both the farmer and his daughter were horrified by the proposal. So the cunning money-lender suggested that they let providence decide the matter. He told them that he would put a black pebble and a white pebble into an empty money bag. Then the girl would have to pick one pebble from the bag.

If she picked the black pebble, she would become his wife and her father’s debt would be forgiven. If she picked the white pebble she need not marry him and her father’s debt would still be forgiven. If she refused to pick a pebble, her father would be thrown into jail.

They were standing on a pebble strewn path in the farmer’s field. As they talked, the moneylender bent over to pick up two pebbles. As he picked them up, the sharp-eyed girl noticed that he had picked up two black pebbles and put them into the bag. He then asked the girl to pick a pebble from the bag.

Now, imagine that you were standing in the field. What would you have done if you were the girl? If you had to advise her, what would you have told her? Take a moment to ponder this. What would you recommend that the girl do?

The girl put her hand into the moneybag and drew out a pebble. Without looking at it, she fumbled and let it fall onto the pebble-strewn path where it immediately became lost among all the other pebbles.

“Oh, how clumsy of me!” she said. “But never mind, if you look into the bag for the one that is left, you will be able to tell which pebble I picked.” The moneylender dared not admit his dishonesty. The girl changed what seemed an impossible situation into an extremely advantageous one.

Most problems do have a solution, sometimes we just need to think in a different way.
Quote of the Day
A question that sometimes drives me hazy: am I or are the others crazy? Albert Einstein
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Reader Response
Sir, I am a regular reader of eMedinewS, it is a wonderful very informative E magazine. You have rightly pointed out regarding maternity leave for women for 8 month. Even in Assam, the Chief Minister is planning to increase maternity leave up to 2 years. Being a woman I do understand the need of leave for rearing a baby. I appreciate their move. But they will have to solve the problem of vacancies that will emerge out of leave. Almost 99% health workers including ASHA/AWW workers are women. Hence the Head of Department or the person in-Charge of the Health Department will have to face the consequences. Even Govt, both central and state cannot solve the shortage of health workers at the present moment, a move such as this will certainly collapse not only medical but other departments also. Anybody can take leave, should offer choices on salary or Govt should think of alternate way of helping women after delivery for the baby. Thanking you Dr (Mrs) Jyoti Bhuyan, Assam
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Wellness Blog
Why is my nose bleeding?

Nosebleed is a common problem, occurring in up to 60 percent of the general population and is often because of a respiratory illness or dry conditions. Nasal drying is common in the hot summer months because of the extreme temperature and dry air due to use of air conditioners.

Here are some typical reasons for nosebleeds:
  • Nasal allergies
  • Blowing your nose too hard or trying to remove something from inside the nose
  • A result of “popping” the ear
  • Nasal exposure to chemicals
  • Frequent sneezing or having an upper respiratory infection
  • Use of nasal spray or a blood-thinning drug, such as aspirin
  • Inhaling air that is extremely dry or cold
  • Having recent surgery on the nose or elsewhere on the face
  • Breaking the nose or a similar injury
  • Uncontrolled blood pressure
Bleeding can be controlled by direct pressure i.e. compression of the nostrils rasping the alae distally so all mucosal surfaces are opposed. Direct pressure should be applied continuously for at least five minutes, and for up to 20 minutes. The patient should be encouraged not to check for active bleeding. Patients who are properly instructed may control their bleeding while the evaluation gets underway.

Other maneuvers include bending forward at the waist while sitting up (to avoid swallowing blood), placing a plug of cotton wool or gauze into the bleeding nostril (sometimes coated with antibiotic ointment), expectorating out blood that accumulates in the pharynx and a cold compress applied to the bridge of the nose.

These maneuvers also should be taught to high-risk patients for use at home. Many ENT specialists recommend initial treatment with two puffs of oxymetazoline to hasten hemostasis.
eIMA 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.

Answers received from: Dr Jalnedra Upadhyah, Dr Shangarpawar. Dr K Raju, Viswanatha Sarma, Dr Poonam Chablani, Daivadheenam Jella

Answer for 4th September Mind Teaser: C. About 30 percent of your daily calories.

Correct Answers received from: Viswanatha Sarma, Dr Poonam Chablani, Daivadheenam Jella.
IMA Humor
Civil Servant

Three boys are in the schoolyard bragging of how great their fathers are. The first one says, "Well, my father runs the fastest. He can fire an arrow, and start to run, I tell you, he gets there before the arrow".

The second one says, "Ha! You think that's fast! My father is a hunter. He can shoot his gun and be there before the bullet."

The third one listens to the other two and shakes his head. He then says, "You two know nothing about fast. My father is a civil servant. He stops working at 4:30 and he is home by 3:45!!"
Rabies News (Dr A K Gupta)
Do antibodies from rabies vaccination cross an intact blood–brain barrier?

No. Antibodies from vaccination do not cross an intact blood–brain barrier.
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Press Release
A World Heart Month initiative

Creating a heart healthy work and learning environment

We live in a country, which has seen a drastic rise in the incidence of cardiovascular disease in the past decade. People are being diagnosed with heart attacks as early as at the age of thirty, which was unheard in the past. Unhealthy lifestyle choices and increasing stresses at work and home are to blame for this. With World Heart Day around the corner, it is important that together we raise awareness about the need to create a heart healthy India. Modifying a few basic lifestyle habits can go a long way in helping reduce the incidence heart disease and stroke in the country.

Heart disease is reversible if lifestyle modifications are made in a timely manner. Nine potentially modifiable risk factors of heart attacks include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, lack of adequate fruits and vegetables in the diet and a sedentary lifestyle. Over 90%, Indians suffer their first heart attack due to one or several of these lifestyle irregularities. Modifying one’s bad habits can go a long way in helping prevent the onset of heart diseases.

Speaking about this, Padma Shri Awardee, President HCFI & Honorary Secretary General IMA, Dr KK Aggarwal said, “Given that people spend a majority of their time at work or at educational institutions, it is important that these are made heart friendly. One of the primary reasons for the high incidence of hypertension, diabetes, obesity and heart attacks in the country is the increasing competition and stresses a person face at their work places or during their educational years.“

Here are a few simple ways in which work places and educational institutions can be made more heart friendly:

Say no to smoking
  • Demand a smoking ban in your workplaces and ask your employer to provide help to colleagues who want to quit
  • Ensure that your co-workers comply with the ban
  • Make a complaint when you see smoking zones situated near playgrounds or schools, or close to hospital or work entrances
Bring exercise to work
  • Cycle or walk to work or get off the bus a stop or two early
  • Take the stairs and encourage others to do so
  • Encourage employers to use pedometers or a smartphone apps to track steps and even hold walking competitions
  • Stand up while you're on the phone or at your desk
Watch what you eat
  • Urge schools, workplaces, hospitals and clinics to offer healthy, affordable food
Reduce stress
  • While stress hasn't been shown to be a direct CVD risk factor, it is related to smoking, excessive drinking and unhealthy eating - all risk factors for heart disease
  • Take time for lunch away from work to get some fresh air and gentle exercise
  • Have regular breaks - try stretching or exercising for 5 minutes at regular intervals throughout 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