March 7  2015, Saturday
Suggestions for Medical Emblem Received So Far
Wound Hygiene
Dr KK AggarwalSimple wounds as a result of fall, animal bite etc. are a common occurrence at home. Following are some ways to manage them:
  • Irrigation is the most important thing for reducing bacterial impact.
  • Irrigation should be urgently done in every wound. It can be done by warm normal saline or simple running tap water.
  • One can add dilute iodine or any aseptic solution if required.
  • Irrigation can be low pressure or high pressure. At home low pressure injection is sufficient which can be done using any of the infant milk bottle.
  • If there is a burn, irrigation should be done continuously till the burning disappears.
  • In case there is a foreign body with irritation, continuous irrigation should be done till burning disappears.
  • Do not forget to wash your hands with soap and water before cleaning the wound and wear medical gloves, if available.
  • It is good idea to let the injured person clear his or her own wounds, if possible.
  • Rinsing of the wounds should be done for at least 5–10 minutes.
  • Cool water may feel better than warm water on the wound.
  • If there is a mild bleeding, clean the wound first and then stop the bleeding.
  • Moderate scrubbing can be done if the wound is very dirty.
  • If there are foreign bodies or objects, remove them using a clear tweezers. Do not push the tweezers, deeply into the wound.
  • Apply dressing and bandage to the wound as the need may be.
CPR Training, Chinmaya Vidyalaya at Vasant Vihar, Delhi 4th February 2014
  • Higher levels of fluoride in drinking water appear to be associated with an increased risk for hypothyroidism, reports a new study from England, published online in the Journal of Epidemiology and Community Health.
  • The Italian PROTEUS study reveals that when men are offered colorectal cancer (CRC) screening with CT colonography, instead of flexible sigmoidoscopy, participation rates improve. The findings were presented at the European Congress of Radiology 2015.
  • The colon and ileum should be regarded as separate entities, each containing dendritic cells with distinct roles in mucosal immunity and imprinting, suggests a new study published online in the British medical journal Gut.
  • Obesity and overweight are known risk factors for developing renal cell carcinoma (RCC); however, a new validation data analysis has confirmed that excess weight in patients with RCC may be beneficial. Researchers noted that those with a higher body mass index (BMI) were more likely to have a higher overall survival, longer time to treatment failure, and better tumor shrinkage when compared with patients with normal or lower BMI. The findings were presented at the 2015 Genitourinary Symposium.
  • A new study suggests that spider venom could lead to a more effective treatment for those who suffer from chronic pain. Hd1a has been identified in the venom of a species of spider called Haplopelma doriae that blocks the human Nav1.7 pathway, thus having strong potential as an effective painkiller in humans. The findings are published online March 4 in the British Journal of Pharmacology.
Dr KK Spiritual Blog
Managing grief by free expressive writing

The loss of a loved is often painful. The resultant grief makes it hard to eat, sleep and leads to loss of interest in routine life affecting behavior and judgment.

Some can feel agitated or exhausted, to sob unexpectedly, or to withdraw from the world and others may find themselves struggling with feelings of sorrow, numbness, anger, guilt, despair, irritability, relief, or anxiety.

It is well known that disclosing deep emotions through writing can boost immune function as well as mood and well–being. Conversely, the stress of holding in strong feelings can increase blood pressure and heart rate and increase muscle tension.

One can write on a piece of paper, in your personal book, on the open website with nick name or keep it in the mind. One doesn’t have to preserve the emotions and can throw away the writings.

In absence of deeply troubling situations, such as suicide or a violent death, which are best explored with the help of an experienced therapist, one can choose writing as a way to express the grief.
  1. Start writing for 15 to 30 minutes a day for 3 to 4 days.
  2. Continue up to a week if it is helping.
  3. Continue writing for 15 to 30 minutes once a week for a month.
  4. Writing has stronger effects when it extends over for more number of days.
  5. Remember writing about grief and loss can trigger strong emotions (one may cry or feel deeply upset)
  6. Many people find journal writing valuable and meaningful and report feeling better afterward.
  7. Don’t worry about grammar or sentence structure.
  8. Truly let go. Write down how you feel and why you feel that way. You’re writing for yourself, not others. (Source Harvard News Letter)
Cardiology eMedinewS
  • Having a healthy heart may protect against Alzheimer's disease, suggests a new study published in the journal Circulation. Researchers noted that people with decreased heart function were two to three times more likely to develop significant memory loss over a decade.
  • Patients with severe mitral regurgitation (MR) often suffer from psycho-emotional symptoms, such as depression and anxiety, but after undergoing mitral valve repair surgery, patients experience a significant improvement in emotional and physical wellbeing, suggests an article published in the March 2015 issue of The Annals of Thoracic Surgery.
Wellness Blog
Harvard 4 simple ways to boost your energy
  • Pace yourself: Keep going, but don’t risk overtaxing yourself. Instead of burning through all your battery life in two hours, spread it out between morning tasks, afternoon tasks, and evening activities — with rest and meals between.
  • Take a walk or a nap: However, if you have trouble sleeping at night, napping can make the insomnia worse. If that’s the case for you, get moving instead. Get up and walk around the block, or just get up and move around. If you are not an insomniac, enjoy that 20– to 30–minute power nap.
  • Skip most supplements. There is no evidence that they works.
    • DHEA: There is no evidence that DHEA offers any real benefits.
    • Iron. Iron only improves energy if you are clearly deficient.
    • B vitamins. It is true that B vitamins (B1, B2, B6, B12) help the body convert food into the form of energy that cells can burn, but taking more B vitamins doesn’t supercharge your cells.
  • Fuel up wisely. A sugary bakery roll delivers plenty of calories, but your body tends to metabolize them faster, and then you can end up with sinking blood sugar and fatigue. You’ll maintain a steadier energy level by eating lean protein and unrefined carbohydrates. Try low–fat yogurt with a sprinkling of nuts, raisins, and honey.
Pediatrics eMedinewS
  • In a study from a pediatric intensive care unit in a children's hospital in Spain, investigators noted that while more boys than girls were admitted (57.5% vs. 42.5%), death rates were higher in girls (4.9% vs. 3.3%). Girls died from a wider range of causes while boys died most often from respiratory and polytraumatic injuries. The study is published online in the American Journal of Human Biology.
  • A new study published in the British Journal of Developmental Psychology suggests that children who lack sympathy for others are more likely to engage in sharing if they respect the morals of their peers.
Make Sure
Situation: A patient with rheumatic arthritis was not given penicillin prophylaxis, and subsequently developed another attack.

Reaction: Oh my God! Why was the prophylaxis not started?

Lesson: Make sure that one administers secondary prophylaxis in the setting of suspected poststreptococcal reactive arthritis for up to one year after the onset of symptoms. Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued.
Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS

Negligence must be gross for the criminal charge–Supreme Court

The judgment given by the Honorable Supreme Court of India, consisting of a three judges bench, in October 2005, ruled that doctors should not be held criminally responsible unless there is prima facie evidence before the court in the form of a credible opinion from another competent doctor, preferably a Government doctor in the same field of medicine, supporting the charges of rash and negligent act.
  • We have noticed that doctors being subjected to criminal prosecution are on the rise; such prosecutions are filed by private complainants or by the police on an FIR lodged and cognizance taken.
  • The criminal process once initiated, subjects the medical professional to serious embarrassment and harassment. He has to seek bail to escape arrest, which may or may not be granted to him. At the end he may be exonerated by acquittal or discharge, but the loss he has suffered in his reputation cannot be compensated by any standard.
  • It’s a laudable judgment in the light of criminal procedures filed against them in trivial cases under Sections 304 and 304–A of IPC where the prima–facie, there seems to be no neglect in these medical treatments.
  • Section 304–A of IPC reads as "Causing death by negligence–whoever causes the death of any person by doing any rash or negligent act not accounting to culpable homicide shall be imprisoned with imprisonment of either description for a term which may extend to two years or with fine or both.
  • Degree of negligence required to prosecute them under the charge of criminal negligence, must be gross or even high degree.
  • Lord President Clyde observed "the true test for establishing negligence in diagnosis or treatment on the part of the doctors is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would have been guilty of, if acting with reasonable care and this is concise definition of medical negligence."
Dr Good Dr Bad
Situation: A patient came with classical benign postural vertigo.

Dr Bad: Take these drugs

Dr Good: Do Epley maneuver.

Lesson: Epley maneuver in most situations can cure benign postural vertigo.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
Rabies News (Dr A K Gupta)
What is the criterion for "protection" after immunization?

The rabies virus neutralizing antibody (RVNA) titer of 0.5 IU/ml of serum in the vaccinated person is considered protective. The facility for this test is available at NCDC, Delhi, CRI, Kasauli, Pasteur institute, Coonnor, NIV, Pune and NIMHANS, Bangalore.
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
Homoeopathic Medical Association demands ban on OTC sale of Influenzinum200 for swine flu
Swati Rana, Mumbai/ PharmaBiz

Thursday, March 05, 2015, 08:00 Hrs (IST)

The Indian Homoeopathic Medical Association (IHMA) has demanded to the government to ban the over-the-counter (OTC) sale of the swine flu drug Influenzinum200, manufactured by Dr Reckeweg, a German pharmaceutical company.

The association has written to Central Council of Homoeopathy (CCH), Central Council for Research in Homoeopathy (CCRH), Central Ayush department, Maharashtra FDA and all the state drug control authorities to immediately stop the OTC sale of Influenzinum200. According to sources, the drug is being promoted by pharmaceutical lobbies on whatsapp and facebook as a preventive medicine for swine flu and it is being sold without the prescription of registered homoeopathic practitioners.

Dr.Pawan S Chandak, national vice president, IHMA informed that Influenzinum was not included in Homoeopathic Pharmacopoeia of India, so it cannot be sold directly without the prescription. It is prepared from virus, yet it lacks efficacy with no scientific clinical research data available. Therefore, it is not proved, so its dangerous to use it without the prescription of registered homoeopathic practitioners.

He further says, “Homoeopathic pharmacy in Andheri, Mumbai sold 20,000 dilution bottles of ‘Influenzinum. It is unethical and legally serious matter if pharmacists are selling Influenzinum200 over-the- counter and promoting it on whatsapp & FB without any scientific base. It is unnecessarily promoted by pharmaceutical lobbies for self interest, as Influenzinum is a rarely used medicine and its stock is pending since 2009 after the epidemic of swine flu in 2009.”

The drug is not registered in Homoeopathic Pharmacopoeia of India and in homoeopathy preventive medicine is prescribed only on the basis of ‘Genus Epidemicus'. Even as per Materia Medica no clinical picture of swine flu matches with Influenzinum.

“We are objecting the OTC sale of Influenzinum200 because it is going against the Homoeopathic Laws & Organon. It is good to promote homoeopathy amongst general public on social media. But it must be within our Homoeopathic Laws & Principles. We all must understand that homoeopathy is based on individualisation concept. In case of epidemic diseases we must follow ‘Genus Epidemicus concept’,” says Dr Chandak.

Further he opined that CCRH suggested Arsenicum album 30 as a preventive medicine for swine flu and it was better to use commonly used medicines such as Gelsemium, Bryonia, Eupatorium as preventive medicine as per locality and common clinical picture of viral illness.
Sonal Namaste
When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet.
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IMA Videos
Inspirational Story
The Value of an Hour

A man came home from work late, tired and irritated, to find his 5 year old son waiting for him at the door. Son "Daddy, May I ask you a question?" Daddy "Yeah sure, what it is?” Son "Dad, how much do u make an hour?

Daddy "That's none of your business. Why do u ask such a thing?" That man said angrily. Son “I just want to know. Please tell me, how much do you make an hour?" Daddy “If you must know, I make 20 dollar an hour." "Oh," the little boy replied, with his head down. Looking up, he said, "Dad, may I please borrow 10 dollar?”

The father was furious," If the only reason u asked that is so u can borrow some money to buy a silly toy or other nonsense, then march yourself to your room and go to bed. Think why u are being so selfish. I work hard every day for such this childish behavior."

The little boy quietly went to his room and shut the door. The man sat down and started to get even angrier about the little boy's questions. How dare he ask such questions only to get some money?

After about an hour or so, the man had calmed down, and started to think: "May be there was something he really needed to buy with that 10 dollar and he really didn't ask for money very often!" The man went to the door of little boy's room and opened the door. "Are u asleep, son?" He asked. "No daddy, I'm awake," replied the boy. "I've been thinking, maybe I was too hard on you earlier," said the man, "It's been a long day and I took out my aggravation on you. Here's the 10 dollar you asked for."

The little boy sat straight up, smiling. "Oh thank you dad!" He yelled. Then, reaching under his pillow he pulled some crumpled up bills. The man, seeing that the boy already had money, started to get angry again. The little boy slowly counted out his money, then looked up at his father. "Why do you want money if you already have some?" the father grumbled.

"Because I didn’t have enough, but now I do," the little boy replied. "Daddy. I have 20 dollar now. Can I buy an hour of your time? Please come home early tomorrow. I would like to have dinner with you.

THE MORAL OF THIS STORY: It's just a short reminder to all of you working so hard in life. We should not let time slip through our fingers without having spent some time with those who really matter to us, those close to our hearts. If we die tomorrow, the company that we are working for could easily replace us in a matter of days.... may be hours even.

But the family & friends we leave 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 family. An unwise investment indeed!!!
Mental health in a state of neglect: IMA chief

The mental health sector in India is in a state of neglect, Indian Medical Association (IMA) president A. Marthanda Pillai has said.

Dr. Pillai was inaugurating the National Mental Health Initiative of the IMA at the Pushpagiri Medical College in Thiruvalla on Wednesday.

According to him, the investment of the Union and State governments in the mental health sector was grossly inadequate, considering its grave need in different parts of the country.
8th February is International Woman's Day
Give her a heart checkup : IMA

Cardiovascular diseases are the most common cause of death and disability in women, said Dr A M Pillai National President and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General IMA and President Heart care Foundation of India..

Important differences between women and men in the presentation of coronary heart disease may make it more difficult to establish the diagnosis in women
1. Women present about 10 years later than men and with a greater risk-factor burden.
2. Women are less likely than men to have typical angina.
3. Women who present to the emergency department with new onset chest pain are approached and diagnosed less aggressively than men
4. Women are more likely to initially present with chest pain than a more clearly defined event such as a heart attack
5. The symptoms of heart attack in women may differ slightly from those in men.
6. Many cases of heart attack in women go unrecognized, particularly at younger ages or in patients with diabetes
7. Treadmill exercise testing has a higher false-positive rate in women
8. Stress echocardiography appears to have similar accuracy.
9. The prevalence of significant blockages in coronary angiography is lower in women than men presenting with chest pain.
10. Women with chest pain and no evidence of blockages on coronary angiography may have cardiac syndrome X or microvascular disease
eMedi Quiz
LE cell is a:

a. Neutrophil
b. Macrophage
c. Histiocyte
d. Dendritic cell

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

a. Benzylpenicilloyl
b. Procaine
c. Crystalline
d. Benzathine penicillin

Answer for yesterday’s Mind Teaser: b. Procaine

Correct Answers received from: Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan, Dr Poonam Chablani,

Answer for 4th March Mind Teaser: b. Auspitz sign

Correct Answers receives: Dr Shangarpawar, Daivadheenam Jella, Dr Avtar Krishan, Dr Poonam Chablani
IMA Humor
A Texas millionaire

A Texas millionaire had fallen ill. The doctors consulted did not seem to understand what ailed him. The millionaire let it be known that any doctor who could heal him could have whatever he desired.

A country doctor was finally able to cure him, and as the doctor was leaving after a week’s stay, the Texan said, "Doc! I am a man of my word. You name it, and if it is humanly possible I’ll get it for you." "Well," said the doctor, "I love to play golf, so if I could have a matching set of golf clubs, that would be fine." With that the physician left.

The doctor didn’t hear from the Texan millionaire for some months. Then, one day, he got a phone call from the millionaire.

"Doc, I bet you thought that I had gone back on my word. I have your matching set of golf clubs. The reason it took so long is that two of them didn’t have swimming pools, and I didn’t think they were good enough for ya. So I had pools installed and they're all ready for you now!"
Quote of the Day
Turn every problem into a wonder, every adventure in to a joy. And this starts happening inside you with the very glimpse and experience of this deep, pure, Divine Love. Sri Sri Ravi Shankar
Reader Response
  • Dear Sir, Pls start with financial advice and planning advice for average member of our organisation before we start advice reg our patients and finances! Things like starting at young age with rs 1 crore term insurance and other advice to invest a proportion of money in land and immovable property would be a great help indeed.

    Arguably, the best financial help we can do to our patients is to increase the health budget to 10% of GDP and get the govt to fund 80% of the health needs of our population. This is the need of the century for Indian development into a progressive economy with due care to our countrymen. Kind regards: Dr Girish Kumar FRCS Ortho
News on Maps
S Moorei responsible for bad breath
Persistent bad breath, is often caused by the breakdown of bacteria in the mouth, producing foul-smelling sulfur compounds that reside on the surface of the tongue, said Padma Shri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA and President Heart Care Foundation of India. Solobacterium moorei, a gram-positive anaerobic bacillus originally isolated from human feces has been shown to be responsible for chronic bad breath, or halitosis. Citing a study of 21 people with chronic bad breath and 36 subjects without this problem from the State University of New York at Buffalo School of Dental Medicine, he said that S. moorei was found in every patient who had halitosis compared with only four control subjects.

Brushing twice a day with antibacterial toothpaste and using a toothbrush with a built-in tongue scraper can eliminate chronic bad breath.

Identifiable causes of bad breath is periodontal disease, gingivitis, postnasal drip and systemic illness. Bad oral hygiene is also associated with increased risk of heart disease.

Oral source of bad breath can be alleviated by:
  • Proper dental care and oral hygiene.
  • Gentle cleaning of the posterior portion of the dorsum of the tongue with a plastic tongue cleaner.
  • Rinsing and deep gargling with an effective mouthwash. One should extend the tongue while gargling.
  • Eating fibrous foods especially at the breakfast.
  • Gum chewing for 5 minutes if the mouth is dry, or after meals, especially with high protein intake.
  • Sufficient water intake.
  • Antibiotics, if bacteria are present, provide temporary relief. One should floss their teeth properly, smell the floss between each passage, and clean the malodorous sites carefully. Flossing should include cleaning the posterior surface of the back teeth as well.
Effective tongue brushing requires access to the deep posterior part of the dorsal tongue; odors often lurk 10 cm or more back from the tongue tip. The basic idea is to sweep away the mucus, desquamated cells, and other debris.

Some mouthwashes contain components that may harm soft oral tissues (e.g., alcohol, sodium dodecyl sulfate, strong oxidizing agents). The best time to use a mouthwash is before bedtime since the residue of the mouth rinse may remain in the mouth for a longer period of time and have a greater effect. Also bacterial activity leading to bad breath is greatest during the nighttime, when saliva flow is practically zero and microbial activity is highest.