September 7   2015, Monday
eMedinewS
editorial
England not the best place to tour on weekends
Dr KK Aggarwal Weekend hospital deaths in England

11,000 excess deaths from the 'weekend effect'

15.9m hospital admissions a year

1.8% of patients die within 30 days of visit

15% more likely to die if admitted on a Sunday compared to a Wednesday

10% more likely to die if admitted on a Saturday compared to a Wednesday
Source: British Medical Journal

Weekend effect: The research - carried out by seven leading doctors and statisticians, including Sir Bruce - looked at hospital records during 2013-14. During the year studied, 15.9m patients were admitted to hospital and 290,000 - 1.8% - of them died within 30 days. An admission on Fridays led to a 2% increased risk of death, on Saturdays it was 10%, on Sundays 15% and Mondays 5%.
 
ABO Blood Type is a Risk Factor for Coronary Heart Disease
Two prospective cohort studies have identified the ABO blood group as a risk factor for the development of heart disease. People with blood groups A, B, or AB were 5–23% more likely to develop coronary heart disease compared with those with O blood type. The study by Dr Meian He from Harvard School of Public Health, Boston, MA included 62 073 women from the Nurses’ Health Study (NHS) and 27 428 men from the Health Professionals Follow–up Study (HPFS) and is published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.

In the NHS and HPFS, the incident rates of coronary heart disease per 100 000 person–years were 125, 128, 142, and 161 for women with type O, A, B, and AB, respectively, and 373, 382, 387, and 524 for men with type O, A, B, and AB, respectively. Compared with individuals with O blood type, individuals with blood group A, B, or AB had a respective 5%, 11%, and 23% increased risk of developing coronary heart disease in an age–adjusted model.

In non–O individuals, plasma levels of factor VIII–von Willebrand factor (vWF) are approximately 25% higher than in individuals with type O blood type. Elevated levels of factor VIII–vWF have been previously identified as a risk factor for coronary heart disease. The vWF has an important role in hemostasis and thrombosis by mediating platelet adhesion to the vascular wall, especially under high shear stress conditions.
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eMedipics
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Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
News
Neurology
Obesity

Individuals who are overweight or obese at the age of 50 may be at greater risk of earlier onset of Alzheimer's disease, suggests new research published in Molecular Psychiatry.

Oncology
Gastroenterology

Nearly all advanced esophageal cancers harbor genetic mutations that can be targeted with emerging drug therapies, suggested a new study published in The Oncologist. The findings suggest a potential role for the use of targeted therapy in addition or as an alternative to conventional treatment in patients with esophageal cancer.

Hematology
Emergency Medicine

A new study, published in the British Journal of Pharmacology, suggests that a drug related to commonly used diabetes treatments provides protection against terminal blood loss.

Rheumatology
Patients who develop rheumatoid arthritis at older ages typically have more severe joint damage, suggested analysis of data from five longitudinal cohorts. The results were published online in Arthritis Research & Therapy.

Infectious Diseases
A study investigating the impact of pre-exposure prophylaxis for preventing HIV infection has reported that no new infections occurred over an observation period of more than 2.5 years. The results are published in Clinical Infectious Diseases.
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Cardiology eMedinewS
  • New research suggests drinking coffee could increase the risk of cardiovascular events such as heart attacks in young adults with mild cases of high blood pressure. The results were presented at the European Society of Cardiology (ESC) Congress.
  • Evolocumab has become the second drug in a new class known as "PCSK9 inhibitors" to be approved by the Food and Drug Administration (FDA) for the treatment of high cholesterol. The drug is approved for treatment of high cholesterol in patients who are unable to control their low-density lipoprotein cholesterol (LDL-C) with current treatments.
Pediatrics eMedinewS
Pediatrics
Cardiology

An inverse association between sugar-sweetened beverage (SSB) intake changes and HDL-cholesterol increases (HDL-C is the "good cholesterol") in children has been observed in a new study published September 2 in The Journal of Nutrition. The results also showed that a higher intake of SSB was associated with a higher triglyceride concentration.

Pediatrics
Genetics

Ophthalmology New research has suggested that when children carrying a variant of a gene called APLP2 spend much of their time doing activities that involve close work such as reading, they are more likely to develop nearsightedness (myopia). The findings are published in the journal PLos Genetics.
Pulmonary Embolism
D Dimer and PE
  • For patients in whom PE is unlikely and the D-dimer level is <500 ng/mL, no further testing is required
  • For patients in whom PE is unlikely and the D-dimer is ≥500 ng/mL, diagnostic imaging should be performed
  • For patients in whom PE is unlikely who fulfill all eight PERC rule criteria, no further testing is required
  • For patients in whom PE is unlikely who do not fulfill all eight criteria, further testing with sensitive D-dimer measurement or imaging should be performed
Dr KK Spiritual Blog
Why do We Worship the Tulsi Plant?

Yanmule sarvatirhaani
Yannagre sarvadevataa
Yanmadhye sarvavedaascha
Tulasi taam namaamyaham


"I bow to the Tulsi, at whose base are all the holy places, at whose top reside all the deities and in whose middle are all the Vedas."

The Tulsi or Sacred Basil is one of the most sacred plants. There is a saying in Sanskrit: "Tulanaa naasti athaiva tulsi" that which is incomparable in its qualities is the tulsi. It is the only pooja samagri, which can be washed and reused.

Satyabhama once weighed Lord Krishna against all her legendary wealth. The scales did not balance until a last single tulsi leaf was placed along with the wealth on the scale by Rukmini with devotion. Thus, tulsi played the vital role of demonstrating that even a small object offered with devotion is of greater value than all the wealth in the world.

The Tulsi leaf has great medicinal value and is used to cure various ailments, including the common cold. Tulsi seeds are good for male infertility and increase the viscosity of semen and sperm counts. It has detoxifying properties and is used in fasts including the Satynarayana Katha where a thousand tulsi leaves are added to the water for pooja, and which is consumed later by everybody.

Tulsi also symbolizes Goddess Lakshmi. Those who wish to be righteous and have a happy family life worship the tulsi. Tulsi is ‘married’ to Lord Vishnu with pomp and show like any other wedding. This ‘marriage’ is solemnised because according to a legend, the Lord blessed her to be His consort. Tulsi is worshipped in the months of Magh and Kartik. Tulsi vivah is observed in the month of Kartik and is the symbolic marriage of Lord Vishnu in the form of a shaligram (sacred stone) and Tulsi. It indicates the importance of Tulsi for fertility. Tulsi pooja is an important component of any marriage. (Suggestion: give the English equivalent months for magh and kartik)
Scientific awareness on personal hygiene and prevention from obesity among school going children, N P CO. ED. Sr. Sec. School, Kali Bari Lane, Havlock Square, New Delhi
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Make Sure
Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.
Dr Good Dr Bad
Situation: An HIV reactive patient came with TB pericarditis
Dr Good: Do not give steroids
Dr Bad: Give steroids
Lesson: For HIV-infected patients with tuberculous pericarditis that is not constrictive, and who are not felt to be at high risk of developing constrictive pericarditis, do not administer steroids.

(Copyright IJCP)
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Rabies News (Dr A K Gupta)
Is there a need to alter the dose or schedule of any concomitant medication during IDRV?

There is no need to alter the dose or schedule of any concomitant medication during IDRV.
IJCP Book of Medical Records
Quote of the Day
The best thing about dreams is that fleeting moment, when you are between asleep and awake, when you don’t know the difference between reality and fantasy, when for just that one moment you feel with your entire soul that the dream is reality, and it really happened. Johann Wolfgang von Goethe
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CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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
  • Reputed Surgeon from Bhavnagar India - Dr. M. F. Kapasi died in Birmingham, U.K. on the 30.08.15 after a short illness at the age of 80. Dr Kapasi served as a highly acknowledged Surgeon at Sir Takhtasinhji Hospital, Bhavnagar. He practiced as a Surgeon at various hospitals before opening his own Hospital in Dawn Chowk, Bhavnagar. He came to Birmingham, U.K. 8 years ago and settled here with his children. His son Dr. Faiyaz Kapasi is a reputed Urologist.
  • 90% of risk for acute MI is predicted by 9 modifiable risk factors ( lipids, smoking, HT, DM, abdominal obesity, stress, fruits/ vegetables, alcohol, exercise)
  • Novartis plans the first human tests next year of a "smart" contact lens it is developing with Google designed to help restore the eye's natural autofocus.
  • Novartis with google is also developing smart contact lenses to help diabetics track their blood glucose levels.
News
  • Altered colonic bacterial fermentation is associated with symptoms and colon transit time in individuals with irritable bowel syndrome (IBS). (American Journal of Gastroenterology, online August 25)
  • Adherence to treatment guidelines is low in the outpatient treatment of Clostridium difficile infection, particularly for severe cases, and the potential consequences are troubling. (International Conference on Emerging Infectious Diseases)
  • Dipeptidyl peptidase-4 (DPP-4) inhibitors for type 2 diabetes may cause joint pain so intense it is disabling, the US Food and Drug Administration (FDA) warned. Fortunately, the pain goes away, usually in less than a month, once patients stop taking the medicine.
  • Heart-attack patients whose ambulances were diverted from crowded emergency rooms to hospitals farther away were more likely to be dead a year later than patients who were not diverted. (Health Affairs)
  • The risk for stroke or acute myocardial infarction (AMI) is increased in patients who have suffered central retinal artery occlusion (CRAO), particularly in the week after the occlusion occurs. (Ophthalmology, online August 19)
  • In separate decisions, the European Commission has approved panobinostat (Farydak, Novartis) for the treatment of multiple myeloma and the combination of dabrafenib (Tafinlar, Novartis) and trametinib (Mekinist, Novartis) for use in advanced melanoma. The approval of panobinostat, an oral drug, is for use in combination with bortezomib (Velcade, Millennium) and the anti-inflammatory agent dexamethasone for the treatment of adults with relapsed and/or refractory multiple myeloma who have received at least two previous regimens, including bortezomib and an immunomodulatory agent.
  • The Advisory Committee on Immunization Practices (ACIP) has revised its interval recommendations for the pneumococcal polysaccharide vaccine (PPSV23) and pneumococcal conjugate vaccine (PCV13) in older healthy adults. Immunocompetent adults older than 65 years who have not previously been vaccinated with pneumococcal vaccine should receive a dose of PCV13, followed at least 1 year later by a dose of PPSV23. If PPSV23 is given earlier than the recommended interval, the dose need not be repeated, the guidelines specify. (Morbidity and Mortality Weekly Report, September 4)
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Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

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Inspirational Story
Temper Control

There once was a little boy who had a bad temper. His father gave him a bag of nails and told him that every time he lost his temper, he must hammer a nail into the fence.

The first day the boy had driven 37 nails into the fence. Over the next few weeks as he learned to control his anger, the number of nails hammered daily, gradually dwindled down. He discovered it was easier to hold his temper than to drive those nails into the fence. Finally the day came when the boy didn’t lose his temper at all. He told his father about it and the father suggested that the boy now pull out one nail for each day that he was able to hold his temper.

The days passed and the young boy was finally able to tell his father that all the nails were gone. The father took his son by the hand and led him to the fence. He said "you have done well, my son, but look at the holes in the fence. The fence will never be the same. When you say things in anger, they leave a scar just like this one."

You can put a knife in a man and draw it out. It won’t matter how many times you say I’m sorry, the wound is still there. Make sure you control your temper the next time you are tempted to say something you will regret later.
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Reader Response
I am for supporting women and stand for women empowerment. The discussion is on giving maternity leave for women for 8 months at a stretch. The Govt. opts for giving the leave not after delivery, but 4 months before and 4 months after delivery. We all know that women employees form a major part of any organization, especially 90% of hospital nurses are women. So this much lengthy paid maternity leave will surely affect the running of such institutions and will put them into a big financial crisis. We obstetricians advice our patients to do regular work with healthy eating habits and exercise during the antenatal period till delivery. It will help them in delivery. Sitting ideal at home will not be good for normal antenatal women. To those patients who have contraindications for regular work, let them take leave on their own by producing a valuable medical certificate, but it should not be paid leave. After delivery, 3 months maternity leave is good, if they want more for any reason, let them take leave with loss of pay. It is not the responsibility of the women folk alone to look after the baby, let the husbands also take unpaid leave to look after their babies. This is just my opinion. Warm regards: Dr Shirly Joh

Sir . Maternity leave is essential. The present 180 days meet the need to most of the women. If the Govt need to help Pregnant women. It should sanction separate sick leave for pregnancy and postpartum complications and maternity leave should be utilised only after delivery with a live baby. Pregnancy complications are unique to women and the general medical leave which is there for everyone does not meet the need.If a women develops severe hypertension or uncontrolled diabetes sepsis etc long hospitalisation is needed. Similarily recurrent pregnancy loss..I request to putforward this need to the Ministry. On the whole 15 percent of women develop life threatening pregnancy complications. Giving 2 years maternity leave for all women is not the need of the hour. Definitely it will create lot of problems in all organisations. Thanking you. Dr. Papa Dasari, Prof. OG. Jipmer
Birthday Wishes Received From
Amit Khandelwal, Dr Praveen Chabdra, Sonia Madan, Kapil Juneja, Dr Ashok Aruna Birbal, Anand Bhatnagar, Dr Shantanu, Maneesh, Daivadheenam Jella, Muthumperumal Thirumalpillai, Dr Bharath Prakash Avula, Dr Roy Kallivaylila, Prof. Dr. Akhilesh Verma, Sreekumar Ramachandran, Kailash Gupta, Dr.Kiran Shankar Deoras, Ashok Johari, Bahaar Nikhil, Dr Naresh Trehan, Dr Rajiv Khosla, Subrato Dhar, Deepti Vashsisht, Dr Poonam Bali, Dr Ajay Kate, Dr Delvirajan, Kshitij Bhatnagar, Poornima, Paramjit Chadha, Som Dutt Bherwal, Dr Padma Iyer, Dr Shailendra Gupta, Dr.Shyamsunder .kasapa, Dr Mritunjay Singh, Dr. Harihar Dikshit, Dr Jainendra Upadhyay
Media
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Wellness Blog
Triphala can help in reducing bronchial hyperreactivity

Triphala (TRP), a herbal extract, has been shown to affect lymphocytes and natural killer T (NKT) cell function. It has been shown to ameliorate bronchial hyperreactivity through immune–cell modulations. In a study carried out at the Division of Allergy, Immunology and Pulmonary Medicine, Washington University in Saint Louis, Saint Louis, MO, asthma mouse models were generated through intraperitoneal (IP) injections of ovalbumin (OVA)/2 weeks followed by repeated intranasal OVA challenges.

Mice were then treated with normal saline (OVA/NS) or Triphala (OVA/TRP). Data were compared with mice treated with inhaled budesonide. Both TRP and budesonide significantly ameliorated functional and histological OVA–induced bronchial hyperreactivity. Triphala causes a significant decrease in bronchial reactivity. It alters immune–cell distributions and show antioxidative properties. Immune–cell modulation with triphala can ameliorate lung injury.

(Ref: Horani A, et al. Triphala (PADMA) extract alleviates bronchial hyperreactivity in a mouse model through liver and spleen immune modulation and increased anti-oxidative effects. Ther Adv Respir Dis 2012 Aug;6(4):199–210).
eIMA Quiz
What is a healthy blood pressure level?

A. 110/70.
B. 125/85.
C. 135/90.
D. 140/95.
E. 150/95.

Yesterday’s Mind Teaser: 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.

Answer for Yesterday’s Mind Teaser: B. Giving yourself a treat, like comfort food or a cocktail.

Answers received from: Daivadheenam Jella, Dr Avtar Krishan, Dr.K.Raju, Dr Poonam Chablani, Dr Ridu Kumar Sharma

Answer for 5th September Mind Teaser: C. Yes, and the headaches are more severe.

Correct Answers received from: Dr Poonam Chablani, Dr Raghvendra Chakurkar.
IMA Humor
Never be rude to anyone

An American tourist asked a boat guy in Zanzibar, "Do you know Biology, Psychology, Geography, Geology or Criminology?"

The boat guy said, "No. I don’t know any of these."

The tourist then said, "What the hell do you know on the face of this Earth? You will die of illiteracy!"

The boat guy said nothing. After a while the boat developed a fault and started sinking. The boatman then asked the tourist, "Do you know Swimology and Escapology from Crocodiology?"

The tourist said, "No!"

The boat guy replied, "Well, today you will Drownology and Crocodiology will eat you. I will not Helpology and you will Dieology because of your Badmouthology."
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Press Release
A World Heart Month initiative

Creating Heart Healthy Homes It is World Heart Month and the theme for the upcoming World Heart Day is creating heart-healthy environments. Given that we live in a country, which is soon to become the heart disease Capital of the world, each one of us must work towards making their homes heart friendly. Making even just a few changes can help reduce your own and your family's risk of heart disease and stroke.

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 on this topic, Padma Shri Awardee, Dr. KK Aggarwal, President HCFI & Honorary Secretary General IMA said, “Inculcating heart healthy practices within one’s home can go a long way in reducing the incidence of cardiovascular disease in India. Children should be taught about the ill effects of smoking, the benefits of consuming a healthy diet and regularly exercising from the very onset. Parents play an extremely important role in influencing the choices their children make in their future. If they regularly smoke at their homes, live high-stress and inactive lives; their children are more likely to do the same."

A few ways in which each one of us can make their homes heart friendly are:
• Stock your home with healthy food options

• Limit the consumption of junk or pre-packed food that are often high in sugar, fat, and salt

• Incorporate fresh fruit and vegetables in your meals and reduce sweet cravings by swapping sweet treats with mango or other sweet fruits

• Prepare healthy yet creative lunch at home and for your child’s school tiffin

• Ban smoking in your home, this will not only improve your health but also your children's health and discourage them from picking up the habit in the first place. Quitting smoking is a great way to be a positive role model for your children

• Be active, limit the number of hours spent watching TV or playing games on various electronic gadgets

• Organize outdoor activities such as cycling, hiking or simply playing in the garden

• Recognize your heart attack risk

• Visit a health professional who can measure your blood pressure, cholesterol and glucose levels, weight and body mass index, and advise on your risk.

• Once you know your CVD risk, you can make a specific plan to improve your heart health and your healthcare professional can also advise on appropriate treatment options where necessary
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