April 8  2015, Wednesday
editorial
Donating blood reduces chances of heart attack
Dr KK AggarwalOne should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion.

All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

In the current medical tourism scenario, many patients who are Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. They also do not accept transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.
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eMedipics IMA,IJCP,HCFI
Heart Care Foundation of India & Indian Medical Association trained over 4000 people in hands only CPR 10 & essential food safety measures on World Health Day
News
  • Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs), have been linked to an increased risk for first-time seizures in patients being treated for depression, suggests new research presented at the European Psychiatric Association (EPA) 23rd Congress.
  • Basophil activation testing (BAT) may assist in the prediction of food allergy reaction severity, suggests new research published online April 1 in the Annals of Allergy, Asthma & Immunology.
  • Pooled data do not prove the safety of finasteride for androgenic alopecia (AGA), with sexual side effects in particular not sufficiently analyzed, suggests a new meta-analysis published online in JAMA Dermatology.
  • Obese people are better at detecting the scent of chocolate and find it more pleasant than non-obese people, suggests a small study from the UK published online in Chemical Senses.
  • Once-daily dolutegravir maintains its higher virological response rates over those of ritonavir-boosted darunavir in treatment-naïve adults with HIV-1 infection, suggest the 96-week results from the FLAMINGO study published online in Lancet HIV.
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Dr KK Spiritual Blog
Positive Attitudes

All those out there who feel you are at your wits end wondering how things don't ever work out for you can now relax and dwell on all those failures that life has taken you through and turn failure into success.

Positive Attitudes
  • Failure doesn’t mean you are a failure. But it does mean you haven’t succeeded yet.
  • Failure doesn’t mean you have accomplished nothing. It does mean you have learned something.
  • Failure doesn’t mean you have been a foolish. It does mean you had a lot of faith.
  • Failure doesn’t mean you've been discouraged. It does mean you were willing to try.
  • Failure doesn’t mean you don’t to do. It does mean you have to do it in a different way.
  • Failure doesn’t mean you are inferior. It does mean you are not perfect.
  • Failure doesn’t mean you have wasted your life. It does mean you have a reason to start afresh.
  • Failure doesn’t mean you should give up. It does mean you must try harder.
  • Failure doesn’t mean you'll never make it. It does mean it will take a little longer.
  • Failure doesn’t mean God has abandoned you. It does mean God has a better idea.
Cardiology eMedinewS
  • Occurrences of sports-associated sudden cardiac arrest (SCA) in middle-aged athletes appear to be few, especially in those without previous cardiovascular risk factors or symptoms, suggests new research published April 6 in Circulation.
  • Researchers estimate that about 400 000 more 17- to 21-year-olds currently living in the US would be eligible for statin therapy based on pediatric as opposed to adult guidelines for treating elevated serum lipids, suggests a study published online April 6 in JAMA Pediatrics.
Pediatrics eMedinewS
  • The recently updated bronchiolitis guideline from the American Academy of Pediatrics (AAP) emphasize the need to avoid unnecessary or unproven interventions, thus pointing back to recommendations put forth half a century ago, reports an editorial published online April 6 in Pediatrics.
  • Three large trials, published in The Lancet and The Lancet Global Health journals, suggest that simplified antibiotics regimens delivered outside of a hospital setting can successfully treat severe bacterial infections safely and effectively in newborns and young infants.
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Wellness Blog
Every arthritis is not same

Every arthritis is not the same. While osteoarthritis, also called as green arthritis, may require only painkillers and rehabilitation exercises, the red inflammation arthritis called rheumatoid arthritis, if not treated early and aggressively, can end up with serious deforming complications.

Any arthritis in young women of child–bearing age should not be ignored, especially if it is worse in the morning and improves by movement. Most of them will have high platelet count on blood examination. These patients require aggressive treatment with disease–modifying drugs within days of the onset of symptoms and diagnosis. Approximately 1–2% of population may have this type of disease.

Osteoarthritis, on the other hand, is a disease of 50+age group and is due to wear and tear of various joints in the body and break down of the cartilage cushion in the joints. It mainly affects the weight–bearing joints like the knees, hips, neck and lower back joints. Inflammation is not a major feature of osteoarthritis. The experts said that another form of joint disorder is due to gout, which is never seen in people below 40 years of age and is almost never seen in young women before the onset of menopause unless there is a known underlying kidney disease and never seen in children.

The progression of osteoarthritis can be arrested with appropriate exercises, weight reduction and preventing posture and movement that worsen the disease.

Typical wear and tear of osteoarthritis is caused by sitting cross legged, doing Padmasana, squatting, other non physiological postures, sitting on low level surface like floor and low chairs, doing push-ups, going up and down on stairs, etc.

Most yoga postures should be done under medical supervision and should follow with a counter yoga exercise.

Most patients of serious arthritis end up with treatment with other systems of medicines or with quacks.
Make Sure
Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.
Beneficiaries of Sameer Malik Heart Care Foundation Fund
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Dr Good Dr Bad
Situation: A pregnant lady developed hypotension with respiratory distress immediately after delivery.

Dr Bad: This is an internal bleed.

Dr Good: It looks like amniotic fluid embolism syndrome.

Lesson: Amniotic fluid embolism syndrome (AFES) is a catastrophic condition that occurs during pregnancy or shortly after delivery. It is characterized by the abrupt and fulminant onset of hypotension due to cardiogenic shock, hypoxemia, respiratory failure, and disseminated intravascular coagulation. Clinicians should suspect AFES whenever shock or respiratory compromise develops during labor and delivery, or immediately postpartum. Other causes of sudden intrapartum or postpartum cardiorespiratory failure must be excluded.

(Copyright IJCP)
eMedi Quiz
Acantholysis is characteristic of:

1. Pemphigus vulgaris.
2. Pemphigoid.
3. Erythema multiforme.
4. Dermatitis hepetiformis.

Yesterday’s Mind Teaser: Which of the following is not a post transcriptional modification of RNA?

1. Splicing.
2. 5' Capping.
3. 3' polyadenylation.
4. Glycosylation.

Answer for yesterday’s Mind Teaser: 4. Glycosylation.

Correct Answers received from: Daivadheenam Jella, Arvind Diwaker, Dr Avtar Krishan, Dr KV Sarma, Dr K Raju, Dr G Madhusudhan.

Answer for 6th April Mind Teaser: 2. Corticosteroid.

Correct Answers receives: Daivadheenam Jella, Arvind Diwaker, Dr Avtar Krishan, Dr Poonam Chablani.
Rabies News (Dr A K Gupta)
Is sera testing of IDRV patients for antirabies antibodies necessary as a measure of knowing its efficacy?

Routine sera testing for rabies antibodies to know its efficacy is not required.
IJCP Book of Medical Records
IJCP’s ejournals
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
IMA NEWS
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.
Facts about Tuberculosis (TB)
Why is directly observed treatment (DOT) necessary?
 
  • DOT or directly observed treatment is administration of TB drugs under direct supervision of a trained DOT provider.
  • It is necessary to supervise treatment since the treatment for TB is prolonged (6-9 months) and there is tendency for patients to stop the treatment once they start feeling better within the first few months.
  • DOT also helps in preventing treatment interruption and assists in early identification of adverse reactions and ensures timely follow up.
IMA commits to make food safety a priority within its Swachh Bharat Swasth Bharat programme
By EH News Bureau on April 7, 2015: Financial Express
Announces day long ‘World Health Day 2015 Celebrations’ in association with the Heart Care Foundation of India, Delhi Medical Association and NDMC

Addressing a press conference on the occasion of the upcoming World Health Day in New Delhi, Dr KK Aggarwal, Honorary Secretary General, Indian Medical Association (IMA) and President, Heart Care Foundation of India, said, “We at Indian Medical Association would like to invite all the ministries to join hands with us to make India a country free of diarrhoeal deaths.”

Dr Aggarwal informed that in an endeavour to raise awareness about food safety and prevent food and waterborne illness, they are organising a day-long awareness programmme at the Talkatora Indoor Stadium. The programme will be organised in association with the Heart Care Foundation of India, Delhi Medical Association and NDMC with special support from Indian Oil and the Lions Club.”

The activities of the World Health Day celebrations will include a Perfect Health Parade, CPR training camp, panel discussion open to the public consisting of leading influencers and doctors including paediatrician Dr Anupam Sachdeva, dietician Dr Shikha Sharma, renowned dancers Nalini and Kamilini, surgeon Dr RN Tandon amongst others.

Addressing the cause, Dr Marthanda Pillai, President, IMA said, “IMA will write to the health ministry, commerce ministry, consumer ministry and agriculture ministry, to join hands with IMA to get rid of diarrhoeal deaths in the country.”

Dr Aggarwal added, “At present the government has earmarked a budget worth Rs 33,152 crores for health. A separate budget for the Swachh Bharat campaign with six-crore toilets will bring hygiene and cleanliness; six-crore new houses with a toilet each under Amrut Mahotsav (75th year of independence), Rs 68968 crores for education and mid-day meals; Rs 5,300 crores for micro-irrigation, service tax exemption in cold storage services and transportation of food stuff by rail/road; and thousands of crores for agriculture ministry if properly utilised can make India a country free of food and water borne diseases.”

Sharing his views, Dr Ajay Lekhi, President, Delhi Medical Association and Dr PK Sharma, MOH, New Delhi Municipal Council in a joint statement said, “The way to good health is through proper education of the masses. For example, people should know that cut open fruits and vegetables are banned and one should not eat them. Through various public health activities, we hope that the message of food safety would reach to one and all and they would be better equipped to deal with each and every aspect of it. We are proud to be associated with this noble initiative of Heart Care Foundation of India and Indian Medical Association.”
Hostility, aggression & anger a dangerous mix
Bindu Shajan Perappadan, New Delhi, April 7, 2015, The Hindu

Those who drive have experienced this feeling at some point of time — a surge of irritation and anger at possible aggressive or dangerous driving.

But few would stop, step out and physically assault another person. However, it’s a different picture on Delhi roads. The Capital records at least two to three cases of road rage a month.

Psychiatrists claim that over-crowding, oppressive weather, disturbed/tense state of mind are all contributing factors to road rage.

Physician and office bearer of the Indian Medical Association (IMA) Dr. K.K. Aggarwal said: “We have seen a rise in the number of road rage cases in the age group of 17-30 years. The youth today is showing what is now called AHA (anger, hostility and aggression). While city life takes its toll, ego and substance abuse create a dangerous situation on the road.’’

Dr. Samir Parikh, director, Mental Health and Behavioural Sciences at Fortis Healthcare said: “The rise in the number of these cases is a clear reflection of the fact that we are increasingly on the edge and stress is forcing us to disregard the consequences of our action. The non-interventional attitude of bystanders, too, is a case of worry and concern.”
ORS properties
  1. ORT is based on the preserved co-transport of glucose and sodium in patients with diarrhea due to gastroenteritis.
  2. ORS that is isotonic with equimolar concentrations of glucose and sodium is as effective as intravenous hydration in treating hypovolemia patients with cholera
  3. ORS properties
    • Total osmolality between 200 and 310 mosmol/L
    • Equimolar concentrations of glucose and sodium
    • Glucose concentration <20 g/L (111 mmol/L)
    • Sodium concentration between 60 and 90 mEq/L
    • Potassium concentration between 15 and 25 mEq/L
    • Citrate concentration between 8 and 12 mmol/L
    • Chloride concentration between 50 and 80 mEq/L
  4. Fluids (fruit juices and soda beverages) have a molar ratio of glucose in excess of sodium will increase diarrheal losses because the higher unabsorbed glucose load will increase the osmolality in the lumen, resulting in decreased water absorption.
  5. Fluids with excess sodium concentration compared with glucose (chicken broth) will increase diarrheal losses, as there is no organic solute for facilitated transport of sodium.
  6. Fluids with high sodium concentration also may result in hypernatremia.
  7. Decreasing osmolality reduced stool volume and the duration of diarrhea. Based upon these results, the WHO changed the formulation of ORS in 2002 from an osmolality of 311mosmol/kg to 245 mosmol/kg, and concentrations of glucose from 20 g/L (111 mmol/L) to 13.5 g/L (75 mmol/L) and sodium from 90 to 75 (2.6 gm/L) mEq/L. The new formulation preserved the molar 1:1 ratio of sodium and glucose, and is the only ORS used globally by the WHO. Examples
  8. Ingredients of WHO packet (245 mEq/L)
    • Sodium Chloride 2.6 grams (75 mEq/L Sodium)
    • Potassium Chloride 1.5 grams (20 mEq/L Potassium)
    • Glucose (Dextrose) 13.5 grams (75 mEq/L)
    • Trisodium Citrate 2.9 grams (10 mEq/L, used instead of sodium bicarbonate)
    • Total osmolality: 245 mEq/L (includes 65 mEq/l chloride)
  9. Ingredients of older WHO packet (311 mEq/L)
    • Sodium Chloride 3.5 grams (90 mEq/L Sodium)
    • Potassium Chloride 1.5 grams (20 mEq/L Potassium)
    • Glucose (Dextrose) 20 grams (2% Carbohydrate)
    • Sodium Bicarbonate 2.5 grams (30 mEq/L bicarbonate), Alternative: Trisodium Citrate 2.9 grams
    • Total osmolality: 311 mEq/L
Inspirational Story
We Live by Faith

A man's daughter had asked the local minister to come and pray with her father. When the minister arrived, he found the man lying in bed with his head propped up on two pillows. An empty chair sat beside his bed.

The minister assumed that the old fellow had been informed of his visit. "I guess you were expecting me," he said. "No, who are you?" said the father. "I'm the new minister at your church," he replied. "When I saw the empty chair, I figured you knew I was going to show up." "Oh yeah, the chair," said the bedridden man. "Would you mind closing the door?"

Puzzled, the minister shut the door. "I have never told anyone this, not even my daughter," said the man. "But all of my life I have never known how to pray. At church I used to hear the pastor talk about prayer, but it went right over my head." "I abandoned any attempt at prayer," the old man continued, "until one day about four years ago my best friend said to me, "Joe, prayer is just a simple matter of having a conversation with Jesus. Here is what I suggest. Sit down in a chair; place an empty chair in front of you, and in faith see Jesus on the chair. It's not spooky because he promised, "I'll be with you always." Then just speak to him in the same way you're doing with me right now."

So, I tried it and I've liked it so much that I do it a couple of hours every day. I'm careful though. If my daughter saw me talking to an empty chair, she'd either have a nervous breakdown or send me off to the funny farm."

The minister was deeply moved by the story and encouraged the old man to continue on the journey. Then he prayed with him, anointed him with oil, and returned to the church. Two nights later the daughter called to tell the minister that her daddy had died that afternoon.

"Did he die in peace?" he asked. "Yes, when I left the house about two o' clock, he called me over to his bedside, told me he loved me and kissed me on the cheek. When I got back from the store an hour later, I found him dead. But there was something strange about his death. Apparently, just before Daddy died, he leaned over and rested his head on the chair beside the bed. What do you make of that?"

The minister wiped a tear from his eye and said, "I wish we could all go like that."
Quote of the Day
If you have zest and enthusiasm you attract zest and enthusiasm. Life does give back in kind. Norman Vincent Peale
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Reader Response
Dear Sir, Very informative news. Regards: Dr Krish
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IMA Humor
Doctor complaining to mechanic

A doctor is taking to a car mechanic, "your fee is several times more per hour then we get paid for medical care."

‘Yeah, but you see, doc, you have always the same model! It hasn’t changed since Adam. But we have to keep up to date with new models coming every month"
Heart Care Foundation of India & Indian Medical Association trained over 4000 people in hands only CPR 10 & essential food safety measures on World Health Day
On the occasion of World Health Day, Heart Care Foundation of India and Indian Medical Association organized a day-long awareness program on food safety and essential life-saving techniques. The event was organized jointly with Delhi Medical Association and NDMC and supported by Lions Club and India Oil. The event, which took place from 8am – 5pm consisted of a CPR training camp, a perfect health parade, panel discussion on food safety, inauguration and a cultural show.

Speaking on the occasion, Padma Shri Awardee Dr A Marthanda Pillai, National President IMA and Padma Shri & Dr. B C Roy National Awardee & DST National Science Communication Awardee Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA in a joint statement said, “Awareness about food safety is essential at all levels. Towards this endeavor we will be roping in all 2.5 lakh doctors who are members of IMA to help raise awareness about its importance. What people do not realize is that diseases such as diarrhea are food- & water-borne and preventable, if food safety and hygiene measures are adhered to. At present over 6.9 lakh people die of diarrheal diseases in India with many deaths not being accounted for. Three lakh of these are in the age group 0-5 years. Lives of several children can be saved through the widespread use of a simple solution of oral rehydration salts (ORS) and zinc supplementation. Today’s program will help educate the masses so that they are informed and can make sensible choices.”

Adding to this Mr Jalaj Srivastava, Chairman, NDMC emphasized on prevention and said, “Prevention is always better than cure. Money spent on food safety today will reduce our expenditure on the treatment of a disease in future.”

A panel discussion on food safety by renowned influencers from different fields was also organized. Some of the panelists included dietician Dr Shikha Sharma, scientist Dr Anuj Sinha, pharmacist Ms Pallavi, pediatrician Dr Anupam Sachdeva, dancers Nalini Kamalini, journalist Sh. Dhananjay, hotelier Sh. Udit Kumar & surgeon Dr RN Tandon amongst others. The panel discussion was moderated by Dr K K Aggarwal.

Dr Anupam Sachdeva, Chairman, Pediatrics, Director, Pediatric Hematology Oncology and Bone Marrow Transplantation Institute for Child Health, Sir Ganga Ram Hospital, who was one of the panelists said, “Diarrhea is a leading killer of children, accounting for 9 per cent of all deaths among children under age 5. Several studies have demonstrated that zinc supplementation reduces the severity and duration of diarrhea and reduces the incidence of subsequent episodes of diarrhea for several months. WHO recommends zinc for children under 5 years of age with diarrhea (10 mg/day for under 6 months and 20 mg/day for 10 days for 6 months to 5 years). Zinc deficiency is common in children in developing countries, and zinc deficiency appears to contribute to the risk of developing diarrhea and pneumonia. Sufficient dietary zinc sources are available in a typical mixed diet, but lacto-ovo vegetarians need more milk, eggs, grains, legumes, nuts and seeds to achieve adequate levels.”

Dr Ajay Lekhi, President, Delhi Medical Association and Dr P K Sharma, MOH, NDMC in a joint statement said, “Raw materials like water, ice, fruits and vegetables are common sources of bacteria. Using safe water, pasteurized milk and checking for expiry dates can ensure food safety. Do not store food in the refrigerator for too long and avoid thawing at room temperature.”

Ten tableaus with health messages on TB Control, Cancer Control, Food Safety, CPR 10 – Save a life, Sameer Malik Heart Care Foundation Fund for heart patients, Formula of 80 - how to live longer healthy life were also flagged off on the occasion.