July 8  2015, Wednesday
eMedinewS
editorial
Tackling Vitamin B12 Deficiency
Dr KK AggarwalVitamin B12 deficiency can be prevented if you are strict vegetarian. 3.2% of adults over age of 50 have a serious low B12 levels and up to 20% may have a borderline deficiency. The common causes of B12 deficiency are being on a vegetarian diet and after a weight loss surgery. Plants do not make Vitamin B12. It is only present in animal food.

Symptoms
  1. Strange sensations, numbness or tingling in the hands, legs or feet.
  2. Difficulty in walking (staggering, balance problem)
  3. Anemia
  4. A swollen inflamed tongue.
  5. Difficulty thinking and reasoning (cognitive difficulties) or memory loss.
  6. Yellowed skin (jaundice)
  7. Paranoia or Hallucinations
  8. Weakness
  9. Fatigue
Ask your Doctor about having your B12 level check if you:
  • Are over 50 years old
  • Take a proton–pump inhibitor or H2 blocker drugs for acidity
  • Take metformin (a diabetes drug)
  • Are a strict vegetarian
  • Had weight loss surgery or have a condition that interferes with absorption of food.
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eMedipics IMA,IJCP,HCFI
Heart Care Foundation of India, IMA, Delhi Branch of the Indian Red Cross Society & the Delhi Police join hands to train over 8000 PCR Van staff in a span of 40 days
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TRENDO 2015
The 3rd Annual meeting of the Endocrine Society of Tamil Nadu and Puducherry will be held in Kodaikanal on 11th and 12th of July 2015. TRENDO 2015 is proposed to address latest updates, emerging concepts, clinical applications and controversies in diabetes, thyroid disorders, gonadal problems, pituitary disorders, metabolic bone disease and adrenal diseases.
News
  • Transcranial magnetic stimulation (TMS), in combination with standard cognitive-behavioral therapy (CBT), improves smoking abstinence rates in the short-term compared with CBT plus sham TMS, suggests a pilot study presented at the 12th World Congress of Biological Psychiatry.
  • A simple panel of genetic biomarkers may predict which individuals are at high and low risk of developing colorectal cancer following screening colonoscopy, and could identify those who should have repeat screening, suggests new research presented at the 17th World Congress on Gastrointestinal Cancer (WCGC).
  • A new study has discovered how a small molecule that regulates gene expression - miR-132 - plays a key role in progressing wounds through their healing stages. Researchers suggest that the new molecule could be a target for new treatments for difficult-to-treat wounds. The findings are published in the Journal of Clinical Investigation.
  • Pregnant women with epilepsy tend to have a higher relative risk of death during delivery, suggests a large retrospective population-based study published in JAMA Neurology.
  • Intake of nonsteroidal anti-inflammatory drugs (NSAIDs) declines in a daily practice setting among patients with early axial spondyloarthritis who are treated with tumor necrosis factor (TNF) inhibitors, suggests a prospective multicenter observational study published in Arthritis and Rheumatology.
Cardiology eMedinewS
  • Women in menopause have a lower risk of coronary heart disease (CHD) events compared with men irrespective of race and whether their menopause is natural or the result of surgery, suggests a large cohort study published in the Journal of the American Heart Association.
  • The extent of coronary artery calcification (CAC) is an accurate predictor of 15-year mortality in asymptomatic individuals, suggests a new study published online July 6 in the Annals of Internal Medicine.
Pediatrics eMedinewS
  • Young children, who possess a good understanding of their own emotions and of those of their fellow human beings early on, suffer fewer attention problems than their peers with a lower emotional understanding, suggests a new study published in the journal Kindheit & Entwicklung (Childhood & Development).
  • Rapid eye movement or REM sleep actively converts waking experiences into lasting memories and abilities in young brains, suggests a new study published in Science Advances. The study broadens the understanding of children's sleep needs and puts into question the increasing use of REM-disrupting medications.
Dr KK Spiritual Blog
Why most temples are located in faraway places?

Most temples represent God or the spirit the deity located in the temple or mandir situated in an area at the outskirts of the city. A spiritual atmosphere is devoid of pollution and anything which promotes rajsik or tamsik behavior. The silence of the spiritual atmosphere reduces the internal noise and helps us onward in our inner journey. The inner journey of being in touch with one’s consciousness requires detachment from worldly pleasures and the withdrawal of the five senses of the body.

To be in touch with one’s consciousness one needs to bypass the disturbed state of consciousness controlled by emotion, memories and desires, through mind, intellect and ego.

This bypass usually requires a prolonged period of persistence and undertaking the inward journey devoid of external stimuli. The parikrama, which means "the path surrounding something", incorporating many long walks helps to detoxify the mind and thus shifts the consciousness from a disturbed state to an undisturbed, calm state.

A long walk not only has physical benefits but one also gets the benefits of nature as one’s inner stimuli are exposed to the outer stimuli during the parikrama. The person is often required to walk bare foot on natural ground, inhale pure air and concentrate and listen to the sounds of the nature, birds and trees. This proximity of nature helps in the inward spiritual journey and shifts one from the sympathetic to parasympathetic mode described by lowering of blood pressure and pulse rate and rise in skin resistance.

The final happiness invariably comes from within us at the time of final darshan when a person invariably closes his eyes and experiences God within his heart.

Most temples today are being constructed in residential colonies and provide a holy atmosphere to people right at their doorstep. However, this does not have the same spiritual significance and benefits as a temple located at the outskirts of a city.

There is no way a person can go to a temple in the vicinity of his house and detoxify his mind as this can hardly be achieved in minutes unless you are a siddha yogi, and if you are one, you need not go to a temple as the temple is within you.

In Vedic texts, it has been clearly mentioned that to acquire powers and inner happiness, rishi, munis were also required to do tapasya for months and years together.

This tells us that spiritual well–being is acquired over an extended period of time as the process of detoxification is a long drawn process. Cars and other vehicles should not be allowed near temples as the basic motive is to have a pollution–free atmosphere and to give time and space for the mind to detoxify.
Events
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Make Sure
Situation: A patient with 3 hour of developing chest pain went into acute cardiac arrest.
Reaction: Oh my God! Why was water–soluble aspirin not given at the time of chest pain?
Lesson: Make sure that all patients with suspected MI are given water–soluble aspirin to reduce chances of death.
Dr Good Dr Bad
Situation: A patient came with 10–second episodes of chest pain.
Dr. Bad: It is classical angina.
Dr. Good: This is non–cardiac chest pain.
Lesson: Cardiac pain is never less than 30 seconds.

(Copyright IJCP)
eMedi Quiz
Heat labile instruments for use in surgical procedures can be best sterilized by:

1. Absolute alcohol.
2. Ultra violet rays.
3. Cholorine releasing compounds.
4. Ethylene oxide gas.

Yesterday’s Mind Teaser: Which one of the following conditions may lead to exudative pleural effusion

1. Cirrhosis.
2. Nephrotic syndrome.
3. Congestive heart failure.
4. Bronchogenic carcinoma.

Answer for yesterday’s Mind Teaser: 4. Bronchogenic carcinoma.
Correct Answers received from: Dr Jainendra Upadhyay, Dr Bitaan Sen & Dr Jayashree Sen, Dr Poonam Chablani, Dr Avtar Krishan, Dr. Sushma Chawla.
Answer for 5th July Mind Teaser: 2. Giardia lamblia
Correct Answers received: Dr G Madhusudhan, Dr Avtar Krishan.
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IJCP Book of Medical Records
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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
eIMA News
News
  • A report that blames sugary drinks for almost 200,000 deaths worldwide every year has just been published in Circulation, with the authors emphasizing "a need for strong, global prevention programs." (Medscape)
  • Enrolment is set to begin for the largest-ever study to test a two-drug therapy aimed at restoring insulin production in people with type 1 diabetes. The protocol combines two already-available generic oral drugs, the immunosuppressant cyclosporine and the proton-pump inhibitor omeprazole, to try to overcome the immune system attack on the pancreatic islets and promote beta-cell regeneration, respectively. (Medscape)
It’s the western culture which has spoiled India
The Centers for Medicare & Medicaid Services has shown that 1400 drug and device companies paid $6.49 billion in 2014 to more than 600,000 physicians and more than 1100 teaching hospitals.

Of this amount, $3.23 billion was for research and $2.56 billion was for general purposes such as consulting and speaking fees, travel, food, and gifts.

The payments to physicians included $2.02 billion in general payments, $2.52 billion in research payments, and $703 million to physicians who owned or invested in drug and device companies. The research payments to physicians included payments to institutions where a physician was named as a principal investigator on a research project.

The hospitals received $543 million in general payments and $705 million in research payments. None of the hospitals had ownership or investment interests in any drug or device companies.

Manufacturers are not required this year to disclose payments for continuing medical education activities.

The Open Payments program, which was created by the Affordable Care Act, requires drug and device manufacturers to report transfers of value to providers. These include payments, honoraria, and research grants, as well as income from physicians' industry-related investments. The purpose of the program is to allow individuals to get information about physicians' financial relationships with the companies that make the products they prescribe or use with patients.

CMS invites physicians and teaching hospitals to review the data submitted by manufacturers. The providers who registered to do that reviewed nearly 30% of the total value of the payments reported to the government. The median value of the total payments to registered physicians was $3644 compared with $747 made to nonregistered physicians. (Medscape)
Inspirational Story
Do not be jealous

We all have experienced how jealousy can disturb our peace of mind. You know that you work harder than your colleagues in the office, but sometimes they get promotions; you do not. You started a business several years ago, but you are not as successful as your neighbor whose business is only one year old. There are several examples like these in everyday life.

Should you be jealous? No. Remember everybody’s life is shaped by his /her destiny, which has now become his/her, reality. If you are destined to be rich, nothing in the world can stop you.

If you are not so destined, no one can help you either. Nothing will be gained by blaming others for your misfortune.

Jealousy will not get you anywhere; it will only take away your peace of mind.
Quote of the Day
Never Miss First Opportunity, because the Second Opportunity Will be Much More Difficult than First!
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Reader Response
Dear Sir, Thanks for the nice information: Regards: Dr Jatin
Media
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Wellness Blog
Hookah as bad as smoking

An hour of puffs from a hookah packs the same carbon monoxide punch as a pack–a–day cigarette habit.

Hookahs have grown in popularity in recent years and Hookah bars have appeared in cities all over the world that allow people to smoke these water pipes.

Users inhale tobacco smoke after it bubbles through water, a process that some people think filters toxins from the tobacco.

Hammond and a student, in a study published in the Journal of the American Medical Association, recruited 27 students who smoked water pipes for an hour on three different evenings in April 2006. Another five students did not smoke the hookahs but stayed in the room with those who did. The participants abstained from water pipe smoking for 84 hours before taking part in the study; the bowls of their water pipes were filled with water and 10 grams of Al Fakher mu'assal tobacco, and then heated with charcoal.

Researchers monitored carbon monoxide in the breath of the participants both before and after the experiment using a machine designed to detect if people are smokers.

The exhaled carbon monoxide in participants was an average of 42 parts per million, higher than that reported in cigarette smokers (17 parts per million). The study also found that carbon monoxide levels grew in the room where the subjects smoked hookahs and might reach environmentally unhealthy levels, as determined by the federal government, during longer sessions.

Smoking a water pipe for 45 minutes produces 36 times more tar than smoking a cigarette for five minutes.
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IMA Humor
Tomatoes

A small boy was looking at the red ripe tomatoes growing in the farmer’s garden. "I’ll give you my two pennies for that tomato," said the boy pointing to a beautiful, large, ripe fruit hanging on the vine.

"No," said the farmer, "I get a dime for a tomato like that one."

The small boy pointed to a smaller green one, "Will you take two pennies for that one?"

"Yes," replied the farmer, "I’ll give you that one for two cents."

"OK," said the lad, sealing the deal by putting the coins in the farmer’s hand, "I’ll pick it up in about a week."
Rabies News (Dr A K Gupta)
Is hydrophobia a sign of rabies in dogs?

Hydrophobia is not a sign of rabies in dogs. Rabid dogs can drink water and even swim in water. If a rabid dog is not able to drink water, it is because of paralysis of jaw muscles and not due to hydrophobia.
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News on Maps
Press Release
By Independence Day, Delhi to be the first city in India where each and every Police PCR van staff will be trained in the life-saving technique of Hands Only CPR

Heart Care Foundation of India, IMA, Delhi Branch of the Indian Red Cross Society & the Delhi Police join hands to train over 8000 PCR Van staff in a span of 40 days

As a part of a first of its kind initiative, Heart Care Foundation of India, a leading National non-profit organization will be training over 8000 Delhi Police PCR van staff in the life-saving technique of hands only CPR-10. The 40-day long training camp is being organized by the NGO in association with the Indian Medical Association, Delhi State Branch of Indian Red Cross Society & Delhi Police. As a part of inauguration, Dr. KK Aggarwal and his team at Heart Care Foundation of India trained over 250 police offers at the IMA Hall in New Delhi today. The project will be completed by 15th August 2015. Mr. B.S. Bassi, Commissioner of Police Delhi was the chief-guest for the evening and inaugurated the training.

Delhi, a city of 22 million people, has only 152 state-run ambulances. That’s one for every 144,736 people. However, the World Health Organization states that there should be at least one ambulance per 100,000 people clearly indicating the shortage in the capital. In such cases, the first to reach most accident venues and emergency situations are the 8000 police persons who man all the PCR vans in Delhi. It is a known fact that 50 percent of the people who suffer a sudden cardiac arrest can be brought back to life within 10 minutes of their death if someone performs hands only CPR on them. By the coming Independence Day, Delhi will now be the only city in the country where each and every police person manning the PCR van will be able to provide emergency CPR and first aid to victims,

Speaking about the initiative, Padma Shri Awardee Dr A Marthanda Pillai - National President, Indian Medical Association & Padma Shri Awardee, Dr KK Aggarwal Honorary Secretary General, Indian Medical Association & President, Heart Care Foundation of India in a joint statement said, “Around 240,000 people die every year due to heart attacks in the country and we believe that 50% of them can be saved if 20% of the population learns hands only CPR. The fastest to reach an accident site or an emergency situation are the neighborhood PCR vans given the shortage of ambulances in the National Capital Region. We are extremely happy to announce this first of its kind initiative being organized jointly by the Heart Care Foundation of India, IMA, Delhi Police and the Indian Red Cross Society to train 8000 police personnel in this life-saving technique. Hands-Only CPR 10 is easy to learn; can be performed by anyone and is extremely effective. What people need to remember is two things, one CPR must not be practiced on a person who is breathing, has a pulse rate and is clinically alive. It must be administered within ten minutes of someone's death and continued till the ambulance arrives, or the person is revived.”

“The Heart Care Foundation of India Hands- Only CPR 10 mantra is: Within 10 minutes of death (earlier the better), for a minimum of 10 minutes (longer the better), compress the center of the chest of the deceased person continuously and effectively with a speed of 10×10 = 100 per minute” he added.

In Hindi the mantra is "marne ke dus minute ke ander, kam se kam dus minute tak, 10 x 10, 100 per minute ki speed se, apni chate petne ke badle mare hue admi ki chati peto"

A sudden cardiac arrest occurs when the electrical conducting system of the heart fails and the heartbeats irregularly and very fast (more than 1000 times, technically called as ventricular fibrillation). Soon after the heart suddenly stops beating and the blood flow to the brain stops. As a result, the person becomes unconscious and stops normal breathing. A cardiac arrest is not the same as a heart attack, but it may be caused by a heart attack. In most cases, sudden cardiac arrest may be reversible in the first 10 minutes. This is possible because the brain remains alive during this period when the heart and respiration have stopped, a situation called clinical death.

Inaugurating the camp, Mr. B S Bassi, Commissioner of Police, Delhi who was the Chief Guest at the inauguration ceremony said, “The Delhi Police is committed to the safety and over well-being of all the city's residents and this initiative is a testament of this. CPR training is a must for all PCR van staff as it enables them to save lives in emergency situations even in situations where an ambulance may not reach the victim in time. We are extremely thankful to our partners for making this project a reality. It is with great pride that I say that by this Independence Day, each and every Delhi Police PCR Van officer will be trained in the life-saving technique of Hands Only CPR.”

Special Commissioner (Operations) Sundari Nanda said that " the earlier you give CPR to a person in cardiac arrest, the greater the chance of a successful resuscitation".

Continuous compression only CPR compresses the heart between the sternum and the backbone and builds up the pressure that keeps the oxygenated blood flowing to the brain and keeps the person alive until a defibrillator becomes available or expert medical help arrives. Therefore, if you see someone collapse from sudden cardiac arrest, acting promptly can save his or her life. It is important to act quickly for every minute lost reduces the chances of revival by 10%. So, if you wait 5 minutes, the chances of surviving are 50% less. To know more or to organize a training camp in your locality, please call the NGO’s helpline number 9958771177.

Apart from CPR 10 tips were also taught about common first aid emergencies.