August 8  2015, Saturday
eMedinewS
editorial
Healthy obesity does not exist
Dr KK AggarwalA research published in the Annals of Internal Medicine suggests that individuals cannot be simultaneously overweight and physically fit.

As BMI rose, so rose blood pressure, waist circumference and insulin resistance. As BMI increased, levels of HDL cholesterol, thought to protect against heart attack and stroke, decreased.

While participants who were either overweight or obese "may not yet have reached the points that define metabolic illness, they appeared to be on that road as their weight" increased.
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eMedipics
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Heart Care Foundation of India’s (HCFI) annual flagship event - 22nd Perfect Health Mela to be held from November 4 to 8 at the Talkatora Indoor Stadium
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News
Surgery
Diabetes

The weight loss and diabetes remission achieved with laparoscopic sleeve gastrectomy (LSG) appear to wane by 5 years, suggests a new cohort study published online August 5 in JAMA Surgery.

Allergy and Immunology
Tralokinumab, a human IL-13-neutralizing monoclonal antibody, did not significantly reduce asthma exacerbations in a phase 2b study of patients with severe uncontrolled asthma, but provided signs of benefit in post-hoc subgroup analyses, reported a paper published online in The Lancet Respiratory Medicine.

Diabetes
Coffee drinkers were about half as likely to develop type 2 diabetes as those who did not drink coffee, and researchers speculated an inflammation-lowering effect to be the key, reported a long-term study published online in the European Journal of Clinical Nutrition.

Gastroenterology
Serum biomarker assays measuring neo-epitopes can discriminate between Crohn's disease (CD) and ulcerative colitis (UC), suggests new research published in the Journal of Crohn's and Colitis. Researchers said that these neo-epitopes are increasingly released into the circulation as part of the inflammatory condition.

Oncology
Men with newly diagnosed prostate cancer are initially treated with hormonal therapy, and chemotherapy is used only when the disease is no longer responsive. However, it has now been shown that using chemotherapy early on in the treatment of prostate cancer can improve survival. The results are published online August 5 in the New England Journal of Medicine.
Cardiology eMedinewS
  • A "urine-output–guided diuretic adjustment" protocol may decrease persistent venous congestion in patients with acute decompensated heart failure (ADHF) who have developed cardiorenal syndrome, suggested a new analysis published online in the Journal of Cardiac Failure.
  • Hypertensive patients with significant changes in blood-pressure readings over several office visits had an increased risk of stroke, MI, heart failure, and death during a 2.8-year follow-up, independent of how well their hypertension was controlled, reported a post hoc analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), published in the Annals of internal Medicine.
Pediatrics eMedinewS
Pediatrics
Neurology

Vaccination-associated seizures generally do not affect cognitive outcome or the course of disease in children with Dravet syndrome (DS), a rare and severe form of epilepsy, reported a new retrospective cohort study published online in Neurology.

Pediatrics
Urology

Transcutaneous posterior tibial nerve stimulation is an effective treatment for non-neurogenic overactive bladder in pediatric patients, suggested an Indian study published online in the Journal of Pediatric Urology.
Dr KK Spiritual Blog
Sacrifice a goat and clear the board exam: It’s scientific

“Students in tribal-dominated Jhabua district in Madhya Pradesh and adjoining villages in Gujarat believe that sacrificing got can make them pass an exam. Ranapur, 45 km from Jhabua, an idol of Baba Dongar, a tribal god is making all wishes come true. Here, photocopies of exam admit cards are tied around trees and in return for their entreaties coming true, the supplicants promise to offer the god a goat, a hen or a bottle of liquor. Some 500 animals are sacrificed here every day and there are more than a dozen such priests who do the slaughtering.”

This story was published in TOI and may be correct as per mythology provided one understands the mythology.

In mythology riding means controlling, sacrificing means killings and animals are symbolized by human natures and behaviors.

For example, mouse is the vahan (vehicle) of Ganesha and symbolizes that to overcome obstacles one needs to control one’s greed. Similarly, owl is the vahan of Laxmi and means that for righteous earning, one should be able to control one’s foolishness.

Goats and Rams represent sexuality and sexual desires and lambs represent purity and innocence.

Goat is mentioned in mythology both as a symbol and as a vehicle of Gods. In the Samkhya system, Prakriti is depicted as a female goat (Mother Nature). The color of goat is red, black or white representing Sattva, Rajas, and Tamas.

The vehicle of Goddess Kali is a black goat. Agni rides Mesha – a ram. Kubera, the God of wealth, also has a ram as his vehicle. A ram is an uncastrated adult male sheep.

Sacrificing during exams means controlling your tamas or inertia and rajas or aggression, and controlling your sexual desires (un-castrated males).

Brahmacharya in mythology is a period where you are supposed to keep your sexual deviations and other desires under control.

So goat sacrifice does not mean physical killing of goat but killing of goat like activities within you.
Make Sure
Situation: A foreigner with a single loose stool developed sepsis.
Reaction: Oh my God! Why were antibiotics not started in time?
Lesson: Make sure that all foreigners are diagnosed to be suffering from Traveler’s diarrhea even if there is one single loose motion.
Dr Good Dr Bad
Situation: A patient with FUO was put on a trial of anti–tuberculosis treatment.
Dr. Bad: Continue it.
Dr. Good: The trial is not recommended.
Lesson: Patients with FUO should not have empiric antibiotic started solely to treat fever. Rifampin used in therapeutic trial for TB may suppress staph bone infection or diminish the ability to detect organism causing endocarditis.

(Copyright IJCP)
eMedi Quiz
A client has been diagnosed with hypertension. The nurse priority nursing diagnosis would be:

a. Ineffective health maintenance
b. Impaired skin integrity
c. Deficient fluid volume
d. Pain

Yesterday’s Mind Teaser: What is a healthy blood pressure level?

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

Answer for yesterday’s Mind Teaser: A. 110/70.

Correct Answers received from: Daivadheenam Jella, Dr Avtar Krishan, Dr G Madhusudhan, Raju Kuppusamy, Dr K V Sarma, Dr Poonam Chablani, Dr Jainendra Upadhyay.

Answer for 6th August Mind Teaser: B. Giving yourself a treat, like comfort food or a cocktail.

Correct Answers received: Dr G Madhusudhan. Pandit Hantodkar, Dr Avtar Krishan, Dr A C Dhariwal, Dr Bitaan Sen & Dr Jayashree Sen.
eMedinewS Humor
Mum: If you wash your face, Sammy, you can have one slice of chocolate cake. But if you wash your neck, too, you can have two slices.

Sammy: What if I have a bath?
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Rabies News (Dr A K Gupta)
Can a vaccinated dog transmit rabies? How effective is dog vaccine?

If a potent veterinary vaccine is given correctly as per pre–exposure schedule, it will mostly prevent rabies in the vaccinated dog, unless the exposure is severe. Ideally, its sera should be tested for protective antibody titer level but this is rarely practicable due to scarce facilities in our country. Consequently, PEP vaccination is recommended following bites even by vaccinated dogs. It has been noted that:
  • 6% of dogs found rabid have a reliable pre–exposure rabies vaccine history
  • 40% of dogs vaccinated only one time lost most of their immunity 4–6 months later.
  • Post Exposure Prophylaxis (PEP) vaccination is not very successful in dogs.
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CPR 10
Total CPR since 1st November 2012 – 113241 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
Salient Features of IMA NHS
  1. In IMA NHS there is no escalation of annual premium amount even if the age progresses to the next slab for that particular insured amount. For example a person joining the scheme at the age of 25 years, will be paying the same amount of Rs.3000/- as renewal fee per annum for an upper limit of 2 lakhs, even if his age passes on to the next slab.

    Y You can join and avail benefits even if you are a member of other schemes
  2. All pre-existing diseases are covered.
  3. No screening test required.
  4. You can join up till the age of 80 years.
  5. Immediate relatives of life members of IMA can join.
  6. Original bills are returned at request, and hence can be utilised for other insurance schemes.
Stemming Brain Drain of Doctors
During 2010-2014, a total number of 3947 Statement of Need (SON) Certificates and Exceptional Need Certificates (ENC) were issued by the Ministry of Health and Family Welfare to Indian doctors to enable them to pursue higher medical studies in the United States of America (USA).

As per the revised guidelines of the Ministry of Health & Family Welfare, No Obligation to Return to India (NORI) Certificate will not be issued in any circumstance, except for those who are above 65 years of age.

The following steps have been taken by the Central Government to improve the working conditions of the doctors:-
  • Pay and allowances of doctors have been enhanced considerably after implementation of the 6th Central Pay Commission.
  • MCI regulations have been amended to provide the age of superannuation for doctors in teaching cadre, which can go up to 70 years.
  • Assured Career Progression Scheme for faculty of Central Government Institutions has been revised to make it more beneficial.
  • Various allowances available to faculty like Non Practicing Allowance, Conveyance Allowance, Learning Resource Allowance, etc. have been enhanced considerably.
The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha.

No Obligation to Return to India (NORI) Certificate is required by a person who has gone to USA on J-1 visa.

J-1 visa is subject to a two-year home-country physical presence requirement which requires J-1 holders to return to their home country for at least two years at the end of their exchange visitor program.

This is also known as the foreign residence requirement under U.S. law, Immigration and Nationality Act, Section 212(e). If someone is unable to return to one’s home country to fulfill the two-year requirement, one must obtain a waiver from Embassy /Consulate General of India in the USA/Canada. In order to enable the Embassy to issue a "WAIVER CERTIFICATE", for the purpose of immigration, it is necessary for the applicant to obtain clearance directly from the authorities concerned in India.
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Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs
unless we do it public will not listen to us

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ICON 2015
Inspirational Story
God's embroidery

When I was a little boy, my mother used to embroider a great deal. I would sit at her knee and look up from the floor and ask what she was doing. She informed me that she was embroidering. I told her that it looked like a mess from where I was. As from the underside I watched her work within the boundaries of the little round hoop that she held in her hand, I complained to her that it sure looked messy from where I sat. She would smile at me, look down and gently say, "My son, you go about your playing for awhile, and when I am finished with my embroidering, I will put you on my knee and let you see it from my side." I would wonder why she was using some dark threads along with the bright ones and why they seemed so jumbled from my view. A few minutes would pass and then I would hear Mother's voice say, "Son, come and sit on my knee." This I did only to be surprised and thrilled to see a beautiful flower or a sunset. I could not believe it, because from underneath it looked so messy.

Then Mother would say to me, "My son, from underneath it did look messy and jumbled, but you did not realize that there was a pre-drawn plan on the top. It was a design. I was only following it. Now look at it from my side and you will see what I was doing." Many times through the years I have looked up to my Heavenly Father and said, "Father, what are you doing?" He has answered, "I am embroidering your life." I say, "But it looks like a mess to me. It seems so jumbled. The threads seem so dark. Why can't they all be bright?" The Father seems to tell me, "'My child, you go about your business of doing My business, and one day I will bring you to Heaven and put you on My knee and you will see the plan from My side."
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Cheerfulness is the principle ingredient in the composition of health. Arthur Murphy
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Your efforts are truly rewarded. congratulations Sir

Dr E Prabhavathi
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 age 50+ 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.
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Press Release
Heart Care Foundation of India’s (HCFI) annual flagship event - 22nd Perfect Health Mela to be held from November 4 to 8 at the Talkatora Indoor Stadium

As a prelude to the event, a 200 school program on obesity and hygiene will be organized in association with NCSTC, DST & the Govt. of India

HCFI, a leading national non-profit organization committed to making India a healthier and disease-free nation, today announced the dates and program of its flagship event, the 22nd MTNL Perfect Health Mela 2015. An annual event curated to spread mass health awareness using entertainment as a medium; the theme for the 22nd Perfect Health Mela is “Health, Hygiene & Sanitation”. The mela will be organized from November 4-8, 2015 at the Talkatora Indoor Stadium, New Delhi in association with MTNL, Coke, LIC, NDMC & MCD. The Indian Medical Association for the first time will be extending its full support towards the event this year.

In line with its theme, a series of pre-event activities will be organized in the months prior to the Mela. The first such activity, a 200-school project in being organized in association with the NCSTC, DST & Govt. of India was launched today. The aim of the project is to raise scientific awareness about hygiene and the ill effects of obesity amongst children.

Addressing a press conference, Padma Shri Awardee Dr KK Aggarwal, President HCFI said, “HCFI is committed to raising awareness about the various health issues in the country and providing solutions for them. As a part of this endeavor, we have been successfully organizing the Perfect Health Mela for twenty-one years now. In its 22nd edition, the Perfect Health Mela will lay an increased focus on youth education, for early and timely awareness about preventive health care can help reduce the disease burden in our country drastically. A leading example of this is the fact that a heart attack takes about 15-20 years to manifest. So if a person wishes to avoid becoming a victim to it at the age of 45, he must start taking preventive measures in the school itself. I am extremely thankful to all our sponsors, partners and the participating schools and colleges for without their support none of this would be possible".

Speaking about the Indian Medical Association’s support towards the event, Padma Shri Awardee Dr. A Marthanda Pillai – National President IMA said, “The IMA is committed to raising the standards of healthcare in our country. The Perfect Health Mela is in line with our aim of making India a Swachch and Swasth country”.

Started in 1993, the Perfect Health Mela caters to people from all age groups and all walks of life. It showcases activities across categories such as health education seminars, check-ups, entertainment programs, lifestyle exhibitions, lectures, workshops, and competitions. The Mela is attended by over 200 organizations each year including those from the State and Central government, PSUs, and leading corporates. The theme of this year’s Mela has been kept keeping the on-going Swachch Bharat – Swasth Bharat initiative in mind. Health and sanitation are key contributors to the overall health of a Nation. A special focus will be laid on prevention of water, vector air borne diseases including flu & tuberculosis, control of waste including bio-medical waste, pollution-related cardio vascular diseases and lifestyle diseases due to environmental factors.

Adding to this, Dr P K Sharma, Medical Health Officer, NDMC & Dr N K Yadav, Director, MCD in a joint statement said, ‘We congratulate Heart Care Foundation of India on this initiative and we assure you that we will do all we can to make the 22nd Perfect Health Mela a success”.
For more information about the event, please visit: www.perfecthealthmela.com. Entry to the Mela is free for all.