September 8   2015, Tuesday
eMedinewS
editorial
Rise and fall of Nuclear Cardiac Imaging
Dr KK Aggarwal The use of nuclear myocardial perfusion imaging (MPI) declined substantially in a large integrated healthcare system during a recent 5–year period.

Following an increase in use from 2000 to 2006 at Kaiser Permanente Northern California, MPI use dropped by a relative 51% through 2011 according to Edward McNulty, MD, of Kaiser Permanente Medical Center in San Francisco.

Replacement by cardiac CT and stress echocardiography did not explain the pullback from using MPI, the researchers reported March 26 issue of JAMA.

The fact that we observed greater declines amongst lower–risk subsets (outpatients and younger persons) suggests MPI use became more discriminating (used preferentially in higher–risk persons), as per the authors.

Other reasons may be "more recently, factors potentially discouraging use, such as appropriate use criteria, declining reimbursement, radiology benefits managers, and more publicized concerns about the health effects of radiation have emerged." (Source: Medpage Today)
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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
Diabetes
Being a smoker and having diabetes increases the relative risk of total mortality and cardiovascular events by about 50%, and quitting smoking can reduce these risks, according to a new study published online August 26 in Circulation.

Rheumatology
Anesthesiology

New research, published in the journal Pain Medicine, revealed that patients with spinal stenosis (SS) experienced good short term benefit, lasting from weeks to months, after receiving epidural steroid injections (ESI).

Oncology
Gastroenterology
Surgery

Extensive lymph node removal during surgery for esophageal cancer might not necessarily improve survival, suggest new findings published online in JAMA Surgery.

Nephrology
Adults with chronic kidney disease (CKD) attain significant benefits from regular exercise training, suggests new research published in the British Journal of Sports Medicine.

Diabetes
A new study, published in the journal Cell Metabolism, suggests that a drug that shuts down a protein that controls glucose production in the liver could help treat type 2 diabetes by reducing blood sugar levels.
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Cardiology eMedinewS
  • A postural modification to the standard Valsalva maneuver for supraventricular tachycardia more than doubles the number of patients returning to sinus rhythm, suggests new research published online in The Lancet.
  • A study, presented at the American Physiological Society's 14th International Conference on Endothelin, suggested that vitamin C supplementation represents an effective lifestyle strategy for reducing the blood vessel constriction – responsible for increasing the risk of vascular disease - that is increased in overweight and obese adults.
Pediatrics eMedinewS
Pediatrics
Anesthesiology

New research, published in Anesthesiology, suggests that multiple exposures to anesthesia during infancy could have an impact on emotional behavior, leading to alterations such as an increase in anxious behaviors that persist into later life.

Pediatrics
Pulmonary Medicine

A new study published in the September issue of the Journal of Pediatrics suggested that administering dexamethasone to children admitted for asthma exacerbation had shorter hospital stays, resulting in admission cost savings of 8% over patients who received prednisone, a commonly used steroid for these inpatients.
Pulmonary Embolism
Hypoxemia (partial pressure of oxygen in arterial blood on room air <80 mmHg in the setting of a normal chest radiograph, or hypoxemia that is disproportionate to the chest radiograph appearance, should prompt consideration of pulmonary embolism.
Dr KK Spiritual Blog
The Scientific Aspects of Prayer

Whenever our near or dear ones suffer a sickness, most of us often pass on the heartfelt promise that we’ll "pray for him or her". So many people believe in the power of prayer that it has now caught the attention of scientific doctors.

Today most hospitals and nursing homes are building separate prayer rooms for their patients. It is based on the principle that the relaxed mind is a creative mind. During prayer, when one is in touch with the consciousness, one is able to take right conscious-based decisions. Most doctors even write on their prescriptions "I treat He cures".

Medically it has been shown that even the subconscious mind of an unconscious person is listening. Any prayer would be captured by him building his or her inner confidence and faith to come out of the terminal sickness. We have seen the classical example of the effect of mass prayer when Amitabh Bachchan was battling for life after a nearly fatal injury sustained during the filming of Coolie.

"Praying for your health is one of the most common complementary treatments people do on their own," said Dr. Harold G. Koenig, co–director of the Center for Spirituality, Theology and Health at Duke University Medical Center. About 90% of Americans and almost 100 % Indians pray at some point in their lives, and when they’re under stress, such as when they’re sick, they’re even more likely to pray.

More than one–third of people surveyed in a recent study published in the Archives of Internal Medicine said they often turned to prayer when faced with medical concerns. In the poll involving more than 2,000 Americans, 75 percent of those who prayed said they prayed for wellness, while 22 percent said they prayed for specific medical conditions.

Numerous randomized studies have been done on this subject. In one such study, neither patients nor the health–care providers had any idea who was being prayed for. The coronary–care unit patients didn’t even know there was a study being conducted. And, those praying for the patients had never even met them. The result: While those in the prayer group had about the same length of hospital stay, their overall health was slightly better than the group that didn’t receive special prayers.

"Prayer may be an effective adjunct to standard medical care," wrote the authors of this 1999 study, also published in the Archives of Internal Medicine. However, a more recent trial from the April 2006 issue of the American Heart Journal suggests that it is even possible for some harm to come from prayer. In this study, which included 1,800 people scheduled for heart surgery, the group who knew they were receiving prayers developed more complications from the procedure, compared to those who had not been a focus of prayer.

Many patients are reluctant and do not talk on this subject with their doctors. Only 11% patients mention prayer to their doctors. But, doctors are more open to the subject than patients realize, particularly in serious medical situations. In a study of doctors’ attitudes toward prayer and spiritual behavior, almost 85 percent of doctors thought they should be aware of their patients’ spiritual beliefs. Most doctors said they wouldn’t pray with their patients even if they were dying, unless the patient specifically asked the doctor to pray with them. In that case, 77% of doctors were willing to pray for their patient.

Most people are convinced that prayer helps. Some people are ‘foxhole religious’ types and prayer’s almost a reaction or cry to the universe for help. But, many people do it because they’ve experienced benefit from it in the past.

If it’s something you want to do and you feel it might be helpful, there’s no reason you shouldn’t do it. If one has inclination that prayer might work, he or she should do it.
Scientific awareness on personal hygiene and prevention from obesity among school going children, N P CO ED. Sr. Sec. School, Baber Road, Near Mandi House-4-9-15
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Make Sure
Situation: A patient with acute heart attack died on the way to the hospital

Reaction: Oh my God! Why was the patient not accompanied by the doctor?

Lesson: Make sure that all heart attack patients are accompanied by the doctor to the hospital so that chest compression CPR can be given, if the heart stops, on the way.
Dr Good Dr Bad
Situation: A patient with MI was undergoing primary PCI

Dr Bad: Go for thrombus aspiration also

Dr Good: No need for thrombus aspiration

Lesson: Do not routinely perform thrombus aspiration in patients undergoing primary PCI.

(Copyright IJCP)
HCFI Videos
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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 scare facilities in our country. Consequently, PEP vaccination is recommended following bites even by vaccinated dogs. It has been noted that:
  1. 6% of dogs found rabid have a reliable pre–exposure rabies vaccine history and that
  2. 40% of dogs’ vaccinated only one time lost most of their immunity 4–6 months later.
  3. Post Exposure Prophylaxis (PEP) vaccination is not very successful in dogs.
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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
Dengue scare affects platelet availability in city
PTI | Sep 6, 2015, 11.49 AM IST

NEW DELHI: With dengue scare gripping the city and people rushing to secure platelets needed for the management of the fever, stocks at several blood banks in the city have gone down even as health officials stressed that transfusion is not necessary in all cases, reports the Times of India dated Sep 6, 2015.

In view of the situation, health department and civic body officials today urged people not to panic, stating that platelet transfusion plays a limited role in the management of dengue fever and is not necessary in all cases.

"Platelet transfusion plays a limited role in management of dengue fever and thus is not necessary in all cases. People contracting dengue do not need to panic as in initial stages a patient needs fluid management.

"All dengue patients do not need blood or platelets. If there are no bleeding manifestations, in terms of bleeding from nose, gums, mouth, under the skin, or in the vomit, urine or stool, even if one's platelets fall up to 20,000 the person should not panic," said a health department official.

The entire dengue management is based on fluid management and platelets are required to be transfused if the count goes below 10,000 and even then only if there are signs of bleeding.

People have this assumption that platelets have to be transfused if the platelet count falls below one lakh which is wrong.

According to the doctors at government hospitals, due to dengue scare people are rushing to hospitals to secure platelets as a result of which patients who really need blood transfusions are getting adversely affected.

"Several patients who are critically ill and need blood transfusions, are affected due to this dengue scare because people are rushing to hospitals to secure platelets," said a doctor.

Some health experts also blamed the doctors who do not have full knowledge of the disease and end up generating a scare among people about the disease.

The Guidelines for Dengue Management of the World Health Organisation has no mention about platelets transfusion.

"Also, drop in platelet count is no confirmation of dengue, as it could be due to other infection. So specific test should be done to confirm if one has contracted dengue," said the official.

The city has till August 29 reported 831 cases with north Delhi recording the highest at 352 and south Delhi 220. East Delhi posted the lowest with 73 cases while 115 cases were reported from areas outside the jurisdiction of the three municipal corporations.
News
  • US FDA has approved the first medication Fibanserin designed to help women distressed about their lack of lipido. FDA noted "a potentially serious interaction" when combining Addyi with alcohol, and said women who drink alcohol should not take it. The drug can cause low blood pressure and fainting.
  • There's no known risk to fetuses from ultrasound and MRI, and they are considered safe for pregnant women, according to the report published in the August print issue of the Journal of the American Academy of Orthopaedic Surgeons.
  • About 5 to 8 percent of pregnant women suffer traumatic injuries, such as broken bones and muscle tears. (American Academy of Orthopaedic Surgeons). Car crashes are the most common cause.
  • No individuals taking preexposure prophylaxis (PrEP) were diagnosed with HIV during 388 person-years of follow-up in a study published online September 1 in Clinical Infectious Diseases.
  • A new policy statement by the American Academy of Pediatrics (AAP) makes it mandatory for all healthcare personnel to have influenza vaccination.
  • Inadequate control of blood pressure (BP) after intracerebral hemorrhage (ICH) raises the risk for repeat ICH, and the association is stronger with worsening severity of hypertension (JAMA).
  • Altered colonic bacterial fermentation is associated with symptoms and colon transit time in individuals with irritable bowel syndrome (IBS), as per a study in The American Journal of Gastroenterology, online August 25.
  • Vision-threatening diabetic retinopathy (DR) is rare in children, regardless of the duration of diabetes and blood glucose control, so DR screening could begin later than previously recommended, according to a new study published online August 31 in Ophthalmology.
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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
The Cookie Thief

A woman was waiting at an airport one night, with several long hours before her flight. She hunted for a book in the airport shops, bought a bag of cookies and found a place to drop. She was engrossed in her book but happened to see, that the man sitting beside her, as bold as could be…grabbed a cookie or two from the bag in between, which she tried to ignore to avoid a scene. So she munched the cookies and watched the clock, as the gutsy cookie thief diminished her stock. She was getting more irritated as the minutes ticked by, thinking, "If I wasn’t so nice, I would blacken his eye." With each cookie she took, he took one too, when only one was left; she wondered what he would do. With a smile on his face, and a nervous laugh, he took the last cookie and broke it in half.

He offered her half, as he ate the other; she snatched it from him and thought… oooh, brother. This guy has some nerve and he’s also rude, why he didn’t even show any gratitude! She had never known when she had been so galled and sighed with relief when her flight was called. She gathered her belongings and headed to the gate, refusing to look back at the thieving ingrate.

She boarded the plane, and sank in her seat, then she sought her book, which was almost complete. As she reached in her baggage, she gasped with surprise, there was her bag of cookies, in front of her eyes. If mine are here, she moaned in despair, the others were his, and he tried to share. Too late to apologize, she realized with grief, that she was the rude one, the ingrate, the thief.
Quote of the Day
Anxiety does not empty tomorrow of its sorrows, but only empties today of its strength. Charles Spurgeon
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Reader Response
Sir, I totally accept the IMA view i.e. leave for 6 months only. Women empowerment can be done by making every hospital women-friendly by enforcing "National guidelines on infant and young child feeding" and stop keeping/selling infant foods and feeding bottles in Hospitals/ pharmacies. This is first respect that every health care provider must show to mothers. Dr Muthuswami A
Media
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Wellness Blog
Routine ECG Does Not Help

In populations of older adults, prediction of coronary heart disease (CHD) events through traditional risk factors is less accurate than in middle–aged adults. It has been shown that electrocardiographic (ECG) abnormalities are common in older adults and might be of value for CHD prediction. However, performing routine ECG among asymptomatic adults is not supported by current evidence and is not recommended by the US Preventive Services Task Force and the American College of Cardiology Foundation/American Heart Association.

The aim of this study by Auer and colleagues was to determine whether baseline ECG abnormalities or development of new and persistent ECG abnormalities are associated with increased CHD events.
eIMA Quiz
How many cups of fruit and vegetables should you eat daily?

A. At least one cup of fruit or vegetables.
B. One cup of fruit and one cup of vegetables.
C. One cup of fruit and 1 1/2 cups of vegetables, for a total of 2 1/2 cups.
D. Two cups of fruit and two cups of vegetables.
E. Four to five cups of fruit and vegetables.

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.

Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Daivadheenam Jella.

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

Correct Answers received from: Dr Poonam Chablani, Dr Raghvendra Chakurkar.
IMA Humor
Teacher: Ellen, give me a sentence starting with "I".
Ellen: I is…
Teacher: No, Ellen. Always say, I am.
Ellen: All right. I am the ninth letter of the alphabet.
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Press Release
Heart Disease in children

India is inching towards becoming the heart disease capital of the world. With the increasing lifestyle irregularities and stresses of the 21st century, heart disease is extremely common in the age group of 30+. However the incidence of the disease in young children is also very high.

Heart disease in children can be of different kinds, congenital and acquired heart disease. Around one percent of children in India are born with congenital heart disease and some of them are often referred to as blue babies. There was a time when there was no cure for this and parents were just informed the inevitable fate of their child. However medical advancements over the past few decades have made it possible for most children suffering from congenital heart disease to live normal lives post timely surgical intervention.

Speaking on this topic, Padma Shri Awardee Dr A Marthanda Pillai, National President, Indian Medical Association (IMA) & Padma Shri Awardee Dr K K Aggarwal, Hony Secretary General, Indian Medical Association (IMA) said, "Rheumatic heart disease is common amongst school going children and develops post strep throat infection. Given this it is always recommended that parents must never ignore a cough in a child who has no cough and sneezing since that is the most common indication of the bacterial infection which often leads to the development of heart disease affecting the child’s heart valves. While the sore throat, or swollen joints and fever, in the child may get okay and disappear, the valves of the heart run the risk of getting permanently damaged causing rheumatic heart disease. The affected children may require valve replacement, which if not done in time may even result in death."

A large number of children with congenital heart disease and rheumatic heart disease die because of non-availability of operative facilities in the country, especially for complex congenital heart disease. Additionally the lack of funds for the usually expensive surgery forces parents to ignore the illness and accept the fate of their child. However what a lot of people do not realize is that there are ways to overcome this and help can be sought.

The following options are available for children with heart diseases who cannot afford treatment:
  • Sameer Malik Heart Care Foundation Fund, an initiative by Heart Care Foundation of India provides assistance to the needy and underprivileged children suffering from heart disease in need of surgical intervention. Anyone can call the Helpline no. 09958771177, which is open from Monday to Saturday and ask for help
  • Various Rotary Clubs in the country provide free surgery to children with heart disease.
  • ‘Being Human’, the organization run by the actor Salman Khan also provides financial assistance to children with congenital heart diseases.
  • Most states provide assistance of up to Rs 1 lakh for congenital heart disease to children if they possess BPL or equivalent card in the state.
  • The Delhi State Government also provides free heart treatment to children whose parents have annual income of less than Rs 3 lakhs.
  • Parents can apply through legal counsel to municipal corporations for assistance, through their local MLA or through their MP to the Prime Minister Relief Fund.
  • Children can also approach Puttaparthi Heart Centre at Bengaluru, which provides free surgeries to such children.
  • Various NGOs and associations also provide free treatment; for example, Maheshwari Club provides free treatment to Maheshwari families.
  • People can also approach their religious organizations like Gurudwaras, Mosque committees and Hindu Mahasabhas etc. for free assistance in respective category.
  • Under Article 21 of the Constitution of India, people can also approach respective High Courts for directions to respective state heart departments to avail free surgeries.
  • In every state, there are government hospitals, which provide free surgeries; for example, GB Pant Hospital provides free surgery to everyone with heart disease.
  • Safdarjung Hospital, New Delhi provides free heart surgery to all BPL patients from across the country.
  • People can also approach various PSUs for assistance under their CSR policy.
  • People can also approach various large private companies for assistance under their CSR policy.
The end result is – no children in India should die of curable heart disease just because he or she cannot afford it.