August 9  2015, Sunday
eMedinewS
editorial
Five cholesterol friendly foods
Dr KK Aggarwal1. Oats: It gives you 1 to 2 grams of soluble fiber.

2. Beans: are rich in soluble fiber. They also take a while for the body to digest.

3. Nuts: Eating 2 ounces of nuts a day can slightly lower LDL, on the order of 5%.

4. Foods fortified with sterols and stanols: gum up the body's ability to absorb cholesterol from food. Getting 2 grams of plant sterols or stanols a day can lower LDL cholesterol by about 10%.

5. Fatty fish. Eating fish two or three times a week can lower LDL
(Source: Harvard)
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ICON 2015 IMACGP International Conference of Family Medicine Organized by: IMA HQ, New Delhi
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News
Geriatrics
The Mediterranean diet may help preserve structural connectivity in the brain in older adults, suggests a French study published online in Alzheimer's & Dementia.

Hemato-oncology
A new study published in the journal Blood has shown for the first time how a topical gel called resiquimod may help treat a rare type of non-Hodgkin lymphoma - cutaneous T cell lymphoma - by triggering an immune response to kill malignant cells.

Obesity
The US Food and Drug Administration has approved the Orbera Intragastric Balloon System as a weight-loss device that deposits a balloon in the stomach, through the mouth, via a minimally invasive endoscopic procedure with the patient under mild sedation.

Diabetes
Ophthalmology
Serum levels of oxidized low-density lipoprotein (LDL) may be associated with the incidence of proliferative retinopathy in patients with type 1 diabetes; however, no significant connection has yet been shown, suggested new research published in JAMA Ophthalmology.

Geriatrics
Nutrition
New research has demonstrated that the aging process known to damage the immune system could be slowed down by including antioxidants in the diet. The findings are published in Cell Reports.
Cardiology eMedinewS
  • Novel research suggests that the oral factor Xa inhibitor rivaroxaban may be an effective treatment option over warfarin for patients with atrial fibrillation (AF), irrespective of diabetes status. The findings are published online in the American Heart Journal.
  • Nonadherence to medication is common in patients with newly diagnosed hypertension; however, those with greater compliance may have a lower risk of early heart failure, suggests a new study from Italy published in Hypertension.
Pediatrics eMedinewS

Pediatrics
Allergy and Immunology

All persons at least 6 months of age should have routine annual influenza vaccination unless they have specific contraindications, according to updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for the 2015 to 2016 influenza season. The updated recommendations were published in the August 6 issue of the Morbidity and Mortality Weekly Report.

Pediatrics
Rheumatology
Treatment of the enthesitis-related arthritis (ERA) category of juvenile idiopathic arthritis (JIA) with etanercept, a human tumor necrosis factor (TNF) receptor fusion protein, reduced the signs and symptoms of ERA at 24 weeks with a marked improvement in measures of disease activity that was sustained through to week 48 in patients who continued to receive active therapy, reported a phase II study published in Arthritis & Rheumatology.

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 in our inner journey. The inner journey of being in touch with one’s consciousness requires detachment from worldly pleasures and 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, the 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.
Make Sure
Situation: An 18–year–old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make Sure to remember that the macrolide, clarithromycin 500 mg twice–daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.
Dr Good Dr Bad
Situation: A patient with COPD developed herpes zoster.
Dr Bad: They are not related.
Dr Good: There is an association between the two.
Lesson: People with chronic obstructive pulmonary disease, or COPD, are more likely than others to develop shingles (CMAJ 2011 Mar 22;183(5):E275-80).

(Copyright IJCP)
eMedi Quiz
When should you have your first cholesterol screening?

A. At age 10.
B. At age 20.
C. At age 35.
D. At age 40.
E. It depends on your risk factors.

Yesterday’s Mind Teaser: 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

Answer for Yesterday’s Mind Teaser: a. Ineffective health maintenance

Correct Answers received from: Dr Poonam Chablani, Dr.K.Raju, Dr Pandit Hantodkar, Dr.K.V.Sarma, Dr Avtar Krishan,

Answer for 7th August Mind Teaser: A. 110/70.

Correct Answers received from: Daivadheenam Jella, Dr Avtar Krishan, Dr. G. Madhusudhan, Dr. G. Madhusudhan, Raju Kuppusamy
eMedinewS Humor
The well-behaved son

Lady 1: My son is very well-behaved.
Lady 2: How can you say that? Wasn't he arrested and imprisoned for 5 years.
Lady 1: Yes, but he got out after 2 years for good behavior inside the jail.
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Rabies News (Dr A K Gupta)
What are the types of rabies?

There are mainly two types of rabies.
a) Two-third of rabies patients suffer from the typical furious (encephalitic) type of rabies. The virus replicates in portions of the brain including the hippocampus, amygdala, anterior thalamic nuclei and limbic cortex. Furious rabies has three cardinal signs:

• Fluctuating consciousness, episodes of excitement and hallucinations.

• Phobic spasms – Aerophobia, hydrophobia and photophobia

• Autonomic dysfunctions like increased salivation, excessive, priapism and pupillary abnormalities.

It is typically believed that salivation and vomiting are linked, and contribute to the apparent hydrophobia (fear of water) in patients. These symptoms can last for few days, after which the patient may suffer from the second type of rabies, or may slip into a coma and die. It is when suffering from furious rabies that a person or animal is likely to attack those near them and spread the disease.

b) Dumb (paralytic) rabies, which is characterized by flaccid muscle weakness, constipation, urinary retention, stupor and coma. Hydrophobia is usually absent in these cases. This is a condition resembling Guillain Barre syndrome. It occurs as the result of the virus replicating in the brain’s neocortex.

It is much harder for a doctor to diagnose rabies in its "dumb" form than it is in its "furious" form, because the symptoms are less indicative of a specific medical issue. Both forms are progressive and will lead to death, usually within 7 days in patients with encephalitic rabies and 3 weeks in those with paralytic rabies.
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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 the memory of Sameer Malik to ensure that no person dies of a heart disease just because they cannot afford treatment. Any person can apply for 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
IMA to create awareness about anti-child abuse laws among doctors
By PTI | 7 Aug, 2015

Economic Times-Thiruvananthapuram: In the wake of increasing instances of child sexual abuse, Indian Medical Association has drawn up a programme to create awareness among its members and parent-teacher community about various anti-child abuse laws.

The programme, which has already been launched at the national and state level among doctors, will soon be expanded to educational institutions through awareness drives among the members of parent teacher associations.

Presently the drive is focused on gynaecologists, pediatricians and forensic experts, and doctors of all streams will be brought under the programme in the next phase, IMA office bearers here said.

Five workshops at the national level and two workshops at the state level have been conducted for doctors in this regard and more are planned, they said.

A senior IMA official said doctors should have a thorough knowledge about various child abuse prevention laws including Protection of Children against Sexual Offences Act as they are the first contact persons in such cases.

"If a doctor fails to record the evidences as per protocol, the case will not stand at the court and the victims will not get deserved justice," IMA Kerala secretary A V Jayakrishnan told PTI.

"But, if the doctor is completely aware about the laws and other protocols he or she has to follow in such cases, the victims’ rights will be protected," he said.

He said as part of expansion of the drive, awareness will be created among parents and teachers through parent-teacher associations in schools.

As part of the programme, the IMA state officials recently had a discussion with the state Child Rights Commission and decided to go together to create awareness about child rights among people.

The doctor also said the reported cases of child abuse is on the rise in the state.

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unless we do it public will not listen to us

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ICON 2015
Inspirational Story
The Secret of Success!

A young man asked Socrates, an ancient Greek philosopher, the secret of success. Socrates told the young man to meet him near the river the next morning. They met. Socrates asked the young man to walk with him toward the river.

When the water got up to their necks, Socrates took the young man by surprise and ducked him into the water. The man struggled to get out but Socrates was strong and kept him under water until he started turning blue. The young man struggled hard and finally managed to get up. The first thing he did was to gasp and take a deep breath.

Socrates asked, “What did you want the most when you were under the water?”

The man replied “Air”.

Socrates said: “That’s the most secret to success. When you want success as badly as you want air, you will get it. There is no other secret”.

Reflection: A burning desire is the starting point of all accomplishments. Just like a small fire cannot give much heat, a weak desire cannot produce great results…
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Reader Response
Dear Dr. Manesh,
I appreciate your plan of action. Please write to TV channels and cinema people about IMS Act and request them to adhere the act. The thrust must be on hospitals and doctors. I like to remind our IMA national secretary’s appeal i.e. every person who conducts the delivery must adhere to the statuary obligation of giving breast milk as a first food with in first hour. If that is not done he /she must write in the case-record the reason for not giving breast milk. It must also be recorded in the discharge summary. If every health care provider follows this, we will definitely achieve our goals. Muthuswami A
Wellness Blog
The Science of Hygiene
All of us are taught about hygienic living and this subject should be included as a chapter in the curriculum of every school. There are many different kinds of hygiene.

Respiratory hygiene: This is important to prevent cross infection, specifically, from flu and related respiratory illness. One should keep a distance of minimum 3 ft, from a person who is coughing, sneezing or singing. Most respiratory particles are more than 5 microns in size and do not travel a distance of more than 3 ft. This respiratory hygiene, however, will not prevent transmission of the tuberculosis bacteria, which are less than 5 microns and keep circulating in the area.

Hand hygiene: This is the fundamental principle for any disease prevention and the catch phrase is “before and after”, i.e. one should wash hands before and after eating food, touching any infected material, seeing a patient or after normal evacuation of stool in the morning.

Food hygiene: This means maintaining hygiene at home while cutting, serving and eating food. While cutting a vegetable, the surface or the cutting board should be clean and hygienic including the knife, hands, water, utensils etc. If that hygiene is not possible, follow the formula of ‘boil it, heat it, peel it, cook it or forget it’. This means that any food which has been boiled, heated or peeled is safe for eating. Peeling means removing the skin of a fruit such as banana or oranges.

Water hygiene: This involves drinking safe water, safe drinking glass, proper washing of glass, not washing multiple glasses in the same utensil and picking up glasses properly. People often try to pick up four glasses of water at the same time with one finger in each glass.

Sexual hygiene: This involves washing local areas before and after sexual contact.

Body hygiene: This involves 16 upchars, as mentioned in mythology. Out of these 16 basic steps, some are related to body hygiene and they involve washing feet first and then hands followed by mouth and finally the body. Washing of the feet is the most important as they are the ones which carry infections into one’s house.

Cleaning of mouth is cleaning the teeth with one finger, gums with two fingers, tongue with three fingers and palate with thumb.

Abhishekam or the snana of the body involves multiple steps. Ancient steps have been washing the body with milk water (rose water etc.) followed by rubbing with curd (soap), honey (moisturizers), ghee (oil), sugar (the drying agent) and finally with milk water again. This facilitates natural bathing and not dependent on soap.

Nail hygiene: This is also a very important hygiene, especially for food handlers, because they are responsible for causation of water and food disease. It is important that they be given typhoid vaccines and de-worming tablets every three months.

Another important hygiene to be observed at our homes is that of the servants or the help. They are often provided soap at the start of the month and they are supposed to use that bar of soap for a month. If by any chance, they lose that soap in 2-3 weeks’ time, they are apprehensive in asking the owners for soap. As a result, they may wash their hands without soap for the next 2-3 weeks, which includes washing of hands in morning.
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Is alcohol consumption actually beneficial for your health?

Numerous discussions regarding the consumption of alcohol in restricted or altered amounts for a healthy and sound heart often do the rounds. These certainties additionally guarantee that reasonable intake of liquor can lead to curtailed aging and lower the chances of heart attacks and paralysis.

Speaking about the issue, Padma Shri Awardee & Secretary General of IMA, Dr KK Aggarwal said, “Most of these claims remain unproved and in my opinion are just myths. I strongly believe that half the data is equivalent to no data and no lab or scientific agency has till date managed to prove the cardiovascular benefits of alcohol consumption for Indians”.

“Most of the scientific claims about the benefits of alcohol consumption are restricted to patients from developed countries like the US, Great Britain and France amongst others. What one must understand is that the body composition of people from different nations varies drastically. For instance in India the incidence of fatty liver disease is extremely high affecting over 35%. In a case such as this, the consumption of alcohol in any measure is not only unsafe but can also prove to be fatal”, he added.

Most people remain unaware of the face that the definition of a standard measure of alcohol differs from country to country. While in the US 45 ml of a drink is accepted as a standard measure, in Great Britain it is 24ml, Japan 80 ml and in India 30ml. So if today a person reads an international study about the benefits of drinking two measures of whiskey for a healthy heart, he in most cases will either under or over-consume alcohol on a regular basis which may cause more harm than good. Please note that here we are taking a measures of neat spirits such as Whiskey, Vodka, Rum and Gin into consideration and not beer and wine which are calculated on the basis of a per glass or bottle/can intake.

Another factor which people often oblivious to is that most studies prove the consumption of limited quantities of alcohol beneficial for diseases like coronary heart blockages, ischemic paralysis and diabetes which affect only patients above the age of 45. So consumption of alcohol by people under the age of 45 is not only harmful for the heart but also poses a risk of alcohol dependency in the future.

Detailing the guidelines one must keep in mind while consuming alcohol and what is actually considered a safe limit of alcohol consumption, Dr KK Aggarwal said:
Firstly alcohol consumption during pregnancy, by people who have a strong family history of alcoholism, previous brain hemorrhage, liver or pancreatic disease can be extremely dangerous and should in all possibilities be avoided.

Secondly the use of alcohol should be restricted and closely monitored in patients with active gastritis, esophagitis, premalignant GI lesions such as Barrett’s esophagus, or a strong family history of breast cancer as over-consumption can cause complications in the future. For people without any of these conditions, the social limit of alcohol can be defined basis the following:

1. Men can tolerate more alcohol than women

2. The ideal dose of alcohol is 5-7 grams per day (One drink every other day). In women, the dose is 4 g/day. (One drink every third day)

3. 10 to 15 grams of ethanol is found in one glass of wine, one can or bottle of beer, or one mixed drink

4. People who are socially active and consume alcohol on a regular basis must keep in mind that drinking and driving is extremely dangerous and for every 30ml of alcohol they consume, they must avoid going behind the wheel for one hour. So if a person consumes 3 small drinks in a night he must not drive for a minimum of 3 hours after

5. Young to middle aged women must regulate their alcohol consumption as moderate drinking (90 ml of alcohol everyday) can drastically increase the chances of sudden death due to trauma or the incidence of breast cancer

6. According to Ayurveda, one should not consume any fermented items post sunset. So drinking alcohol during the day is safer for the heart than consuming it in the night Thus, it is recommend that people abstain from drinking alcohol. And if they must drink socially, it is extremely important that they stick to the safe limits of drinking and ensure that they eat a healthy and balanced diet and get adequate exercise to avoid becoming victims of leading lifestyle diseases and cardiovascular ailments. For those who often quote different studies when told to restrict their alcohol consumption stating that its actually beneficial for their health, must consult their doctor and understand how applicable it is to them. And lastly with the growing pub culture in the country, young people and their parents must ensure that they keep a check on their alcohol intake as it may lead to a dependency in the future.