September 9   2015, Wednesday
eMedinewS
Fecal Microbial Transplantation for Ulcerative Colitis
Dr KK Aggarwal Fecal microbial transplantation (FMT) via enema is shown to be effective, tolerable, and feasible for treating children with ulcerative colitis (UC), according to findings from a phase 1 pilot study published in the Journal of Pediatric Gastroenterology and Nutrition. FMT involves infusion of human stool from a healthy adult donor into the patient’s intestine and has been proposed as an option for recurrent Clostridium difficile infection and possibly for ulcerative colitis.

Sachin Kunde, MD, MPH, from Spectrum Health Medical Group, Helen DeVos Children’s Hospital in Grand Rapids, Michigan said that this procedure may restore ‘abnormal’ bacteria to ‘normal’ in patients with UC.

In the study, 10 children, aged 7 to 21 years, who had mild to moderate UC, received freshly prepared fecal enemas daily for 5 days.

The investigators collected data on tolerability, adverse events, and disease activity during FMT and weekly for 4 weeks thereafter. At baseline, pediatric UC activity index ranged from 15 to 65. The investigators considered a reduction in PUCAI by more than 15 to be clinical response, and PUCAI lower than 10 to be clinical remission.

There were no serious adverse events. Self–limiting adverse events were mild cramping, fullness, flatulence, bloating, diarrhea, blood in the stool, and moderate fever. Although 1 child could not retain fecal enemas, average tolerated enema volume in the other 9 children was 165 mL/day.

Clinical response within one week occurred in 7 (78%) of the 9 children, including 3 (33%) who had clinical remission and 6 (67%) who maintained clinical response at 1 month. Compared with baseline, median PUCAI significantly improved after FMT. (Medscape)
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Beneficiaries of Sameer Malik Heart Care Foundation Fund, tuesday meeting
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Cardiology eMedinewS
  • Patients with coronary spasm have a higher risk of experiencing future heart attack particularly when a spasm occurs at the site of atherosclerotic coronary artery narrowing, i.e., coronary atherosclerotic stenosis, according to a study published online in The Journal of the American College of Cardiology.
  • First-line treatment with catheter ablation is superior to drug therapy for reducing atrial fibrillation, suggest five year results from the MANTRA-PAF trial presented at the ESC Congress 2015.
Pediatrics eMedinewS
Pediatrics
Infectious Diseases

A new study published in the journal Pediatrics has identified a shift in the way pertussis (whooping cough) is transmitted, revealing that infants are most likely to catch the condition from their siblings.

Pediatrics
Anesthesiology
Dental Health

A new study suggests that the use of local anesthetic may affect tooth cell growth and the development of children's teeth. The study is published September 7 in Cell Death Discovery.
Pulmonary Embolism
A definitive diagnosis of pulmonary embolus (PE) is made radiographically by one of the following modalities:
  • CT pulmonary angiography (CTPA): The demonstration of a filling defect in any branch of the pulmonary artery (main, lobar, segmental, subsegmental) by contrast enhancement is diagnostic of PE.
  • Ventilation/perfusion scan: A high-probability V/Q scan is sufficient to confirm PE, whereas a normal scan is sufficient to exclude PE. All other patterns (low or intermediate probability) are nondiagnostic.
  • Contrast-enhanced or magnetic resonance pulmonary angiography: The demonstration of a filling defect or abrupt cut-off of a vessel on either of these modalities is diagnostic of an embolus.
Echocardiography is not diagnostic of PE. Occasionally a presumptive diagnosis can be made by echocardiography in cases of high clinical suspicion in patients who are hemodynamically unstable so that life-saving therapy can be administered.

Similarly, lower-extremity proximal vein compressive ultrasound (CUS) is not definitively diagnostic of PE. However, strategies that use CUS are sometimes used in patients with a moderate suspicion for PE in whom definitive imaging is indeterminate or contraindicated.

Rarely, PE is diagnosed on a standard contrast-enhanced CT performed for an alternate reason or discovered pathologically in a resected pulmonary lobe.
Dr KK Spiritual Blog
The Infinite Powers of the Spirit

Om Poornamadah
"Om Poornamadah Poornamidam
Poornaat Poornamudachyate
Poornasya Poornamaadaaya
Poornameva Avasihyate"

‘The whole is whole; if you take away the whole away from the whole the whole will still remain.’ (That is infinite, this is infinite, from the infinite, the infinite has come out. Having taken the infinite out of the infinite, the infinite alone remains). (In Vedanta, "That" represents superconsciousness, God or the Brahman and "This" the visible universe)

Atman, which makes up our body, is 99.99 per cent space or void and if we look at the rest, it is also nothing but space or void. This void or ‘akasha’ is what is called Brahman, God or consciousness and is a web of energized information.

This web of information of inner space called inner consciousness is the Atman or the Soul. This is connected with the outer space in the universe having a similar web of energized information called the Spirit or Brahmand.

The Spirit has been given many names by different religions: Allah, Buddha, Brahman, Christ or Wahe Guru. They all signify the same. This spirit, the energized field of information, is a powerful expression of live energy which can move faster than the speed of light. Soul is nothing but an individualized expression of the spirit.

This energy containing information in the spirit cannot be seen, felt, touched, tasted or smelt. It is beyond the perception of the five senses. One cannot destroy it with a weapon, fire, water or air. This consciousness is embedded in the space of each and every cell of the body. It is like sugar added to the milk. Once added, you cannot find it as it gets embedded with each and every drop of the milk.

Soul originates from the spirit. Each soul differs from the other by way of the subtle layer of consciousness called the ‘Sukshma Sharir’, which is controlled by the triad of actions, memories and desires.

Spirit is like the light, which is always positive and removes darkness. The basic nature of consciousness is "truth and bliss". The soul and the spirit are devoid of hatred, anger or jealousy and are full of unconditional love. They are nothing but a treasury of information about everything. This infinite information is capable of doing anything, including miracles.

It is like the flame of a candle, which can light an infinite number of candles, while still retaining its illumination to the same degree.

Deepak Chopra once said that the soul is like the voice of Lata Mangeshkar coming through a radio; but, if you break the radio, you will not find Lata Mangeshkar in it. Similarly, if you cut the body into pieces, you cannot find the physical presence of the spirit. Spirit is omnipresent and any amount of Spirit taken out from it will not make any difference to it.

In religious terms, the infinite or the vastness is equated and described by the blue color, and that is one reason why most gods are represented in blue color, or are shown in the background of blue sky. This only represents the vastness and infinite character of the consciousness.

A guru explained the Spirit to his disciples by the following equation: 1 × 1 = 1, 1/1=1 or, in other words everything is One. One can also explain it by the equation that infinity when added, subtracted, multiplied or divided by infinity will result only in infinity.

This infinite potential in our minds is present in between the thoughts and can be experienced by enabling oneself to go in between the thoughts by a process called meditation. The silent gap between the thoughts can be experienced either with the use of primordial sound mantra as a vehicle or by way of yoga. People who have learnt meditation and have achieved the ability to go into the silent gaps can accomplish everything in their life using the principles of intention and attention. After any intention is introduced in the silent gap, a new reality can be created.

"That which is born of the flash is a flash; that which is born of the spirit is spirit" (John)
Beneficiaries of Sameer Malik Heart Care Foundation Fund
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Make Sure
Situation: A patient after receiving 40 units of insulin developed severe hypoglycemia.
Reaction: Oh my God! The order was for 4 units.
Lesson: Make sure that 4 unit is not written as 4.0 units. This may result in medication error with often disastrous consequences.
Dr Good Dr Bad
Situation: A patient came with acute STEMI with critical involvement of non-culprit vessel
Dr Bad: Touch only the culprit vessel
Dr Good: Do PCI of non-culprit critical lesion also
Lesson: For most patients undergoing primary PCI, perform non-culprit vessel PCI of significant lesions rather than culprit vessel only PCI.

(Copyright IJCP)
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Psychiatry
Geriatrics

Late-life depression can be difficult to treat, and in elderly patients, response to antidepressant therapy can vary considerably, suggests new research published online in JAMA Psychiatry.

Diabetes
The euglycemic diabetic ketoacidosis (DKA) that has recently been associated with the use of sodium–glucose cotransporter 2 (SGLT2) inhibitors will probably turn out to be very infrequent in patients with type 2 diabetes, and "predictable, detectable, and preventable" in those with type 1 diabetes, asserted two leading clinical trialists in a new editorial published in the September issue of Diabetes Care.

Oncology
A new study of active surveillance for prostate cancer in men with very-low-risk and low-risk prostate cancer offers reassurance, suggesting that carefully selected patients enrolled in active surveillance programs for their low-risk prostate cancers are not likely to be harmed by their disease. The findings were published online in the Journal of Clinical Oncology.

Infectious Diseases
Medical Diagnostics

A new diagnostic device created by a collaborative team of UA engineers and scientists may significantly reduce the amount of time necessary to diagnose tissue infections. The device's novel approach to molecular diagnostics, called DOTS qPCR, is faster, more efficient and less expensive than alternatives currently being used in clinics. The findings are published online in the journal Science Advances.

Neurology
Psychiatry

A commonly prescribed antidepressant, sertraline, may alter brain structures in depressed and non-depressed individuals in very different ways, suggests new research published online in the journal Neuropharmacology.
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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
A rainy night in New Orleans

It was a rainy night in New Orleans; at a bus station in the town, I watched a young girl weeping as her baggage was taken down. It seems she’d lost her ticket changing buses in the night. She begged them not to leave her there with any sign of help in sight.

The bus driver had a face of stone and his heart was surely the same. "Losing your tickets like losing cash money," He said, and left her in the rain. Then an old Indian man stood up and blocked the driver’s way and would not let him pass before He said what he had to say. "How can you leave that girl out there? Have you no God to fear? You know she had a ticket. You can’t just leave her here. You can’t put her out in a city where she doesn’t have a friend. You will meet your schedule, but she might meet her end."

The driver showed no sign that he’d heard or even cared about the young girl’s problem or how her travels fared. So the old gentleman said, "For her fare I’ll pay. I’ll give her a little money to help her on her way." He went and bought the ticket and helped her to her place and helped her put her baggage in the overhead luggage space.

"How can I repay," she said, "the kindness you've shown tonight? We’re strangers who won’t meet again a mere ‘thank you’ doesn’t seem right." He said, "What goes around comes around. This I’ve learned with time – What you give, you always get back; what you sow, you reap in kind. Always be helpful to others and give what you can spare; for by being kind to strangers, we help angels unaware."
Quote of the Day
Dream as if you’ll live forever, live as if you'll die today. James Dean
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Sir, leave for 6 months is a good suggestion but there should also be a provision of Leave Vacancy as is the policy in Delhi University so that work is not affected. Neerja Varshney
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Wellness Blog
Role of folate or folic acid in cancer prevention

The role of folic acid in cancer prevention is uncertain. Large observational studies have suggested a decrease in risk of colorectal and other cancers with dietary folate but others randomized trials have raised the possibility of harm.

In the largest meta–analysis of individual patient data from randomized trials of folic acid for the prevention of cardiovascular disease and colorectal adenoma during an average of 5.2 years of treatment, there was no significant difference in overall cancer incidence for patients assigned to folic acid or placebo.

Vollset SE, Clarke R, Lewington S, et al. Effects of folic acid supplementation on overall and site–specific cancer incidence during the randomised trials: meta–analyses of data on 50,000 individuals. Lancet 2013;381(9871):1029-36.
eIMA Quiz
Mr X who was diagnosed with brain tumor was scheduled for craniotomy. In preventing the development of cerebral edema after surgery, the nurse should expect the use of:

a. Diuretics
b. Antihypertensive
c. Steroids
d. Anticonvulsants

Yesterday’s Mind Teaser: 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.

Answer for Yesterday’s Mind Teaser: E. Four to five cups of fruit and vegetables.

Answers received from: Dr Shangarpawar, Raghavendra Chakurkar, Dr Poonam Chablani, Daivadheenam Jella, Dr BR Bhatnagar, Dr Jainendra Upadhyay, Dr Avtar Krishan.

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

Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Daivadheenam Jella.
Over 50 doctors attended the IMA Rise & Shine CME on Vitamin D deficiency in Srirampur
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IMA Humor
Winning election

The politician was sitting at his campaign headquarters when the phone rang. He listened intently, and after a moment his face brightened. When he hung up, he immediately phoned his mother to tell her the good news.

"Ma!!!" he shouted, "The results are in. I won the election!!!"

"Honestly?" his mother replied.

The politician’s smiled faded. "Aw hell, ma, why bring that up at a time like this?"
Rabies News (Dr A K Gupta)
Why is rabies an important disease?

Rabies is one of the oldest and most feared zoonotic diseases, and has been a threat to human health for more than 4000 years. Rabies is a neglected and severely under–reported disease killing each year an estimated 55,000people (24,000 to 90,000 deaths) worldwide (WHO 2007). All mammals, but mainly carnivores and bats, are susceptible and can transmit rabies virus. Human exposures are most frequently associated with bites by rabid dogs and transmission of virus from dogs’ saliva. The Association for the Prevention and Control of Rabies in India (APCRI) estimated in 2004 that in India, there were 20,565 reported human deaths every year. About half of the world’s population lives in areas in which rabies is enzootic. Rabies is practically 100% fatal even today but easily preventable.
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Press Release
Heart Disease is the most common cause of death and disability in urban women

In India, urban women are at a greater risk of heart disease today. The reasons for this include an unhealthy lifestyle characterized by a predominantly high trans fat, sugar and salt diet, inadequate physical exercise, increased stress levels, dependence on addictive and harmful substances like alcohol and cigarettes amongst others. The largest group of women at risk of cardiovascular disease (CVD) is aged between 35 to 44 years. The risk of CVD is as high amongst housewives as it is amongst working professionals. As far as risk factors for CVD are concerned, low HDL or “good” cholesterol and high body mass index (BMI) are the two most common contributors to CVD risk setting in as early as 35 years for women.

“Important differences between women and men in the presentation of heart disease make it more difficult to establish a diagnosis in women. For instance, heart disease in women generally presents 10 years later than men and with greater risk factor burden. Women are also less likely than men to have typical angina and have a higher false positive rate in the treadmill test. The symptoms of heart disease in women are different from those seen in men,” said 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).

It is a fact that women are more likely to present initially with chest pain than a more clearly defined event such as heart attack. Many cases of heart attack in women also go unrecognized. Also, small vessel disease is more common in women than in men. The established risk factors of heart disease in women include the presence of history of heart blockages; age over 55 years; high LDL “bad” cholesterol or low HDL “good” cholesterol , diabetes, smoking, high blood pressure, peripheral artery disease or family history of heart disease.

Risk factors, which are more potent in women than in men include regular consumption of tobacco, which causes 50% of all cardiac events in women; obesity and diabetes.

Following are the ways in which women can prevent future heart disease
  • Moderate intensity physical activity for at least 30 minutes and for 60 to 90 minutes for weight management on most days of the week
  • Avoidance and cessation of cigarette smoking and passive smoking
  • Keep waist circumference less than 35 inches
  • Consume a heart-friendly diet.
  • Control cholesterol level, high blood pressure and diabetes.
  • Women who smoke should avoid oral contraceptive pills.
  • Aspirin 80 mg should be added in women older than 65 years of age.
  • Treat underlying depression.
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