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Editorial (Dr K K Aggarwal)                                                                                 (Dr RN Tandon)
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20th October, 2017
IMA is change maker: Medical voice is heard
Dr KK Aggarwal
As clinicians, doctors prescribe treatments for patients so that they get better. Making the right diagnosis and then prescribing the right treatment is the primary responsibility of doctors. This is what they have been trained for. But, a doctor however plays multifaceted roles. A doctor is not simply a medical expert; he/she is also a communicator, collaborator, manager, health advocate, scholar, professional, community leader. Doctors therefore are also change agents in the community.
The words of a doctor carry weight and they can bring about change that is appropriate to the need. This requires them to be aware of the needs of the community they practice in, the resources available to their patients and any problems regarding these.
Drug shortage, due to multitude of reasons, is one such crisis that rears up time and again. Recently, there was a shortage of two drugs in the market, d-penicillamine (DPEN) and penicillin G potassium (Pentid-Abbott).
D-penicillamine is used to treat patients with Wilson's disease (copper overload) with liver, neurological and psychiatric manifestations. And, patients have to be on this drug lifelong.
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Top News
UN health experts launch plan to stop transmission of bovine TB to humans
Stressing the damaging impact on poor rural communities in Africa and South-East Asia of animal tuberculosis' (bovine TB) transmission to humans, United Nations health experts from WHO, the Food and Agriculture Organization (FAO), World Organisation for Animal Health (OIE), and International Union Against Tuberculosis and Lung Disease have launched the first-ever 'Roadmap for Zoonotic TB' at the 48th Union World Conference on Lung Health. The roadmap articulates 10 priority actions that human and animal health actors should take, and defines milestones for the short- and medium-term, which include improving the evidence base; reducing transmission between animals and humans; and strengthening intersectoral collaboration.. (UN, October 12, 2017).
Cannabis as medicine: more research needed, says WMA
Legislation to allow the recreational use of cannabis has been strongly opposed on health grounds by the World Medical Association. But in a policy statement, the Association says that laws governing research grade cannabis should be reviewed to allow more scientific research on the use of cannabis for medicinal purposes. At their annual General Assembly in Chicago, WMA delegates from more than 50 national medical associations, said more rigorous research was necessary before governments decided whether or not to legalise cannabis for medical purposes. At the moment evidence supporting the use of medical cannabis is inconsistent and of low to moderate quality. In those countries where cannabis has been legalised for medicinal purposes, the WMA says regulations are necessary. The WMA says that medical professionals often found themselves in a medico-legal dilemma as they tried to balance their ethical responsibility to patients for whom cannabis may be an effective therapy and compliance with local laws and regulations. This dilemma can affect both patients who may benefit medically from the use of cannabis, and those who are not likely to do so but pressure medical professionals to prescribe it.
Delegates at the Chicago Assembly strongly opposed recreational cannabis use because of the serious adverse health effects. These include the increased risk of psychosis, fatal road accidents, dependency, as well as harm to verbal learning, memory and attention. The use of cannabis before the age of 18 doubled the risk of psychotic disorder.
The WMA statement declares: 'The ominously growing availability of cannabis or its forms in foodstuffs such as sweets and "concentrates", which have enormous appeal to children and adolescents, requires intensive vigilance and policing'.
WMA President Dr. Yoshitake Yukokura said: 'National medical associations should support strategies to prevent and reduce the use of recreational cannabis. It is also important that effective control measures are put in place to prevent illicit use of medical cannabis. (WMA, 15 October 2017).
Practice Updates
Older adults often delay going to the hospital when experiencing a heart attack
A new study published October 18, 2017 in the Journal of the American Geriatrics Society has shown that pre-hospital delay (six or more hours before getting to the hospital) was much more common (42%) in older adults aged 75 or above compared to younger heart attack patients (20-25%). Factors like non-white race, atypical symptoms and heart failure were found to be associated with delay in going to the hospital.

Study shows benefit of diphenhydramine as an adjunctive sedative for colonoscopy
Findings of a study presented October 16, 2017 at the World Congress of Gastroenterology at ACG2017 in Orlando, USA show that in patients on chronic opioids administration of diphenhydramine at the start of colonoscopy as an adjunct to conventional sedatives improves the quality of sedation without increasing the number of adverse events.

First appropriate use criteria for treatment of patients with severe aortic stenosis
The first appropriate use criteria (AUC) for the treatment of patients with severe aortic stenosis have been jointly released by 11 cardiology societies including the American College of Cardiology as a guide to physicians, patients, and policy makers regarding the rational use of the available treatment option. Published online in the Journal of American College of Cardiology as well as journals of the other society, the guideline addresses 95 clinical scenarios and up to 6 potential treatment options for them.

A 5-minute intervention improves inpatient satisfaction
According to results of a study published October 16, 2017 in the journal Family Medicine, a daily five-minute conversation that focused on hospitalized patients "as people" significantly improved their satisfaction with their medical care. The study used a psychosocial intervention called BATHE (Background, Affect, Trouble, Handling and Empathy) to encourage patients to talk about anything that is bothering them, and then doctors were required to respond with empathy and encouragement. Patients in the BATHE intervention group were more likely to rate their medical care as excellent and to express a high degree of satisfaction.

Bariatric surgery lowers risk of cancers in obese women
In a retrospective cohort study of patients with severe obesity undergoing bariatric surgery, the risk of incident cancer, particularly obesity-associated cancers, such as postmenopausal breast cancer, endometrial cancer, and colon cancer was lower. The study is published online September 21, 2017 in the Annals of Surgery.
eMedi Humor
Salesman: This computer will cut your workload by 50%.
Office Manager: That's great, I'll take two of them.
Medicolegal Corner
Legal Quote
Martin F. D'Souza vs Mohd. Ishfaq, 3541 of 2002, dated 17.02.2009
"...simple negligence may result only in civil liability, but gross negligence or recklessness may result in criminal liability as well. For civil liability only damages can be imposed by the court but for criminal liability the doctor can also be sent to jail (apart from damages which may be imposed on him in a civil suit or by the consumer fora). However, what is simple negligence and what is gross negligence may be a matter of dispute even among experts."
eMedi Quiz
Twenty four hours after admission for an acute MI, the patient's temperature is noted at 39.30C. The nurse monitors him for other adaptations related to the pyrexia, including: 
A. Shortness of breath 
B. Chest pain
C. Elevated blood pressure
D. Increased pulse rate
Lifestyle Updates
eWellness: Lifestyle changes should start in childhood

The seeds of heart blockages are born while a person is in his adolescence or childhood. Prevention, therefore, must start right at that age.

The doctors said that heart attack cannot be given or accepted as a Gift. It takes minimum 15 years to live a lifestyle against the laws of nature to develop early blockages. Heart disease, therefore, is reversible and gives you enough time to reverse. They also said that in diet one should adopt the principle of moderations and variety and include all seven colours and six tastes in their diet.
Traditional dances are better than western dance as classical traditional dance is a mix of yoga, meditation, relaxation and exercise.
ESpiritual: Annakoot emphasizes the importance of eating mixed vegetables

Annakoot festival is observed on the day of Govardhan Pooja after Diwali. There are many mythological scientific descriptions for this pooja.

On this day, there is a change in the season so is change in the availability of fruits and vegetables in the market. On the day of Annakoot, people cook all types of outgoing and incoming vegetables and eat them. It reminds people that this is the last day for eating these outgoing vegetables for health reasons.

Annakoot emphasizes the importance of eating mixed vegetables. It is traditionally said that one should eat all seven colors and six tastes. Mixed vegetables provide all vitamins.

Annakoot is observed after Diwali. During Diwali people eat a lot of heavy food with predominant sweet taste. On the day of Annakoot, eating a diet predominant in vegetables (bitter and green taste) helps to undo the imbalance caused by eating the heavy sugary food items during Diwali.

In mythology it is also said that on this day, a mountain heap is created of all the cooked vegetables, eaten and distributed. It also indicates that from now onwards, one should eat only light food and distribute the leftovers.

(Disclaimer: The views expressed in this write up are my own).

Inspirational: 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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