June 26  2015, Friday
Even Children Can Have Acidity
Dr KK Aggarwal Children who have continuing recurrence of cough and croup could be suffering from stomach acid reflux problems.

Croup or ‘Kali Khansi’, as it is called in local parlance, is recognized by a loud cough that often sounds like the barking of a seal. It can cause rapid or difficult breathing, and sometimes wheezing. Croup is thought to be caused by a virus, but reflux acidity has been suggested as a possible trigger.

In gastroesophageal reflux disease, stomach acid causes swelling and inflammation of the larynx, which narrows the airway. It can trigger more swelling with any kind of viral or respiratory infection.

Identifying children with gastroesophageal reflux disease could help treat and improve recurring croup. It is unusual for a child to have three or more bouts of croup over a short period of time. These children need to be evaluated.

The same is true for adults also. Patients with non responding asthma should be investigated for underlying acidity as the cause of acute asthma.
This World Health Day, the Indian Medical Association commits to making food safety a priority within its Swachh Bharat Swasth Bharat program
Cardiology eMedinewS
  • For older patients with a low left ventricular ejection fraction (LVEF) following MI, less than one in 10 receive an implantable cardioverter defibrillator (ICD) within 1 year after hospital discharge, despite clinical guidelines recommending primary-prevention ICD use in these patients, suggests a new study published in the June 23 issue of the Journal of the American Medical Association.
  • The European Society of Cardiology (ESC) has recommended uninterrupted anticoagulation with vitamin K antagonists during ablation and device implantation in a position paper presented at EHRA EUROPACE - CARDIOSTIM 2015.
Pediatrics eMedinewS
  • A new study published online June 24 in JAMA Psychiatry suggests that it is unlikely that birth by cesarean delivery is a causal risk factor for autism spectrum disorder.
  • Children who benefit from a good memory are much better at covering up lies, suggests new research published in the Journal of Experimental Child Psychology. The study investigating the role of working memory in verbal deception amongst children found a link between verbal memory and covering up lies.
Dr KK Spiritual Blog
Search for Happiness in the Present Moment

Happiness should not be considered as being synonymous with pleasure. Pleasure is transient and is always associated with pain later on. Any transient addiction to any of the five senses will either lead to pleasure or pain. Pleasure leads to attachment resulting in more intense and greater desires, and if these are not fulfilled, they cause pain, which manifests as anger, irritability or even a physical disease. This type of transient pleasure is chosen by the individuals who attach themselves not only to the actions, but also to its results.

The soul, which is an energized field of information and energy, is controlled by the person’s action, memory and desire. With every action, a memory is created which either gets stored or is recirculated again as an action. If one does not control the desires, the recurrent actions may cause more problems than happiness.

True happiness, on the other hand, is internal happiness or the happiness of the soul or of the consciousness. It is often said, "You are what you eat, you are what you think and you are what you do." Hence, your own internal happiness will vary with what you eat, think, and do.

Being in the present moment leads to true happiness. If one laments about the past or keeps fearing about the future all the time, you will never be able to live in the present. Not living in the present is bound to cause unhappiness. One should learn to live and enjoy the present, which can only be done by attaching oneself to the actions and not to its results.

Doing one’s duty with devotion and discipline also helps one to remain in the present. Performing good action is important, but it is equally important to maintain the purity of the mind at the same time. Because any intention in the thought creates the same chemical reaction as when the actual deed is done, abusing a person in thought is the same as abusing him in person. Cultivating positive actions in day–to–day life, like, giving or sharing etc., helps in acquiring internal happiness.

Thoughts ultimately get metabolized into various chemicals and hormones changing the internal biochemistry of the person; hence, by thinking about cancer all the time, one can actually induce it over a period of time. And similarly, cancers can be cured by thinking positive over a period of time.

Internal happiness gives a deep feeling of satisfaction and is not associated with any transient chemical changes which are generally associated with bodily pleasure activities. People who are internally happy are always contented and are devoid of jealousy, anger, irritability, greed and ego.

One should learn to disassociate from, both, external pain as well as pleasure, and only then can one acquire true internal happiness.
Make Sure
Situation: A patient with rheumatoid arthritis developed deformity.
Reaction: Oh my God! Why was treatment not started early?
Lesson: Make sure all patients with rheumatoid arthritis are started with specific treatments within 3 months of diagnosis.
Dr Good Dr Bad
Situation: A patient on aspirin was to go for non vascular surgery
Dr Bad: Stop aspirin for two days
Dr Good: Stop aspirin for seven days
Lesson: The POISE-2 findings suggest discontinuing aspirin about seven days before noncardiovascular surgery.

(Copyright IJCP)
eMedi Quiz
Acantholysis is characteristic of:

1. Pemphigus vulgaris.
2. Pemphigoid.
3. Erythema multiforme.
4. Dermatitis herpetiformis.

Yesterday’s Mind Teaser: The protein efficiency ratio (PER) is defined as:

1. The gain in weight of young animals per unit weight of protein-consumed.
2. The product of digestibility coefficient and biological value.
3. The percentage of protein absorbed into the blood.
4. The percentage of nitrogen absorbed from the protein absorbed from the diet.

Answer for yesterday’s Mind Teaser: 1. The gain in weight of young animals per unit weight of protein-consumed.
Correct Answers received from: Dr Poonam Chablani, Dr G Madhusudhan, Daivadheenam Jella, Dr K V Sarma, Dr Avtar Krishan, Dr Pandit Hantodkar, Dr Shangarpawar.
Answer for 24th June Mind Teaser: 1. The source of infection is mainly clinical cases.
Correct Answers received: Pandit Handotkar, Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K Raju, Dr Avtar Krishan.
eMedinewS Humor
A certain little girl, when asked her name, would reply, "I’m Mr. Sugarbrown’s daughter."

Her mother told her this was wrong, she must say, "I’m Jane Sugarbrown."

The Vicar spoke to her in Sunday school and said, "Aren’t you Mr. Sugarbrown’s daughter?"

She replied, "I thought I was, but mother says I’m not."
Rabies News (Dr A K Gupta)
Can a rabies vaccine be given to a pregnant woman?

Following animal bite, rabies vaccine can be given to a pregnant woman. Medical termination of pregnancy should not be done as a routine clinical practice.
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 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
  • Indian Medical Association in collaboration with the All India Ophthalmological Society has launched a nationwide project “Prevention of Diabetes in India” and is being successfully implemented. As part of the program, an Awareness Campaign has been launched, and an information Poster for display at hospitals, clinic and public places has been designed by IMA.
  • A study at Oregon State University indicates that both high-fat and high-sugar diets, compared to a normal diet, cause changes in gut bacteria that appear related to a significant loss of “cognitive flexibility,” or the power to adapt and adjust to changing situations. This effect was most serious on the high-sugar diet, which also showed an impairment of early learning for both long-term and short-term memory. (Financial Express)
  • Tribune News Service: Fatehabad, June 24: The district unit of the Indian Medical Association (IMA) has condemned police action after Dr OP Dahmiwal, Medical Superintendent of the Fatehabad General Hospital, was booked for negligence following death of a woman.
  • Supporting the demand of resident doctors, the Delhi Medical Association (DMA) today asked the city government to ensure availability of adequate life-saving drugs in hospitals, security at workplace and timely payment of salaries.
  • Now, a team that successfully stopped cocaine and alcohol addiction in rats using a drug already approved for the treatment of high blood pressure, suggests the compound - called isradipine - may prevent relapse by erasing unconscious memories of the triggers underlying addiction. The researchers, from The University of Texas at Austin, report their findings in the journal Molecular Psychiatry. (MNT Report)
  • Fewer than one in 10 older patients with low ejection fractions received implantable cardioverter-defibrillators (ICDs) within a year after myocardial infarction (MI), according to a retrospective analysis of Medicare beneficiaries. Just 8.1% (95% CI 7.6%-8.7%) of the patients (median age 78) included in the analysis received an ICD, reported Sean Pokorney, MD, of Duke University Medical Center, and colleagues. However, those patients who did get ICDs had a 36% lower risk of dying within 2 years (adjusted hazard ratio 0.64, 95% CI 0.53-0.78), they wrote in JAMA. (Medpage Today)
  • Results of a large cohort study reported online June 23 in JAMA suggest that lifestyle factors might explain why men who take popular phosphodiesterase type 5 (PDE5) inhibitors for ED ? sildenafil, vardenafil and tadalafil ? are at a slightly but significantly increased risk of developing malignant melanoma, according to Stacy Loeb, MD, from the NYU Langone Medical Center, in New York City, and colleagues. The risk was highest among men who filled only a single prescription for a PDE5 inhibitor. Thus, the risk was not highest among men who filled multiple prescriptions, suggesting that the risk might be associated with lifestyle or demographic factors. (Medscape)
  • Dear IMA Members, All are invited for Doctors’ Day Celebrations (IMA-Karnataka State Branch) on 01.07.2015 at 11.00.A.M at Kuvempu Kalakshetra, Vakkaligara Sangha Campus (KIMS Hospital Premises), KR Road, VV Puram, Bangalore-56004.
-Sd/-                                        -Sd/-
Dr Honnegowda                      Dr ST Yavagal
President                                 Honorary State Secretary
  • A preliminary study of men with type 2 diabetes suggests that the use of phosphodiesterase type-5 (PDE5) inhibitors is associated with reduced all-cause mortality, even in men who had a previous myocardial infarction (MI), during a 5-year follow-up. The findings were presented at the American Diabetes Association (ADA) 2015 Scientific Sessions.
  • People who live in areas with noisy road traffic may have lower life expectancy and greater risk of stroke than those who live in quieter areas, suggests a new study published in the European Heart Journal.
  • A diet high in fat or sugar may lead to reduced cognitive functioning, with a high-sugar diet being the biggest culprit, suggests a study published in the journal Neuroscience. Such diets triggered alterations to the gut microbiome that were linked to reduced cognitive functioning.
  • Vitamin D supplementation in Crohn's disease (CD) patients in remission is associated with short-term maintenance of intestinal permeability and improvement of markers of disease activity, suggests new research published online in the United European Gastroenterology Journal.
  • A new study suggests that weight-loss surgery may help reduce urinary incontinence in extremely obese people. The findings were published June 22 in JAMA Internal Medicine.
WMA Welcomes New Report on Climate Change and Health
The World Medical Association today welcomed the Lancet Commission's latest report on climate change, which it says reiterates the serious concerns of physicians that climate change poses an unacceptably high threat to health.

In particular the WMA strongly supports the report's new estimates of exposure to climate change and human health. It also welcomes the indications that climate change mitigation has the potential to substantially improve public health by reducing the burden of disease from a variety of illnesses, provide economic savings, support sustainable development and advance global equity

WMA President Dr. Xavier Deau said: 'The Lancet Commission's findings that changes in population distribution and demographic structure over the coming century will put more people in harm's way highlights the need for urgent action to cut greenhouse gas emissions to protect health.

‘We, physicians, have the opportunity to help the public and decision-makers better understand the health implications of climate change. We can explain how the rapidly emerging risks associated with climate change are connected with individual and community health and we can help develop public understanding of the full scope of the problem, and contribute to relevant and comprehensive responses.

'I would hope that governments across the world will take seriously this report's suggestions for action now and its proposal for a ‘countdown 2030' process to monitor progress over the next 15 years.'
Doctor-patient relationship: What do doctors expect from their patients
1st July in India is observed as Doctor’s day in memory of Bharat Ratna Dr B C Roy whose birthday and death anniversaries fall on the same day.

Although well-informed choices have raised the expectations of patients from their doctors, the medical professionals too have some expectations from their patients.
  • Just like a patient has the right to choose his doctor so does a doctor. MCI Code of Ethics Regulations 2.1.1 states: “A physician is not bound to treat each and every person asking his services.” In non emergent situations, the doctor has a right to choose his patients.
  • As per MCI Code of Ethics Regulations 3.3 Punctuality in Consultation, a patient expects his doctor should be punctual. The doctor expects the same from his/her patient.
  • A doctor has a right to choose his fee as long as it is transparent and displayed, says Regulation 3.7.1 of MCI Code of Ethics.
  • Regulation 6.4.1 does not allow a doctor to give rebates.
  • Patients should be truthful to their doctor about their past medical history, about smoking, alcohol, drugs and high risk behaviors etc.
  • Patients should pay doctor’s fee in time.
  • It is ethical to charge a fee each time a patient is seen.
  • Patients should bring all their medical records each time they come for a check up or follow up.
  • Patients should know that if a doctor has referred them to a particular lab for a test, it does not mean that it is linked to commission. Different labs have different facilities.
  • Doctors do not like to be disturbed by calls on mobiles in non emergent situations.
  • Patients should always have a designated person to take briefings from the doctor in a hospital setting.
  • If the doctor fills a wrong information in the Mediclaim form, he/she can be imprisoned in jail.
  • A doctor can be imprisoned if he/she gives a false medical certificate.
  • A doctor can be imprisoned if he/she gives a false medical certificate for your child for not attending classes.
  • Patients should know that error of judgment is not negligence.
  • Patients should know that difference of opinion is not negligence.
  • Patients should know that deviation from standard practice is not negligence.
  • Sudden death in a hospital does not mean negligence.
  • Patients should know that a doctor is not required to possess maximum skill and knowledge. He/she is only supposed to possess an average degree of skill and knowledge.
  • Patients should know that medical accidents do not mean negligence.
  • The very fact that insurance companies allow doctors to be covered under indemnity insurance for deficiency of service or medical negligence, it means that every case of negligence is not criminal in nature.
  • One has to pay a price for quality in life. For example, if you get a fracture and do not get surgery done, then there may be no risk to life. But getting a surgery done for early recovery and better quality of life will always carry some risk.
  • Costly drugs do not mean that they are better. All drugs cleared by federal agencies are safe for human consumption.
  • Hospitals are run by doctors appointed by management. It is not possible for consultants to be physically present in every emergency.
  • No drug is 100% safe.
  • Patients should take their medicines as directed and visit as advised by their doctors.
Inspirational Story
Monetary Reminder

Imagine there is a bank, which credits your account each morning with £86,400, carries over no balance from day to day, allow you to keep no cash balance, and every evening cancels whatever part of the amount you had failed to use during the day. What would you do? Draw out every penny, of course!

Well, everyone has such a bank. Its name is Time.

Every morning, it credits you with 86,400 seconds. Every night it writes off, as lost, whatever of this you have failed to invest to good purpose. It carries over no balance. It allows no overdraft. Each day it opens a new account for you. Each night it burns the records of the day. If you fail to use the day's deposits, the loss is yours.

There is no going back. There is no drawing against the "tomorrow."

Therefore, there is never enough time or too much time. Time management is decided by us alone and nobody else. It is never the case of us not having enough time to do things, but the case of whether we want to do it.
Quote of the Day
If we did all things we are capable of, we would literally astound ourselves. Thomas A. Edison
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Reader Response
Dear Sir, very informative news. Regards: Dr karuna
Wellness Blog
Prevention strategy relies on lifestyle

Stenting may not always be the answer to treating heart disease with stable coronary artery disease.

A German study has shown that patients with stable coronary artery disease who were put on an exercise regimen had significantly higher rates of event–free survival than those who had undergone percutaneous coronary intervention (PCI). In the study, patients in the exercise program had higher event-free survival –– no stroke, heart attack, or death –– compared with stented patients after four years.

Exercise is an important part of any type of prevention, and it should be instituted for "anyone with stable coronary heart disease."

The study on stenting versus exercise come was a continuation of a pilot study first reported in 2004 in the journal Circulation. That study of 101 male patients found that after one year, 88% of patients who exercised had event–free survival compared with 70% of stented patients.

The updated data reflect an additional 100 patients, who performed moderate intensity exercise for two weeks under hospital supervision, and then were given an exercise bike to continue their regimen at home.

Patients with stable angina exercised at 80% of their threshold, and that after four weeks of exercising, their angina threshold increased.

The clear message for patients is to get 30 to 60 minutes of moderate–intensity aerobic activity every day, noting that 30% of heart disease could be prevented by 2.5 hours of walking per week.
IMA Videos
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Press Release
The five Cs of five a day in selecting fruits and vegetables

It is currently recommended that one should eat 5 or more servings of variety of fruits and vegetables daily to prevent cancer and heart disease. Fruits and vegetables contain vitamins, minerals, phytochemicals, and antioxidants and are low in calories. Those with the most color – dark green, red, yellow and orange – have the most nutrients. Carrot, Celery, Cantaloupe, Cucumber and Corn are the five "Cs" which can be incorporated in the five a day diet. One should mix all seven colors and six tastes when choosing fruits and vegetables.

The USDA new Food Plate recommends filling half your plate with fruits and vegetables.

Fruits, vegetables and grain products that contain fiber, particularly soluble fiber, may help reduce the risk of coronary heart disease. Fiber-containing grains, fruits and vegetables also reduce the risk of some cancers, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

A serving size is: one medium-size fruit, 1/2 cup raw or cooked fruits or vegetables, 180 ml fruit or vegetable juice, 1/2 cup cooked or canned legumes (beans and peas), 1 cup raw leafy vegetables, 1/4 cup dried fruit.

Five servings mean 2 fruits and 3 vegetables; 7 servings means 3 fruits and 4 vegetables and 9 servings means 4 fruits and 5 vegetables.

Tips for safe eating
  • Snack with raw vegetables instead of potato chips.
  • Add fruits in breakfast.
  • Prefer fresh fruit juice instead of a usual coffee, tea or soda.
  • Wash fruits and vegetables with water and scrub with a dish brush when appropriate.
  • Throw away the outer leaves of leafy vegetables, such as lettuce and cabbage.
  • Peel and cook when appropriate, although some nutrients and fiber may be lost when produce is peeled.
  • Avoid fruits and vegetables that look brownish, slimy or dried out. These are signs that the product has been held at an improper temperature.
  • Wash chopping boards with hot water, soap and a scrub brush to remove food particles.
  • Wash hands with warm water and soap for at least 20 seconds before and after handling food, especially fresh whole fruits and vegetables and raw meat, poultry and fish. Clean under fingernails, too.