April 9  2015, Thursday
Occult atrial fibrillation in cryptogenic stroke or TIA
Dr KK AggarwalIn patients with a cryptogenic ischemic stroke or TIA with no evidence of atrial fibrillation on ECG and 24-hour holter monitoring one should go for ambulatory cardiac monitoring for several weeks.

CRYSTAL AF trial: 441 patients with cryptogenic stroke and no evidence of AF during at least 24 hours of ECG monitoring were randomly assigned to prolonged ambulatory cardiac monitoring with a subcutaneous implantable loop recorder or to a control group with conventional follow-up.

At six months, AF detection was significantly higher in the implantable recorder group (8.9 versus 1.4 percent in the control group). (N Engl J Med 2014; 370:2478.) EMBRACE trial: 572 patients who had a cryptogenic stroke or TIA (and no evidence of AF on routine monitoring) were randomly assigned to additional ambulatory monitoring with a 30-day external loop recorder or a 24-hour Holter monitor. The rate of AF detection was significantly greater in the group monitored for 30 days (16.1 versus 3.2 percent). (N Engl J Med 2014; 370:2467.)
Heart Care Foundation of India & Indian Medical Association trained over 4000 people in hands only CPR 10 & essential food safety measures on World Health Day
  • Eating two large, fiber-rich meals a day as part of a calorie-restricted diet, rather than six smaller meals spread throughout the day, helps people with type 2 diabetes feel less hungry and less depressed, suggests a secondary analysis of a crossover trial published in the European Journal of Clinical Nutrition.
  • A reduced abundance of the Prevotellaceae bacteria family has been noted in the gut microbiome of Parkinson’s disease (PD) patients compared with healthy control persons in a new study. This could be an important clue to what drives PD. The findings are published in Movement Disorders.
  • Patients with lumbar spinal stenosis (LSS) who receive physical therapy (PT) seem to have similar symptom relief and functional improvements during the first 2 years as those who undergo surgical decompression, suggests new research published online April 6 in the Annals of Internal Medicine.
  • Certain types of mutation in specific parts of the BRCA1 and BRCA2 genes can alter the risk for breast or ovarian cancer, suggests a study published in the April 7 issue of JAMA.
  • Tofacitinib impairs responses to pneumococcal vaccine, but not influenza vaccine, in patients with rheumatoid arthritis (RA), suggests new research published online in Annals of the Rheumatic Diseases.
Dr KK Spiritual Blog
What are Satvik offerings in Vedic literature?
  • Food Offerings: Panchashasha (grains of five types – brown rice, mung or whole green gram, til or sesame, mashkalai (white urad dal) or any variety of whole black leguminous seed, jowar or millet)
  • Panchagobbo (Five items obtained from cow: milk, ghee or clarified butter, curd, cowdung and gomutra), curd, honey, brown sugar, three big noibiddos, one small noibiddo, three bowls of madhupakka (a mixture of honey, curd, ghee and brown sugar for oblation), bhoger drobbadi (items for the feast), aaratir drobbadi mahasnan oil, dantokashtho, sugar cane juice, an earthen bowl of atop (a type of rice), til oil (sesame oil).
  • Water offerings: Ushnodok (lukewarm water), coconut water, sarbooushodhi, mahaoushodhi, water from oceans, rain water, spring water, water containing lotus pollen.
  • Three aashonanguriuk (finger ring made of kusha).
  • Puja Items: Sindur (vermillion), panchabarner guri (powders of five different colors – turmeric, rice, kusum flowers or red abir, rice chaff or coconut fiber burnt for the dark colour, bel patra or powdered wood apple leaves), panchapallab (leaves of five trees – mango, pakur or a species of fig, banyan, betel and Joggodumur or fig), pancharatna (five types of gems – gold, diamond, sapphire, ruby and pearl), panchakoshay (bark of five trees – jaam, shimul, berela, kool, bokul powdered in equal portions and mixed with water), green coconut with stalk, three aashonanguriuk (finger ring made of kusha).
  • Panchamrit: A mixture of Honey, Milk, Curd, Ghee and Brown Sugar.
Cardiology eMedinewS
  • Patients with atrial fibrillation (AF) who have no other additional risk factors, aside from gender in the case of females, are at a very low risk for stroke and bleeding, reported registry data from Denmark published in the April 14 issue of the Journal of the American College of Cardiology.
  • Among cardiac arrest patients who lost consciousness, survival and cognitive function were similar in those treated with hypothermic therapy to target temperatures of 33°C (91.4ºF) and 36ºC (96.8ºF) in a randomized trial published online in JAMA Neurology.
Pediatrics eMedinewS
  • The absolute risk of major congenital anomalies was similar among infants born to smokers and those born to women on nicotine replacement therapy (NRT), but respiratory problems were worse in the latter group, reported new research published online in the May issue of Pediatrics.
  • Eating a high-fat diet during the perinatal period may increase obesity risk in offspring by modulating the processing of central vagal neurocircuits, suggests new research published online in the Journal of Physiology.
Quote of the Day
Happy is the man who can do only one thing; in doing it, he fulfills his destiny. Joseph Joubert
Make Sure
Situation: A foreigner with a single loose stool developed sepsis.

Reaction: Oh my God! Why were antibiotics not started in time?

Lesson: Make sure that all foreigners are diagnosed to be suffering from Traveler’s diarrhea even if there is one single loose stool.
Beneficiaries of Sameer Malik Heart Care Foundation Fund
Dr Good Dr Bad
Situation: A 25–year–old male with normal body mass index (BMI) came with mild abdominal obesity.

Dr Bad: Do not worry.

Dr Good: Rule out diabetes.

Lesson: Indians are susceptible to diabetes at a younger age and at a relatively lower BMI compared to the white Caucasians. This is partly explained by the fact that the thin–looking Indians are quite adipose (higher body fat percent).

(Copyright IJCP)
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
Sonal Namaste
The SAVE LIVES: Clean Your Hands annual initiative is part of a major global effort led by the World Health Organization (WHO). It includes the "My Five Moments for Hand Hygiene", which define the key moments when healthcare workers should perform hand hygiene.

This evidence-based, field-tested approach is applicable in a wide range of settings. The WHO approach recommends HCWs clean their hands:
  • Before touching a patient
  • Before clean/aseptic procedures
  • After body fluid exposure/risk
  • After touching a patient
  • After touching patient surroundings
Facts about Tuberculosis (TB)
Who can become a DOT provider?
  • The only criteria for becoming a DOT provider is that he/she should be acceptable to the patient and accountable to the health system.
  • The identified DOT providers are given adequate training on administration of drugs, identification of adverse reactions, follow up and retrieval of the patient in case of treatment interruption.
  • DOT providers include
  • Staff of the health system (Doctors, Nurses, MPW, ANM, pharmacists etc),
  • NGOs
  • Private practitioners
  • Community volunteers – Teachers, religious leaders, anganwadi workers, dais, ASHAs, Shop owners, cured TB patients etc.
  • The programme discourages the use of family members as they have not been found to be effective treatment observers.
Massive Tea Consumption Linked to Kidney Failure
By Gene Emery (Reuters Health)

Iced-tea nephropathy: New England Journal of Medicine, published a letter describing the case April 1 online. The source of the problem was an excessive amount of oxalate. The man reported that he was drinking 16 nine-ounce glasses of iced tea each day, giving him more than 1,500 mg of oxalate per day.

The Academy of Nutrition and Dietetics advises consuming no more than 40-50 mg of oxalate per day, the authors note.

The irony is that previous research has suggested that "people who take tea in the usual amounts actually have a lower risk of kidney stones," Curhan said. But in this case, the person was drinking huge amounts of oxalate.

Such regular excessive consumption of oxalate "may be an underrecognized cause of renal failure."
Single Antibiotic as Good as Combination for Pneumonia
For patients admitted to non–intensive care unit (ICU) wards who have suspected community-acquired pneumonia (CAP), a strategy of empirical treatment with a beta-lactam antibiotic alone was found to be just as good as the currently recommended combination therapy.

Specifically, the single-treatment strategy, which allowed for deviations for medical reasons, had results similar to those of the usual beta-lactam–macrolide combination therapy or fluoroquinolone monotherapy, in terms of 90-day all-cause mortality. Also, the beta-lactam antibiotic alone did not lengthen hospital stays or result in more complications. Results were published in the April 2 issue of the New England Journal of Medicine. (Medscape)
Portable Ultrasound to Improve Emergency and Critical Care
Ultrasound devices have shrunk to the point where they are now handheld and can be used in the emergency department or the critical care unit for easier triage, faster interventions for acute events, and better monitoring.

Delegates attending the American Institute of Ultrasound in Medicine 2015 Annual Convention in Lake Buena Vista, Florida, heard about quick bedside scans to detect bleeding after trauma, fractures, or torn tendons, and to assess fluid accumulation around the lungs, which could indicate congestive heart failure. (Medscape)
Inspirational Story
What Goes Around Comes Around

His name was Fleming, and he was a poor Scottish farmer. One day, while trying to make a living for his family, he heard a cry for help coming from a nearby bog.

He dropped his tools and ran to the bog. There, mired to his waist in black muck, was a terrified boy, screaming and struggling to free himself. Farmer Fleming saved the lad from what could have been a slow and terrifying death. The next day, a fancy carriage pulled up to the Scotsman's sparse surroundings. An elegantly dressed nobleman stepped out and introduced himself as the father of the boy Farmer Fleming had saved.

"I want to repay you," said the nobleman. "You saved my son's life." "No, I can't accept payment for what I did," the Scottish farmer replied, waving off the offer.

At that moment, the farmer's own son came to the door of the family hovel. "Is that your son?" the nobleman asked. "Yes," the farmer replied proudly. "I'll make you a deal. Let me take him and give him a good education. If the lad is anything like his father, he'll grow to a man you can be proud of.

"And that he did. In time, Farmer Fleming's son graduated from St. Mary's Hospital Medical School in London, and went on to become known throughout the world as the noted Sir Alexander Fleming, the discoverer of Penicillin. Years afterward, the nobleman's son was stricken with pneumonia. What saved him? Penicillin. The name of the nobleman? Lord Randolph Churchill. His son's name? Sir Winston Churchill.

Someone once said: What goes around comes around. Work like you don't need the money. Love like you've never been hurt. Dance like nobody's watching.
eMedi Quiz
Elements of primary health care include all of the following except:

1. Adequate supply of safe water and basic sanitation.
2. Providing essential drugs.
3. Sound referral system.
4. Health Education.

Yesterday’s Mind Teaser: Acantholysis is characteristic of:

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

Answer for yesterday’s Mind Teaser: 1. Pemphigus vulgaris.

Correct Answers received from: Viswanatha Sarma, Dr Poonam Chablani, Dr Shangarpawar, Dr Avtar Krishan.

Answer for 7th April Mind Teaser: 4. Glycosylation.

Correct Answers receives: Daivadheenam Jella, Arvind Diwaker, Dr Avtar Krishan, Raju Kuppusamy, Dr Shanta Chitlangi, Dr Khatija Shameem, Dr Poonam Chablani.
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Wellness Blog
Artificial sweeteners

Artificial sweeteners like acesulfame, aspartame, saccharin, sucralose give the sweetness of sugar with virtually none of the calories. Most people who use artificial sweeteners or choose foods or beverages made with them do so because they want to lose weight. And for a lot of people, they do help. But some research suggests that the use of artificial sweeteners may actually promote weight gain.

Artificial sweeteners are hundreds to thousands of times sweeter than table sugar. People who use these sweeteners often may desensitize themselves to sweetness. If that happens, they may find healthful but not–so–sweet foods such as fruits and vegetables unappetizing by comparison.

Calories removed from the diet by swapping sugar for sweeteners may re–enter in the form of refined carbohydrates (like those found in crackers, chips, pastries, and the like) and unhealthy saturated and trans fats.
Reader Response
Dear Sir, Very nice stories. Regards: Dr Fatima
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IMA Humor
Doctor complaining to mechanic

A doctor is taking to a car mechanic, "your fee is several times more per hour then we get paid for medical care."

‘Yeah, but you see, doc, you have always the same model! It hasn’t changed since Adam. But we have to keep up to date with new models coming every month"
Best time to have a heart attack is week days
15 minutes of sun exposure must and Best time to have a heart attack is week days are the two main highlights and importance to India said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.
  • 15 minutes of sun exposure must: New research by Dr. Michal Melamed, at Albert Einstein College of Medicine in New York City has discovered that people with low blood levels of vitamin D were found to have a higher incidence of peripheral arterial disease (PAD), potentially dangerous blockages in the leg arteries. The study of nearly 4,900 American adults found more than double the incidence of PAD among those with the lowest levels of vitamin D compared to those with the highest levels. Vitamin D is made when the body is exposed to sunlight. Current guidelines recommend a vitamin D intake of 400 International Units a day for people aged 50 and older. In addition to sunlight, other sources of the vitamin are salmon, sardines, cod liver oil, fortified milk and some fortified cereals. Exposure to sunlight "always calls for a balance. Overexposure raises the risk of skin cancer. The recommendation about 10 to 15 minutes of direct exposure.
  • Best time to have a heart attack is week days: Your chances for surviving a cardiac arrest are 13.4 percent worse if you are admitted to the hospital on the weekend versus a weekday. Even after taking into account factors such as hospital size and location and the person's age, gender and other illnesses, the lower survival rate remains the same. "A higher death rate among patients admitted on weekends may be due to lack of resources for treating cardiac arrest," as per the study author Richard M. Dubinsky, of the University of Kansas Medical Center in Kansas City. The findings come from researchers analyzing a national database containing a 20 percent sampling of all U.S. hospital admissions for cardiac arrest from 1990 to 2004. The analysis included 67,554 admissions. During cardiac arrest, the heart slows or stops working, and brain death can occur in just four to six minutes.
Rabies News (Dr A K Gupta)
What are the signs of rabies in dogs/cats?
  • Any change in normal behavior suggesting either undue aggression or depression.
  • Running aimlessly and attacking others without provocation.
  • Becomes too drowsy and withdraws to a corner.
  • Change in voice/bark.
  • Excessive salivation.
  • Refusal to feed or eating objects like stone, paper, wood, metal pieces etc.