February 21  2015, Saturday
Steps to Lower Alzheimer’s Risk
Dr KK Aggarwal
  • Maintain a healthy weight.
  • Check your waistline.
  • Eat mindfully. Emphasize colorful, vitamin–packed vegetables and fruits; whole grains; fish, lean poultry, tofu, and beans and other legumes as protein sources plus healthy fats. Cut down on unnecessary calories from sweets, sodas, refined grains like white bread or white rice, unhealthy fats, fried and fast foods, and mindless snacking. Keep a close eye on portion sizes, too.
  • Exercise regularly. Aim for 2½ to 5 hours weekly of brisk walking (at 4 mph). Or try a vigorous exercise like jogging (at 6 mph) for half that time.
  • Keep an eye on important health numbers. In addition to watching your weight and waistline, keep a watch on your cholesterol, triglycerides, blood pressure, and blood sugar numbers.
CPR 10 Utsav 15th December 2013
News Around the Globe
  • The US Food and Drug Administration (FDA) warned in a safety communication that the complex design of duodenoscopes used during endoscopic retrograde cholangiopancreatography (ERCP) may impede effective cleaning, thus spreading multidrug-resistant bacterial infections.
  • Older adults who follow a mindful meditation program have improved sleep quality as well as less daytime fatigue and depression compared with their counterparts who take part in a sleep hygiene education (SHE) program, suggests new research published online in JAMA Internal Medicine.
  • At present, active surveillance is largely limited to men with low-risk prostate cancer, but it might also be suitable for those with "favorable" intermediate-risk prostate cancer, and could thus manage more men with the disease, suggests a new study published online February 19 in JAMA Oncology.
  • Patients who are dehydrated have more severe stroke and poorer short-term outcomes than stroke patients who are adequately hydrated, suggests a new study presented at the International Stroke Conference (ISC) 2015.
  • Sofosbuvir plus ribavirin may effectively treat patients co-infected with HIV and hepatitis C virus (HCV) genotypes 1-4, suggests a new study published online in The Lancet.
Dr KK Spiritual Blog
Top Characters of Mahabharata

To be in harmony with the body (five elements represented by Draupadi) one must acquire five qualities or in other terms live a focused life, full of strength and not being disturbed with loss or gain and finally working for the welfare of the society without having any partiality towards anyone.
  • Balanced mind: Yudhishtir ("sthir" or balanced in "yudh" or disturbed state of mind)
  • Focused vision (Arjuna)
  • Using internal power or strength (Bhima)
  • Not being partial or remaining neutral (Nakul)
  • Working for the welfare of the society (Sahdev)
With this, one can kill 100 negative qualities that a person can have (the 100 Kauravs). The hundred negative qualities are acquired because of cunningness (Shakuni), not working with the eyes of the soul (Dhritarashtra) and keeping a blind eye to any wrong happening (Gandhari).

The main negative qualities are taking decisions in day–to–day life situations (Duryodhana: dusht in yudha or war) and choosing wrong choices as a ruler (dusshasana: dusht and shasan).

The positive qualities once acquired will also win over other negative qualities like blind faith or undue attachments (Bhishma pitamaha); unrighteous loyalty (Dronacharya) and unrighteous ego (Karna).
Cardiology eMedinewS
  • Frail elderly with a systolic BP <130 mm Hg (low systolic BP) who also received two or more antihypertensive agents had a twofold higher risk of dying within 2 years compared with their peers, suggested the results of the Predictive Values of Blood Pressure and Arterial Stiffness in Institutionalized Very Aged Population (PARTAGE) longitudinal study published online in JAMA Internal Medicine.
  • Children with low serum vitamin D levels in childhood appear to have an increased likelihood of developing subclinical atherosclerosis in adulthood independent of conventional cardiovascular risk factors, suggests a Finnish study published online in the Journal of Clinical Endocrinology and Metabolism.
Pediatrics eMedinewS
  • New research has found that daytime napping is associated with poorer sleep quality in young children over the age of 2. The study is published in Archives of Disease in Childhood.
  • Researchers from the Albert Einstein College of Medicine of Yeshiva University, New York, have found that the increased risk of a child being born with Down syndrome could be attributable to the genetic process of recombination, in which pairs of chromosomes exchange genetic material with each other before separating. The new study is published in Nature Communications.
Make Sure
Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.
Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What is World Medical Association Declaration Principle VIII–Continuing Medical Education

  • All physicians are committed to lifelong learning.
  • These educational experiences are essential if the physician is to keep updates of developments in medicine and if the physician is to maintain the knowledge and skills necessary to provide high quality care; scientific advances are essential to an adequate health care of the people.
  • Medical schools, hospitals and professional societies share the responsibility for developing and making available to all physicians opportunities for continuing medical education.
  • The demand to provide medical care, prevent disease and give advice in health matters calls for the highest standards of undergraduate post graduate and continuing medical education.
  • Internationally standardize methods of assessing professional competence and performance should be developed and applied in medical care.
(Adopted by the 39th World Medical Assembly Madrid Spain, October 1987)
Dr Good Dr Bad
Situation: A patient had a break of policy for two days.
Dr. Bad: You will have to go for new policy now.
Dr. Good: Your old policy should be continued.

Lesson: Cumulative bonus provisions are applicable only in respect of continuous insurance without break excepting, however, in exceptional circumstances, the break in period for maximum of seven days is approved as a special case subject to medical examination and explanation of diseases contracted during the break period.
IJCP Book of Medical Records
IJCP’s ejournals
Wellness Blog
Do not ignore transient brain dysfunction

Transient ischemic attack or TIA or mini paralysis is a brief episode of neurologic dysfunction caused by lack of blood supply in the focal brain or eye, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction or brain attack

It is a neurological emergency and early recognition can identify patients who may benefit from preventive therapy or from surgery of large vessels such as the carotid artery.

The initial evaluation of suspected TIA and minor non disabling ischemic paralysis includes brain imaging, neurovascular imaging, and a cardiac evaluation. Laboratory testing is helpful in ruling out metabolic and hematologic causes of neurologic symptoms.

TIA or minor non disabling ischemic paralysis is associated with a high early risk of recurrent paralysis. The risk of paralysis in the first two days after TIA is approximately 4 to 10 percent.
Immediate evaluation and intervention after a TIA or minor ischemic reduces the risk of recurrent stroke. Risk factor management is appropriate for all patients. Currently viable strategies include blood pressure reduction, statins, antiplatelet therapy and lifestyle modification, including smoking cessation.

For patients with TIA or ischemic stroke of atherothrombotic, lacunar (small vessel occlusive), or cryptogenic type, antiplatelet agents should be given. For patients with atrial fibrillation and a recent ischemic stroke or TIA, the treatment is blood thinners. For patients with carotid blockages, surgery is needed.
Twitter of the Day
Dr KK Aggarwal: The very purpose of life is to face sufferings…According to Hinduism, the very fact …http://youtu.be/NMIK16PyBrY?a via @YouTube

Dr Deepak Chopra: : Your true self is nameless & formless http://bit.ly/DC_Ananda #ananda
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
How is RIG life saving?

Administration of anti–rabies vaccine stimulates production of neutralizing antibodies by the patient’s immune system. Protective levels of antibodies (more than 0.5 IU/ml of serum) are seen 7 to 14 days after the initial dose of vaccine (window period). Moreover when the bites are on the head, neck, face & hands, the incubation period will be shorter.

Thus the patients are vulnerable to develop rabies during this window period of 7 to 14 days. RIGs are readymade anti–rabies antibodies and provide passive immunity to rabies.
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
About the Editor
National Science Communication and Dr B C Roy National Awardee, Honorary Secretary General IMA, Immediate Past Senior National Vice President IMA, Professor of Bioethics SRM University, Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand, President Heart Care Foundation of India, Chairman Legal Cell Indian Academy of Echocardiography, Editor in Chief IJCP Group of Publications & eMedinewS, Member Ethics Committee Medical Council of India (2013-14), Chairman Ethical Committee Delhi Medical Council (2009-14), Elected Member Delhi Medical Council (2004-2009), Chairman IMSA Delhi Chapter (March 10- March13), Director IMA AKN Sinha Institute (08-09), Finance Secretary IMA (07-08), Chairman IMAAMS (06-07), President Delhi Medical Association (05-06)
Sonal Namaste
Environmental cleaning, disinfection, and sterilization are important measures used to prevent or reduce infections in the hospital environment
Towards Elimination of Parent to Child Transmission of Syphilis
Launch Function of “Towards Elimination of Parent to Child Transmission of Syphilis” (E-PTCT). The Launch will be done by Shri B. P. Sharma IAS, Secretary (Health), Ministry of Health and Family Welfare, Government of India on 25.02.2015 at ‘The Oberoi’ Zakir Hussain Marg, New Delhi 110003. The National Strategy for E-PTCT is made by National AIDS Control Organization, Ministry of Health and Family Welfare and World Health Organization.
Ghaziabad district magistrate tests positive for swine flu
GHAZIABAD: The Ghaziabad district magistrate is down with swine flu. Vimal Kumar Sharma has been admitted to Pushpanjali Crosslay Hospital in Vaishali after testing positive for the H1N1 virus. Confirming this, additional district magistrate Kapil Singh said, "The DM is currently undergoing treatment in Pushpanjali Crosslay Hospital after it was confirmed around 8.30pm that he has contracted the disease".

Dr Ajay Aggarwal, chief medical officer, who was in the hospital, said, "He has not been well for a couple of days and on Wednesday his sample was sent to Pushpanjali Crosslay Hospital, which confirmed H1N1 on Thursday evening," Aggarwal said. Aggarwal said that from January 1, only one death has been reported because of swine flu in Ghaziabad. Dr Vinay Agarwal, president of Pushpanjali Crosslay Hospital, said, "We got the sample tested on Wednesday morning in a private lab and the report on Thursday evening confirmed it. The DM was told after the CMO seconded the report," Agarwal said. "At present, the DM is in an isolation ward and is doing fine," he said.

Kapil Singh, additional district magistrate, suspects that Sharma might have contracted the disease after meeting the husband of Shubra Saxena, the DM of Shahjahanpur. Saxena is currently undergoing treatment for swine flu in a Delhi hospital.

Another possibility, according to Kapil Singh, is that he might have contracted the disease between February 11 and 14, when "he had attended an IAS officers' meeting in Lucknow as he had been unwell since his return on Feb 14".

There has been a spurt in swine flu cases in Ghaziabad in the past fortnight. Till Thursday, 250 suspected patients have been tested. According to Dr Ajay Agarwal, CMO, until now 24 people have tested positive in the city. "The number is expected to rise as the health department is on Friday expecting the results of tests on 20 more patients," Agarwal said. "About 80% of patients are being treated in the city's government hospitals while the rest are being treated in at least three private hospitals – Pushpanjali Crosslay, Yashoda and Columbia Asia," the CMO said.

Meanwhile, the Indian Medical Association has demanded that the Rs 4,500 fee for a swine flu test in the national capital region be reduced further. IMA general secretary Dr K K Agarwal said, "A swine flu test kit comes for just Rs 600 and the Rs 4,500 cap is high and should be reduced further". Dr Gyanendra Sharma, district malaria officer, has been deputed as nodal officer to keep a 24x7 vigil on district and designated hospitals where suspected swine flu patients are under treatment. Dr P N Arora, managing director of Yashoda Hospital, said that H1N1 virus was getting "weaker by the day" as the mercury was rising and would die a natural death.
No.F.II(1)/Misc/PNDT/SD/2006/Pt.I/Dated:14/01/2015/ CIRCULAR

In pursuance to a letter No. F. 12011/10/2014-PNDT dated 19/08/2014 received issued by the Ministry of Health & Family Welfare, Govt. of India duly endorsed by the State Appropriate Authority, Govt. of Delhi, it is informed that as per the provision under the PC & PNDT Act and Rules framed thereunder, MD (Radiology), DNB & Post Graduate Diploma in Medical Radio–diagnosis are the MCI recognised courses under Radio-diagnosis and

have also been recognised as credentials to grant registration/renewal under PC & PNDT Act/Rules. Diploma in Medical Radiology and Electrology/Electrotherapy (DMRE) does not qualify for registration/renewal granted as per the provision of the Act.

Therefore, it is advised that the person conducting Ultrasonongraphy must possess the requisite qualification as prescribed under the Act/ Rules.

(Dr. G.C. Mallik) CDMO (South District)
No. F. II(1)/Misc/PNDT/SD/2006/Pt.I/5012 Dated: 18/02/2015/ CIRCULAR

In pursuance to a Letter No.9(7)/23/PNDT/DFW/2014/898-914 dated 03/02/2015 issued by Directorate of Family Welfare, GNCT of Delhi, it is informed that as per the PC & PNDT Act, the portability of the ultrasound machine is prohibited and in reference to Rule 3B(1) and 3(B(2) of PC & PNDT Rules, 1996 the use of Portable ultrasound machine or any other portable machine or device which has the potential for selection of sex before conception or detection of sex during pregnancy shall be permitted only in the following conditions; namely

(a)The portable machines being used, within the premise it is registered for providing services to the Indoor patients and

(b) As a part of a Mobile Medical Unit offering a bouquet of other health and medical services;

Apart from the conditions permitted under Rule 3B(1) and 3B(2) PC & PNDT, the portable machines cannot be moved from one centre to another and the same would be violation of the provisions of the PC & PNDT Act and Rules, made there under.

As many centres are having portable mode of ultrasound machines which have the propensity of being used illegally at unregistered places/ mobile van. Such centres, which already have portable machines and do not fall under the categories as mentioned above under the Act need to fix such machines at the centre. In view of this, the Authorities have decided that the center should fix such machines so that the same are not being misused and are not made portable by the diagnostic centres.

All centres/ Hospitals/ Clinics/ Institutions etc registered with South District, GNCT of Delhi under PC & PNDT Act, having portable ultrasound machine are mandatorily required to get such machines fixed through wall mounting or get affixed to structure such as trolley, table etc; or by any other means, so that such portable machine are get fixed in the centre and are not being misused by moving them from one place to another and are also readily available during inspections.

All centres registered under PC & PNDT Act under South District are required to submit a compliance report within 15 days of issue of this circular failing which necessary action shall be initiated under the provision of PC & PNDT Act.

(Dr. G.C. Mallik) CDMO (SD)
WMA calls for charges against physicians to be dropped
(19.02.2015) The World Medical Association has today demanded that all charges be dropped against the Ankara Medical Chamber and has offered its continuing support to Turkish physicians who are facing resumed court action tomorrow (Friday) for providing urgently needed emergency medical care to demonstrators injured during the Gezi Park demonstrations in 2013.

A further court hearing is due in Ankara in the lawsuit brought by the Ministry of Health for the dismissal of the governing bodies of the Ankara Chamber of Medicine and their replacement by newly elected bodies. The Ministry claims that the Chamber established and operated health units called infirmaries during the Gezi Park protests and refused to supply the Ministry with information about patients receiving first aid services in these units as well as health workers delivering these services.

Today the WMA Chair of Council, Dr. Mukesh Haikerwal, called for the Turkish authorities to drop all the charges against these physicians who were performing their ethical duty to care for all those injured while maintaining the core obligation of medical care   patient confidentiality that all patients of the world expect, demand and deserve.

‘Physicians must be able to practise their profession without any fear or intimidation in Turkey and in all other parts of the world. They should be able to help anybody anywhere without any distinction.

‘These charges are a challenge to the universal principles of medical autonomy and patient confidentiality and must be dismissed. For the sake of patients and doctors we urge the Turkish authorities to think again’
Medscape Family Physician Lifestyle Report 2015
Does Living with a Partner Reduce Family Physicians Burnout?

Slightly less than half (49%) of family physicians who are living with partners are burned out, while 59% of those without partners experience burnout. When looking at specific living status, the highest rates of burnout were among those who are separated (64%) or divorced (60%) and living alone. Those who were widowed or in a first marriage had the lowest burnout rates (48%).
Inspirational Story
A small boy worked as an apprentice in a bicycle shop. A man sent a bicycle for repair. After repairing the bicycle, this boy cleaned up the bicycle and it looked like a new one. Other apprentices laughed at him for doing redundant work. The second day after the owner claimed the bicycle back, this boy was pinched and offered a job.

Moral of the story
  • Go the extra mile to be successful.
  • Doing more gains more and doing less loses more.
Quote of the Day
Coming together is a beginning. Keeping together is progress. Working together is success. Henry Ford
IMA in Social Media
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Twitter @IndianMedAssn 797 followers

http://imahq.blogspot.com/ www.ima-ams.org

http://www.imacgpindia.com/ http://www.imacgponline.com/


Reader Response
  1. MEDICAL PROFESSION TO HAVE ITS OWN EMBLEM it is a much wanted and welcome move.keep it up dear fellows. SHIVRATRI KE PAWAN AWSAR PE SABHI KO SHUBHKAMNAYEN. –Dr.V.K.Agarwal
  2. Congratulations for excellent quality informative and useful devotional divine work.–Dr Rohit Mody.
IMA Videos
News on Maps
IMA Humor
Traffic Court

A New York man was forced to take a day off from work to appear for a minor traffic summons. He grew increasingly restless as he waited hour after endless hour for his case to be heard. When his name was called late in the afternoon, he stood before the judge, only to hear that court would be adjourned for the next day and he would have to return the next day. "What for?" he snapped at the judge.

His honor, equally irked by a tedious day and sharp query roared, "Twenty dollars contempt of court. That’s why!" Then, noticing the man checking his wallet, the judge relented. "That’s all right. You don’t have to pay now." The young man replied, "I’m just seeing if I have enough for two more words."
eMedi Quiz
A 5 year old boy passed 18 loose stools in last 24 hour and vomited twice in last 4 hour. he is irritable but drinking fluids. The optimal therapy for this child is:

1. Intravenous fluids.
2. Oral rehydration therapy.
3. Intravenous fluid initially for 4 hours followed by oral fluids.
4. Plain water ad libitum.

Yesterday’s Mind Teaser:: A couple, with a family history of beta thalassemia major in a distant relative. has come for counseling. The husband had HbA2 of 4.8% and the wife has HbA2 of 2.3%. The risk of having a child with beta thalassemia major is.
1. 50%
2. 25%
3. 5%
4. 0%

Answer for yesterday’s Mind Teaser:: 4. 0%
Correct Answers received from: : Daivadheenam Jella, Arvind Diwaker, Dr Avtar Krishan,
Answer for 20th Feb Mind Teaser:2. Bilateral cordectomy.
Correct Answers receives: Daivadheenam Jella, Dr Avtar Krishan, Raju Kuppusamy
Press Release of the Day
IMA to train master trainers in Swine Flu

In the current outbreak of Swine Flu, IMA has asked for rationalization of charges for Swine Flu management in the private sector. Addressing a Press Conference, Padmashri Awardee , Prof  (Dr.) A. Marthanda Pillai,  National President and Padmashri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA said that CGHS charge one for Swine flu test is Rs. 1084/- ands the same should be born by the government like any subsidy in a natural calamity.

Guidelines should also be addressed when not to go for swine flu testing and no subsidy should be given to patients who wants to get their testing done not adhering to the guidelines.

 As per IMA, whenever an outbreak is declared, charges for hospitalization, investigations and drugs should all be borne by the Govt. or fixed at a nominal price with subsidy provided by the Govt to the Private Sector.

IMA will be training Master Trainers in India through its 30 State Branches who in turn will train trainers through its 1700 local branches present in every district. IMA has also written letter to Shri J.P. Nadda, Union Health Minister regarding the same. IMA has also proposed to the Union Health Minister for a joint Press Advertisement clarifying the myths regarding the flu menace.

IMA has also written to the Health & Finance Ministers that a separate budget should be allocated for outbreaks and epidemics. 

IMA will also be observing World TB day on 24th March which is another air born disease.

IMA also issued today a public education leaflet about dos and dots about swine flu. The same will be distributed in regional languages across the country through IMA branches