August 28   2015, Friday
eMedinewS
editorial
Fever in children
Dr KK Aggarwal
  1. Do not ignore fever in children.
  2. Fever with cough and cold means viral sore throat.
  3. Fever with chills and rigor may be due to malaria.
  4. Fever with severe headache and pain behind the eyes may be dengue.
  5. If a child has fever with urinary symptoms, the child needs further investigations.
  6. Do not ignore fever with jaundice.
  7. Do not give aspirin to children for fever.
  8. Immediately lower the temperature if the fever is more than 104°F.
  9. If fever is associated with altered behavior, then immediately contact the doctor.
  10. Tepid water sponging is better than sponging with cold and ice water.
  11. In heat stroke, cold water sponging can lower the temperature if anti-fever medication is not working.
  12. Do not ignore if body temperature is low.
  13. If body temperature is less than 95°F, immediately warm the child using blankets and other measures.
  14. Paracetamol is the safest medicine for children in fever.
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News
Obesity
Simply drinking 500 ml of water 30 minutes before each meal can help in losing weight, suggests a new study published in the journal Obesity.

Neurology
Stroke patients with an occluded artery who were treated with the Solitaire stent-retrieval device within 120 minutes of symptom onset had a more than 80% chance of a nondisabled outcome, defined as a modified Rankin scale (mRS) score of 0 to 2 at 3 months, suggested a new study published online in Annals of Neurology.

Oncology
A new study shows that the extracellular matrix (ECM) of the adipose tissue is stiffer in obesity and is characterized by ECM components typically associated with tumor phenotype, thus explaining the mechanism behind how obesity increases the risk for breast cancer. The findings were published in Science Translational Medicine.

Geriatrics
Neurology

Two randomized controlled studies published in the journal JAMA failed to reveal any benefit against cognitive decline for older people taking structured exercise or nutritional supplements.

Urology
Nerve-sparing surgery technique improves long-term continence rates after radical prostatectomy, suggests new research published online in European Urology.
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Cardiology eMedinewS
Cardiology
Obstetrics and Gynecology
Atrial fibrillation and atrial flutter are rare in pregnant women with structural heart disease, but these arrhythmias are associated with an increased risk of maternal death and low fetal birth weight, suggests a new study published in the August 2015 issue of JACC: Clinical Electrophysiology.

Cardiology
Smoking/Addiction

Smokers who quit after having a heart attack have similar levels of chest pain and mental health as non-smokers, suggested new research published in the journal Circulation: Cardiovascular Quality and Outcomes.
Pediatrics eMedinewS
Pediatrics
Allergy and Immunology
Clinicians should recommend introducing peanut-containing foods into the diets of high-risk infants aged between 4 and 11 months, suggests a new consensus statement from 10 medical organizations in Europe and the United States. The consensus statement will be published online August 31 in Pediatrics.

Pediatrics
Nephrology

More than three quarters of neonates and infants who require chronic peritoneal dialysis in the first year of life survive at least three years, suggested a database study published online in Pediatrics.
Dr KK Spiritual Blog
Why do we not offer Vanaspati Ghee at the time of cremation or worship?

Vanaspati Ghee is never offered to God at the time of Aarti in the Diya or to the dead body at the time of cremation. Only pure ghee is offered.
It is considered a bad omen to offer Vanaspati ghee at the time of the cremation ritual even though the consciousness has left the body.

What is not offered to God should not be offered to our consciousness and that was the reason for this ritual in a temple. Vanaspati ghee increases bad cholesterol and reduces level of good cholesterol in the blood. On the other hand, pure ghee only increases bad cholesterol but does not reduce the level of good cholesterol. The medical recommendation is that one should not take more than 15 ml of oil, ghee, butter or maximum ½ kg in one month.

It is a spiritual crime to offer vanaspati ghee to God.
Inspirational Story
The Bird Feeder

Last fall I hung outside my window a bird feeder. Now not knowing the first thing about wild birds, I assumed that as soon as I hung this bird feeder outside, a multitude of beautiful birds would be swooping to my new addition. Days, weeks and months went by; NO BIRDS.

I asked so many people what to do? What was I doing wrong? "Nothing" most of them replied. "Just wait." So I waited and waited and waited trying everything possible, to attract these birds. I cleaned off the deck, I changed the feed, I washed the feeders, I even made the cat go out the other door! But nothing seemed to work. So......I waited, "with patience and hope."

Two (2) months later, on a Saturday afternoon, I FROZE! What to my eyes had appeared on the bird feeder but the most beautiful bird I have ever seen in my life! All of a sudden HUNDREDS UPON HUNDREDS OF BIRDS WERE APPEARING FROM EVERYWHERE!

What a beautiful lesson I learned from this little creature. "Patience and hope" and "things" will attract the beautiful things in life. I never realized how much patience I really do have and how much I do rely upon "hope" to sort out the questions in my heart.

So I keep hoping and waiting, waiting and hoping. I will try to use this "little lesson" with so many other things in my life. I guess "patience is a virtue" after all.
Scientific awareness on personal hygiene and prevention from obesity among school going children, Mount ABU Public School, 19th August 2015
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Make Sure
Situation: A patient with gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make Sure to only moderately tap ascitic fluid as overenthusiastic tapping can be life–threatening.
Dr Good Dr Bad
Situation: A patient with sepsis developed thrombocytopenia.
Dr Bad: It is due to drugs.
Dr Good: It is due to sepsis.
Lesson: More than 50% of patients with sepsis show thrombocytopenia in their peripheral smear.

(Copyright IJCP)
Wellness Blog
When we speak of tea, it is commonly assumed to be black tea with milk and sugar. However, the word ‘Tea’ means any herb. This means even hot Tulsi water is Tulsi tea or hot mint water is Mint tea. Many herbs can be converted into tea such as jasmine tea, lemon tea, lemon grass tea, masala tea, sounf tea etc.

When the leaves are boiled in water and reduced to 50%, it is called Kadha (decoction). Black tea without milk and sugar is much healthier than black tea with milk and sugar.

Classical tea without sugar and milk has an astringent taste. But according to Ayurveda, this is good for health as it reduces Kapha imbalance. When sugar and milk are added, both of which have sweet taste, they neutralize the weight-reducing and kapha–relieving properties of the black tea. Therefore, milk or sugar should not be added to tea. For the purpose of taste, one can add Gur or jaggery or artificial plant sweetener Stevia.

Black tea is also a mild diuretic and increases urination as it contains caffeine, which is also a stimulant. This is the reason why tea is used when there is a need to stay awake. In this regard, coffee is stronger than tea. When taken in moderation, black tea is good for the heart and general health. If one has to choose tea then jasmine, lemon and lemongrass teas are better.

In Ayurveda, different teas have been prescribed for different personalities. Therefore, you can get vata–pacifying tea, pitta–pacifying tea and kapha–pacifying tea.
eMedinewS Humor
Vote for the Devil

A candidate for city council was doing some door–to–door campaigning, and things were going pretty well, he thought, till he came to the house of a grouchy–looking fellow. After the candidate’s little speech, the fellow said, "Vote for you? Why I’d rather vote for the Devil!"

"I understand," said the candidate, "but in case your friend is not running, may I count on your support?"
eIMA Quiz
How much exercise do you really need?

A. 45 minutes twice a week.
B. 30 minutes three or four days a week.
C. 60 minutes at least three or four days a week.
D. 30 minutes at least four or five days a week.
E. It depends on your age and overall physical-fitness level.

Yesterday’s Mind Teaser: All are precancerous for carcinoma colon except

a. Crohn's disease
b. Bile acids
c. Fats
d. Carotene

Answer for Yesterday’s Mind Teaser: d. Carotene

Answers received from: Dr B R Bhatnagar, Dr Shangarpawar, Dr V R Tindwani, Dr Poonam Chablani, Dr K Raju, Daivadheenam Jella, Dr Avtar Krishan.

Answer for 26th August Mind Teaser: c) It is associated with APC mutation

Correct Answers received from: Dr Shangarpawar, Dr B R Bhatnagar, Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K Raju, Raghu Chaks, Dr Avtar Krishan, Daivadheenam Jella.
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Rabies News (Dr A K Gupta)
Is it essential to perform an antibody test on the patient following antirabies vaccination?

Antibody tests – rapid fluorescent focus inhibition test (RFFIT), mouse neutralization test (MNT) – are done only at select few reference centers in India. Antibody tests are not required on a routine basis following antirabies vaccination if vaccination is correct and reliable.
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CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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
IMA Community Service Day
On the occasion of "IMA Community Service Day" IMA Jabalpur Branch organised a free Health Check up and diabetes detection camp. State Secretary Dr. R.K. Pathak, Branch Secretary Dr. Kshitij Bhatnagar and other members participated. Dr. R.K. Pathak, Honorary State Secretary, IMA MP State Branch, Jabalpur
News
  • People around the world are living longer, but many are also living sicker lives for longer, according to a study of all major diseases and injuries in 188 countries. General health has improved worldwide, thanks to significant progress against infectious diseases such as HIV/AIDS and malaria in the past decade and gains in fighting maternal and child illnesses. But healthy life expectancy has not increased as much, so people are living more years with illness and disability, according to the analysis, published in The Lancet journal. The study's main findings were that global life expectancy at birth for both sexes rose by 6.2 years -- from 65.3 in 1990 to 71.5 in 2013. Healthy life expectancy at birth rose by 5.4 years -- from 56.9 in 1990 to 62.3 in 2013. (Reuters)
  • Life expectancy has increased in India, reports The Hindu, dated Aug 27, 2015. Life expectancy has increased by 6.9 years for men between 1990 and 2013 and 10.3 years for women during the same period, notes a study published today in the journal The Lancet. In 1990, the life expectance was 57.25 years for men, and 59.19 years for women. This has now increased to 64.16 years for men and 68.48 years for women in 2013. The healthy life expectancy has been more for women than men in India.
  • Natalie Kwit, DVM, from the Epidemic Intelligence Service and the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues have suggested that clinicians should consider human plague in any patient who has compatible symptoms and has reasonable risk factors. Key risk factors include residing or traveling in the western United States, recent proximity to rodent habitats, or direct contact with rodents or sick domestic animals (published online August 25 in the Morbidity and Mortality Weekly Report).
  • The first-ever three-dimensional (3D) printer system to manufacture denture bases has been cleared for marketing by the US Food and Drug Administration. Although currently designed for use in laboratories, the Dentca Denture Base may soon allow dentists to make dentures in their offices, said Dentca Chief Executive Officer Sun Kwon in a news release. (Medscape)
Very few dengue cases critical: IMA
The Asian Age

New Delhi: As the National capital witnessed maximum number of dengue cases in August compared to last five years, health experts said that risk of complications is in less than one percent of dengue cases. Indian Medical Association Secretary-General Dr KK Aggarwal said that a platelet transfusion is not needed if the platelet counts are more than 10,000 and unnecessary platelet transfusion can cause more harm than good. According to Dr Aggarwal, International guidelines say that unless a patient’s platelet count is below 10,000 and there is spontaneous active bleeding, no platelet transfusion is required. http://www.pressreader.com/india/the-asian-age/20150826/282454232742490/TextView
Beware of Dengue mosquitoes: They breed in fresh water and bite only during the day
Dengue cases are on rise, and everyone is rushing to find ways to protect him or herself from the disease. However, what most people must remember while taking necessary precautions is that dengue mosquitoes only bite during the day and breed in clean, fresh water.

Often people remain unaware of these facts and protect themselves from bites during the nights by using mosquito nets and repellent creams. They also feel that they are the safest when in clean urban environments, not realising that mosquitoes could be breeding in the clean water filled bucket kept in their backyard.

Remaining in well-screened or air-conditioned buildings during the day can reduce the risk of exposure. When outside during the day, one should wear clothing that reduces the amount of exposed skin and use an effective mosquito repellent.

In Focus

Speaking about the issue, Padma Shri Awardee Dr. KK Aggarwal, President HCFI & Honorary Secretary General IMA said in a press statement, "With the rising incidence of dengue in the city, it is extremely important that adequate precautions be taken against the disease. While dengue is only dangerous in 1% of the cases, dramatic plasma leakage can develop suddenly causing complications. Keeping this in mind, substantial attention must be placed upon the early identification of patients at higher risk of shock syndrome and other complications. Staying well hydrated is key for patients suffering from dengue."

To prevent complications due to dramatic plasma leakage, the following clinical parameters must be kept in mind:

Duration of illness: The period of maximum risk for shock is between the third and seventh day of illness. This tends to coincide with the resolution of fever. Plasma leakage first becomes evident between 24 hours before and 24 hours after the fever is over.

Alarm signs: Severe abdominal pain, persistent vomiting, an abrupt change from fever to hypothermia, or abnormal mental status, such as disorientation, are noted in a minority of patients.

Hematocrit: An elevation of the hematocrit is an indication that plasma leakage has already occurred and that fluid repletion is urgently required.

Platelet count: Severe thrombocytopenia (<100,000/mm3) is one of the clinical criteria for dengue hemorrhagic fever and usually precedes overt plasma leakage

Serum aspartate transaminase (SGOT):Mild elevations in serum transaminases are common in both dengue fever and dengue hemorrhagic fever. However, levels are significantly higher in patients with dengue hemorrhagic fever and elevated SGOT levels are noted earlier in illness.

Patients with suspected dengue who do not have any of the above indicators can be safely managed as outpatients as long as close clinical observation is assured. They must regularly consume fluids as the dangers of dengue come with dehydration.

Platelet transfusion is only needed when the counts are less than 10,000, and there is active bleeding. In all other scenarios, platelet transfusion is unnecessary and can cause more harm than good. Prevention of dengue is always better than cure since it is a painful illness.

A patient should be hospitalized only when:

• Blood pressure <90/60 mmHg
• Hematocrit >50 percent
• Evidence of bleeding other than petechiae

www.merinews.com/article/beware-of-dengue-mosquitoes-they-breed-in-fresh-water-and-bite-only-during-the-day/15909090.shtml#sthash.59jTg973.dpuf
To provide technical excellence to doctors, Lybrate ties up with Indian Medical Association as Digital Partner
New Delhi, August 26, 2015: Furthering its aim to democratize healthcare in India and make it accessible to the billion plus population of the country, Lybrate, Inc., India’s first and largest mobile healthcare communication and delivery platform, today announced being roped in as the digital partner by the Indian Medical Association (IMA) to educate the over 2.5 lakh doctors under its fold on how best to incorporate technology in their practice for communicating with patients and multiply their presence for reaching out to more people.

Lybrate’s efforts are in line with the Indian government’s visionary initiative of digitizing India that aims to use mobile internet for providing the Indian population benefits of its multifarious schemes and services. The healthcare technology platform is replicating the government’s plan to revolutionize healthcare delivery using technology. However, digitizing healthcare is not possible until doctors adopt technology, so Lybrate’s digital association with IMA has provided its vision a shot in its arms.

Under the partnership spanning over a year, Lybrate will provide technical excellence to IMA in innumerable ways. The foremost will be to coach its members, spread across 30 states and 1700 branches, and the entire medical fraternity about using technology for better communication with the patients and increase their presence across geographies, diminishing the boundary barriers.

“IMA is a prestigious body in the medical arena. It has been doing commendable things relating to people’s health involving its wide network of doctors. As Lybrate is also working to solve the fundamental problem of healthcare delivery in India that is inaccessibility of doctors, our goals are aligned with each other and support our objectives,” said Saurabh Arora, CEO, Lybrate.

“As IMA’s digital partner, it will be our endeavor to help bridge the skills gap in the healthcare sector with respect to technology. Doctors will be taught how to make effective use of the digital space to manage their practice better and communicate with more patients without moving from their place of practice. They will also be encouraged to help the masses by providing second opinions and sharing their experience and knowledge aimed at creating awareness about preventive side of medicine,” he added.

Other than educating doctors to effectively manage their practice online, Lybrate will also help make IMA technologically advanced in its functioning, aiding effective policymaking and programmes’ implementation. The company will also reach out to medical students under the partnership to impart training relating to digitizing practice, which they could immediately implement post their studies.

“The lack of clear guidelines as well as the absence of technical know-how among the medical fraternity have resulted in a slower growth of m-health and e-health space in India. Given the size and vastness of our country, the scope of digital healthcare is immense and if implemented in the right way, it can help solve many problems faced by the sector. We are extremely happy to come along with Lybrate as our digital partner and hope that together we can work towards making healthcare accessible to the people of India,” said a joint statement by Padma Shri Awardee Dr A Marthanda Pillai, National President IMA and Padma Shri Awardee, Dr K K Aggarwal, Hon’ble Secretary General IMA. http://techstory.in/lybrate-08262015/
eBOOKs
Kindly sign this petition: For allowing parliament to function
Link: https://www.change.org/p/members-of-parliament-political-parties-parliament-to-function-urge-all-political-parties-to-have-a-collaborative-and-consultative-process-in-the-parliament

Tiny url to pass on to other members: http://tinyurl.com/qff68sf

To sign, we can login through Facebook or email account on the right hand side.

Dr Marthanda Pillai,                        Dr KK Aggarwal
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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.

Team IMA
ICON 2015
Media
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Quote of the Day
The harder you fight to hold on to specific assumptions, the more likely there's gold in letting go of them. John Seely Brown.
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Thanx for enriching us scientifically, spiritually, medico–legally… Som Datt Bherwal
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Press Release
First-aid measures against snakebites

India is estimated to have the highest snakebite mortality in the world. The World Health Organization (WHO) estimates place the number of bites to be 83,000 per annum with 11,000 deaths. Most of the fatalities occur due to the victim not reaching the hospital in time where definite treatment can be administered.

There are about 236 species of snakes in India, most of which are nonpoisonous. Most people remain under the misconception that all snakes are dangerous; however, this is not the case. Bites from nonpoisonous snakes, apart from causing a panic reaction and local injury, do not harm the patient.

There are 13 known species that are poisonous; of these, four, namely common cobra (Naja naja), Russell’s viper (Dabiola russelii), saw-scaled viper (Echis carinatus) and common krait (Bungarus caeruleus) are highly venomous and believed to be responsible for most of the poisonous deaths in India.

Speaking about this, Padma Shri Awardee Dr KK Aggarwal, President Heart Care Foundation of India & Honorary Secretary General Indian Medical Association said, “One must always remember the basic first aid measures against snake bites. Timely action and treatment can completely eliminate mortality rates. One must also remember that not all snake bites are poisonous and unnecessary panic must be avoided. Initial first aid is directed at reducing the spread of venom and expediting transfer to an appropriate medical center.”

One must remember to:
  • Remove the patient from the snake's territory and help them stay calm and as still as possible.
  • Attempt to identify the snake only if it is safe for the patient and the rescuer.
  • Remove any jewelry from the affected extremity. Footwear can be removed, but other clothing can be left alone unless clearly tight and causing circulatory compromise.
  • Immobilize the injured part of the body with a splint.
  • Fashion a splint out of any rigid object (e.g. padded piece of wood or tree branch, rolled newspaper, sleeping bag pad, or backpack frame).
  • Transport the patient to the nearest medical facility as quickly as possible.
  • Do not allow the victim to walk because exertion and local muscle contraction may increase snake venom absorption.
  • Do not manipulate the wound except to permit gentle bandaging or, if indicated, pressure immobilization or placement of a pressure pad.
  • Withhold all alcohol and any drugs that may confound clinical assessment or interfere with treatment (E.g., anticoagulants, aspirin, non-steroidal anti-inflammatory medications, or beta blockers).
Methods to avoid: The following methods, while used widely in the past and advocated by some, cause more harm than good and should be avoided.
  • Incision and oral suction
  • Mechanical suction devices
  • Cryotherapy
  • Surgery
  • Electric shock therapy
For example, a common misconception is that one should apply a tourniquet, suck out the poison, and spit it out. However, this approach is strongly discouraged, since it can damage nerves, tendons, and blood vessels and lead to infection. Furthermore, venom removal by suction is minimal. Tourniquets may cut off arterial blood flow and cause significant ischemic damage, especially when left on for a prolonged period.