March 29  2015, Sunday
editorial
Natural foods and not supplements prevent heart disease
Dr KK AggarwalOne should take seasonal and locally grown natural foods and vegetables grown out of organic farms. Eat less, dinner lighter then lunch, eat natural and in moderation– are few of the mantras.

Eating food supplements can be harmful. According to the American Heart Association (AHA), supplementation with beta-carotene and vitamin E, either alone or in combination with each other or other antioxidant vitamins does not prevent heart disease.

High dose vitamin E supplementation (400 IU/day) may be associated with an increase in all–cause mortality.

Supplementation with vitamin C does not prevent a second heart attack.

Beta carotene supplementation may be dangerous and should be discouraged.

Vitamin E supplementation may be of benefit for only secondary prevention in heart patients with chronic renal failure who are undergoing hemodialysis.

The AHA concluded that current data do not justify the use of antioxidant supplements for the prevention or treatment of cardiovascular disease risk.

The above recommendations apply to supplementation only. Diets that are rich in natural antioxidants are associated with lower cardiovascular mortality.
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IMA Kancheepuram: Swine Flu – H1N1 Awareness Rally 26.03.2015
News
  • New guidelines from the American Gastroenterological Association (AGA) suggest that incidental pancreatic cysts should not undergo aggressive evaluation. The new guidelines are published online March 25 in the Annals of Internal Medicine.
  • The Advisory Committee on Immunization Practices (ACIP) recommends the 9-valent human papillomavirus vaccine as one of three HPV vaccines that can be used for routine vaccination, according to a report published in the March 26 issue of Morbidity and Mortality Weekly Report.
  • Patients with a higher total fibromyalgia score have poorer outcomes following arthroplasty, even if they fall below the threshold for an actual diagnosis of fibromyalgia, pointed a new observational cohort study published in Arthritis and Rheumatology.
  • A new study, published in Phytomedicine, has revealed that Rhodiola rosea, also referred to as roseroot, could be a potential treatment option for depression.
  • Results from two randomized trials suggest that initial improvements in difficult-to-treat forms of psoriasis persisted for a year with the phosphodiesterase 4 (PDE4) inhibitor apremilast. Among patients who attained at least 50% improvement in nail psoriasis after 16 weeks, 69% maintained the improvement at 52 weeks. Similar 52-week results were observed in patients who had scalp and palmoplantar psoriasis that responded to apremilast at 16 weeks. The findings were presented at the American Academy of Dermatology meeting.
Dr KK Spiritual Blog
On 9th Navratri enjoy the spiritual powers

Siddhidatri is worshipped on the ninth day of Navratri. She gives all eight siddhis – Anima, Mahima, Garima, Laghima, Prapti, Prakamya, Iishitva and Vashitva. She rides on a lion or on a lotus. She has four hands and looks pleased.

Spiritual mantra on the 9th Navratri: By the 9th day of spiritual detoxification, one gets all spiritual powers.
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Cardiology eMedinewS
  • Moderately strenuous aerobic exercise can improve cardiovascular health in patients who have received an implantable cardioverter-defibrillator (ICD), without causing the device shocks that many patients fear working out might cause, suggests new research published in Circulation.
  • Background statin therapy, even the use of high-dose statin therapy, does not seem to affect the ability of alirocumab to reduce LDL-cholesterol levels in patients at high cardiovascular risk, suggests a new analysis of the investigational inhibitor of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor. The study was presented at EAS 2015: the European Atherosclerosis Society 2015 Congress.
Pediatrics eMedinewS
  • A new study shows that hepatitis B virus (HBV) infection exposure increases the immune system maturation of infants, which may give a better survival advantage to counteract bacterial infection during early life. The study is published March 25 in Nature Communications.
  • Measuring minimal residual disease (MDR), or the amount of leukemic cells in the bone marrow, on day 19 and 46 of therapy initiated to induce remission offers considerable guidance on how pediatric patients with acute lymphoblastic leukemia (ALL) should be clinically managed, suggests a report published online in the Lancet Oncology.
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Make Sure
Situation: A patient with rheumatic arthritis was not given penicillin prophylaxis, and subsequently developed another attack.

Reaction: Oh my God! Why was the prophylaxis not started?

Lesson: Make sure that one administers secondary prophylaxis in the setting of suspected poststreptococcal reactive arthritis for up to one year after the onset of symptoms. Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued.
Medicolegal
What is exhumation?

In case of foul play, controversy or dispute related with any unnatural or natural death of a person or persons or death allegedly due to any criminal action and where the cremation had been already performed without any legal investigation and postmortem examination or the reliability of the previous investigation or postmortem examination is proved prima facie doubtful, exhumation of the body is done for further investigation.
  • The word exhumation literally means ‘out of ground.’ The word exhumation comes from Latin words ex meaning ‘out of’, and humus, meaning ‘ground.’
  • Exhumation is necessary, when the first post–mortem was inadequate, and it is thought that a second post–mortem may bring some more facts to light means exhumation combined with doing a second meticulous post–mortem.
  • The dead body can only be exhumed when there is a written order from executive magistrate or a higher Court of Law of the land.
  • In exhumation, the concerned police official should approach the appropriate government hospital in writing along with the order of exhumation to constitute a medical board of at least three qualified and experienced doctors.
  • Material found in exhumation/spot and further examination should be done as per law.
  • Resting places and the norm of many cultures is that the dead should not be disturbed. However, for a variety of reasons, they are disturbed through the process of exhumation.
Dr Good Dr Bad
Situation: A patient with Mediclaim wanted angiography.

Dr. Bad: Get admitted for minimum 24 hours.

Dr. Good: You can go after six hours.

Lesson: If you can justify that due to technological advances, hospitalization is required for less than 24 hours, Mediclaim will be applicable.

(Copyright IJCP)
Wellness Blog
Diabetics Should Undergo Cardiac Evaluation

All diabetics should have their cardiac examination done as cardiovascular disease accounts for 65% of deaths in patients with type 2 diabetes.

Intensive and aggressive management of diabetes can reduce the risk of getting future heart attacks. As per the new guidelines, all patients with diabetes should have a blood pressure below 120/80 mmHg and fasting blood sugar lower than 90 mg%. The ABC of diabetes management is to keep abdominal circumference lower than 32 inches in women and lower than 35 inches in men, blood pressure lower than 120/80 mmHg and LDL cholesterol less than 100 mg%.
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eMedinewS Humor
A couple in their 90s is having problems remembering things. During a checkup, the doctor tells them that they’re physically okay, but they might want to start writing things down to help them remember.

Later that night, while watching TV, the old man gets up from his chair. ‘Want anything while I’m in the kitchen?’ he asks.

‘Will you get me a bowl of ice cream?’ ‘Sure.’

‘Don’t you think you should write it down so you can remember it?’ she asks. ‘No, I can remember it.’

‘Well, I’d like some strawberries on top, too. Maybe you should write it down, so as not to forget it?’ He says, ‘I can remember that. You want a bowl of ice cream with strawberries.’

‘I’d also like whipped cream. I’m certain you’ll forget that, write it down?’ she asks.

Irritated, he says, ‘I don’t need to write it down, I can remember it! Ice cream with strawberries and whipped cream – I got it, for goodness sake!’

Then he toddles into the kitchen. After about 20 minutes, the old man returns from the kitchen and hands his wife a plate of bacon and eggs. She stares at the plate for a moment. ‘Where’s my toast?’
eMedi Quiz
A 64-year-old hypertensive obese female was undergoing surgery for fracture femur under general anaesthesia. Intra operatively her end-tidal carbon-dioxide decreased to 20 from 40mm Hg. followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1. Fat embolism.
2. Hypovolemia.
3. Bronchospasm.
4. Myocardial infarction.

Yesterday’s Mind Teaser: At the end of a balanced anaesthesia technique with non-depolarizing muscle relaxant, a patient recovered spontaneously from the effect of muscle relaxant without any reversal. Which is the most probable relaxant the patient had received?

1. Pancuronium.
2. Gallamine.
3. Atracurium.
4. Vecuronium.

Answer for yesterday’s Mind Teaser: 3.Atracurium.

Correct Answers received from: Viswanatha Sarma, Raju Kuppusamy, Dr Ravindra Kumar, Dr Avtar Krishan.

Answer for 27th March Mind Teaser: 4. Oxygen affinity of haemoglobin.

Correct Answers receives: Dr MadhuSudhan G, Dr Sharad S J, Dr G Madhusudhan.
Rabies News (Dr A K Gupta)
What is the criterion for "protection" after immunization?

The rabies virus neutralizing antibody (RVNA) titer of 0.5 IU/ml of serum in the vaccinated person is considered protective.

The facility for this test is available at NCDC, Delhi, CRI, Kasauli, Pasteur institute, Coonnor, NIV, Pune and NIMHANS, Bangalore.
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
IMA NEWS
Sonal Namaste
Antibiotics are not indicated for most children with acute watery diarrhea; suspected cholera is an important exception in which antibiotic therapy is warranted
Facts about Tuberculosis (TB)
How are TB and HIV related?
  • HIV is the strongest risk factor for tuberculosis among adults as it debilitates the immune system.
  • An HIV positive person is 20-40 times more likely to develop TB disease once infected with TB bacilli as compared to an HIV negative person.
Swine Flu – H1N1 Awareness Rally
As part of community services of IMA Kancheepuram branch, we have participated in ‘Swine Flu Awareness Rally’ organized by Tamil Nadu Food Safety & Drugs Administration Department – Kancheepuram division in association with Indian Academy of Pediatrics - Kancheepuram district branch & Chemist & Druggist Association – Kancheepuram.

Date: 26.03.2015, Thursday Time: 09.00 – 11.00 am
Venue: Theradi to Collectorate, Kancheepuram.

Presided by: Mr. M. Dhilipkumar, Assistant Director, Tamil Nadu Food Safety & Drugs Administration Department – Kancheepuram Division.

Rally Flagged off by:
Mr. V. Somasundaram, MLA, Kancheepuram.
Mr. Walajabad. P. Ganesan, MLA, Uthiramerur.

In presence of:
Dr. P. T. Saravanan, President, IMA Kancheepuram
Dr. S. Jeevanandam, Patron, IMA Kancheepuram
Dr. S. Yoganandan, President, IAP, TN State Chapter
Mr. Murthy, President, CDA, Kancheepuram

About 500 students from Adhibagavan College of Pharmacy and Kanchi Pallavan Engineering College participated as volunteers in this awareness program. They carried banners, placards & posters displaying the methods of prevention of swine flu in the community and also distributed awareness pamphlets to the public.

EVENT was nicely reported in both PRINT & Visual MEDIA.

Dr PT Saravanan President, IMA Kancheepuram, Fellowship Secretary, Tamil Nadu Orthopaedic Association, Sangeetha Ortho Center, 26/110-A, Kamarajar Street, Kancheepuram - 631501
Lifestyle changes can reduce heart disease
The Hindu, March 28, 2015: Lifestyle counselling and healthy change can reduce heart disease, noted non-government organisation Heart Care Foundation of India president K. K. Aggarwal.

He noted that an intensive effort to change lifestyle by controlling high blood pressure, cholesterol and smoking can substantially reduce the risk of heart disease.

Dr. Aggarwal noted that a trial called the EuroAction study, published in The Lancet compared the results of added counselling on lifestyle issues such as diet, physical activity and smoking to the usual care.

The study includes more than 3,000 people with coronary heart disease and 2,300 high risk people.

Half received counselling from a team of nurses, dieticians, physiotherapists and treating doctors. The counselling was given to families as well as individuals.

The trial included two groups of patients — one who had already developed coronary heart disease, and the other who were asymptomatic but at high risk due to a combination of risk factors with a high chance of developing heart disease in over 10 years.

“The study found that 55 per cent of those getting the counselling reduced their intake of saturated fat, compared to 40 per cent of those not getting the advice. Increased consumption of fruits and vegetables was seen in 72 per cent of the counselled group. Seventeen per cent increased consumption of heart-friendly oily fish, compared to 35 per cent and 8 per cent in the other group,” noted Dr. Aggarwal.

The doctor has advocated increased consumption of fruits and vegetables, heart-friendly oily fish and sustained daily physical activity.

Doing their bit for tuberculosis control, doctors associated with the Indian Medical Association (IMA) have jointly signed and released a message — “TB Haarega, Desh Jeetaga” and “Swachh Bharat, Swasth Bharat —TB Mukt Bharat”.

The IMA has demanded that all doctors registered with the Medical Council of India, through their respective State Medical Councils, must notify each and every case of TB in the interest of the nation.
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Inspirational Story
Dealing with Depression

The dictionary describes depression as a condition of general emotional dejection and withdrawal, sadness greater and more prolonged than that warranted by any objective reason.

The question here is why does one get depressed? Is it the inability to cope with the situation or the high stress levels that come with success or failure? Life is full of twists and turns, some pleasant others not so pleasant or at times dreadful. No one is devoid of problems in their lives. Everyone has their own personal set of problems.

Even the people who have a smile constantly on their face have problems. The only difference is they know how to tackle the problems of their life and smile about the fact that they can overcome those problems, similar to Mother Nature.

Someone compared the changes in Mother Nature with depression so aptly. He said each year nature sheds all its charm and the vibrant colors but then again it blooms to its optimum capacity to smile and teach us the most valuable lesson of life.

Seasonal changes are the main reason for depression in nature. Change is inevitable, be it in nature or in our life, but what are the changes is subjective. They may differ person to person, and so will the approach towards them.

Getting into depression is a normal phenomenon, but letting it over take us completely is not the best thing. There are no specific rules or concepts to deal with it, whatever way one feels is the best way, and one should adopt to tackle it.

Here are some really easy ways to tackle this "blown out of proportion problem".
  • Lead your life on the basis of fundamental values of what is right and what’s wrong.
  • Avoid hurting others and yourself too.
  • It is easier to change and adapt ourselves to new circumstances, than to expect vice versa.
  • Don’t make any decisions when angry or sad.
  • Fight it. If you can’t, then get help.
  • Enjoy nature; it’s free.
  • Spend time with our own self to introspect and retrospect daily.
  • Yell, scream or punch the bag if you feel like doing it.
  • Be joyful genuinely and not just put up the mask of happiness.
  • Last, but not the least, do not underestimate the power of Prayers.
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Quote of the Day
A dreamer is one who can only find his way by moonlight, and his punishment is that he sees the dawn before the rest of the world. Oscar Wilde
Reader Response
Tomatoes and prostate cancer is not a new news .I have known about it for some years. I think the prostate cancer prevalence in Italy is lower because of higher tomato consumption. Regards, Vijay Anthwal
7th April WHO Day
Heat It Boil It Cook it Peel it or forget it

IMA today released prevention tips regarding food safety. Giving details Padma Shri Awardee Dr A. Marthanda Pillai National president and Padma Shri Awardee Dr KK Aggarwal Honorary Secretary general IMA, said that if one is not sure about food safety one should follow the formula of: Heat it; boil it; cook it; peel it or forget it.

One should learn food and water hygiene. According to the World Health Organization, contaminated food can cause more than 200 diseases — and foodborne and waterborne diseases that cause diarrhea are estimated to kill 2 million each year worldwide.

Follow the general principles said DR Aggarwal. Keep clean; separate raw from cooked food; cook thoroughly; keep food at safe temperature and use safe water and raw materials.

Following guidelines were released
  1. Do not drink raw (unpasteurized) milk or foods that contain unpasteurized milk. Raw milk is milk from cows, goats, sheep, or other animals that has not been pasteurized (heat treated) to kill harmful germs. A wide variety of germs that can make people sick have been found in raw milk, such as Brucella, Campylobacter, Listeria, Mycobacterium bovis, Salmonella, and Shiga toxin-producing Escherichia coli, including E. coli O157. E. coli O157 can cause hemolytic uremic syndrome, which is a sometimes deadly cause of anemia and potentially permanent kidney failure. Raw milk contaminated with disease-causing bacteria does not smell or look any different from uncontaminated raw milk, and there is no easy way for the consumer to know whether the raw milk is contaminated
  2. Wash raw fruits and vegetables thoroughly before eating. They should be washed by rinsing well in running cold water and scrubbing, instead of by soaking in standing water.
  3. Keep the refrigerator temperature at 4.4ºC or lower
  4. Keep the freezer temperature at -17.8ºC or lower.
  5. Refrigerate foods promptly. Never leave cooked foods at room temperature for more than two hours (one hour if the room temperature is above 32ºC).
  6. Use precooked, perishable, or ready-to-eat food as soon as possible.
  7. Wash hands, knives, and cutting boards after handling uncooked food
  8. Do not eat pre-prepared salads
  9. Do not eat soft cheeses such as feta, Brie, and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, or Panela, unless they have a label that clearly states that the cheese is made from pasteurized milk.
  10. Bacteria like Listeria can grow in the refrigerator so, even if you consume foods that are considered safe, be sure to eat them from freshly opened packs and not from leftovers in the refrigerator.
  11. 2-Hour Rule: Put foods in the fridge or freezer within 2 hours after cooking or buying from the store. Do this within 1 hour if it is 90 degrees or hotter outside.
  12. Never thaw food by simply taking it out of the fridge. Thaw food: - In the fridge - Under cold water - In the microwave (thaw = pighlana)
  13. Marinate foods in the fridge. (TEL MASALE ADI KE MISHRAN MEN LAPETANA)
Non Vegetarian foods
  1. Keep raw meat, fish, and poultry separate from other food.
  2. Wash hands, knives, and cutting boards after handling raw meat, fish, or poultry.
  3. Thoroughly cook raw food from animal sources to a safe internal temperature: ground beef 71ºC; chicken 77ºC; turkey 82ºC and pork 71ºC.
  4. Seafood should be cooked thoroughly to minimize the risk of food poisoning.
  5. Eating raw fish (sushi) poses a risk for a variety of parasitic worms (in addition to the risks associated with organisms carried by food handlers). Freezing kills some, although not all, harmful microorganisms. Raw fish that is labeled "sushi-grade" or "sashimi-grade" has been frozen.
  6. Cook chicken eggs thoroughly, until the yolk is firm.
  7. Do not eat hot dogs, pâtés, luncheon meats, bologna, or other delicatessen meats unless they are reheated until steaming hot; avoid the use of microwave ovens since uneven cooking may occur.
  8. Avoid spilling fluids from raw meat and hot dog packages on other foods, utensils, and food preparation surfaces. In addition, wash hands after handling hot dogs, luncheon meats, delicatessen meats, and raw meat, chicken, turkey, or seafood or their juices.
  9. Do not eat pre-prepared ham salad, chicken salad, egg salad, tuna salad, or seafood salad.
  10. Do not eat refrigerated pates or meat spreads. Canned or shelf-stable products may be eaten.
  11. Do not eat refrigerated smoked seafood unless it has been cooked. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel, is most often labelled as "nova-style," "lox," "kippered," "smoked," or "jerky." The fish is found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. Canned or shelf-stable smoked seafood may be eaten.
Dry Fruits
  1. Humidity should be eliminated from any area where dry food is being stored.
  2. Any oxygen at all can be considered a threat to the quality of dry food and can actually decrease its shelf life.
  3. Keep it in its original packaging—since a product’s packaging is typically designed to keep its contents fresh. If an item’s original packaging has been tampered with, or it is not possible to keep the food inside of the packaging (due to limited space, bulky packaging etc.) then the best alternative is to disperse the products into a range of airtight containers. As a general rule of thumb, food storage areas should never have a humidity level that’s higher than 15%
  4. When dry food products are exposed to a lot of sunlight, photodegradation occurs, which causes foods to lose nutrients such as fats, proteins and vitamins.
  5. Dry food products should always be stored in a cool and well-ventilated area. In fact, the storage temperature for dry food should always be somewhere between 50°F and 70°F. Industry professionals recommend that the area where dry food is stored should be well-ventilated and void of any equipment that produces heat. This can include water heaters, steam generators and transformers.
  6. Keep track of when each and every item was first placed into the pantry. Do not eat after the expiry date.
General Precautions
  • People with diarrhea and/or vomiting should be cautious to avoid spreading infection to family, friends, and co-workers. A person is considered infectious for at least as long as vomiting or diarrhea continues, and sometimes longer depending upon the microbe.
  • Microorganisms that cause food poisoning are usually spread from one person to another by hand to mouth contact. As a result, hand washing, care with diapering, and staying out of work or school are a few ways to prevent infecting family and other contacts.