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18th October, 2017
Global issues discussed during the WMA General Assembly 
Dr KK Aggarwal
The World Medical Association (WMA) concluded its annual General Assembly in Chicago held from October 11-14. More than 50 national medical associations attended the annual General Assembly and discussed various global issues.
Dr Yoshitake Yokokura, President of the Japan Medical Association, was installed as President of the WMA for 2017-18. Dr Leonid Eidelman, President of the Israel Medical Association, was elected President elect. He will take office in a year's time to serve as President in 2018-19. 
Hunger strikes: The Assembly agreed that the WMA would support any physician who faces political pressure to take part in forced feeding of hunger strikers against their ethical advice. In a revision of its policy on hunger strikers, the WMA says that national medical associations 'have a responsibility to make efforts to prevent unethical practices, to take a position against ethical violations, and to investigate them properly'. Delegates agreed that where physicians are pressured to take part in torture, the WMA would protest internationally and publicize information about the case.
Bullying: A policy of zero tolerance towards bullying and harassment in the medical profession was supported by the meeting. Delegates agreed a statement condemning bullying under any circumstances and encouraging all national medical associations members, medical schools, employers, and medical colleges to establish and implement anti-bullying and harassment policies.
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Top News
HIV prevention 2020 road map to reduce new HIV infections by 75% by 2020: UN
The United Nations has launched a 10-point plan that lays out immediate, concrete steps countries can take to accelerate progress in reducing new HIV infections. As part of global efforts to end AIDS as a public health threat, the Joint UN Programme on HIV/AIDS (UNAIDS), the UN Population Fund (UNFPA) and other partners launched on Tuesday the HIV prevention 2020 road map at the first meeting of the Global HIV Prevention Coalition to reduce new HIV infections by 75% by 2020. Cases of new HIV infections among adults have declined by only 11%, whereas in children, new HIV infections among children have fallen by 47% since 2010.
The 10-point action plan includes:
  1. Conduct a strategic assessment of key prevention needs and identify policy and programme barriers to progress
  2. Develop or revise national targets and road maps for HIV prevention 2020 
  3. Make institutional changes to enhance HIV prevention leadership, oversight and management
  4. Introduce the necessary legal and policy changes to create an enabling environment for prevention programmes
  5. Develop national guidance, formulate intervention packages, identify service delivery platforms and update operational plans
  6. Develop a consolidated prevention capacity-building and technical assistance plan
  7. Establish or strengthen social contracting mechanisms for civil society implementers, and expand community-based responses
  8. Assess available resources for prevention and develop a strategy to close financing gaps
  9. Establish or strengthen prevention programme monitoring systems
  10. Strengthen national and international accountability for prevention
(UN, October 11, 2017)
Practice Updates
Men develop irregular heartbeat earlier than women
Men develop atrial fibrillation about a decade earlier than women on average. Being overweight was also a major risk factor, according to a large new study published in the journal Circulation, October 16, 2017. New atrial fibrillation cases increased more in men (31%) than women (18%) with increases in body mass index (BMI); 31% in men and 18% in women.

Atypical presentation of Chikungunya virus infection more common in older adults
A retrospective study reported online September 21, 2017 in the Journal of the American Geriatrics Society says that in older adults, the acute phase of Chikungunya-virus (CHIKV) infection commonly do not have fever, joint pain, or both, the classical presentation of the infection. Typical presentation was present in 8.2% of older adults, while atypical presentation was seen in 29.6% of older adults.

Healthy lifestyle reduces heart attack, stroke risk after gestational diabetes
Analysis of data from the Nurses' Health Study II shows that women who have had gestational diabetes may be able to reduce or even eliminate their risk for cardiovascular disease by following a healthy lifestyle in the years after giving birth. The study is published October 16, 2017 in JAMA Internal Medicine.

Clinical practice update on the use of POEM in achalasia 
The American Gastroenterological Association (AGA) has released a clinical practice update on the use of per-oral endoscopic myotomy (POEM) in achalasia, published October 6, 2017 in the journal Gastroenterology. The recommendations state that if the expertise is available, POEM should be considered as primary therapy for patients with type III achalasia.

Use of multivitamin during pregnancy may reduce risk of autism and intellectual disability risk
New research published online October 4, 2017 in the BMJ suggests that the use of multivitamins in early pregnancy reduced the risk for autism spectrum disorder (ASD) and intellectual disability by 31% compared with no maternal use of multivitamins, iron, or folic acid.
eMedi Humor
Smart Kid

So little Johnnie comes home with his report card for 5th grade, and shows it to his mother. His Mom reads the report card and gets 'more and more upset as she sees his grades. "Johnnie, you have 5 "F's"and a "D" in Math! Wait until your Father sees this! 
So Johnnie's dad comes home from his job at the lab, looks the report card over thoughtfully. Johnnie's Mom says, "Well, aren't you going to say SOMETHING to him?" 
Johnnie's dad pulls him aside, and says, "Son, I think you are putting too much time and effort on your Math."
Medicolegal Corner
Can a doctor who has been convicted for a criminal act continue to practice?
No, a doctor who has been convicted by a Court of Law for offences involving moral turpitude/criminal acts
cannot practice (Regulation 7.5 MCI Act).
eMedi Quiz
The prevalence of skin infections in HIV infection is approximately
d. Extremely rare
Lifestyle Updates
eWellness: Tips on Water Hygiene
  1. Travelers should avoid consuming tap water.
  2. Avoid ice made from tap water.
  3. Avoid any food rinsed in tap water.
  4. Chlorination kills most bacterial and viral pathogens.
  5. Chlorination does not kill Giardia cysts.
  6. Chlorination does not kill amoeba cysts.
  7. Chlorination does not kill Cryptosporidium.
  8. Boiled/treated water is safe.
  9. Carbonated drinks, wine and drinks made with boiled water are safe.
  10. Freezing does not kill the organisms that cause diarrhea. Ice in drinks is not safe unless it has been made from adequately boiled or filtered water.
  11. Alcohol does not sterilize water or the ice. Mixed drinks may still be contaminated.
  12. Hot tea and coffee are the best alternates to boiled water.
  13. Bottled drinks should be requested without ice and should be drunk from the bottle with a straw rather than with a glass.
  14. Boiling water for 3 minutes followed by cooling to room temperature will kill bacterial parasites.
  15. Adding two drops of 5% sodium hydrochloride (bleach) to quarter of water (1 liter) will kill most bacteria in 30 minutes.
  16. Adding 5 drops of tincture of iodine to 1 liter of water will kill bacteria within 30 minutes.

ESpiritual: What is the importance of silence?
True silence is the silence between the thoughts and represents the true self, consciousness or the soul. It is a web of energized information ready to take all provided there is a right intent. The process of achieving silence is what meditation is.
Observing silence is another way of getting benefits of meditation. Many yogis in the past have recommended and observed silence now and then. Mahatma Gandhi used to spend one day of each week in silence. He believed that abstaining from speaking brought him inner peace and happiness. All such days he used to communicated with others only by writing on paper.
Hindu principles also talks about a correlation between mauna (silence) and shanti (harmony). Mauna Ekadashi is a ritual followed traditionally in our country. On this day the person is not supposed to speak at all and keep complete silence throughout day & night. It gives immense peace to the mind and strength to the body. In Jainism this ritual has a lot of importance. Nimith was a great saint in Jainism who long ago asked all Jains to observe this vrata. Some people recommend that on every ekadashi one should observe silence if not the whole day but for few hours in a day.
Deepak Chopra in his book "The Seven Spiritual Laws of Success" talks in great detail about the importance of observing silence in day today life. He recommends everyone should observe silence for 20 minutes every day. Silence helps redirecting our imagination towards self from the outer atmosphere. Even Swami Sivananda in his teaches recommend to observe mauna daily for 2 hours for ekadashi, take milk and fruits everyday, study one chapter of Bhagwad Gita everyday, do regular charity and donate one-tenth of the income in the welfare of the society. Ekadashi is the 11th day of Hindu lunar fortnight. Ekadashi is the day of celebration occurring twice a month, meant for meditation and increasing soul consciousness. Vinoba Bhave was the great sage of our country who is known for this bhoodaan movement. He was a great advocator and practical preacher of mauna vrata.
Mauna means "silence" and vrata means "bow". Mauna vrata therefore means bow of silence. Mauna was practiced by saints to end enmity and recoup their enmity. Prolonged silence as the form of silence is observed by the rishi munis involved for prolonged periods of silence. Silence is a source of all that exists. Silence is where conscious dwells. There is no religious tradition which does not talk about silence. It removes worldly communication and forces a dialogue towards inner communication that one reason why all prayer, meditation and worship or any other practice whether we attune our mains to the spiritual consciousness within are done in silence.  After the death of a person it is a practice to observe silence for two minutes. The immediate benefits is that it saves a tremendous amount of energy.
Silence is cessation of both sensory and mental activity. It is like having a still mind and listening to the inner mind. Behind this screen of our internal dialogue is the silence of spirit. Meditation is the combination of observing silence and the art of observation.
(Disclaimer: The views expressed in this write up are my own).
Inspirational: It's All Good
I heard the story told recently about a king in Africa who had a close friend that he grew up with. The friend had a habit of looking at every situation that ever occurred in his life (positive or negative) and remarking, "This is good!"
One day the king and his friend were out on a hunting expedition. The friend would load and prepare the guns for the king. The friend had apparently done something wrong in preparing one of the guns, for after taking the gun from his friend, the king fired it and his thumb was blown off. Examining the situation the friend remarked as usual, "This is good!" To which the king replied, "No, this is NOT good!" and proceeded to send his friend to jail.
About a year later, the king was hunting in an area that he should have known to stay clear of. Cannibals captured him and took them to their village. They tied his hands, stacked some wood, set up a stake and bound him to the stake.
As they came near to set fire to the wood, they noticed that the king was missing a thumb. Being superstitious, they never ate anyone that was less than whole. So untying the king they sent him on his way.
As he returned home, he was reminded of the event that had taken his thumb and felt remorse for his treatment of his friend. He went immediately to the jail to speak with his friend. "You were right" he said, "it was good that my thumb was blown off." And he proceeded to tell the friend all that had just happened. "And so I am very sorry for sending you to jail for so long. It was bad for me to do this."
"No," his friend replied, "this is good!"
"What do you mean, "this is good"! How could it be good that I sent my friend to jail for a year."
"If I had NOT been in jail, I would have been with you."
Trauma-related deaths can be prevented by timely action
Need for more trauma centres across cities that are up-to-date and organized
New Delhi, 17 October 2017:In India, one person dies of a road accident every minute, indicate statistics. Road accidents account for about 1,50,000 deaths every year. Injuries and the resultant trauma rank fourth in the causes of death across all age groups children, adolescents, and young adults. These are also reasons for more premature deaths than cancer, heart disease or other such diseases.(1) On World Trauma Day, there is a need to raise awareness on the fact that majority of these trauma-related deaths can be prevented through timey action and medical care.
Many deaths occur either within minutes of the injury, at the scene of accident or injury, before the victim is taken to the medical facility, or immediately upon arrival at the hospital. Some of the reasons for death include massive hemorrhage or severe neurological injury.
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