August 30   2015, Sunday
Water Hygiene
Dr KK AggarwalSafe water is an essential commodity to prevent most water and food-borne diseases like diarrhea, typhoid and jaundice. These diseases are 100% preventable. All of them can be lethal if not prevented, diagnosed or treated in time.

Transmission of parasitic infections can also occur with contaminated water. Here are a few tips:
  • Travelers should avoid consuming tap water.
  • Avoid ice made from tap water.
  • Avoid any food rinsed in tap water.
  • Chlorination kills most bacterial and viral pathogens.
  • Chlorination does not kill giardia cysts.
  • Chlorination does not kill amoeba cysts.
  • Chlorination does not kill cryptosporidium.
  • Boiled water is safe.
  • Treated water is safe.
  • Bottled water is safe.
  • Carbonated drinks, wine and drinks made with boiled water are safe.
  • 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.
  • Alcohol does not sterilize water or the ice. Mixed drinks may still be contaminated.
  • Hot tea and coffee are the best alternatives to boiled water.
  • Bottled drinks should be requested without ice and should be drunk from the bottle with a straw rather than with a glass.
  • Boiling water for 3 minutes followed by cooling to room temperature will kill bacterial parasites.
  • Adding two drops of 5% sodium hydrochloride (bleach) to quarter of water (1 liter) will kill most bacteria in 30 minutes.
  • Adding five drops of tincture of iodine to a quarter of water (1 liter) will kill bacteria within 30 minutes.
Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
The US Food and Drug Administration (FDA) has approved a new type 2 diabetes drug that combines the sodium glucose cotransporter 2 (SGLT2) inhibitor empagliflozin with metformin hydrochloride.


Total hip replacement (THR) factors, including cement and type of prosthesis, have a significant effect on the survival of the prosthesis, suggests new research published online in JAMA Surgery.

The investigational anti-CD38 monoclonal antibody daratumumab has demonstrated promising single-agent activity in patients with difficult-to-treat multiple myeloma, suggested a new study published online in the New England Journal of Medicine.

Pain Medicine

Older women with lower back pain who add pilates to their physical therapy routine may observe improvements in balance and reductions in fear of falling that do not result from other types of exercise, suggests a Spanish study published online in the journal Maturitas.

Obstetrics and Gynecology

Women with inflammatory arthritis who are currently using oral contraceptives (OCs) or who have used them in the past have better patient-reported outcomes within the first 2 years of being diagnosed with the disease, suggest the findings from the Course and Prognosis of Early Arthritis (CAPEA) inception cohort published online in Arthritis Care & Research.
Cardiology eMedinewS
Obstetrics and Gynecology

A new study published in the Journal of the American Society of Nephrology has revealed that the siblings of women who have high blood pressure during pregnancy may be at an increased risk of developing hypertension later in life.


Eating foods rich in amino acids could be as good for your heart as stopping smoking or getting more exercise, suggests new research from the University of East Anglia (UEA), published in the September issue of the Journal of Nutrition.
Pediatrics eMedinewS

Researchers from the Norwegian University of Science and Technology (NTNU) have found a link between aggression and variants of a particular gene in children. The findings, published in Developmental Psychology, help to substantiate 'differential susceptibility,' where some individuals are more susceptible to environmental conditions partly due to genotype.


New research suggests that survivors of childhood cancer have a high risk of suffering a stroke at a surprisingly young age. The findings are published online in Neurology.
Dr KK Spiritual Blog
Importance of vitamin D in mythology

Today it is a known fact that majority of people in India are vitamin D deficient. It was probably known to our Rishi Munis and they created rituals so that everybody could get vitamin D from sunlight. Shahi snan in sunlight has been mentioned in our Vedic literature.
  • The months of Magha, Vaishakha and Kartik are considered as months for Shahi Snans where one is supposed to worship sun early in the morning and eat calcium-rich food whether it is Urad Ki Daal or sesame seeds.
  • Chhat pooja, which falls immediately after Diwali, is also linked to worship of sun.
  • The Marghshirsha month immediately after the month of Kartik also involves worshipping sun.
  • Kartik purnima and Vaishakh purnima are especially known for sun worshiping.
Vitamin D deficiency has been linked with metabolic syndrome, heart diseases and also with fertility. All these months when sun is worshipped are also the months of increased fertility. After the chaturmas ends, Tulsi vivah starts the marriage season during which one worships both Tulsi and Amla. Both of them are known to increase the quantity of semen and increased ovulation.

Probably, the age old treatment of infertility was to acquire vitamin D, taking calcium-rich food and consume both tulsi and amla on regular basis.

The current vitamin D mantra is that 40 days in a year for atleast 40 minutes, one should expose 40% of the body to the sunlight either after sunrise or just before sunset.
Scientific awareness on personal hygiene and prevention from obesity among school going children, S D Public School, Pitampura-27-8-15
Make Sure
Situation: A patient with LDL cholesterol 100 mg% and hsCRP 3 developed MI
Reaction: Oh my God! Why was a statin not started earlier?
Lesson: Make sure that all patients with even normal cholesterol are considered for statins if the hsCRP is high.
Dr Good Dr Bad
Situation: A 16–year–old female was diagnosed to have calcific lesions in the ventricles on a CT scan.
Dr Bad: This is a typical case of neurocysticercosis.
Dr Good: This is not neurocysticercosis.
Lesson: Calcification in neurocysticercosis is seen only in the parenchyma and not in the ventricles or cisterns.

(Copyright IJCP)
eMedinewS Humor
Communication technician

A communication technician drafted by the army was at a firing range. At the range, he was given some instructions, a rifle and 50 rounds. He fired several shots at the target. The report came from the target area that all attempts had completely missed the target. The technician looked at his weapon, and then at the target. He looked at the weapon again, and then at the target again. He then put his finger over the end of the rifle barrel and squeezed the trigger with his other hand. The end of his finger was blown off, whereupon he yelled toward the target area: "It’s leaving here just fine, the trouble must be at your end!"
eIMA Quiz
What is not true for HNPCC?

a) It is the most common hereditary colorectal cancer syndrome in USA.
b) It is associated with MMR gene mutation.
c) It is associated with APC mutation.
d) It is associated with carcinoma colon and extraintestinal cancers.

Yesterday’s Mind Teaser: Since sunscreen-awareness campaigns began, have skin cancer rates decreased?

A. Yes, fewer people are getting skin cancer.
B. No, skin-cancer rates and deaths from the disease are on the upswing.
C. No, skin cancer is on the rise, but fatalities are down.
D. Skin-cancer rates have been stable over the past decade.
E. Yes, but only among older women.

Answer for Yesterday’s Mind Teaser: B. No, skin-cancer rates and deaths from the disease are on the upswing.

Answers received from: Dr G Madhusudhan, Dr Poonam Chablani, Dr B R Bhatnagar, Dr K V Sarma, Dr K Raju, Dr Shangarpawar, Dr Ridu Kumar Sharma.

Answer for 28th August Mind Teaser: D. 30 minutes at least four or five days a week

Correct Answers received from: Dr Avtar Krishan, Daivadheenam Jella, Dr Bitaan Sen & Dr Jayashree Sen, Dr Jainendra Upadhyay.
Rabies News (Dr A K Gupta)
The IM dose of Verorab (PVRV) and Abhayrab (PVRV) is 0.5mL; that of Rabipur (PCEC) and PVRV (Coonoor) is 1mL. Is the ID dosage of all vaccines uniformly 0.1mL?

The ID dosage of all approved vaccines is uniformly 0.1 mL per ID site irrespective of their IM dosage
IJCP Book of Medical Records
IJCP’s ejournals
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
Press Release
A second attack of dengue can be more dangerous than the first one

If a person has suffered from dengue in the past year, they must take additional precautions to prevent the disease because a second attack of dengue may be more dangerous than the first attack, said Padma Shri Awardee, Dr KK Aggarwal, President HCFI & Hony. Secretary General IMA.

Elaborating on this, Dr. Aggarwal further said that there are four different types of dengue and one can, therefore, suffer from dengue four times in his or her lifetime. The second or subsequent dengue infections tend to be more serious. A person with dengue can also simultaneously suffer from malaria. Malaria and dengue together can lower platelet counts to a dangerous level leading to complications. One must however always remember that platelet transfusion in dengue patients can cause more harm than good and must only be administered if a persons platelet count is less than 10,000 and he has active bleeding

In a monsoon season, everyone should avoid taking aspirin for fever as it can precipitate bleeding if the person isinfected with dengue.

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. The symptoms include severe joint and muscle pain, swollen lymph nodes, headache, fever, exhaustion, and rashes. Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is directed toward relief of the symptoms. The acute phase of the illness with fever and myalgias lasts about one to two weeks.

In dengue, most complications occur within two days of the fever subsiding and most people are casual during this period. Any abdominal pain, giddiness or weakness after the fever has subsided should be attended to, by a doctor. Dengue complications during this period are due to a shift of blood volume and patient requires a rapid infusion of oral or intravenous fluids in large quantities.

The risk of complications is in less than 1% of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided. The onus of prevention lies in the hands of each person. We must not let mosquitos breed around our houses, wear full sleeve clothes while going out and use mosquito repellent in the monsoon season.
eIMA News
IMA Community Service Day
IMA Gwalior Branch distributed free food to poor people. State President Dr AS Bhalla, Past State President Dr. Ashok Mishra, Branch President Dr DK Jain, Secretary Dr HS Kushwaha and other members participated. Dr RK Pathak, Honorary State Secretary, IMA MP State Branch, Jabalpur
Medical negligence, sub-standard drugs caused Chhattisgarh sterilisation tragedy: Panel
Aug 26, 2015 21:42 IST, PTI Raipur: The distribution of "sub-standard" and "poison-contaminated" medicines besides "medical negligence" led to the death of 13 women at family planning camps in Chhattisgarh's Bilaspur district last year, as per the judicial commission which probed the botched tubectomies.

The report of the panel was on Wednesday tabled before the state cabinet at a meeting chaired by Chief Minister Raman Singh at the secretariat here. "As per the conclusions of the report, distribution of sub-standard and poison-contaminated medicines and medical negligence (at the sterilisation camps) led to the incident," Health and Family Welfare Minister Ajay Chandrakar told reporters after the meeting.

The camps were organised by the Bilaspur district administration at Sakari village on 8 November and at Gaurela, Pendra and Marwahi on 10 November. While 13 out of several women who underwent the procedure at the camps died, many others fell ill and were hospitalised.

A one-member judicial commission was set up to probe the incident, which submitted its report to the government on 10 August.

The Minister said the cabinet has decided to take a stringent disciplinary action against the officials and employees concerned who have been found guilty in the probe. He said legal action will be taken against manufacturers and suppliers of sub-standard and poison-contaminated medicines (ciprocin 500 and ibrufen 400) distributed at the sterilisation camps. Besides, appropriate action will be taken by Health, Education, Higher Education and General Administration departments as per recommendations laid down by the Commission to avoid such incidents in future, he added.

Lybrate ties up with IMA to train registered doctors on using technology
India’s first and largest mobile healthcare communication and delivery platform Lybrate has announced that it has been roped in as digital partner by the Indian Medical Association (IMA), to educate the over 2.5 lakh doctors under its fold on effective ways to incorporate technology into their practice, to communicate with patients and reach out to more people.

PTI | 26 August 2015, 5:38 PM IST

New Delhi: India's first and largest mobile healthcare communication and delivery platform Lybrate has announced that it has been roped in as digital partner by the Indian Medical Association (IMA), to educate the over 2.5 lakh doctors under its fold on effective ways to incorporate technology into their practice, to communicate with patients and reach out to more people.

Under the partnership - which will span a year - Lybrate will provide technical training to IMA, coaching its members - spread across 30 states and 1,700 branches - and the medical fraternity at large about using technology for better communication with patients, as well as on increasing presence across geographies.

"As IMA's digital partner, it will be our endeavour 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," said Saurabh Arora, CEO of Lybrate. "They will also be encouraged to help the masses by providing second opinions and sharing their experience and knowledge aimed at creating awareness about the preventive side of medicine."

Lybrate will also reach out to medical students under the partnership to impart training relating to digitising practice, which they can immediately implement post their studies.

"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 hope to work together with Lybrate towards making healthcare accessible to the people of India," said a joint statement by Dr A Marthanda Pillai, national president of IMA and Dr KK Aggarwal, secretary general of IMA.

Lybrate will look at associating at other levels with the umbrella body of doctors to help more people benefit moving forward.
Non-medical items may soon disappear from chemist shops
Himani Chandna, Hindustan Times, New Delhi Updated: Aug 28, 2015 01:29 IS

Baby food, soaps and health supplements could soon disappear from your friendly neighbourhood chemist’s shelves if the government decides to turn this proposal into a regulation. According to minister of state for chemicals and fertilisers Hansraj Gangaram Ahir, “Companies buy consumer trust by selling products at pharmacies. Products like Nestle Cerelac and Johnson & Johnson’s baby soaps, or health supplements are not meant for sale at medical stores.”

“We are considering a proposal to restrict pharmacies from selling categories apart from drugs and medical devices, where over 7 lakh pharmacies would only sell approved products,” Ahir told HT.

And there’s a Maggi element in this plan. The recent controversy over instant noodles made by Nestle India had also featured the company’s baby food supplement, Nan Pro, coming under the safety scanner. The noodle row saw the government expanding its vision to think of banning the sale of baby food, cosmetics, health supplements and similar other non-medical products at pharmacies.

“These products are not medicines and people should not buy them under the impression that they are safe, effective and good for health because medical stores sell them,” Ahir said.

Consumer activists and chemists’ organisations don’t agree. “We strongly oppose the move. It would impact the volume of sales at medical stores and drastically impact the availability of non-medical products across the country,” said JS Shinde, president, All-India Organisation of Chemists and Druggists.

There is no clause at present under the Drugs and Cosmetics Act, 1940 to regulate the list of products that can be sold at pharmacies.

One is allowed to open a medical store after seeking a licence from the Food and Drug Administration (FDA). Bejon Misra, a consumer activist, trashed the move. “The government should encourage more competition and choice. If consumers would not get a product from a medical store, they would buy it from some other shop but after facing inconvenience.”

Control of pharmacies comes under state governments, and that means a central proposal can be rejected. “Medical stores get licence under the D&C Act which is governed by the central government but implemented by state governments and state drug controllers,” Shinde said. Mails sent to companies that are likely to be affected by such regulation did not get any response till late on Thursday.
  • Penny Yin, MD, from the Department of Medicine, University of Toronto, Ontario, Canada, and colleagues have reported in their study published online August 17 in JAMA Internal Medicine that positive urinalysis results can introduce cognitive biases in favor of a UTI diagnosis, even when patients lack accepted criteria. Positive results from these asymptomatic patients significantly increased their odds of receiving additional low-value care, including urine cultures and antibiotics for asymptomatic pyuria or bacteriuria.
  • Vaccination campaigns that use a single dose of oral cholera vaccine (OCV) may be able to prevent more deaths than the standard two-dose campaign, according to a modeling study published online August 25 in PLOS Medicine. Such a strategy may be especially important when vaccine supplies are limited or when an outbreak is characterized by complex logistics.
  • Jeffrey R. Kaiser, MD, of Baylor College of Medicine in Houston, and colleagues report in JAMA Pediatrics that transient hypoglycemia (<35 mg/dL) in a newborn was associated with the decreased likelihood of proficiency on literary achievement testing (adjusted odds ratio 0.49, 95% CI 0.28 to 0.83) and mathematics achievement testing (adjusted OR 0.49, 95% CI 0.29 to 0.82) as a fourth grader. (Medpage Today)
  • The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America have collaborated with the International Antiviral Society-USA to update several sections of their website devoted to the treatment of hepatitis C virus (HCV) infection. The update includes a new section that provides an overview of costs, reimbursement, and cost-effectiveness consideration for the HCV treatment regimens.
  • In 2013, the top ten causes of disability-adjusted life years (DALYs) in both sexes in India were from ischemic heart disease, COPD, TB, lower respiratory infections, neonatal preterm birth, neonatal encephalopathy, diarrhoea, stroke, road injuries, and low back and neck pain. For Indian men, the fastest-growing leading causes of health loss between 1990 and 2013 were self-harm, ischemic heart disease and stroke, which increased at rates of 149.9 per cent, 79.9 per cent, and 59.8 per cent respectively. While self-harm did not figure among India’s top ten causes of health loss in 1990, it is ranked tenth in men in 2013. Iron-deficiency anaemia, which was ranked ninth in 1990 in men, is no longer the cause of health loss in 2013. In the case of women, the largest increases among the leading causes of disability-adjusted life years occurred for ischemic heart disease (69 per cent), depressive disorders (66.1 per cent), and stroke (36.8 per cent). Only ischemic heart disease was among the 10 leading causes of health loss for women in 1990. (The Hindu, Aug 27, 2015)
Inspirational Story
Be Positive

Father: "I want you to marry a girl of my choice." Son: "I will choose my own bride!"

Father: "But the girl is Bill Gate’s daughter." Son: "Well, in that case… ok"

Next Father approaches Bill Gates. Father: "I have a husband for your daughter."

Bill Gates: "But my daughter is too young to marry!" Father: "But this young man is vice–president of the World Bank."

Bill Gates: "Ah, in that case… ok" Finally Father goes to see the president of the World Bank.

Father: "I have a young man to be recommended as your vice–president." President: "But I already have more vice–presidents than I need!"

Father: "But this young man is Bill Gate’s son–in–law." President: "Ah, in that case… ok"

This is how business is done!!

Moral: Even if you have nothing, you can get anything. But your attitude should be positive.
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Quote of the Day
Honesty is something you can’t wear out. Waylon Jennings
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Wellness Blog
Mobile phone Illnesses

Up till now the debate has been whether mobile radiations can cause brain cancer or not. However, there is a range of diseases related to use of mobile phones and it is anticipated that 10 years from now they will take an epidemic shape
  • Computer vision syndrome: It occurs in 90% of people who use computer for more than 3 hours at a stretch. It leads to drying of eyes and headache. To prevent it, take a 20 seconds break after every 20 minutes and look at a distance of 10 feet for these 20 seconds.
  • Blackberry thumb: This is inflammation of the tendons in the thumb leading to pain. This can be prevented by alternatively using fingers while texting on a Blackberry phone.
  • Stiff neck occurs due to constant use of mobile in one hand with neck flexed. It can be prevented by alternative shifting of phone from one hand to another.
  • Cellphone elbow is a pain in the elbow because of the stretching of ulnar nerve because of use of mobile phone in a flexed position. Using hands–free set can prevent this.
  • Nomophobia: It is present in 50% of the mobile users and is a type of mobile addiction. The term literally means, ‘no mobile phobia’, which means that a person always fears losing his/her phone.
  • Ringxiety: It is the anxiety resulting due to not receiving a call in the last 30 minutes. It is present in 30% of the mobile users.
  • Phantom ringing: It is present in 20–30% of mobile users. You can feel that your phone is ringing but when you check, it is actually not ringing.
  • Social site addiction: With the growing popularity of smartphones, one is addicted to Facebook, internet, Twitter and other such applications. These can cause insomnia, fragmented sleep, etc.
  • After TV, Facebook is the second leading cause of relational disharmony within the family and is present in 20% of the houses.
  • Smartphone is a cause for parent–child conflict in 30% of the cases. Often children stay up late and go to school unprepared. On an average, people spend 30–60 minutes in bed playing with their smartphone before sleeping.
  • Electronic curfew means not using any electronic gadgets 30 minutes before sleep.
  • Facebook holiday: Take a Facebook holiday for 7 days every three months.
  • Social media fast: Avoid use of social media once in a week for the entire day.
  • Use your mobile phone only when mobile.
  • Do not use computer for more than 3 hours in a day.
  • Limit your mobile talk time to not more than 2 hours in a day.
  • Do not recharge your mobile battery more than once in a day.
Mobile phones may also be a source of infection in the hospital setup.
Reader Response
Dear Sir, very useful information. Regards: Dr Karan
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