February 5  2015, Thursday

Treatment of mild hypertension in low-risk patients
Dr KK Aggarwal
There is no convincing data to show the benefit from antihypertensive therapy in patients with mild hypertension and no preexisting cardiovascular disease.

A meta–analysis combined four placebo–controlled trials totaling 8912 patients with mild hypertension and no preexisting cardiovascular disease (1). During 4 to 5 years of follow–up, antihypertensive therapy resulted in lower rates of mortality and stroke but higher rates of myocardial infarction. Low-risk patients with mild hypertension and no preexisting cardiovascular disease who fail to reduce their blood pressure with lifestyle modification should receive antihypertensive therapy.

Treatment of hypertension in frail older adults

Older adults who are frail may not benefit from antihypertensive therapy. In an observational study of 2340 adults older than 65 years, the association between blood pressure and mortality was examined according to whether or not individuals were frail (2). Frail is defined as an inability to walk six meters in less than eight seconds. Among frail adults, there was no association between blood pressure and mortality. In addition, a higher blood pressure was associated with a lower risk of death among the most frail (i.e., those who could not walk the distance at all).

  1. Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev 2012;8:CD006742.
  2. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 2012;172:1162.



IMA White Paper on Cancer Prevention

News Around the Globe
  • Most patients presenting to the emergency department (ED) with syncope or dizziness may not benefit from a computed tomography (CT) scan of the head unless they are older than 60 years, have a focal neurologic deficit, or have a history of recent head trauma, researchers have found. Myles Mitsunaga, MD, resident at John A. Burns School of Medicine, University of Hawaii, Honolulu, and Hyo-Chun Yoon, MD, from the Department of Diagnostic Imaging, Kaiser Foundation Hospital, Honolulu, studied the clinical factors that potentially predict acutely abnormal head CT findings and hospital admission. (MedPage)
  • Curcumin, a constituent of the turmeric rhizome, is a bright-yellow polyphenolic compound, chemically diferuloylmethane. Preliminary research suggests that turmeric and curcumin have a variety of pharmacologic properties, including anti-inflammatory, antitumor, and antimicrobial activities. Some research suggests that curcumin might have neuroprotective and antioxidant activity, which might be useful for treatment of seizures. Studies in several animal models have shown that curcumin can reduce seizures that have been induced chemically or electrically. (Medscape)
  • The US Food and Drug Administration has approved the empagliflozin/linagliptin combination as adjunctive treatment to diet and exercise for adults with type 2 diabetes. The tablets contain 10 or 25 mg of empagliflozin and 5 mg of linagliptin.
  • Even just a little jogging done at a very easy pace helps in increasing longevity, suggests a new analysis. However, too much running, done more frequently, for longer periods, or at a greater intensity, was not associated with any additional mortality benefits compared with sedentary nonrunners. The report is published February 2 in the Journal of the American College of Cardiology.
  • Women with polycystic ovary syndrome (PCOS) are at heightened risk for a number of long-term adverse cardiovascular, metabolic, psychological, oncologic, and reproductive health consequences, reported a new study published online in the Journal of Clinical Endocrinology & Metabolism.
  • The more boxers and martial arts practitioners experience head trauma, the more likely they are to have lower brain volume, particularly caudate and thalamus volume, suggests a new study published online in the British Journal of Sports Medicine.

U.K. Parliament approves controversial three-parent mitochondrial gene therapy

By Gretchen Vogel Erik Stokstad

The United Kingdom’s House of Commons voted overwhelmingly to allow British researchers to pursue a new fertility treatment that could prevent certain kinds of genetic diseases. The technique, called mitochondrial DNA replacement therapy, could allow women who carry disease-causing mutations in their mitochondrial genes to give birth to genetically related children free of mitochondrial disease.

The measure, which passed 382 to 128, has been controversial, especially because it would alter the DNA of an embryo in a way that could be passed on to future generations. Some scientists and nongovernmental organizations have argued that not enough is known about possible side effects of the technique to go forward in human patients. “We believe the House of Commons has made a serious mistake, which we hope does not have dire consequences,” said Marcy Darnovsky, executive director of the Center for Genetics and Society in Berkeley, California, in a statement.

Proponents of the measure quickly began to celebrate. “I am delighted that (members of Parliament) have voted to allow the introduction of mitochondrial transfer techniques into the clinic," said John Tooke, president of the Academy of Medical Sciences in London, in a statement. Robert Meadowcroft, head of the Muscular Dystrophy Campaign in London, added: “We have finally reached a milestone in giving women an invaluable choice, the choice to become a mother without fear of passing on a lifetime under the shadow of mitochondrial disease to their child."

Mitochondria are the energy-producing engines of a cell. These organelles contain their own set of genes, called mtDNA. When mitochondria don’t work properly, a variety of symptoms can result, which can make mitochondrial diseases difficult to recognize and diagnose. Some babies born with defective mitochondria die within months. Other people don’t show any symptoms until much later in life.

Researchers have developed ways to transfer the genetic material from an egg cell that carries faulty mitochondria into a donor egg that has healthy mitochondria. The resulting embryo carries nuclear DNA from the mother and father and mitochondrial DNA from the egg donor.

Some scientists have argued that potential mismatches between donated mtDNA and host nuclear DNA could cause unanticipated problems. However, several ethical and scientific reviews and a public consultation in the United Kingdom all supported allowing the Human Fertilisation and Embryology Authority (HFEA) to grant licenses for experimental use of the technique in humans. (Previously, HFEA was not allowed to grant licenses for any techniques that would alter the DNA in an embryo.)

The measure must also be passed by the House of Lords. Approval does not necessarily mean that the technique will be used. Fertility clinics will have to apply for a license to use the technique, and each application will be judged on its own merits.

Regulators in the United States are also considering whether to allow the technique. The Food and Drug Administration held a 2-day hearing on the science of mtDNA replacement last year. They have asked the Institute of Medicine to issue a consensus study on the ethical and social policy issues the technique raises. The committee held its first meeting on 27 January; further meetings are planned for March and May. (Science)

Even Numbers & Non-Bailable Offences in Law

Mostly odd numbers in end of IPC section are safer in law & bailable than even numbers, which are non-bailable.

Some examples of non-bailable offences related to forensic medicine.

IPC 274: Adulteration of drugs

IPC 302: Murder

IPC 304: Culpable homicide - 304B dowry death.

IPC 306: Abetment of suicide.

IPC 308: Attempt to commit culpable homicide.

IPC 314: Causing Death by act with intent of miscarriage.

IPC 316: Causing Death of a quick unborn child.

IPC 324: Dangerous weapon causing hurt.

IPC 326: Dangerous weapon causing grievous hurt.

IPC 332: Voluntarily causing hurt to deter public servant from duty.

IPC 354: Outrage modesty of woman (354B-intent to disrobe woman).

IPC 364: Kidnapping for murder/ransom.

IPC 370: Human trafficking.

IPC 372: Selling/hiring minor for prostitution.

IPC 376: Rape.

IPC 384: Extortion.

IPC 392: Robbery.

IPC 406: Criminal Breach of trust.

IPC 420: Cheating.

IPC 436: Mischief by fire/ Explosive.

IPC 466: Forgery of a record of -court/ Birth & Death register/ kept by public servant.

IPC 498A: cruelty to married woman.

Exceptions of odd numbers in end of IPC which are non-bailable:

IPC 303: Murder by person under sentence for life imprisonment.

IPC 305: Abetment of suicide committed by child, insane or intoxicated.

IPC 307: Attempt to murder.

IPC 313: Miscarriage without women’s consent.

IPC 333: Voluntarily causing grievous hurt to deter public servant from duty.

IPC 377: Unnatural offences.

IPC 379: Theft.
(Contributed by: vivekanshu)

Dr KK Spiritual Blog

Why do We Worship the Tulsi Plant?

Yanmule sarvatirhaani, Yannagre sarvadevataa,
Yanmadhye sarvavedaascha,Tulasi taam namaamyaham

“I bow to the Tulsi, At whose base are all the holy places, At whose top reside all the deities and In whose middle are all the Vedas.”

The Tulsi or Sacred Basil is one of the most sacred plants. There is a Sanskrit saying: “Tulanaa naasti athaiva tulsi” that which is incomparable in its qualities is the tulsi. It is the only pooja samagri which can be washed and reused.

Satyabhama once weighed Lord Krishna against all her legendary wealth. The scales did not balance until a single tulsi leaf was placed along with the wealth on the scale by Rukmini with devotion. Thus, tulsi played the vital role of demonstrating that even a small object offered with devotion is of greater value than all the wealth in the world.

The Tulsi leaf has great medicinal value and is used to cure various ailments, including the common cold.

Tulsi (shyama) seeds are good for male infertility and increase the viscosity of semen and sperm counts (as per Ayurveda). It has detoxifying properties and is used in fasts including the Satynarayana Katha where a thousand tulsi leaves are added to the water for pooja, and which is consumed later by everybody.

Tulsi is worshipped in the months of Magh and Kartik. Tulsi vivah is observed in the month of Kartik and is the symbolic marriage of Lord Vishnu in the form of a shaligram (sacred stone) and Tulsi. It indicates the importance of Tulsi for fertility. Tulsi pooja is an important component of any marriage.

Cardiology eMedinewS
  • There seem to be no significant differences in pregnancy loss, need for high-level neonatal care, or overall maternal complications in women with mild-to-moderate hypertension at 14 to 33 weeks gestation randomized to tight vs. "less-tight" BP control, suggested an international trial. However, women assigned to tight BP control were significantly less likely to develop severe hypertension. The report is published online in the New England Journal of Medicine.
  • Prescribing the antibiotic trimethoprim-sulfamethoxazole in tandem with spironolactone, a diuretic used to treat patients with heart failure, can double an older patient's risk for sudden death, suggests a new study published online February 2 in the Canadian Medical Association Journal.

Pediatrics eMedinewS
  • At 24 months of age, moderately preterm children appear to have less-developed receptive communication skills than their term-born peers, suggests a new study published online in Archives of Disease in Childhood.
  • A new study has found that at the age of 6 years, children who had four or five early-life risk factors had a 47% higher fat mass and were 4.65 times more likely to be overweight or obese than those with no risk factors. The study is published in The American Journal of Clinical Nutrition.

Make Sure
Situation: A 62–year–old diabetic with coronary artery disease, on treatment for the same, comes for follow up.

Reaction: Oh my God! Why was he not put on antioxidants?

Lasson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

Beneficiaries of Heart Care Foundation Fund


(Contributed by Dr MC Gupta, Advocate)

Q. A patient was advised admission but he declined to be admitted. His condition deteriorates. He files a complaint against the doctor alleging negligence, saying that the doctor should have advised admission but he never did so. The doctor has a carbon copy of the prescription given to the patient where he has written that "Advised admission. Refused." It does not bear the signature of the patient. What is its legal validity?

It may have some validity but the patient is likely to say that:
  • He was not given any prescription slip at all. OR
  • He has lost the slip but it did not contain the words "Advised admission. Refused" and that these words have been added later on.
It is advisable that the refusal should be signed by the patient. If he refuses to sign, this fact should be testified by somebody else such as another doctor or staff member.

Dr Good Dr Bad

Situation: A patient with hypertension had non–responding cough.

Dr. Bad: Take an X–ray.

Dr. Good: Stop ACE inhibitors.

Lesson: The commonest cause of cough in a patient with high blood pressure is the intake of ACE inhibitors.

(Copyright IJCP)

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eMedinewS Humor

Never be rude to anyone

An American tourist asked a boat guy in Zanzibar, "Do you know Biology, Psychology, Geography, Geology or Criminology?" The boat guy said, "No. I don’t know any of these."

The tourist then said, "What the hell do you know on the face of this Earth? You will die of illiteracy!"

The boat guy said nothing. After a while the boat developed a fault and started sinking. The boatman then asked the tourist, "Do you know Swimology and Escapology from Crocodiology?"

The tourist said, "No!"

The boat guy replied, "Well, today you will Drownology and Crocodiology will eat you. I will not Helpology and you will Dieology because of your Badmouthology."

Twitter of the Day

Dr KK Aggarwal: Diabetes is a progressive disease http://bit.ly/15QdVeB #Health

Dr Deepak Chopra: You were created to be completely loved and completely lovable, for your whole life http://bit.ly/15QdVeB #Health
Wellness Blog
Triphala can help in reducing bronchial hyperreactivity
Triphala (TRP), a herbal extract, has been shown to affect lymphocytes and natural killer T (NKT) cell function. It has been shown to ameliorate bronchial hyperreactivity through immune–cell modulations. In a study carried out at the Division of Allergy, Immunology and Pulmonary Medicine, Washington University in Saint Louis, Saint Louis, MO, asthma mouse models were generated through intraperitoneal (IP) injections of ovalbumin (OVA)/2 weeks followed by repeated intranasal OVA challenges. Mice were then treated with normal saline (OVA/NS) or Triphala (OVA/TRP). Data were compared with mice treated with inhaled budesonide.

Both TRP and budesonide significantly ameliorated functional and histological OVA–induced bronchial hyperreactivity. Triphala causes a significant decrease in bronchial reactivity. It alters immune–cell distributions and show antioxidative properties. Immune–cell modulation with triphala can ameliorate lung injury.

(Ref: Horani A, Shoseyov D, Ginsburg I, et al. Triphala (PADMA) extract alleviates bronchial hyperreactivity in a mouse model through liver and spleen immune modulation and increased anti-oxidative effects. Ther Adv Respir Dis 2012 Aug;6(4):199–210).

CPR 10

Total CPR since 1st November 2012 – 101090 trained

eMedi Quiz

Haemorrhage secondary to heparin administration can be best corrected by administration of:

1. Vitamin K.
2. Whole blood.
3. Protamine.
4. Ascorbic acid.

Yesterday’s Mind Teaser: Raised serum level of lipoprotein (a) is a predictor of:

1. Cirrhosis of liver.
2. Rheumatic arthritis.
3. Atherosclerosis.
4. Cervical cancer.

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

Correct Answers received from: Daivadheenam Jella.

Answer for 3rd Feb Mind Teaser: 2. Herpes simplex virus.

Correct Answers receives: Dr Poonam Chablani, Dr. Jainendra Upadhyay, Dr Avtar Krishan, Daivadheenam Jella, Thulasi suji.

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,

Rabies News (Dr A K Gupta)

Is there a need to alter the dose or schedule of any concomitant medication during IDRV?

There is no need to alter the dose or schedule of any concomitant medication during IDRV.

Video of the Day
Quote of the Day
The best thing about dreams is that fleeting moment, when you are between asleep and awake, when you don’t know the difference between reality and fantasy, when for just that one moment you feel with your entire soul that the dream is reality, and it really happened. Johann Wolfgang von Goethe

About the Editor

Padma Shri, 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)
ET Health World: An initiative of The Economic Times

'Cancer control in India': Prof Dr A Marthanda Pillai, National President, IMA

Cancer has become an important public health problem in India with nearly 25 lakh cases in the country at any given point of time. Importantly, 71% of cancer deaths occur in patients in their prime productive years (between 30 and 69 years of age)

Increasing burden of Cancer

Classical infectious disease rates have declined while increased rates of so-called modern diseases like heart disease, cancer and immune deficiency diseases are now being observed in epidemic proportions throughout the world. India is experiencing a rapid epidemiological transition, with a large and rising burden of chronic diseases, which were estimated to account for 53% of all deaths and 44% of Disability Adjusted life Years (DALYs) lost in 2005. Non-communicable diseases (NCDs), especially Diabetes Mellitus, cardiovascular diseases (CVD), cancer, stroke and chronic lung diseases have emerged as major public health problems due to an ageing population and environmentally-driven changes in behaviour.

Cancers are increasingly affecting poor people in developing countries, many of which are inadequately prepared. The costs of treating cancers are high and contribute a lot to household poverty. Globally, cancer is one of the top ten leading causes of death. It is estimated that 83.2 million would die due to cancer by the end of this year. Among women, breast cancer is the most common cause of cancer mortality, accounting for 16% of cancer deaths in adult women. In developing countries, the top five female cancers in rank order of incidence are breast, cervical, stomach, lung and colorectal cancer and the top five male cancers are lung, stomach, liver, esophageal and colorectal cancer.

Although information about cancer in India is incomplete, as the Commission by Paul Goss and colleagues published in The Lancet Oncology in 2014 showed that after being in operation for 30 years, population-based registries cover only 7% of patients with cancer; cancer is now emerging as an important health problem, and already causes 6% of all adult deaths in India every year (055 million). 50% of all cancer deaths in India can be attributed to oral and lung cancer in men and cervical and breast cancer in women, with 40% of all cancers attributable to tobacco use. The most common sites of cancer in men are the oral cavity, lung, oesophagus, and stomach; in women, the most common cancers are cervical, breast, and oral cavity cancers. Data from urban cancer registries (with the exception of Chennai) shows that breast cancer is the most common type of cancer among women and its incidence is increasing. Although the incidences of most cancers are low in India, the mortality burden from cancer is higher than UK and USA.

Cancer has become an important public health problem in India with nearly 25 lakh cases in the country at any given point of time. Importantly, 71% of cancer deaths occur in patients in their prime productive years (between 30 and 69 years of age). Mortality is twice as high among the least educated (1066 per 100 000 population) than among the most educated (457 per 100 000 population) groups. Despite the incidence of cancer in rural areas being half of those in urban areas, age standardised mortality rates for cancer were similar in rural and urban areas. India's class structure affects the incidence of some cancers, for instance, 90% of rural patients with oral cancer are poor.

The major risk factors to cancer are tobacco, unhealthy diet, physical inactivity, stress and consumption of alcohol. The cancer registry data reveals that 48% of cancers in males and 20% in females are tobacco related and are totally avoidable. Common cancers caused by smoking tobacco are lung, larynx, pharynx and oesophagus, while cancers of the mouth, tongue and lip are due to chewing and smoking tobacco. The National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS) proposes to supplement ongoing government efforts by providing technical and financial support to states in effective cancer control and care. In all, 27 RCCs and 50 Govt. Medical College Hospitals are currently supported to provide super specialty cancer care in the Government Sector.

Way forward

The country badly needs more reliable information regarding the occurrence and distribution of cancers as well as demographic and risk factors, for which we need more population based cancer registries. We need to establish and assess effectiveness of prevention and screening programmes. Reduction of tobacco use in all age groups and detection and treatment of stage I breast cancer is highly cost effective for primary and secondary prevention of cancer. India should effectively implement tobacco control activities in line with the WHO Framework Convention on Tobacco Control. All women of the age group 30-69 years approaching a hospital should be screened at regular intervals (opportunity screening) for early detection of cervix cancer and breast cancer.

As promised by the National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke, District hospital should have required equipments and laboratory services.NCD Clinic at District Hospital shall provide regular management and annual assessment of persons suffering from cancer, including day care chemotherapy facility for patients on chemotherapy regimens. Community based palliative care program should be established with a field nurse trained in identifying symptoms, pain management, communication, psychosocial & emotional care, nursing needs of the terminally ill and ethics of palliative care.

More Government Medical Colleges and private institutions (in PPP mode) should be converted to Tertiary Cancer Centres with facilities like Radiotherapy, Surgical Oncology, Medical Oncology, pain and palliative care services, cancer diagnostics equipments, CT scan, other related departments etc. including Cobalt Source. Cost of cancer drugs is an important factor in affordability of cancer care. Even though we comply with the World Trade Organization directives, India patent laws still allow for more equitable access to cancer treatment.

Public awareness should include messages on include increased intake of healthy foods, increased physical activity through sports, exercise, avoidance of tobacco and alcohol; stress management and warning signs of cancer. Government should maximize the available opportunities in our patent laws to take the benefit of new anti-cancer drugs to majority of our cancer patients

ET Health World: An initiative of The Economic Times

'Most cancers can be prevented': Dr. KK Aggarwal, Honorary Secretary General, IMA

Price control is very necessary to provide people with affordable cancer medicines

The prevalence of cancer in our country is not uniform all over. There is a difference in the types of cancer that affect people basis rural and urban settings. We have seen that in rural women, cervical cancer is the most widespread while in urban women, breast cancer is the most rampant. In case of men, rural people are majorly affected by cancers of the oral cavity while rural men are greatly inflicted by cancer of the lung.

In India, tobacco causes 90% of cancers. It is made to believe that the tobacco industry should not be shut as it generates employment and is a huge source of revenue for the country. However, the truth is that the revenue generated by the tobacco industry is much lesser when compared to the money spent on the treatment of patients affected with cancer caused due to tobacco abuse. Given this light, the government must ensure that stricter laws and regulations govern this industry and a curb is put specially on its promotion among the young and more vulnerable.

In addition to this there is also a lot of debate regarding the price of cancer medicines. As per the Indian Patent Law, if any medicine from abroad is introduced in India, the prices cannot be reduced unless it is proved that the disease which that particular medicine treats is of critical importance. Cancer medicines are critical given their role in helping saving lives and must be subject to strict price controls. At present the margins on these medicines is extremely large and in a matter of life and death profits cannot be something that determine the availability of such essential medicines.

Cancer has become an epidemic with a steep rise in the incidence of the disease. However, the irony is that cancer medicines are very expensive and beyond the reach of a common man. Thus, price control is very necessary to provide people with affordable cancer medicines. Government should include cancer drugs too under the Jan Aushadhi scheme wherein people can buy low cost generic medicines of cancer from any chemist shop. The govt should get cancer medicines for the benefits of the population at large. Currently, under this scheme the government has identified 504 essential medicines which include antibiotics, painkillers, vitamins and medicines used mainly in the treatment of diabetes, gastroenterology and respiratory diseases.

Government should also take adequate steps to ensure early diagnosis of cancer because it has been a proven fact that early diagnosis save lives

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NABH Update

Wellness center is an healthcare facility that provides scientifically proven physical interventions with repeatable positive outcomes for improvement or maintenance of physical form, enhancement of functions or improvement of beauty* for achieving the state of wellness of an individual. (Gymnasiums, Spas, Skincare Centers, Cosmetic Care Centers, Fitness Centers, Immunization Centers, Executive Health Checkup Centres with associated advice etc)

Tip of the day for safe and effective strength training Breathe out when you are lifting or pushing; breathe in as you slowly release the load or weight. Never hold your breath while straining. Valsalva maneuver can temporarily raise your blood pressure considerably and can be risky for people with cardiovascular disease.

10 Worst Medical Treatment Dangers 2015
"Dose Creep" in Diagnostic Radiation Exposures
The progress from film to the use of digital detectors in diagnostic radiography has led to "dose creep," whereby radiation exposure levels are increased by clinicians over time in order to achieve better image quality. Patients may be exposed to unnecessarily high radiation levels. The cumulative effect on patients subjected to multiple studies—particularly neonatal patients—can become significant. ECRI recommends that hospitals investigate whether a software upgrade is available if digital radiology systems aren't already equipped to use the standardized exposure index.
(Source: Medscape)

Medscape Family Physician Lifestyle Report 2015
Family Physicians Burnout and Vacation Time
Although studies suggest that taking time off reduces stress, the United States is one of only 13 countries in the world that do not mandate vacation time. Approximately one fourth of US workers do not have paid time off; about half are in the bottom fourth of earners vs a much smaller 10% of those in the top quarter.[12] Even US family physicians don't fare very well in terms of vacation time. Nearly half (46%) of burned-out family physicians take 2 weeks or less each year, with 7% having no vacation, compared with 34% and 3%, respectively, of their non–burned-out peers.


Inspirational Story
Temper Control

There once was a little boy who had a bad temper. His father gave him a bag of nails and told him that every time he lost his temper, he must hammer a nail into the fence.

The first day the boy had driven 37 nails into the fence. Over the next few weeks as he learned to control his anger, the number of nails hammered daily, gradually dwindled down. He discovered it was easier to hold his temper than to drive those nails into the fence. Finally the day came when the boy didn’t lose his temper at all. He told his father about it and the father suggested that the boy now pull out one nail for each day that he was able to hold his temper.
The days passed and the young boy was finally able to tell his father that all the nails were gone. The father took his son by the hand and led him to the fence. He said "you have done well, my son, but look at the holes in the fence. The fence will never be the same. When you say things in anger, they leave a scar just like this one."
You can put a knife in a man and draw it out. It won’t matter how many times you say I’m sorry, the wound is still there. Make sure you control your temper the next time you are tempted to say something you will regret later.
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The Year in Medicine 2014: News That Made a Difference
Readers Respond: Most Proud
The Medscape survey also asked what medical news this year made our members most proud to be a clinician. Forty-eight percent of respondents said the launch of curative treatments for hepatitis C virus infection. The second choice, at 24%, said that the cases of Ebola contracted in the US were cured made them most proud. Third choice was that a nephrologist, Rita McGill, donated her kidney to a stranger, and fourth was the first birth by a woman with a uterine transplant. Under "other," several members said that physicians going to West Africa to fight Ebola made them most proud, others named the implementation of the ACA and the fight against MOC. And finally 19% of those who selected "other" (but 1.4% of the total respondents) said none, nothing, or not applicable.(Source: Medscape)
Press Release of the Day
IMA White Paper on Cancer Prevention
IMA Delhi State Cancer Institute Initiative
World Cancer Day: On the occasion of World Cancer Day, the Indian Medical Association said that cancer is preventable and curable provided it is detected early. IMA National President Padma Shri Awardee Dr A M Pillai and Honorary Secretary General Padma Shri Awardee Dr K K Aggarwal released guidelines for cancer prevention for the public.
Addressing a press conference here today the IMA officials said that any symptoms or sign which is unusual, appearing for the first time or which cannot be explained should not be ignored.
Padma Shri Awardees Dr Rajesh Grover and Dr Ashok Vaid, in a joint statement said that most cancers can be prevented with a correct and healthy lifestyle. The following guidelines were released at the press conference.
Nine warning signals of cancer
  1. Unusual bleeding or discharge from any site or orifice (even a single episode, especially if painless).
  2. A lump, nodule or swelling in any part of the body (especially in breast).
  3. An ulcer or wound anywhere that does not heal, including mouth cavity.
  4. Persistent irritating cough or hoarseness of voice.
  5. Indigestion or pain difficulty during swallowing.
  6. Recent change in bowel or bladder habits.
  7. Obvious change in shape, size or appearance of a wart or mole.
  8. Repeated headaches, progressive change in vision, convulsions or progressive weakness of one part or side of the body.
  9. Unexplained irregular fever, progressive weight loss, and persistent loss in appetite or progressive weakness.
General lifestyle recommendations
  • Say no to active and passive tobacco and smoking.
  • Be physically active.
  • Maintain a healthy weight and abdominal (waist) circumference.
  • Eat a diet rich in fruits, vegetables, and whole grains and low in saturated/trans fats.
  • Limit alcohol intake.
  • Protect against sexually transmitted infections.
  • Avoid excess sun.
  • Get regular screening for breast, cervical, and colorectal cancer.
IMA Delhi State Cancer Institute Pledge
I will keep
  1. Myself away from tobacco/betel/quid in all forms like smoking, chewing, sniffing, dental paste/powders etc.
  2. In my meals regularly a variety of vegetables, fruits, whole grains - red/yellow/green leafy vegetables, fruits, beans etc.
  3. Away from non-vegetarian food and even if I take, I shall limit consumption of red meat (like beef, pork, lamb) and avoid processed meats.
  4. Myself free from HPV (Human Papilloma Virus), HBV (Hepatitis B Virus) and HIV (Human Immunodeficiency Virus) infections.
  5. Myself physically active and do at least 30 minutes of exercise every day.
  6. My weight within normal range.
  7. Low, my consumption of high energy low fiber foods and drinks.
  8. Low, my consumption of high salty, pickled, smoked foods and foods processed with salt.
  9. Alcohol consumption to the minimum, if at all I take.
  10. My children on breastfeed exclusively for up to first 6 months after birth and then add other liquids and foods (if applicable).
  11. Compliance with the recommendations of my doctors during treatment as well as during follow-up, in case I happen to suffer from cancer at any stage in my life.
  12. My fight back against cancer and will not default in treatment, if I ever happen to suffer from cancer.
  13. Myself checked up once in a year, even if I do not have any symptoms.
Some Facts
  • Tobacco is responsible for 90 percent of all lung cancer deaths.
  • Tobacco is tied to many other cancers.
  • Red meat consumption may promote colorectal cancer.
  • High intake of tomatoes probably decreases prostate cancer risk.
  • Vitamin D may reduce the risk of colorectal cancer.
  • Adequate calcium intake may protect against colorectal cancer but high calcium intake (>2000 mg/day) increases risk for prostate cancer.
  • Folate in diet has been associated with a decreased risk of colon and breast cancer, especially in women who drink alcohol.
  • Alcohol intake, even in moderate quantities, increases the risk for colon, breast, esophageal and oral cancer.
  • Physical activity is inversely related to risk for colon and breast cancer.
  • Excess weight increases the risk of many cancers.
  • HPV, HCV, HIV and Helicobacter pylori have been linked to human cancers.
  • Exposure prevention, screening, vaccination for HPV and early treatment for abnormal cervical findings and HIV infection can prevent cancer.
  • Aspirin and NSAIDs offer protection against adenomatous polyps and colorectal cancer.
  • Tamoxifen decreases incidence of breast cancer in high-risk women.
  • The anti-diabetic drug metformin is associated with reduced cancer incidence in patients with type 2 diabetes.
Reader Response
Dear Sir, Very informative news. Regards: Dr Kanak