New consensus statement discourages contralateral prophylactic mastectomy

New consensus statement discourages contralateral prophylactic mastectomy Women diagnosed with breast cancer who are at average risk should be discouraged from undergoing a contralateral prophylactic mastectomy (CPM), because the majority of women will obtain no oncologic benefit, says a new consensus statement from the American Society of Breast Surgeons (ASBrS). The first part of the statement outlines the effect that CPM has on relevant clinical outcomes and which patients might be appropriate candidates for CPM. While, the second part focuses on issues such as how patients feel about CPM. Key recommendations from the position paper are: • Sentinel lymph node surgery on the CPM side should not be routinely performed • CPM is a cost-effective strategy for women with BRCA mutations. At this time, there is insufficient evidence to support the concept of superior cost effectiveness for CPM in women with sporadic breast cancer and the cost effectiveness is highly dependent on the quality of life assumptions. • Women should be counseled on the potential long-term outcomes of CPM on body image and sexuality. • Shared decision making that includes a comprehensive discussion of risks and benefits of CPM is important. • CPM counseling should include discussion of CPM, risks of CPM, rates of CBC, and ensure patients are engaged in the decision making, and making decisions that are concordant with their treatment preferences and personal values The position statements are published online July 28, 2016 in the Annals of Surgical Oncology. (Source: Medscape)

IMA hails PM taking up the cause of medical profession

IMA hails PM taking up the cause of medical profession

Dr K K Aggarwal PM Modi initiates health campaign and asks people to avoid taking antibiotics without the doctor’s prescription In his monthly address to the people of the nation in ‘Mann Ki Baat’, Prime Minister Shri Narendra Modi urged people to not take antibiotics without the prescription of a doctor since resorting to such short cuts to get better soon has been giving rise to new problems. He also asked the citizens to take antibiotics for the entire course prescribed by the doctors and not leave it midway as it can potentially lead to antibiotic resistance. He informed the people that the Government is resolute on stopping the menace of antibiotic resistance and that antibiotic medicine strips are now having a red line to warn the people. He suggested that in order to get well soon, consuming any antibiotic that is available easily, without consulting a doctor, is not a wise choice. While explaining the issue of antibiotic resistance, he stated that random and excessive use of antibiotics makes the causative organisms accustomed to the particular drug, and the drug thus loses its efficacy and utility. This practice of impetuous use of antibiotics thus creates newer problems that require years of research to find out solutions for. Additionally, leaving an antibiotic course, prescribed by a doctor, midway, or continuing it for longer than prescribed, both will harm the patient and help the bacteria. The causative organisms are fast undergoing mutations and rendering the once-effective antibiotics, ineffective now, thus adding to the problem of antibiotic resistance. While antibiotic resistance is a global public health problem, the issue nowhere is it as stark as in India. Resistance to fluoroquinolones among invasive Salmonella Typhi isolates in India was 8% in 2008 that rose to 28% in 2014. And antibiotic use itself is the most significant driving force behind this resistance. In the year 2010, India was the world’s largest consumer of antibiotics for human health, with consumption estimated at 12.9 x 109 units (10.7 units per person). It is high time that we start taking our health seriously and understand that the use of antibiotics without prescription is going to do more harm than good.

AAP updates guidelines for fetal alcohol spectrum disorders

AAP updates guidelines for fetal alcohol spectrum disorders The American Academy of Pediatrics (AAP) has updated guidelines to diagnose fetal alcohol spectrum disorders, published online July 27, 2016 in the journal Pediatrics. The new guidelines recommend evaluation of maternal alcohol consumption and that she should be interviewed carefully. Begin with more general questions about the child's health and then narrowing the focus to alcohol during and before pregnancy. The definition of alcohol exposure may include at least 6 drinks per week during at least 2 weeks of pregnancy, or at least 3 drinks per occasion on 2 or more occasions. Facial features should be evaluated. A positive result includes 2 of the following 3 criteria: short palpebral fissures, smooth philtrum, and thin vermilion border of the upper lip. If either facial features or maternal alcohol intake are positive, a neuropsychology evaluation is recommended. The guidelines also include a time line of the emergence of different developmental deficits, giving information on what to look for in infants, toddlers, and school-age children (Source: Medscape)

Hepatitis C may spell trouble for the heart

Hepatitis C may spell trouble for the heart This World Hepatitis Day, awareness needs to be created on the causes and effects of Hepatitis as also strategies for prevention and getting the right vaccination for this disease. New Delhi, July 28, 2016: Currently, around the world, about 400 million people are living with viral hepatitis, a liver disease responsible for the death of more people than that caused by HIV, malaria, and tuberculosis. Every year, about 1.4 million die of hepatitis, a figure that is shocking because hepatitis can be prevented! In the World Health Assembly 2014, 194 governments adopted a resolution to promote global action to prevent, diagnose, and treat viral hepatitis. A global strategy has been created by the World Health Organization to eliminate hepatitis B and C. This will be put forward for adoption during the World Health Assembly in 2016. While it is true that people infected with Hepatitis C are at a risk for liver damage, the infection may also spell trouble for the heart, according to a study. The study provides strong evidence suggesting that Hepatitis C can lead to cardiovascular damage. "People chronically infected with Hepatitis C are more likely to harbor abnormal fat-and-calcium plaques inside their arteries. This is known as atherosclerosis, a precursor to heart attacks and strokes. While it is not known exactly how the infection leads to the growth of artery-clogging plaque, the evidence is strong enough to look out for cardiac symptoms in people with Hepatitis C. It is important to look for signs of liver disease in people with Hepatitis C, but at the same time, physicians should also check the cardiac risk profile regularly. Annual cardiac examinations, including cholesterol and glucose testing, blood pressure checks, and assessment of lifestyle habits would also be helpful," said Padma Shri Awardee Dr. KK Aggarwal – President Heart Care Foundation of India and Honorary Secretary General IMA. The Hepatitis C virus is a bloodborne virus leading to an infection with severity range lasting few weeks and sometimes becoming a lifelong condition. The infection can occur through unsafe needle injection practices, inadequate sterilization of medical equipment, and the transfusion of unscreened blood and blood products. Infected people develop liver cirrhosis or liver cancer. Though it is possible to cure 90% of the infections through antiviral medicines, there is no vaccine for Hepatitis C. "Those with higher levels of circulating Hepatitis C virus in their blood have 50% more chance of having clogged arteries. If the infection is poorly controlled, it can lead to inflammation throughout the body thus fuelling blood vessel damage and resulting in heart problems. Hepatitis C is a manageable condition without any severe impact on health provided the diagnosis and treatment are done at the right time. It is essential that a person at risk discusses their case openly with a doctor and finds out the best ways to mitigate the effects of the infection on the liver and the cardiovascular system,” Dr Aggarwal added. It is important to maintain a healthy blood pressure and blood fat ratio to prevent heart disease. However, there is more work to be done if a person has Hepatitis C. Efforts should be made to minimize Hepatitis C viral load. Some steps to be taken include: • Abstaining from alcohol (as it causes the virus to flare-up) • Combating the illness with antiviral combination therapy (approximately half of those infected can conquer the virus) • Keeping cells healthy with antioxidants It is imperative to find ways to control the infection rather than letting Hepatitis C dictate the future of your heart. Follow suggestions from your physician to reduce the risk of coronary artery disease. Additionally, inhibiting the Hepatitis C virus will be beneficial for both the liver and heart

Bacterial infections linked to occurrence of manic episodes

Bacterial infections linked to occurrence of manic episodes

Dr KK Aggarwal
Individuals who are hospitalized with acute mania have a considerably higher rate of bacterial infections, as evident by the recent prescription of antimicrobial agents, says a new study published 17th July, 2016 in the journal Bipolar Disorders. Researchers analyzed recent prescription of systemic antimicrobial medications and the site of presumed bacterial infection in 234 individuals hospitalized for acute mania in either as inpatient or a day hospital. Patients hospitalized for other psychiatric disorders (n=368) vs controls (n=555) were also evaluated. • Patients hospitalized with acute mania had a substantially increased rate of recent antimicrobial prescription, defined as exposure within 3 days of ascertainment. • Overall, 7.7% individuals hospitalized for acute mania were prescribed antibiotics vs 1.3% controls. • Antibiotic prescription was associated with being on an inpatient unit vs being in the day hospital, and having increased mania symptom severity but not with other clinical ratings, demographic variables, or psychiatric medications. • The recent antibiotic prescription did not have any association with hospitalization for other psychiatric disorders. The urinary tract was the most common site of infection in women, while the respiratory tract and mucosal surfaces were the most common sites in men. Though the results did not show any cause and effect association, the authors suggest that the prevention and effective treatment of bacterial infections may be important interventions for the management of individuals with mania.

WHO encourages countries to act now to reduce deaths from viral hepatitis

WHO encourages countries to act now to reduce deaths from viral hepatitis

Dr K K Aggarwal Ahead of World Hepatitis Day falling on 28th July 2016, WHO is urging countries to take rapid action to improve knowledge about the disease, and to increase access to testing and treatment services. Today, only 1 in 20 people with viral hepatitis know they have it. And just 1 in 100 with the disease is being treated. Around the world 400 million people are infected with hepatitis B and C, more than 10 times the number of people living with HIV. An estimated 1.45 million people died of the disease in 2013 – up from less than a million in 1990. “The world has ignored hepatitis at its peril,” said Dr Margaret Chan, WHO Director-General. “It is time to mobilize a global response to hepatitis on the scale similar to that generated to fight other communicable diseases like HIV/AIDS and tuberculosis.” In May 2016, at the World Health Assembly, 194 governments adopted the first ever Global Health Sector Strategy on viral hepatitis and agreed to the first-ever global targets. The strategy includes a target to treat 8 million persons for hepatitis B or C by 2020. The longer term aim is to reduce new viral hepatitis infections by 90% and to reduce the number of deaths due to viral hepatitis by 65% by 2030 from 2016 figures. As of 2014, 184 countries vaccinate infants against hepatitis B as part of their vaccination schedules and 82% of children in these states received the hepatitis B vaccine. This is a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B. (Source: WHO, 20 July 2016)

Eat more of healthy unsaturated fats to reduce risk of type 2 diabetes

Eat more of healthy unsaturated fats to reduce risk of type 2 diabetes Results of a systematic review and meta-analysis of randomized controlled feeding trials published July 19, 2016 in PLoS Medicine indicate that substituting dietary carbohydrates with saturated fat does not have a favorable effect on blood glucose. While, substituting carbohydrate and saturated fat with a diet rich in unsaturated fats (monounsaturated and polyunsaturated fats) led to better control of blood sugar. And, compared to carbohydrates, saturated fats or MUFA, the most consistent favorable effects were observed with PUFA as evident by the improved glycemia, insulin resistance and insulin secretion capacity. The trial summarized findings of 102 randomized controlled trials, which included 4,660 participants. · Replacing 5% energy from carbohydrate with saturated fats had no significant effect on fasting, but lowered fasting insulin. · Replacing carbohydrate with MUFA lowered HbA1c, 2 h post-challenge insulin and homeostasis model assessment for insulin resistance (HOMA-IR). · Replacing carbohydrate with PUFA significantly lowered A1c and fasting insulin. · Replacing saturated fats with PUFA significantly lowered glucose, A1c, C-peptide, and HOMA. Major organizations recommend replacing saturated fats with MUFA or PUFA, mainly to improve lipid profiles rather than glucose-insulin metrics, for the primary and secondary prevention of diabetes. These findings suggest that eating more unsaturated fats in place of carbohydrates or saturated fats may improve glycemic control and focusing on PUFA in particular may have additional benefits on insulin secretion capacity.

Postmenopausal women should get their insulin levels checked

Postmenopausal women should get their insulin levels checked New Delhi, July 18, 2016: "All postmenopausal women should try to keep insulin at normal levels through weight loss, regular exercise, and other methods," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Postmenopausal women with elevated insulin levels are at a higher risk of developing breast cancer. As per a report published in the International Journal of Cancer from Researchers at Albert Einstein College of Medicine of Yeshiva University in New York City, there is a strong association between elevated insulin levels in the blood and increased risk of breast cancer. The researchers examined data gathered from 5,450 women who took part in the Women’s Health Initiative (WHI) and found that women with insulin levels in the highest third were twice as likely to develop breast cancer as women in the bottom third. The link between elevated insulin levels and breast cancer was stronger for thin women than for obese women, as they tend to have higher insulin levels. This finding is potentially important because it indicates that in postmenopausal women, insulin may be a risk factor for breast cancer that is independent of obesity.

Postmenopausal women should get their insulin levels checked

Postmenopausal women should get their insulin levels checked New Delhi, July 18, 2016: "All postmenopausal women should try to keep insulin at normal levels through weight loss, regular exercise, and other methods," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Postmenopausal women with elevated insulin levels are at a higher risk of developing breast cancer. As per a report published in the International Journal of Cancer from Researchers at Albert Einstein College of Medicine of Yeshiva University in New York City, there is a strong association between elevated insulin levels in the blood and increased risk of breast cancer. The researchers examined data gathered from 5,450 women who took part in the Women’s Health Initiative (WHI) and found that women with insulin levels in the highest third were twice as likely to develop breast cancer as women in the bottom third. The link between elevated insulin levels and breast cancer was stronger for thin women than for obese women, as they tend to have higher insulin levels. This finding is potentially important because it indicates that in postmenopausal women, insulin may be a risk factor for breast cancer that is independent of obesity.

India is yaws, maternal/ neonatal tetanus/ Polio / Guinea Worm/ Small Pox free.

India is yaws, maternal/ neonatal tetanus/ Polio / Guinea Worm/ Small Pox free.

Dr K K Aggarwal

This is the strength of Modern Medicine. 1. In May 2016 WHO certified India yaws-free. India is the first country under the 2012 WHO neglected tropical diseases (NTD) roadmap to eliminate yaws, a disease known to affect the most underserved population. It is said ‘where the road ends, yaws begins’. 2. Until a few decades ago the country reported 150 000 to 200 000 neonatal tetanus cases annually. After India’s success in MNTE (maternal and neonatal tetanus elimination), Indonesia was validated for the same on 18 May this year. With this the entire WHO South-East Asia Region has achieved elimination of maternal and neonatal tetanus. WHO SEAR is the second WHO region, after European Region, to achieve MNTE. Indonesia and Timor-Leste are now the only remaining countries with yaws transmission in the WHO South-East Asia Region. 3. India is already Polio free 4. Guinea Worm disease free in February 2000 5. Smallpox free

India is yaws, maternal/ neonatal tetanus/ Polio / Guinea Worm/ Small Pox free.

India is yaws, maternal/ neonatal tetanus/ Polio / Guinea Worm/ Small Pox free.

Dr K K Aggarwal

This is the strength of Modern Medicine. 1. In May 2016 WHO certified India yaws-free. India is the first country under the 2012 WHO neglected tropical diseases (NTD) roadmap to eliminate yaws, a disease known to affect the most underserved population. It is said ‘where the road ends, yaws begins’. 2. Until a few decades ago the country reported 150 000 to 200 000 neonatal tetanus cases annually. After India’s success in MNTE (maternal and neonatal tetanus elimination), Indonesia was validated for the same on 18 May this year. With this the entire WHO South-East Asia Region has achieved elimination of maternal and neonatal tetanus. WHO SEAR is the second WHO region, after European Region, to achieve MNTE. Indonesia and Timor-Leste are now the only remaining countries with yaws transmission in the WHO South-East Asia Region. 3. India is already Polio free 4. Guinea Worm disease free in February 2000 5. Smallpox free

Too much salt damages blood vessels and cause high BP

Too much salt damages blood vessels and cause high BP New Delhi, July 17, 2016: "Eating a high-salt diet for several years is associated with markers of blood vessel damage like high uric acid and presence of albumin in the urine. People with any of these markers of blood vessel damage, with a high-salt diet are more likely to develop high blood pressure," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA.
The study published in the American Heart Association journal Circulation analysed the association between sodium consumption and blood levels of uric acid and albumin in the urine — both markers of blood vessel damage — in participants not taking high blood pressure medicine. Higher sodium intake was associated with increasing levels of uric acid and albumin over time. The higher the levels of these markers, the greater the risk of developing hypertension, if dietary salt intake was high.
Compared with participants eating the least amount of sodium (2.2 grams a day), those eating the most (6.2 grams mg/d) were 21% more likely to develop high blood pressure.
Those who had high uric acid levels and ate the most salt were 32% more likely to develop high blood pressure while those with high urine albumin levels and highest salt intake were 86% more likely to develop high blood pressure.
A high-salt diet is believed to be responsible for 20% to 40% of all cases of high blood pressure.

10 risk factors associated with 90% risk of stroke globally

10 risk factors associated with 90% risk of stroke globally

Dr K K Aggarwal Researchers from McMaster University, Canada have found that 10 potentially modifiable risk factors are collectively associated with about 90% of strokes, 91·5% for ischemic stroke, 87·1% for intracerebral hemorrhage, worldwide in each major region of the world, among ethnic groups, in men and women, and in all ages. The following 10 risk factors were found to be significantly associated with 90% of the risk of stroke: 1. High blood pressure 2. Smoking 3. Waist-to-hip ratio (abdominal obesity) 4. Diet 5. Physical activity 6. Lipids 7. Diabetes mellitus 8. Alcohol intake 9. Stress and depression 10. Heart disorders Hypertension was more associated with intracerebral hemorrhage than with ischemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischemic stroke. The international case-control INTERSTROKE study investigated global and regional effects of potentially modifiable risk factors associated with acute stroke was conducted in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. The findings of the study are published online 15 July 2016 in The Lancet.

Burnout syndrome: A Critical Care Societies Collaborative call-to-action statement

Burnout syndrome: A Critical Care Societies Collaborative call-to-action statement Critical care health care professionals have one of the highest rates of burnout syndrome (BOS), compared with other health care professionals, according to a Critical Care Societies Collaborative call-to-action statement published in the July 2016 issue of the journal Chest. The statement has categorized risk factors by personal characteristics, organizational factors, quality of working relationships and exposure to end-of-life issues and calls for healthy ICU work environments that ultimately improve patients’ quality of care. The Critical Care Societies Collaborative (CCSC) comprises four major US professional and scientific societies: the American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society, and the Society of Critical Care Medicine. The statement reviews the diagnostic criteria, prevalence, causative factors and consequences of BOS along with potential interventions that may be used to prevent and treat BOS. • BOS occurs due to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. • The outcomes include increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. • BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. • Being self-critical, engaging in unhelpful coping strategies, sleep deprivation and a work-life imbalance have been identified as some of the personal traits associated with BOS. • Other personal risk factors associated with BOS are idealism, perfectionism and overcommitment, qualities that are often found in the best and most productive employees. • Critical care health-care professionals and their friends and family should be able to recognize the features of BOS and each critical care health-care professional should be personally responsible for managing their own BOS symptoms and related consequences • ICU teams should improve their ability to function as a group, respect each other, and reduce triggers of BOS. • ICU leaders should implement programs that identify and manage employees with BOS. • Hospitals should provide assistance programs for employees with (or at risk for) BOS and other psychological disorders such as PTSD. • Hospitals or clinical practices should consider limiting the number of consecutive days that a critical care health-care professional works, while promoting healthy sleep habits and the importance of sleep recovery. • Professional societies should educate and inform their members about BOS and other psychological disorders that impair the mental and physical health of their members, reduce the quality of care of their patients, and may deter trainees from entering their specific field.

Do not take drugs with juices

Do not take drugs with juices New Delhi, July 16, 2016: "Grapefruit juice can reduce the absorption of certain medications. Other common juices, including orange and apple, may limit the body’s absorption of drugs, compromising their effectiveness," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Quoting Dr David Bailey from the University of Western Ontario, Canada, Dr Aggarwal said that grapefruit juice markedly reduces the amount of drug that gets into the bloodstream. As per the American Academy of Family Physicians, doctors traditionally warn against drinking grapefruit juice if you’re taking certain medications for high cholesterol, high blood pressure, and heart rhythm problems. Research has shown that grapefruit juice, as well as orange and apple juice, can lower the body’s absorption of some drugs like anti-cancer drug Etopophos, beta-blockers like Atenolol, and anti-transplant rejection drug cyclosporine and antibiotics, including ciprofloxacin, levofloxacin, and itraconazole. Healthy volunteers who took the allergy drug fexofenadine with grapefruit juice absorbed only half the amount of the drug, compared with volunteers who took the medicine with water. Substances in the juices affect the absorption of drugs. Some chemicals block a drug uptake transporter, reducing drug absorption; other chemicals block a drug metabolizing enzyme that normally breaks down the drugs. In general, it’s safest to take medication with water. A glass is better than a sip. It helps dissolve the tablet. Cool water is better than hot because your stomach empties cool water faster, sending the medication on its way to the small intestine and finally the blood stream.

Do not take drugs with juices

Do not take drugs with juices New Delhi, July 16, 2016: "Grapefruit juice can reduce the absorption of certain medications. Other common juices, including orange and apple, may limit the body’s absorption of drugs, compromising their effectiveness," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Quoting Dr David Bailey from the University of Western Ontario, Canada, Dr Aggarwal said that grapefruit juice markedly reduces the amount of drug that gets into the bloodstream. As per the American Academy of Family Physicians, doctors traditionally warn against drinking grapefruit juice if you’re taking certain medications for high cholesterol, high blood pressure, and heart rhythm problems. Research has shown that grapefruit juice, as well as orange and apple juice, can lower the body’s absorption of some drugs like anti-cancer drug Etopophos, beta-blockers like Atenolol, and anti-transplant rejection drug cyclosporine and antibiotics, including ciprofloxacin, levofloxacin, and itraconazole. Healthy volunteers who took the allergy drug fexofenadine with grapefruit juice absorbed only half the amount of the drug, compared with volunteers who took the medicine with water. Substances in the juices affect the absorption of drugs. Some chemicals block a drug uptake transporter, reducing drug absorption; other chemicals block a drug metabolizing enzyme that normally breaks down the drugs. In general, it’s safest to take medication with water. A glass is better than a sip. It helps dissolve the tablet. Cool water is better than hot because your stomach empties cool water faster, sending the medication on its way to the small intestine and finally the blood stream.

Consume natural food and don’t just depend on supplements to prevent heart disease

Consume natural food and don’t just depend on supplements to prevent heart disease New Delhi, July 12, 2016: One should consume seasonal vegetables and locally grown natural food and vegetables or those grown in organic farms," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Eating less, a lighter dinner, and eating natural and in moderation are few of the mantras. Taking food supplements in excessive quantities can be harmful. According to the American Heart Association, 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 second heart attack. Beta carotene supplementation may be dangerous and should be discouraged. Vitamin E supplementation may be of benefit for only secondary prevention of heart patients with chronic renal failure who are undergoing hemodialysis. The American Heart Association 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 high in natural antioxidants are associated with lower cardiovascular mortality. Some tips • Have a mix of all seven colours & six tastes • Avoid refined carbs • Say no to trans fats • Reduce red meat

IMA Safe Sound Initiative: Safe Noise Points

IMA Safe Sound Initiative: Safe Noise Points • Noise has a lot of ill-effects on our health and it is the leading cause for permanent deafness. • Noise is a silent killer and affects all systems especially central nervous, cardiovascular, endocrine and immune systems. • Decibel (dB) is the unit of sound intensity. Zero dB is the minimum hearing capacity of a healthy person in a noise-free environment. Every 10 dB is 10 times more powerful. • Exposure to sounds above 80 dB for even shorter periods has serious effects on our health. • Traffic sounds are a major source of noise in Indian cities (90 to 120 dB). • Use of loudspeakers in public places after 10 pm and before 6 am is illegal. • DJs and cinemas have a noise level of 110 to 120 dB; limit your exposure to less than 2 hours in a week. Please note that even this duration is harmful to young children and pregnant ladies. • Staying away from very noisy situations, even for intervals of 5-10 minutes, reduces the ill-effects of noise to a great extent. • Use of ear plugs or muffler is highly recommended in very noisy situations. It will reduce sound exposure by 15 to 20 dB. • Participate actively in the IMA Safe Sound Initiative for a better, healthy in India. (Contributions from Dr John Panicker: Coordinator, IMA NISS)

Even cycling can cause erectile dysfunction

Even cycling can cause erectile dysfunction New Delhi, July 13, 2016: Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, and upright cycling for more than 3 hours a week can cause erectile dysfunction in men. "Those who cycle for more than 3 hours a week should do so in a reclining position and not upright position," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures. The term "impotent" is reserved for those men who experience erectile failure during attempted intercourse more than 75% of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease. Eight of the twelve most common prescription medications list erectile dysfunction as a side effect. It is estimated that 25% of the cases of erectile dysfunction are due to drugs. Depression, stress, or the drugs used to treat depression can result in erectile dysfunction as well. Neurological causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, and dementia. In addition, pelvic trauma, prostate surgery or priapism may cause erectile dysfunction. Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence. Cycling-induced impotence is primarily a problem of serious cyclists and is reported to occur in Norwegian men competing in a 540-km bicycle race. Penile numbness is attributed to the pressure on the perineal nerves whereas erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries. Recreational cyclists, those who cycle for less than three hours per week, and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting 10 minutes.

Traffic noise linked to increased risk of heart attack

Traffic noise linked to increased risk of heart attack Traffic noise has been known to trigger stress reactions. If you live near a highway, you are at a greater risk of heart attack. Results of a case–control study based on secondary data published 17th June, 2016 in the journal Deutsches Arzteblatt International show that the risk of heart attack increases with the amount of exposure to traffic noise. This increase in risk was found to be greatest with road and rail traffic noise and less with aircraft noise. The evaluation was performed on the basis of the continuous 24-hour noise level and the categorized noise level (in 5 decibel classes). The study compared data from 19,632 patients from the Rhine-Main region of Germany who were diagnosed with myocardial infarction in the years 2006–2010 with 834,734 controls. Their exposure to aircraft, road and rail traffic in 2005 was matched to their residences. Analysing data specifically for those who died of heart attack up to 2014-15, a statistically significant risk increase due to road noise (2.8% per 10 dB rise) and railroad noise (2.3% per 10 dB rise) was observed, but not airplane noise. The author suggest that this may be due to the fact that with aircraft noise, unlike road and rail traffic noise, a continuous noise level above 65 dB did not occur; hence, the low risk association with aircraft noise. This study is part of the Europe-wide NORAH (Noise-Related Annoyance, Cognition, and Health) study investigating the health consequences of traffic noise.