Night urination linked to snoring

Night urination linked to snoring New Delhi, August 07, 2016: Sleep apnea, a common but serious sleep snoring disorder, is the root cause of nocturia, or getting up frequently during the night to urinate said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. The results of a study conducted by researchers at the University of Alabama at Birmingham, which reported these findings are particularly important for older adults who are at greater risk of falling and being hurt if they must get up frequently during the night to urinate. People with nocturia often report the problem to their gynecologist or urologist but not a sleep clinician. Doctors most often attribute nocturia to aging in women or to prostate problems in men. One event per night is within normal limits but two or more events per night may be associated with sleep deprivation. In sleep apnea, the soft structures in the throat relax and close off the airway. Oxygen decreases, carbon dioxide increases, the heart rate drops and blood vessels in the lung constrict. The heart starts racing and experiences a false signal of fluid overload. Body tries to get rid of sodium and water, resulting in nocturia. In sleep apnea airway obstruction lasts for 10 seconds or more, and occurs five or more times per hour of sleep. People with the most severe cases of sleep apnea can have more than 100 such events per hour of sleep. Symptoms include snoring, restless sleep with frequent awakenings, excessive daytime sleepiness, and morning headaches.

Different types of placebo effects

Different types of placebo effects

Dr K K GGARWAL

• The placebo effect in medicine, where getting an inert (e.g. sugar) pill has a large positive effect. It is believed that often there are large positive effects that are simply from the expectation created in the patient. If true, this is the placebo effect, where the intervention in question has no material effect, but the belief of the patient does. Although often transmitted from the doctor's expectancies, it may be independent of the doctor. The placebo effect may be particularly strongly evident in side-effects, where the number and severity of side-effects may be three times larger when patients are warned about the possibility in the study group and in the placebo group.
• The Hawthorne effect (French, 1953) or the observer effect i.e. the effect did not depend on the particular expectation of the researchers, but being studied caused the improved performance. This might be because attention made the workers feel better; or because it caused them to reflect on their work and reflection caused performance improvements, or because the experimental situation provided them with performance feedback they didn't otherwise have and this extra information allowed improvements.
• The John Henry effect (Zdep & Irvine, 1970; Saretsky, 1972) is the opposite of the Hawthorne effect. It is seen when a supposedly control group, that receives no intervention compares itself to the experimental group and through extra effort has similar effects or results. It is a type of counter-suggestibility.
• Jastrow's effect: Here an explicit expectation about performance is transmitted and turned out to change output by a factor of three. (Rosenthal & Jacobson, 1968;   Jastrow, 1900.)
• The Pygmalion effect or "expectancy advantage" is that of a self-fulfilling prophecy. Teachers' expectations of pupils can strongly affect (by about a factor of two over a year) the amount of development they show. (Rosenthal & Jacobson, 1968)

No Exit Exam

No Exit Exam • The Centre's plan to conduct an exit exam for MBBS students is being opposed by Indian Medical Association (IMA). Such a move will belittle the scope of the MBBS exam. Why have another exam when students anyway write the final-year MBBS exam? Does it mean the degree is invalid? • Only the Medical Council of India (MCI) can decide what students should study and how to certify them, not the government. • IMA is also opposing the 6-month training exam under PC PNDT Act. • It is also against registration every 5 years based on an exam or credit hours CME. • India already is facing a shortage of 4 lakh doctors and 10 lakh nurses. Any such rule will demotivate students as it will degrade MBBS as a degree. • The government can if they want conduct a single final year exam combined with the NEET equivalent to certify medical graduates and select them for postgraduate seats. • Re-registration of doctors once in 5 years can be done to maintain accurate data by the medical councils of the state but not linked to passing exam again. The purpose of re-registration is to maintain data. Even now, the councils have data on doctors who are dead. We need to streamline the process to update data. But CME attendance score and credit hours cannot be made mandatory. • What counts in a doctor's profession is experience and not theory. Many councils are making it mandatory for doctors to submit certificates showing 30 points gained by attending CMEs and gaining credit hours. • Many Supreme Court judgments have said that one is supposed to possess an average degree of skill and knowledge to practice. One is not expected to excel in his profession. The passing marks are 50% and not 90%. A fifty percenter is a good doctor. MBBS degree means that the person is qualified enough to practice medicine. • Accreditation, like NABH, also are not mandatory as they are for excellence in health care and not getting NABH does not mean the hospital is negligent or of B grade category.

IMA & HCFI hold public webcast on the importance of breastfeeding for a mother and her baby

IMA & HCFI hold public webcast on the importance of breastfeeding for a mother and her baby Over 5000 doctors and patients education on the occasion of World Breastfeeding week New Delhi, 06th August, 2016: In India, we lose 16.5 lakh children every year due to easily preventable diseases. Early initiation of breastfeeding alone can save the lives of 13% of babies. Raising awareness about the importance of breastfeeding, Heart Care Foundation of India (HCFI) and the Indian Medical Association (IMA) organised a public webcast. Breastfeeding is one of the single most effective nutrition interventions for saving lives. Mother's milk is undoubtedly the best food for babies. It is a living fluid and contains exactly the right amount of nutrients required by a baby, in the right proportions, to ensure that the baby gets the perfect balanced meal. Manufactured milk, no matter how fortified it may be, can come close to being as nutritious as breast milk. Stressing on the need to educate the masses on occasion of World Breastfeeding Week, Padma Shri Awardee Dr KK Aggarwal – President HCFI & Honorary Secretary General IMA said, “It is the responsibility of the medical fraternity to raise awareness about the importance of breastfeeding and advocate for better work laws that allow mothers to feed their child till up until two years of age. Workplaces should have a creche that allows the mother to interact with her baby every two hours. Benefits of both maternity and paternity leave should be extended to the new parents. It is also important to educate and train nurses and hospital staff on how to become effective counsellors to mothers. They can play a key role in encouraging early initiation of breastfeeding by teaching the mother how to hold her child, how often to feed, essential diet tips, etc. Raising awareness, Dr Naveen Prakash Gupta, Consultant Neonatologist, Max Super Specialty Hospital, Patparganj said, “The first milk that flows out of a mother's breast is called colostrum, and it must not be discarded. It is packed with antibodies that increase a baby's immunity and protects a newborn's intestines and strengthens its respiratory system. Breastfeeding is of crucial importance for both the mother and her baby and must be initiated in the first hour of birth itself and carried on exclusively till six months. After that breastfeeding must be continued till up till two years along with complementary feeding”. While using stored breast milk, it is important to remember the milk must be used within 8 hours when kept at room temperature or 24 hours when refrigerated. The milk must not be heated and should be utilized after bringing to room temperature. A breastfeeding mother must eat a healthy and balanced diet and should consume a minimum of 1.5 litres of water every day. Benefits of breastfeeding for both a mother and her baby: • Studies have shown that babies who have been artificially fed have higher chances of developing pneumonia, gastroenteritis, middle ear infections and various other health problems. Breastfed babies also react better to immunisations. • Breastfed babies have better brain development than their non-breastfed counterparts. • Babies who are fed milk formulae fortified with cow's milk or soy milk are more susceptible to developing allergies. Breast milk protects the infant’s intestinal tract without which the wall of the intestine may get inflamed, thereby allowing undigested proteins to leak through and cause allergies. • Breastfeeding is beneficial for Premature Babies • Non-breastfed babies have higher chances of growing into obese adults. • Breastfed babies grow differently to non-breastfed babies, and have separate growth rates and patterns. • Breastfed babies have lower chances of dying from a syndrome called Sudden Infant Death Syndrome • Breastfeeding helps to reduce the mother’s stress levels and their chances of suffering from postpartum depression. • Breastfeeding for a prolonged period of time reduces the mother’s chances of suffering from type 2 diabetes, ovarian or breast cancer in the future.

Underactive thyroid: a marker of heart disease

Underactive thyroid: a marker of heart disease New Delhi, August 05, 2016: Men and women with underactive or overactive thyroid without any symptoms are at an increased risk of heart disease. Silent or "subclinical" thyroid dysfunction" represents a potentially modifiable –– risk factor for coronary heart disease. Quoting a study from the University of Lausanne in Switzerland, by Dr. Nicholas Rodondi and published in Annals of Internal Medicine, Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA said that the likelihood of coronary heart disease, heart–related death and death from any cause is higher by 20 percent, 18 percent, and 12 percent, respectively, in subjects with an underactive thyroid without symptoms –– also referred to as subclinical hypothyroidism. Their findings are based on pooled data from 12 studies identified through a search of MEDLINE (1950 to 2008). Ten of the studies involved population-based groups that included 14,449 subjects. People with an overactive thyroid but without symptoms (silent hyperthyroidism) also had 21 percent, 19 percent and 12 percent greater odds, respectively, of heart disease, heart–related death, and death from any cause. The screening test for thyroid is TSH blood test. The normal values are 0.3 to 3 mIU/L. A value between 3 and 10 is considered subclinical hypoactive thyroid and a value of less than 0.3 without symptoms is considered subclinical overactive thyroid

IMA hails Digital Mission Mode Project of Medical Council of India

IMA hails Digital Mission Mode Project of Medical Council of India Medical Council of India (MCI) has initiated the process of implementing e governance through Digital Mission Mode Project (DMMP). IMA has sent a congratulatory letter to President MCI. As part of the DMMP, MCI through open tender process has selected a System Integrator M/s Bodhtree Consulting Ltd. & M/s Techinfy Solutions Pvt. Ltd. to design, procure/develop, supply, implement, operate and maintain MCI- DMMP solution for e governance purpose. MCI e governance Project will • Provide an on line channel for application to avail the services of MCI • Provide application progress status available online to the applicant • Provide a repository of certificates etc for future reference on MCI's website • Reduced cost to avail service by the applicant due to reduction in physical travel, availability of e-payment etc. • Monitoring of attendance of faculty of medical colleges • Unique ID for each doctor across India • Unified database - "single version of the truth" • Improved complaint and grievance redressal • Workflow based processing • Enhanced and user friendly document management • Availability of MIS and dashboard for management During the integration process MCI will also be interacting with all the medical colleges in India time & again for quick and full proof e-governance system. MCI is also in process of creating details of mandatory & desirable requirements with time lines from the Medical Colleges. The project will be driven under strict time lines & continuous monitoring of MCI- E Governance Team by the Office of the Council. MCI has asked all medical colleges to nominate a nodal officer as one point contact window between medical college & MCI/ System Integrator to facilitate to organize zonal workshops to sensitize about the Digital Mission Mode Project (DMMP-MCI).

Dengue patients don’t die of platelet deficiency

Dengue patients don’t die of platelet deficiency New Delhi, August 04, 2016: According to international guidelines, unless the platelet count is below 10,000 and there is spontaneous active bleeding, no platelet transfusion is required, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. The cause of death in dengue is capillary leakage, which causes blood deficiency in the intravascular compartment, leading to multiorgan failure, he added. At the first instance of plasma leakage from intravascular compartment to extravascular compartment, 20 ml per kg body weight per hour of fluid replacement should be administered to the patient till the difference between upper and lower blood pressure is more than 40 mmHg or the patient passes adequate urine. Giving unnecessary platelet transfusion to the patient can harm the individual. Heart Care Foundation of India has developed a ‘Formula of 20’ for family doctors to understand the severity of dengue. • Rise in pulse by 20 • Fall in upper blood pressure by 20 mmHg • Pulse pressure is lower than 20 • Hematocrit increased by 20% • Platelet count is less than 20,000 • More than 20 petechiae in the tourniquet test