June 19  2015, Friday
Serum Calcium for the diagnosis of Diabetes
Dr KK Aggarwal Increased serum calcium levels can independently predict the risk of type 2 diabetes, according to a Spanish study published in the journal Diabetes Care.

Calcium plays an important role in both insulin secretion and insulin action. Previous studies have shown that elevated calcium levels are linked with insulin resistance.

The study included individuals who did not have diabetes at baseline. In a follow–up of 5 years, in 10% of them who were diagnosed with diabetes, the following parameters were done.
  • The mean baseline albumin adjusted serum calcium was significantly higher for those who developed diabetes than those who did not.
  • Patients who developed diabetes within 6 months were excluded from the study.
  • The risk of developing diabetes for those in the highest serum calcium tertile i.e. 10.2 mg/dL was more than 3 times greater than for the lowest tertile (9.0 mg/dL).
  • For every 1 mg/dL increase in albumin-adjusted serum calcium, the risk of diabetes was 3.52 times higher.
If the study has to be believed, albumin–adjusted serum calcium will be a new test to predict diabetes along with HbA1c.
Indian Medical Association, Bilaspur (CG), organized State level CME on Medical Ethics
  • Memantine, a drug approved for the treatment of dementia, seems to improve executive function in adults with attention-deficient/hyperactivity disorder (ADHD) when administered with standard stimulant therapy, suggests preliminary research. The findings were presented at the 12th World Congress of Biological Psychiatry.
  • A retrospective cohort study published online in the American Journal of Respiratory and Critical Care Medicine suggests that age is a risk factor for treatment failure in adults who have mild to moderate asthma. Patients aged 30 years and older had twice the odds of treatment failure relative to younger patients.
  • A short-acting glucagon-like peptide (GLP-1) agonist given with meals reduces glycemic variability compared with use of bolus insulin, while maintaining similar HbA1c levels, in a type 2 diabetes population at high risk of cardiovascular events, suggests the Fluctuation Reduction With Insulin and GLP-1 Added Together (FLAT-SUGAR) study presented at the American Diabetes Association (ADA) 2015 Scientific Sessions.
  • During the first year after kidney transplantation, vitamin D3 supplementation does not reduce the risk for acute rejection episodes or infection, and might promote the development of hypercalcemia, suggested a randomized controlled trial presented at the European Renal Association–European Dialysis and Transplant Association 52nd Congress.
  • The investigational drug inotuzumab ozogamicin significantly improved complete remission rates in patients with refractory or relapsed acute lymphoblastic leukemia (ALL), compared with standard intensive chemotherapy, suggest the results from an ongoing trial presented at the 20th Congress of the European Hematology Association (EHA).
Cardiology eMedinewS
  • Two studies published online in the American Journal of Transplantation suggest that hyperlipidemia accelerates heart-transplant rejection.
  • People whose chromosomes contain the DNA of the roseola virus are three times more likely to suffer from angina, suggested a new study published in the Proceedings of the National Academy of Sciences.
Pediatrics eMedinewS
  • Changes in a mother's vaginal microbiome caused by stress during pregnancy may affect the gut microbiome and brain development of offspring, suggests a new study published in the journal Endocrinology.
  • The US Food and Drug Administration (FDA) has approved zolmitriptan nasal spray for the acute treatment of migraine with or without aura in children 12 years of age and older.
Dr KK Spiritual Blog
Prakriti, Vikriti and Sanskriti

Prakiti is defined as when a person lives for himself or when his actions are centered towards oneself.

Sanskriti is when one lives for the sake of others and vikriti is nothing but distortion in one’s living.

Greed is one type of vikriti which can make a ‘nar’ a ‘narbhakshi’ and later ‘nar rakshas. On the other hand, if a person works towards sanskriti it can convert him or her ‘nar’ to ‘narottam’ and from ‘narottam’ to ‘Narain’.

The aim in life, therefore, should be to work not for oneself but for the welfare of the others. These people gradually start working for themselves often for the family, society, nation and universe respectively.

Lord Buddha also said that any action done should follow the rule that it is directed for the welfare of all. Gandhi also propagated Sarvodaya or dedicating one’s actions to the welfare of all.

The basic fundamental teaching of the Vedic science is also based on Sarvodaya. Sahdev in Mahabharat and Bharat in Ramayan also talked about the sarvodaya properties, which every human being has.

Dr. Deepak Chopra in his book ‘7 Spiritual Laws of Success’ also writes that one should always ask his or her consciousness when meeting a person as to how one can help the other person.

Even a feeling of helping someone can make a difference.
Inspirational Story
Learn and Earn

Chuan and Jing joined a wholesale company together just after graduation. Both worked very hard.

After several years, the boss promoted Jing to sales executive but Chuan remained a sales rep. One day Chuan could not take it anymore, tender resignation to the boss and complained the boss did not value hard working staff, but only promoted those who flattered him.

The boss knew that Chuan worked very hard for the years, but in order to help Chuan realise the difference between him and Jing, the boss asked Chuan to do the following. Go and find out anyone selling water melon in the market? Chuan returned and said yes. The boss asked how much per kg? Chuan went back to the market to ask and returned to inform boss the $12 per kg.

Boss told Chuan, I will ask Jing the same question? Jing went, returned and said, boss, only one person selling water melon. $12 per kg, $100 for 10 kg, he has inventory of 340 melons. On the table 58 melons, every melon weighs about 15 kg, bought from the South two days ago, they are fresh and red, good quality.

Chuan was very impressed and realised the difference between himself and Jing. He decided not to resign but to learn from Jing.

My dear friends, a more successful person is more observant, think more and understand in depth. For the same matter, a more successful person sees several years ahead, while you see only tomorrow. The difference between a year and a day is 365 times, how could you win?

Think! how far have you seen ahead in your life? How thoughtful in depth are you?
Make Sure
Situation: A 28–year–old pregnant woman was advised erythromycin estolate for her upper respiratory tract infection. A week later she developed jaundice.

Reaction: Oh my God! You should have prescribed erythromycin stearate instead of estolate.

Lesson: Make sure to remember that there is a higher incidence of hepatitis with cholestatic jaundice in pregnancy with erythromycin estolate.
Dr Good Dr Bad
Situation: A patient with severe migraine wanted to know if xylocaine drops would help.

Dr. Bad: They have no role.

Dr. Good: You can try them.

Lesson: As an intranasal spray, 2% xylocaine drops can help migraine patients.

(Copyright IJCP)
eMedi Quiz
Which of the following is present intracellularly in muscle cells?

1. Insulin.
2. Corticosteroid.
3. Epinephrine.
4. Glucagon.

Yesterday’s Mind Teaser: The buffering capacity of a buffer is maximum at pH equal to:

1. 0.5pKa.
2. pKa
3. pKa+1
4. 2pKa

Answer for yesterday’s Mind Teaser: 2. pKa

Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K V Sarma, Daivadheenam Jella, Dr G Madhusudhan, Dr Avtar Krishan.

Answer for 17th June Mind Teaser: 4. Vertebral venous plexus.

Correct Answers received: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K Raju, Dr K V Sarma, Dr G Madhusudhan, Daivadheenam Jella, Dr Avtar Krishan.
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained
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
Cholesterol tips released

Blood lipid levels may exhibit mild seasonal variation with a drop in the summer and total cholesterol levels peaking in the winter. The variation can be up to 5 mg/dL, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

Serum total and HDL-cholesterol can be measured in fasting or non-fasting individuals. There are only small clinically insignificant differences in these values when measured in the fasting or non-fasting state.

The total cholesterol can vary by 4 to 11 percent within an individual due to multiple factors including stress, minor illness and posture. Values may also vary between different laboratories, with data suggesting that a single measurement of serum cholesterol can vary as much as 14 percent. Therefore in an individual with “true” serum cholesterol concentration of 200 mg/dL, the range of expected values is 172 to 228 mg/dL.

More than one measurement of total cholesterol should therefore be obtained when treatment considerations demand a precise determination. Measurement of serum HDL-C and triglycerides may demonstrate even greater variability.

A standard serum lipid profile consists of total cholesterol, triglycerides, and HDL-cholesterol. Lipid profile should be performed after 12 to 14 hours of fasting to minimize the influence of postprandial hyperlipidemia. One can use either plasma or serum specimen. The serum cholesterol is approximately 3 percent lower than the plasma value.
eIMA News
IMA CGP HQ organizes ICON 2015
IMA CGP HQ organizes ICON 2015 - International Conference Family Medicine on 25th and 26th July 2015 at Hotel Country Inn, Ghaziabad, New Delhi with the main theme of “Strengthening Family Practice Culture”. Eminent faculties from various countries like Sri Lanka, Bangladesh, Pakistan, USA, Australia and UK will be delivering lectures mainly on the theme. Interesting topics like how to increase your earning capacity ethically, use pharma companies for higher learning, relevance of Family Physician in today’s scenario are being dealt with.

Kindly register at the earliest to avoid last minute rush for travel and accommodation. For any assistance please contact:

Dr. J A Jayalal – 09443160026; Dr. T N Ravishankar – 09444047724; Dr. Abul Hasan - 09843025300; Dr. A Raja Rajeshwar – 09841428855
214th meeting of the Central Working Committee of Indian Medical Association
IMA/Admn/W-26/298                             June 16, 2015
  1. All members of the Central Working Committee, IMA
  2. All Office bearers of IMA who are not members of the Central Working Committee are invited as per Rule No.27 (B) of the Memorandum, Rules & Byelaws.

It is notified that the 214th meeting of the Central Working Committee of Indian Medical Association is scheduled to be held at Thiruvananthapuram, Kerala on Saturday & Sunday, September 19 & 20, 2015, respectively. The meeting will be chaired by the National President, IMA, Padma Shri Awardee, Dr. A. Marthanda Pillai.

The tentative Programme of the CWC shall be as follow:-
19th September, 2015 (Saturday)

1:00 pm to 2:00 pm: Lunch

2:00 pm to 8:00 pm:CWC Meeting

8.30 pm onwards: Banquet Dinner
20th September, 2015 (Sunday)

Checkout before 12:00 noon

7:00 am to 8:00 am: Breakfast

8:00 am onwards: CWC Meeting continues

1:00 pm to 2:00 pm: Lunch

2:00 pm onwards: CWC Meeting continues

4:00 pm: High Tea

The exact venue of the meeting shall be informed to you shortly. Please intimate your travel itinerary to Dr. Alex Franklin on his email id. dralexfranklin@gmail.com with a copy to the following Email IDs: np@ima-india.org & hsg@ima-india.org. TA will be reimbursed as per IMA Rules.
IMA News
  • Indian Medical Association, Bilaspur (CG), organized CME I Sickle cell Disease, CME II State level CME on Medical Ethics and Violence against doctors, CME III Asthma update. Celebrated World Red Cross Day, World No Tobocco Day and Community Health Services
  • US food safety regulators are banning a major source of artificial trans fats in processed foods in a bid to reduce heart disease and heart attacks among Americans. Cookies as per Medical News Today. The Food and Drug Administration (FDA) say they have finally determined that partially hydrogenated oils (PHOs) - a major source of artificial trans fat in the American diet - are not "generally recognized as safe" for human consumption. The regulators are giving food manufacturers 3 years - until 18th June, 2018 - to remove PHOs from food products. This gives companies time to reformulate products so they do not contain PHOs, or to ask the FDA for permission to use them. "Following the compliance period, no PHOs can be added to human food unless they are otherwise approved by the FDA," say the regulators. PHOs are made by heating up a food oil such as soybean or cottonseed in the presence of hydrogen and a catalyst. This makes the oil into a semi-solid, partially saturated fatty acid - like margarine - making it easier to use as a shortening in baked goods. Trans fats are so called because when hydrogenation breaks double bonds between carbon atoms in the long-chain fatty acid molecules, this results in the hydrogen atoms attached to the carbon atoms at a double bond being on opposite sides of the double bond ("trans" means "other side," or "across").This "trans" configuration is different to naturally occurring versions, which have a "cis" configuration, where the hydrogen atoms attached to carbon at double bonds are on the same side of the double bond. The trans configuration in the fatty acid molecules of manufactured PHOs is thought to be what makes them bad for health - consuming them lowers "good" cholesterol (high-density lipoprotein, or HDL) and increases "bad" cholesterol (low-density lipoprotein, or LDL) in the body, raising the risk of coronary heart disease. The CDC say eliminating the use of PHOs in food could prevent 10,000-20,000 heart attacks and 3,000-7,000 coronary heart disease deaths each year in the US.
  • Complying with the order of the National Consumer Disputes Redressal Commission, New Delhi, Post Graduate Institute of Medical Education and Research (PGIMER) sanctioned the compensation to be paid to the parents of Anupama Sarkar, the 16-year-old accident victim who had died at the hospital in July 2012 while waiting for treatment.
  • The chorus to restrict online sale of drugs, especially prescription drugs, seems to be getting stronger by the day with the Indian Pharmacist Association (IPA) too joining the league. It has written to the Drugs Controller General of India (DCGI) for not allowing online pharmacies in India in view of larger public interest.
  • According to Pharmacy Act, no person other than a registered pharmacist shall dispense any medicine on the prescription of a medical practitioner and whoever contravenes these provisions shall be punishable with imprisonment for a term which may extend to six months.
  • Mr Nadda released a book titled 'Public Health Approaches to Non-communicable Diseases', which has been authored by JS Thakur, professor at the School of Public Health, Postgraduate Institute of Medical Education and Research in Chandigarh. "Health institution should invite people, NGOs, voluntary organisations and others to participate in this endeavour and share the responsibility for cleanliness of the health facility. Motivational incentives such as awards should also be instituted for them," Nadda said.
  • Clamping down further on Nestle over Maggi issue, government has dragged it to the National Consumer Disputes Redressal Commission (NCDRC) for "unfair trade practices and misleading advertisements" and may seek financial penalties among other actions.
  • Men who slept badly were twice as likely to suffer a heart attack and up to four times as likely to have a stroke compared with those who slept well, according to a Russian study presented at EuroHeartCare.
  • On 23 June, the Lancet Commission on Health and Climate Change will launch the results of its second global study, which aims to target “the biggest global health threat of the 21st century”. Building on the success and scientific underpinnings of the 2009 Commission (http://www.ucl.ac.uk/igh/research/a-z/lancet-commission-climate-change), the report aims to be solution-focused, and to provide a policy road map to lever influence on the international community. The official launch event is scheduled on 23 June, 2:00 PM to 6:00 PM (BST), London Please see also: HEAL Webinar series - COP21: Perspectives on how climate action can benefit health, 24 June 12:00 BST/13:00 CET. Many national events are planned around the launch of the report. Please check out in your country. Clarisse Delorme. Advocacy advisor, World Medical Association
Letter from Dr Eidelman
June 15, 2015
Members of Council
World Medical Association

Dear Members of Council,

It has come to our attention that the new Israeli Minister for Interior Security is planning to renew the proposed legislation regarding forced feeding of hunger strikers.

As you may recall, in the previous Knesset, the Ministers' Committee approved legislation on a government bill that would allow forced feeding of hunger strikers in Israeli prisons. The IMA has consistently expressed its opposition to this bill. The proposal enables obtaining legal permission for the provision of medical care and/or providing nutrients (including force-feeding through a tube) despite the active opposition of the prisoner.

The proposed law is unrealistic and does not help solve the problem. It creates an illusion that forced feeding will prevent medical harm to the patient, whereas the opposite may in fact be true. We cannot accept a law that puts physicians at the forefront of a policy - both as a group and as individuals – which is against their professional and ethical obligations.

The fundamental change underlying this proposal is in contradiction with and contrary to accepted medical ethics in Israel and throughout the world, including the IMA's ethical Code and the WMA’s Declaration of Tokyo and Declaration of Malta.

The IMA is strongly opposed to the intended force feeding law. Our opposition was expressed to the government offices and representatives of the attorney general at every possible opportunity. We are prepared to continue to protect the doctors at all levels, including in the public sphere and parliamentary level, in order to thwart the legislative process.

We know our hospital doctors will be presented with ethical dilemmas and be placed in an impossible position professionally. Therefore, we have a hotline for these physicians to call with any questions they may have, as well as guidelines and recommendations that we released in a handbook following last year's mass hunger strikes. The IMA will continue to support our physicians and remind them of their ethical obligations.

Our concern is that the proposed law will move quickly through the legislative process, and we therefore wanted to bring it to your attention as soon as possible. We will continue to update you regarding any developments on this issue.

Yours Sincerely
Dr Leonid Eidelman, President, Israeli Medical Association
Govt wants to prove yoga cures serious ailments
Sushmi Dey, TNN | Jun 18, 2015, 01.14 AM IST

New Delhi: The government's enthusiasm to promote yoga worldwide may not end with grand celebrations on International Day of Yoga on June 21. In an attempt to validate yoga's therapeutic and curative powers, the government has commissioned extensive research by various institutions which will help create documentation detailing yoga's history and efficacy, an official said.

The health ministry is working with institutions such as S Vyasa and Swami Vivekananda Yoga Anusandhana Samsthanam to undertake research and gather scientific evidence to show how yoga can be instrumental in treatment of more serious ailments as well.

Many yoga exponents, as well as, medical practitioners claim that the discipline cannot just provide palliative care but can also be preventive and curative, mainly for lifestyle diseases like diabetes, hypertension, psychological disorders etc.

Some also believe that regular practice of yoga and pranayama can even help avoid certain types of cancers.

"Exercise improves health and can extend life. Adding as little as 30 minute of moderately intense daily physical activity can help one avoid a host of serious diseases, including heart disease, diabetes, depression, and several types of cancer, particularly breast and colon cancers," says Dr K K Aggarwal, president of the Heart Care Foundation of India and secretary general of Indian Medical Association.

Doctors also recommend yoga for better sleep, reduction of stress, weight control etc.

Meanwhile, in the face of opposition from some Muslim outfits to yoga day, the ministry of AYUSH launched a book titled "Yoga and Islam" on Wednesday.

The book published by Muslim Rashtriya Manch (MRM) -- a Muslim organization affiliated to the RSS — claims yoga is not associated with any particular religion and is universally accepted, AYUSH minister Shripad Naik said.

"We faced objection from the Muslim communities over yoga. The motive behind this book is to prove that yogic postures are not different from namaaz," Naik said.

United Nations secretary general Ban Ki-moon has said that yoga does not discriminate. In his message for yoga day, Ban said, "Yoga does not discriminate; to varying degrees, all people can practice, regardless of their relative strength, age or ability. I discovered this for myself on trying to do my first asana, a tree pose suited to beginners. It took a moment for me to gain my balance, but once I did, I appreciated the simple sense of satisfaction that yoga can bring".
Wellness Blog
If you have high BP keep your sugar lower than 90mg%

Hypertension is a risk factor for type 2 diabetes. If not properly managed they are likely to end up with diabetes with subsequent high risk of kidney damage.

The results of the anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) study have shown that the major predictor of new-onset diabetes (NOD) in patients with hypertension is high baseline fasting plasma glucose levels of more than 90mg%. The risk increases by 5.8 times for each 18mg% rise above 90 mg%.

Other risk factors are higher weight, higher blood pressure and higher triglyceride levels. Patients of high BP taking the drugs atenolol (beta blocker drug) regimen with or without a diuretic are also at risk.

On the other hand, high BP patients on amlodipine (calcium blocker) ± perindopril (ACE inhibitor), with high good HDL cholesterol levels, moderate alcohol use and age older than 55 years have protection from developing diabetes.
Quote of the Day
A good book should leave you... slightly exhausted at the end. You live several lives while reading it. William Styron
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IMA Humor
Old age secret

Grandpa was celebrating his 100th birthday and everybody complimented him on how athletic and well-preserved he appeared.

"Gentlemen, I will tell you the secret of my success," he cackled. "I have been in the open air day after day for some 75 years now."

The celebrants were impressed and asked how he managed to keep up his rigorous fitness regime.

"Well, you see my wife and I were married 75 years ago. On our wedding night, we made a solemn pledge. Whenever we had a fight, the one who was proved wrong would go outside and take a walk."
Reader Response
Dear Sirs, Most papers have reported that Dr Rathod - Surgeon at Thane Civic Hospital - had his face blackened after a patient died. Hindustan Times has printed his photo in this state. I feel this only humiliates him further and adds insult to injury. It is quite unfair to the victim of such kangaroo court justice, and only serves to make a spectacle of him as intended by the perpetrators of the grievous injury. An apology would be in order and repetition should not occur in future for similar incidents. Dr Hemang D Koppikar, Mumbai
Rabies News (Dr A K Gupta)
Are there any survivors of human rabies?

Till date only seven survivors have been recorded. These patients survived not due to any specific anti–rabies therapy but following intensive life support and excellent nursing care. These patients survived for variable periods with residual neurological deficits. All the survivors had paralytic form of rabies and majority had history of some anti–rabies vaccination in the past.
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