November 24   2015, Tuesday
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Dr KK AggarwalDr KK AggarwalA diet that is healthy for a person may be junk food for another

We have all wondered why some people do not seem to gain weight, while others do. A new study has found that even if we all ate the same meal, we would all burn it differently and have different blood sugar levels later. These findings draw attention to personalized nutrition.

Eran Elinav, MD, PhD, Weizmann Institute of Science said, "Each human being has a unique response to the food he or she consumes. We need to look at individual responses. Our research shifts our view from this one-size-fits-all dietary approach to a personalized dietary approach and regimen."

High blood sugar levels are associated with several diseases including obesity, diabetes, heart disease, cancer and strokes.

Blood sugar levels of 800 individuals of varying weights continuously were monitored with a glucose monitor for over a week as they ate nearly 47,000 meals. Some had prediabetes. The study subjects used a smartphone app to log when they slept, exercised, and ate. Stool samples were also taken to analyze gut microbiome.

The study revealed a vast variability in the responses to even identical meals. Some people who ate bread did not show any variation in blood sugar levels, while others had high blood sugar with the same meal. Eran Segal, PhD, another researcher who worked on the study noted that one prediabetic obese woman had a blood sugar spike when she ate a tomato, which is a healthy food. The researchers next examined if personalizing the diet improved blood sugar levels for 26 people.

The personalized diets reduced the blood sugar levels after meals and altered their gut bacteria. (Medscape)
Amit Sharma and Nilesh Aggarwal

We are extremely happy to have been part of IMA Satyagraha campaign and would like to congratulate the Indian doctor community as a whole. We are aiming to be a digital voice of all Indian doctors and will continue to work towards raising such important issues. Currently, we are in our Beta phase and we will soon be introducing features such as interesting cases, online CME's, conference updates etc. Please do register and read eMediNews, eIMANews as well as other engaging content on the website/app. You can also add other doctors to your network, find long lost alumni, chat and discuss cases, post questions for the medical fraternity, create your detailed medical resume and lots more.
Breaking News
Rotavirus shots in Govt plan from Jan

Nearly 10 months after Prime Minister Narendra Modi launched the ‘Made In India’ Rotavac, the indigenously developed rotavirus vaccine will be introduced for the first time in the country’s universal immunisation programme from January next year. In the first phase, four States - Haryana, Himachal Pradesh, Odisha and Andhra Pradesh - will be covered. Around 30 lakh kids are targeted to be covered in the first phase in the four States. One dose at the age of one-and-a-half year, two-and-a-half-year and then at the age of three-and-a-half-year will be administered under the programme. Depending on the response, the vaccine will be further introduced in the other part of the country… (The Pioneer - Archana Jyoti)

CHMP backs generic Lopinavir/Ritonavir Mylan for HIV

The European Medicines Agency (EMA) Committee for Medicinal Products for Human Use (CHMP) has recommended approval of Lopinavir/Ritonavir Mylan (Mylan S.A.S.), a generic of Kaletra (AbbVie) for treatment of HIV-1 infection in adults, adolescents, and children older than 2 years. Lopinavir/Ritonavir Mylan will be available in film-coated tablets (100 mg/25 mg and 200 mg/50mg).
Dr Good Dr Bad
Make Sure
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Specialty Updates
• Having a good breakfast is linked to educational attainment, suggested new research published in the journal Public Health Nutrition. Researchers noted that pupils who ate breakfast had chances twice as high of gaining an above-average assessment score, compared with those who did not.

• A new study, published in the American Journal of Epidemiology, suggests that consuming moderate amounts of caffeine during pregnancy will not affect the baby’s intelligence.

• Ranolazine is effective for chronic angina in patients with obstructive CAD, but it did not significantly improve angina symptoms, angina frequency, or coronary flow in the Treatment With Ranolazine in Microvascular Coronary Dysfunction: Impact on Angina Myocardial Ischemia (RWISE) study of patients with chronic angina due to coronary microvascular dysfunction. The drug, however, improved coronary flow reserve in patients with the worst initial coronary blood flow (American Heart Association (AHA) 2015 Scientific Sessions).

• A fixed-dose combination of sofosbuvir plus velpatasvir is highly effective for patients with hepatitis C genotypes 1, 2, 4, 5, and 6, reported the ASTRAL-1 trial, presented at the Liver Meeting 2015 and published online simultaneously in the New England Journal of Medicine.

• The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is an effective tool in everyday clinical practice for the identification of cognitive impairment in patients with MS, suggests a new study published online in BMC Neurology.

• An artificial pancreas was successfully used with islet transplantation in patients with type 1 diabetes in a randomized trial published online in the American Journal of Transplantation. Researchers noted that total pancreatectomy with islet autotransplantation, a closed-loop "pancreas" consisting of an insulin pump and a continuous glucose monitor was more effective at managing the risk of hypoglycemia than conventional therapy over 72 hours.

• Patients with vitiligo commonly have other autoimmune diseases such as thyroid disease, alopecia areata, discoid lupus, Guillain-Barre syndrome, linear morphea, myasthenia gravis, pernicious anemia, Sjogren syndrome, and systemic lupus erythematosus, according to a cross-sectional study published in J Am Acad Dermatol 2015.

Women who have neuromyelitis optica spectrum disorder (NMOSD) are at an increased risk for miscarriage and preeclampsia during pregnancy as reported in the journal Neurology. NMOSD is a severe recurrent antibody-mediated inflammatory disorder of the central nervous system, mainly characterized by optic neuritis and longitudinally extensive transverse myelitis.
Aastik Vs Nastik

Traditionally, people believe that Nastik are people who do not go to temples or related places of worship. They also do not believe in God. To differentiate between Astik and Nastik, we need to first understand the concept of Sanatan Dharma and Arya Samaj Dharma. People who believe in Sanatan Dharma consider God as separate from the self and worship him in the form of an idol. They believe in Dualism theory.

Arya Samaj followers do not do idol worship and believe in non–dualism and treat God and self as one. Arya Samajis, therefore, will not go to a temple where the idols of Gods are placed. Being an Arya Samaji does not mean that the person is Nastik.

The word Nastik means someone who does not believe in God at all, therefore, he or she also does not believe in self as God is nothing but self. In medical sciences, these are the people who have no insight and will usually be suffering from depression and loss of self–esteem.
Legal Quote
Nizam Institute of Medical Sciences vs Prasanth S. Dhananka & Ors on 14 May, 2009

“We are also cognizant of the fact that in a case involving medical negligence, once the initial burden has been discharged by the complainant by making out a case of negligence on the part of the hospital or the doctor concerned, the onus then shifts on to the hospital or to the attending doctors and it is for the hospital to satisfy the Court that there was no lack of care or diligence.”
Digital IMA
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Computation of Gains

• Separate each item into short-term and long-term tax groups.
• Compute loss/gain for each item in short-term tax group.
o For long-term tax group, compute taxes individually on each item using both methods - with indexation and without indexation.
o For calculating indexed cost, use Cost Inflation Index table published by GOI.

(Source: IJCP)
22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
Global TB Report 2015: TB case notifications and treatment outcomes

• In the 20 years since WHO established a global reporting system in 1995, it has received reports of 78 million TB cases, 66 million of which were treated successfully.

• In 2014, that system measured a marked increase in global TB notifications for the first time since 2007. The annual total of new TB cases, which had been about 5.7 million until 2013, rose to slightly more than 6 million in 2014 (an increase of 6%). This was mostly due to a 29% increase in notifications in India, which followed the introduction of a policy of mandatory notification in May 2012, creation of a national web-based reporting system in June 2012 and intensified efforts to engage the private health sector. India accounted for 27% of global TB notifications in 2014.

• Globally, the treatment success rate for people newly diagnosed with TB was 86% in 2013, a level that has been sustained since 2005. Treatment success rates require improvement in the Region of the Americas and the European Region (75% in both regions in 2013).
Health Minister urges family medicine practitioners to contribute to preventive and promotive health care

With the aim to expand the expanse of promotive and preventive health care, and reduce the burden of Non Communicable Diseases (NCDs) in the country, the Union Minister for Health & Family Welfare, Shri J P Nadda has urged the family medicine practitioners to come up with solutions for further improving preventive and promotive health care in the country. He was addressing the 2nd National Conference on Family Medicine and Primary Care being organized by the Academy of Family Physicians of India. Speaking at the National Conference, Shri J P Nadda stated that the theme of the conference “Health Care is Primary” is quite relevant in the context of health care needs of the present time. The Health Minister noted that at a time when the country is facing the twin burden of diseases, NCDs account for over 60% mortality. He also stated that the out of pocket expenses incurred by a large section of population still remain high. Tackling this burden of NCDs and high out of pocket expenses requires focus on preventive and promotive care at primary level and secondary level, the Health Minister stressed… … (PIB)
CDC responds to broad challenges facing US cancer survivors

The number of cancer survivors — people who live after a cancer diagnosis — is expected to grow substantially over the next few decades as the U.S. population ages and as early detection methods and treatments continue to improve. Updates on how the Centers for Disease Control and Prevention is helping Americans meet the challenges of cancer survivorship were published online today at www.ajpmonline.organd appear in the December issue of the American Journal of Preventive Medicine. The supplement, “Addressing Cancer Survivorship through Public Health Research, Surveillance, and Programs,” concludes that concrete plans are needed to ensure that the U.S. health care system can meet survivors’ future needs. “By 2025, there will be more than 24 million people living after a cancer diagnosis,” said CDC Principal Deputy Director Anne Schuchat, M.D. “In addition to better prevention and treatment of cancer, we must plan for the wide variety of issues that people may face after cancer, including physical, financial, and psychological hardships.”.. …(CDC)
Every third child born in India is premature
Mumbai: Every third child born in India is premature, said city's neonatologists while stressing on the need to check this trend by improving the nutrition of young women. Neonatology Forum (NNF) Mumbai's president Dr Kishore Sanghvi said, "It is estimated that 3.6 million premature births took place in India in 2010. India is the biggest contributor to the world's prematurity burden.'' He was speaking at a function held on Saturday to observe World Prematurity Day and highlight the need for better care for premature babies. Statistics provided by NNF and the Indian Foundation of Premature Babies show that 25% of all neonatal deaths in the world occur in India… … (ET Healthworld)
10 top steps to preventing future global pandemics

An independent panel of 19 global experts has called for critical reforms to prevent the future pandemics. The group, convened by the Harvard Global Health Institute (HGHI) and the London School of Hygiene & Tropical Medicine, has issued a hard-hitting analysis of the global response to the 2014-15 Ebola outbreak in West Africa. The report offers 10 major reform proposals to prevent future such catastrophes, with emphasis on: preventing major disease outbreaks; responding to outbreaks; the production and sharing of research data, knowledge, and technologies; and ways to improve the governance of the global health system, with a focus on the World Health Organization (WHO)… …(Financial Express – ANI)
PPIs may be associated with a higher risk for Clostridium difficile–associated diarrhea

The FDA has announced that use of prescription and OTC PPIs may be associated with a higher risk for CDAD and attendant gastrointestinal complications. Symptoms of Clostridium difficile–associated diarrhea (CDAD) may include persistent watery diarrhea, abdominal pain and/or fever. Clinicians should prescribe the lowest dose of a PPI for the shortest duration that is effective for the condition being treated. According to an FDA review of AERS reports and published case reports of CDAD in patients being treated with PPIs, many patients had factors predisposing them to the development of CDAD, but the FDA could not definitively exclude the role of PPI use in contributing to the risk for CDAD. The FDA warns that patients with at least one of these predisposing risk factors and concomitant PPI use may have serious outcomes from CDAD. Colectomy and, rarely, death have been reported. Clinicians should counsel their patients who are taking PPIs to seek immediate care from a healthcare professional if they develop watery stool that does not go away, abdominal pain, and/or fever. However, patients should not discontinue their prescription PPI drug without medical advice. Patients taking OTC PPIs should be advised to carefully follow package directions.
Bioethical issues in medical practice
Perils of Cosmetic Surgery

Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

Young people today are extremely health and appearance conscious. Not only do they follow strict dietary regimens, they religiously take care of their appearance. Repeated surgery for changing the shape of their nose, chin or stomach is frequent. You as a family physician are approached by one such young woman, who has a normal shape and weight but wants liposuction. What should your primary advice/counselling center on?

a) Healthy lifestyle choices
b) Being comfortable with their natural appearance, whatever it may be
c) Perils of cosmetic surgery
d) Involving their family

Any other suggestions and solutions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013):
IMA Digital TV
Inspirational Story
Just listen

I suspect that the most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention. And especially if it’s given from the heart. When people are talking, there’s no need to do anything but receive them. Just take them in. Listen to what they’re saying. Care about it. Most times caring about it is even more important than understanding it. Most of us don’t value ourselves or our love enough to know this. It has taken me along time to believe in the power of simple saying, "I’m so sorry," when someone is in pain. And meaning it.

One of my patients told me that when she tried to tell her story people often interrupted to tell her that they once had something just like that happen to them. Subtly her pain became a story about themselves. Eventually she stopped talking to most people. It was just too lonely. We connect through listening. When we interrupt what someone is saying to let them know that we understand, we move the focus of attention to ourselves. When we listen, they know we care. Many people with cancer can talk about the relief of having someone just listen.

I have even learned to respond to someone crying by just listening. In the old days I used to reach for the tissues, until I realized that passing a person a tissue may be just another way to shut them down, to take them out of their experience of sadness and grief. Now I just listen. When they have cried all they need to cry, they find me there with them.

This simple thing has not been that easy to learn. It certainly went against everything I had been taught since I was very young. I thought people listened only because they were too timid to speak or did not know the answer. A loving silence often has far more power to heal and to connect than the most well intentioned words.
eMedi Quiz
All of the following conditions may predispose to pulmonary embolism except:
1. Protein S deficiency.
2. Malignancy.
3. Obesity.
4. Progesterone therapy.

Yesterday’s Mind Teaser: A vitreous aspirate has been collected in an emergency at 9 pm what advice you like to give to the staff on duty regarding the overnight storage of the sample.

1. The sample should be kept at 4°C.
2. The sample should be incubated at 37°C.
3. The sample should be refrigerated deep freezer.
4. The sample should be refrigerated for the initial 3 hours and then incubated at 37°C.

Answer for Yesterday’s Mind Teaser:. 1. The sample should be kept at 4°C.

Answers received from: Dr Jainendra Upadhyay, Dr.K.V.Sarma, Dr Kailash Chandra Sharma, Dr.B.R.Bhatnagar, Daivadheenam Jella, Dr Avtar Krishan,

Answer for 21st November Mind Teaser: 4. Superior vena caval obstruction

Answers received from: Dr Kailash Chandra Sharma, Daivadheenam Jella,
Teacher: Ellen, give me a sentence starting with "I".

Ellen: I is…

Teacher: No, Ellen. Always say, I am.

Ellen: All right. I am the ninth letter of the alphabet.
Readers column
Dear Sir, Thanks for the nice information: Regards: Dr Jatin
Press Release
How can social jetlag affect your health and aggravate long-term chronic diseases?

Modernization and Westernization of our country have led to a drastic rise in the incidence of lifestyle diseases. The high stress lives that people live today gives birth to the problem of social jet lag.

Social jet lag refers to the mismatch between an individual's biological circadian rhythm and their socially imposed sleep schedules. It puts an individual at a higher risk of developing long-term chronic diseases like type 2 diabetes, obesity and cardiovascular issues like heart stroke and heart attack.

The 21st century Indian has a tendency to sleep less or have an irregular sleep pattern. The reasons for this include weekends spent socializing and going out with friends and colleagues, a high stress working environment with no fixed hours and overdependence on technology, which keeps many, awake till wee hours of the night.

These sleep irregularities substantially decrease our cognitive performance, competence, and memory capacity. They impact our metabolism and immunity making us vulnerable to a host of diseases. Such people also have a higher tendency to develop obesity and depression.

Raising awareness about the issue, Padma Shri Awardee Dr. KK Aggarwal, Honorary Secretary General, IMA and President, HCFI said, “The term social jet lag has been continuously linked to lower HDL (bad cholesterol), higher triglycerides, insulin resistance, greater waist circumference, unbalanced body mass index (BMI), higher fasting plasma insulin and obesity. People living an irregular lifestyle are also more prone to addictions to evils such as cigarettes, alcohol and drugs. While stresses cannot always be eliminated, it is recommended that people consume a healthy diet, get at least 7 hours of sleep in a night, ensure that they spend time in the sunlight to replenish the body’s Vitamin D requirement and opt for relaxing techniques such as deep breathing and yoga as and when they get time. Social Jetlag is an emerging 21st-century problem and awareness must be created in this regard."

It’s natural for a human being to sleep at different times and wake up at different times, for every individual’s circadian rhythms are different. But a minor modification in a person’s lifestyle can also go a long way in helping reverse the increasing incidence of lifestyle diseases in our country.

A few tips to keep lifestyle diseases at bay until the age of 80 years

• Women must keep their abdominal circumference lower than 80 cm and men 90 cm
• Keep your fasting sugar lower than 80 mg %.
• Keep your blood pressure lower than 80 mm Hg.
• Keep your heart rate lower than 80 per minute.
• Keep your bad LDL cholesterol lower than 80 mg %.
• Do not consume more than 80 grams of caloric solid or liquid food at once.
• Observe a carbohydrate fast 80 days a year.
• Do not consume alcohol and if you do, restrict it to not more than 80 ml in a day or 80 grams in a week.
• Consume at least 80 fruits and vegetables servings in a week.
• Do not consume more than 80 ml/gram of ghee, oil and butter in a week.
• Ensure to sit out in the sun for at least 80 days in a year to fulfill the body’s requirement of vitamin D
• Walk for 80 minutes in a day.
• Brisk walk for 80 minutes in a week.
• Keep noise pollution less than 80 dB.
• Avoid areas where the Particulate Matter 2.5 and PM 10 levels are higher than 80