June 25  2015, Thursday
To control TB, prevent diabetes in the community
If you want to control TB, prevent diabetes in the community especially in India where rates of TB are amongst the highest and where the incidence of type 2 diabetes is rising sharply.

As per a WHO report published online September 4 in Lancet Diabetes & Endocrinology, patients with either diabetes or TB need to be cross-checked for the other disease.

Fifteen percent of adult TB cases worldwide are already attributable to diabetes, with more than 40% occurring in India and China alone.

Diabetes can go undiagnosed for a long period, so it makes sense to do proactive screening for diabetes in all patients with TB.

Conversely, diabetes should be on the clinical radar when caring for people with TB.
  • A large cohort study suggests that lifestyle factors might explain why men who take popular phosphodiesterase type 5 (PDE5) inhibitors for erectile dysfunction ? sildenafil, vardenafil, and tadalafil ? are at a slightly but significantly increased risk of developing malignant melanoma. The findings are published online June 23 in JAMA.
  • New phase 2 data on the investigational calcitonin gene-related peptide (CGRP) monoclonal antibodies show significant efficacy in preventing migraine attacks with no major safety signals. The data were presented at the American Headache Society (AHS) 57th Annual Scientific Meeting.
  • In patients with ankylosing spondylitis, smoking might interact with epigenetic factors and promote radiographic progression, suggests new study presented at the European League Against Rheumatism Congress 2015.
  • Adding metformin to lifestyle change lowers body mass index (BMI) and improves menstrual cyclicity, compared with lifestyle change alone, in women with polycystic ovary syndrome (PCOS), suggests a recent meta-analysis published online in Human Reproduction Update.
  • The first large panic disorder trial to compare cognitive-behavioral therapy (CBT), panic-focused psychodynamic psychotherapy (PFPP), and applied relaxation training (ART) showed that although all treatments improved panic disorder, CBT performed most consistently. PFPP also demonstrated efficacy. The findings are published online in the Journal of Clinical Psychiatry.
Cardiology eMedinewS
  • The Cardiorespiratory Fitness on Arrhythmia Recurrence in Obese Individuals with Atrial Fibrillation (CARDIO-FIT) study suggests that cardiorespiratory fitness (CRF) not only helps with relieving symptoms of atrial fibrillation (AF), but it also predicts recurrence in patients who are obese. The findings were presented at the European Heart Rhythm Association (EHRA) EUROPACE-CARDIOSTIM 2015 meeting.
  • For warfarin-treated patients with atrial fibrillation undergoing an elective surgery or invasive procedure, perioperative bridging with low-molecular-weight heparin (LMWH) was not associated with a reduction in stroke, systemic embolism, or transient ischemic attack compared with no bridging but did significantly increase the risk of bleeding, reported a new study presented at the International Society for Thrombosis and Haemostasis (ISTH) 2015 Congress.
Pediatrics eMedinewS
  • The use of a single, narrow-spectrum antibiotic such as ampicillin/penicillin is increasingly the first line of treatment for children hospitalized with community-acquired pneumonia (CAP), suggests a new study published online June 22 in Pediatrics.
  • Children whose parents smoked when they were toddlers are likely to have a wider waist and a higher BMI by time they reach ten years of age, suggest researchers at the University of Montreal.
Dr KK Spiritual Blog
Is time and place of death pre-defined?

Some gurus teach that the time and place of death is predefined and some do not. I personally feel that life and respiration are predefined and not day and time of death.

It is something like - water in a sponge will become empty when every drop of water comes out but it does not matter how much time it takes to come out. It is therefore possible to postpone or prolong the fulfillment of Prarabhdha Karma and postpone death.

As per the Karma theory, unless our Prarabdha Karmas (decided at the time of death and birth) are enjoyed and fulfilled, one cannot die. But once the Prarabhdha Karmas are fulfilled, death is inevitable.
Another unanswered question is ‘can Prarabdha karma be modified’? Fate or destiny may not change, which means one may not be able to prolong the quantity of life but can definitely change the quality of life. The quality of life can be changed by modifying Agami (present Karmas).

Sanchit Karmas can be burnt with the file of knowledge about self. Prarabdha Karmas have to be experienced and Agami Karma can be neutralized by positive and negative Karmas to Zero in the present life.

The last few Prarabdha Karma experienced can thus be slowed down by the net positive result of their Agami karmas.
Make Sure
Situation: A patient of suspected MI died after receiving sublingual nitrate.
Reaction: Oh my God! Why was a history of Viagra drug intake not taken?
Lesson: Make sure to take a history of Viagra drug intake before giving nitrates, because the two drugs co–administered can cause fatal fall in blood pressure.
Dr Good Dr Bad
Situation: A patient with hypertension had non–responding cough.
Dr. Bad: Take an X–ray.
Dr. Good: Stop ACE inhibitors.
Lesson: The commonest cause of cough in a patient with high blood pressure is the intake of ACE inhibitors.
eMedi Quiz
The Protein Efficiency Ratio (PER) is defined as:

1. The gain in weight of young animals per unit weight of protein-consumed.
2. The product of digestibility coefficient and biological value.
3. The percentage of protein absorbed into the blood.
4. The percentage of nitrogen absorbed from the protein absorbed from the diet.

Yesterday’s Mind Teaser: The following statements about meningococcal meningitis are true, except:

1. The source of infection is mainly clinical cases.
2. The disease is more common in dry and cold months of the year.
3. Chemoprophylaxis of close contacts of cases is recommended.
4. The vaccine is not effective in children below 2 years of age.

Answer for yesterday’s Mind Teaser: 1. The source of infection is mainly clinical cases.

Correct Answers received from: Pandit Handotkar, Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K Raju, Dr Avtar Krishan.

Answer for 23rd June Mind Teaser: 3. Third quartile.

Correct Answers received: Dr G Madhusudhan, Daivadheenam Jella, Dr Avtar Krishan.
Rabies News (Dr A K Gupta)
Is there carrier state of rabies in dogs?

A carrier state of rabies in dogs/cats has not yet been conclusively proven and established.
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
eIMA News
  • 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, results from a randomized controlled trial suggest. (Ursula Thiem, MD, from the Medical University of Vienna).
  • Patients with end-stage renal disease (ESRD) receiving dialysis have been reported to have increased risk of cancer. (Medscape)
  • When the FDA advisory committee met this month to consider approvability of two PCSK9 inhibitors, the big question was not lipid-lowering efficacy but which group of patients would get an indication. The panelists voted in favor of approval of both evolocumab (Repatha) and alirocumab (Praluent) based on a slew of trials in a variety of settings showing that LDL fell by an absolute 30% to 60% from baseline. (Medage Today)
  • Antibiotic treatment of patients with computed tomography (CT)-proven, uncomplicated appendicitis may be as effective as appendectomy, according to a new study (JAMA)
  • Daily baricitinib, an oral Janus kinase (JAK)1/2 inhibitor, produces rapid clinical improvement in the signs and symptoms of rheumatoid arthritis in patients with active disease who have failed at least one tumor necrosis factor (TNF) inhibitor, the RA-BEACON trial indicates.
IMA Branch Activity Report
Dr P B Hosmani, Hon Secretary, IMA Mundargi Branch
  • 03-06-2015:-GB meeting with CME -- interesting case presentations.
  • 06-03 2015: Talk by Dr Prakash B H on recent Diabetes management .importance of strict glycemic control.
  • World Environment day celebration - A talk by Dr Virabhadragoud Patil on environmental sanitation & communicable diseases at Bagevadi Village Primary School 350 students participated.
  • World population day was celebrated at Hirewaddatti village by organizing speech competition on population explosion for high school children. Prizes were distributed by Dr Ravi Shankar.
  • Anti drug abuse awareness campaign was done among college students. A rally with a public awareness lecture was arranged involving red cross members & students.
  • 31-03-2015- measles vaccination day
  • 07-04-2015: Free camp on WHO day
  • 10-04 2015: Public health awareness talk by Dr Ravishankar at Tippapur village
  • 25-04-2015: CME by Dr Satish Hadimani on TB and Malaria
  • 14-04-2015: Ambedkar Jayanti Celebration
  • 6-5-2015: World Asthma Day check up camp
  • 12-05-2015: World Nurse's Day: Retired Nurses Honored.
  • 25-05-2015: CME by Dr Kiran Kumar on retained placenta at peripheral practice.
  • 31-05-2015: World Tobacco Day public awareness talk
Inspirational Story
Love Wealth and Success?

A woman came out of her house and saw three old men with long white beards sitting in her front yard. She did not recognize them. She said "I don’t think I know you, but you must be hungry. Please come in and have something to eat."

"Is the man of the house home?" they asked. "No", she said. "He’s out." "Then we cannot come in", they replied. In the evening when her husband came home, she told him what had happened. "Go tell them I am home and invite them in!" The woman went out and invited the men in.

"We do not go into a House together," they replied. "Why is that?" she wanted to know. One of the old men explained: "His name is Wealth," he said pointing to one of his friends, and said pointing to another one, "He is Success, and I am Love." Then he added, "Now go in and discuss with your husband which one of us you want in your home."

The woman went in and told her husband what was said. Her husband was overjoyed. "How nice!!", he said. "Since that is the case, let us invite Wealth. Let him come and fill our home with wealth!" His wife disagreed. "My dear, why don't we invite Success?"

Their daughter–in–law was listening from the other corner of the house. She jumped in with her own suggestion: "Would it not be better to invite Love? Our home will then be filled with love!"

"Let us agree to our daughter–in–law’s advice," said the husband to his wife. "Go out and invite Love to be our guest."

The woman went out and asked the three old men, "Which one of you is Love? Please come in and be our guest." Love got up and started walking toward the house. The other 2 also got up and followed him.

Surprised, the lady asked Wealth and Success: "I only invited Love. Why are you coming in?" The old men replied together: "If you had invited Wealth or Success. The other two of us would've stayed out, but since you invited Love. Wherever He goes, we go with him.

Wherever there is Love, there is also Wealth and Success!!!!!!"
Quote of the Day
The best and most beautiful things in the world cannot be seen or even touched – they must be felt with the heart. Helen Keller
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Reader Response
Dear Sir, Thanks for the useful information. Regards: Dr Shipra
Wellness Blog
Pumpkin Extract Beneficial for Diabetic Patients

Pumpkin extract has insulin–like effects. It can help people with diabetes keep their blood sugar under control.

Quoting Chinese researchers that animals with drug–induced diabetes treated with pumpkin extract had lower blood glucose levels, greater insulin secretion, and more insulin–producing beta cells than diabetic rats that weren’t given the extract. This action may be due to the presence of both antioxidants and D–chiro–inositol, a molecule that mediates insulin activity.

Pumpkin extract is potentially a very good product for pre–diabetic persons, as well as those who have already developed diabetes.

Pumpkin is frequently used to treat diabetes and high blood glucose in Asia.

The results of an animal study have shown that rats with diabetes had 41 percent less insulin in their blood than normal rates; giving them pumpkin extract for 30 days boosted levels of the blood sugar–regulating hormone by 36 percent. And after 30 days of being fed pumpkin extract, diabetic rats had blood glucose levels similar to those of non-diabetic rats.
IMA Humor
The physician writing out a prescription

The physician writing out a prescription for his hypertensive cardiac patient: "Diazepam 5mg (tranquilizer) TDS".

The patient’s wife asks, "Doctor, when are these medicines to be given?"

Doctor: "These are to be taken by you. He needs rest"
IMA Videos
News on Maps
Press Release
On the occasion of Doctors Day, IMA will organize blood donation camps all over the country

Celebrate the success of the IMA Mediation, Conciliation & Grievance Redressal Cell

“The Indian Medical Association on the occasion of Doctors day falling on the 1st of July will organize at least 30 blood donation camps across the country, one in each state" said its National President, Dr A Marthanda Pillai and Honorary Secretary General, Dr K K Aggarwal in a press conference today. In addition to this, they will also make a directory of rare blood donors and pledge to continue to organize blood donation camps in the future. The blood donation camps will be organized from 28th June to 1st July.

The success story of the IMA Mediation, Conciliation & Grievances Redressal Cell at the IMA headquarters in New Delhi was also discussed. The concept of the cell has seen great successes one or two cases getting solved every month. Till today, more than 40 cases have been sorted out by the IMA Mediation, Conciliation & Grievances Redressal Cell. IMA has also written to all its State and local branches to start similar initiatives their respective States.

"Most of the complaints that we receive are an outcome of a communication gap between doctors and patients," said Dr K K Aggarwal & Dr A Marthanda Pillai.

Cases received by the IMA Mediation, Conciliation & Grievances Redressal Cell
  • Four cases out of the 40 received were of a financial dispute. To solve the problem, the IMA Mediation Cell called upon the Medical Superintendent of the respective hospitals and along with the relations of the patient and thereafter settled the issue between the parties amicably.
  • In one case, the IMA Mediation Cell opined that the patient should have the right to choose the type of medicine or medical device to be used. The hospital must not make it compulsory and force the patients to buy medicine from their own pharmacy. If the patient can get a substitute to the medicine at an economical price from elsewhere, they have full rights to do so and the hospital must allow them to use it during the treatment
  • Ever since Jacob Mathew Judgment of the Supreme Court was passed, people have started filing cases against doctors under section 304A of IPC. In five cases, IMA could intervene and provide the expert opinion to the families of the patients. All the patients were satisfied with IMA’s opinion and subsequently cases were not filed in 304 A.
  • In four cases, there existed a mediclaim dispute with various hospitals. The main dispute was that the insurance company denied them mediclaim and the hospital had not communicated effectively to the families of the patients that the denial of cashless mediclaim did not mean that the entire claim was denied. The IMA mediation cell helped and guided all the families and subsequently all of them got their mediclaim.
  • In one of the cases, the patient wanted to consult a doctor on the PSU Panel. The panel reimburses the specialist consultant with only Rs 150. Given that the specialist was not available, the patient requested to be directed to another consultant. As the other consultant was not on the penal of BHEL, he could not provide this service. Counseling was done and explained that only an empanelled doctor can see a patient on PSU fees.
  • One typical complaint was that the doctor purposefully referred him to a particular CT Scan Imaging Centre so that he can fleece money from the patient. The mediation cell having gone through the records found that the patient was sent to the center with minimal X-ray radiation exposure. The cost of CT at such center would be higher. Once the patient was given the underlying explanation, his complaint was withdrawal.
  • One Patient complained that he got his platelet count done from three different laboratories and all reports were different. He filed a complaint against the hospital on the ground that they purposefully gave the wrong reports so that they could admit him. The IMA mediation cell heard both the parties and explained to the patient that platelet count using different machines can give different results and variation can be up to a count of 40,000. As per new recommendations, platelet counts are no more the deciding factors for admissions. It is the difference between the upper and lower blood pressure, if lower than 40, which is the indicator of seriousness
  • In another case, the patient complained that he was overcharged for stents. The party was explained that the cost of the stent would depend upon the metal and which type of drug is used in the stent. Also, whether the stent will stay in the body for the six months or not etc.
  • Another interesting case, which came, was that of a patient who complained that that a particular doctor had given drugs, which cost him, Rs.3000 for a month and the same were available at IMA Jan Aushadhi Store at the cost of Rs.300/-. He suspected a doctor chemist nexus. Counseling was done and the patient was made to understand that the prices of drugs may vary depending on their packaging, size, taste, aftertaste, dosage form, etc. All drugs approved by DCGI can be administered to patients and that the DCGI approves both cheaper and costly versions of drugs and both are equally safe. Cheaper drugs do not mean they are fake or bad and costly drugs do not mean that they are more effective. All drugs will have the same efficacy, but one may pay less if the drug is given three times a day and pay more for a drug if it is to be used only once daily
Other members of the mediation cell are Dr VCP Pillai from Kerala and Dr Harish Grover from Delhi.