July 27  2015, Monday
A Soda a Day Ups CVD Risk by 30%: NHANES Study
Dr KK AggarwalAmerican adults consume on average about 15% of their calories from sugars added to foods during processing, with a whopping 37% of the added sugar consumed in sugar–sweetened beverages, suggests an analysis of data extending back about 25 years.

Regularly drinking as little as one 12–ounce sugary soda a day may increase the risk of cardiovascular disease by about 30%—independent of total calories, obesity, or other risk factors, as per a study in JAMA Internal Medicine.

Epidemiologic studies have linked high consumption of added sugar with an increased risk of type 2 diabetes, obesity and hypertension.

The American Heart Association recommends less than 100 calories a day (about 5% of total daily calories) for women and 150 calories a day (about 7.5% of total daily calories) for men from added sugars.

The risk of CVD mortality becomes elevated once added sugar intake surpasses 15% of daily calories—equivalent to drinking one 20–ounce Mountain Dew soda in a 2000-calorie daily diet.

The risk rises exponentially as sugar intake increases, peaking with a fourfold increased risk of CVD death for individuals who consume one–third or more of their daily calories in added sugar.

eMedinewS Recommendations
  • Do not consume > 80 ml of cold drinks in a day
  • Avoid sweets containing > 30% sugar.
ICON 2015
Infectious diseases
The US Food and Drug Administration (FDA) approved two new drugs for hepatitis C, one for genotype 3 and the other for genotype 4. The first is a combination of ombitasvir, paritaprevir, and ritonavir in a tablet for use with ribavirin in adult patients with hepatitis C virus (HCV) genotype 4 infection without scarring and cirrhosis. The second is the NS5A replication complex inhibitor daclatasvir for use with sofosbuvir to treat HCV genotype 3 infection.

The US Food and Drug Administration (FDA) has approved the once-a-day 200 mg oral therapy sonidegib for the treatment of locally advanced basal cell carcinoma, which accounts for approximately 80% of nonmelanoma skin cancers. It is indicated for adults whose disease has recurred after surgery or radiation therapy and for patients who are not candidates for surgery or radiation therapy.

Adding a potent antagonist of the 5-HT6 serotonin receptor, RVT-101, to standard dementia care with donepezil improves cognitive outcomes in patients with mild to moderate Alzheimer's disease (AD), suggests a new phase 2b double-blind, controlled study presented at the Alzheimer's Association International Conference (AAIC) 2015.

Obstetrics and Gynecology
First-time mothers who have had a miscarriage or abortion early in a previous pregnancy may face an increased risk of complications during delivery, suggests a new study published in the Journal of Maternal-Fetal and Neonatal Medicine. Nephrology
In a comparison of induction treatments for lupus nephritis, tacrolimus was both the most effective and safest of the immunosuppressive agents compared, reported a study published online in Lupus.
Cardiology eMedinewS
  • The European Commission (EC) has granted marketing authorization for evolocumab, the first proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor to be approved in the world, for the treatment of patients with uncontrolled cholesterol who require additional intensive low-density lipoprotein cholesterol (LDL-C) reduction.
  • A large population-based study of randomly selected participants reported that mild cognitive impairment (MCI) occurred significantly more often in individuals diagnosed with a lower ankle brachial index (ABI), which is a marker of generalized atherosclerosis and thus cumulative exposure to cardiovascular risk factors during lifetime. This study was published in the Journal of Alzheimer's Disease.
Pediatrics eMedinewS
Infectious diseases

A suspension formulation of the integrase inhibitor raltegravir may help prevent transmission of HIV from infected women to their newborns, suggests a new study presented at the biennial International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention.

More than half of all transgender youth reported experiencing suicidal thoughts, and a little less than a third had actually attempted suicide, suggested research done at a large, urban transgender youth clinic. The findings are published in the Journal of Adolescent Health.
Dr KK Spiritual Blog
Five Types of People from Nastik to Astik

Following are the five types of people
  1. Nastik – the one who believes in God.
  2. Astik – for whom God exists.
  3. For them the God also exists in them (I and the God are the same)
  4. Tat tvam asi (God not only exists in me but also in you)
  5. God is in everybody
People who believe that God exists are fearful people and they always fear God. People who see God in themselves, live a disciplined Satvik life and do not indulge in activities which are not God-friendly.

People who believe that God is not only in me but also in you, treat every person the same way as they treat themselves.

People for whom God is everywhere always work for the welfare of the society.
Make Sure
Situation: A patient with renal failure came to a doctor.
Reaction: Oh, my God! Why was he given painkillers?
Lesson: Make sure to avoid painkillers in renal failure as most painkillers (barring nimesulide, paracetamol) are not kidney-friendly drugs.
Dr Good Dr Bad
Situation: A patient with high triglycerides developed stroke.
Dr Bad: They are not related.
Dr Good: They are related.
Lesson: Men and women with high triglyceride levels are at an increased risk of ischemic stroke.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 110490 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
Inspirational Story
Happiness is a Voyage

We convince ourselves that life will be better once we are married, have a baby, then another. Then we get frustrated because our children are not old enough and that all will be well when they are older. Then we are frustrated because they reach adolescence and we must deal with them. Surely we’ll be happier when they grow out of the teen years.

We tell ourselves our life will be better when our spouse gets his/her act together, when we have a nicer car, when we can take a vacation, when we finally retire. The truth is that there is no better time to be happy than right now.

If not, then when? Your life will always be full of challenges. It is better to admit as much and to decide to be happy in spite of it all. For the longest time, it seemed that life was about to start. Real life…

But there was always some obstacle along the way, an ordeal to get through, some work to be finished, some time to be given, a bill to be paid. Then life would start. I finally came to understand that those obstacles were life. That point of view helped me see that there isn’t any road to happiness.

Happiness is the road. So, enjoy every moment.

Stop waiting for school to end, for a return to school, to lose ten pounds, to gain ten pounds, for work to begin, to get married, for Friday evening, for Sunday morning, waiting for a new car, for your mortgage to be paid off, for spring, for summer, for fall, for winter, for the first or the fifteenth of the month, for your song to be played on the radio, to die, to be reborn… before deciding to be happy.

Happiness is a voyage, not a destination. There is no better time to be happy than… NOW! Live and enjoy the moment.
Quote of the Day
Ability is what you’re capable of doing. Motivation determines what you do. Attitude determines how well you do it. Lou Holtz
IMA in Social Media
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Reader Response
This is in relation to your editorial on low cholesterol. Good editorial, however would love to have the link to low cholesterol Japan study mentioned in the article. Cholesterol is the first molecule in the steroidogenic pathway in the formation of steroid hormones like pregnenolone, estrogen, testosterone progesterone etc. All these hormones act as neurosteroids. Therefore low cholesterol & poor brain health is not a surprise at all. Dr SD Kar
Wellness Blog
Elderly should Beware of Commonly Prescribed Group of Drugs

Anticholinergics, a commonly prescribed group of drugs, may cause elderly people to "slow down" in their daily physical activities.

Two reports from Wake Forest University School of Medicine support findings that anti-cholinergic drugs used to treat acid reflux, Parkinson's disease and urinary incontinence may cause older people to lose their thinking skills more quickly than those who do not take the medicines.

Anticholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.

Older adults taking anticholinergics become more likely to walk more slowly and to need help in other daily activities. These results are true even in older adults who have normal memory and thinking abilities.

For older adults taking a moderately anticholinergic medication, or two or more mildly anticholinergic medications, their function is similar to that of someone three to four years older.

Common anticholinergic medicines include blood pressure medication, nifedipine; the stomach antacid, ranitidine, and the incontinence medication, tolterodine.

Cholinesterase inhibitors, a family of drugs used to treat dementia by increasing levels of acetylcholine include donepezil, galantamine, rivastigmine and tacrine. About 10 percent of patients may be taking tolterodine and dozepezil together. The two drugs are pharmacological opposites, which led to the hypothesis that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs.
eIMA Humor

One day a girl came home crying to her mom. The mom asked what was wrong.

The girl responded, "I’m not a creation, God made men first! I’m nothing!"

Then the mom said, "Oh baby that’s not true, God may have made men first, but there’s always a rough draft before the masterpiece."
eIMA Quiz
Strong correlation with colorectal cancer is seen in:

1. Peutz-Jegher's polyp.
2. Familial polyposis coli.
3. Juvenile polyposis.
4. Hyperplastic polyp.

Yesterday’s Mind Teaser: A 40-year-old male had undergone splenectomy 20 years ago. Peripheral blood smear examination would show the presence of:

1. Dohle bodies
2. Hypersegmented neutrophils.
3. Spherocytes.
4. Howell-Jolly bodies.

Answer for yesterday’s Mind Teaser: 4. Howell-Jolly bodies.

Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Daivadheenam Jella, Dr. G. Madhusudhan, Dr Avtar Krishan, Dr.Shangarpawar
Answer for 25th July Mind Teaser: 4. Portal hypertension due to extrahepatic obstruction

Correct Answers received: Asha Yahoo, Dr Poonam Chablani, Daivadheenam Jella, Dr Avtar Krishan
IMA Videos
Rabies News (Dr A K Gupta)
What are most dangerous sites of bites/exposure in man?

Theoretically, the richly innervated areas like head, neck, face, hands and genitals are the most dangerous sites of bite in man. But practically, it is often the wounds on legs, which are ignored/neglected, that cause rabies.
News on Maps
Press Release
IMA to come out with 25 points about 100 common diseases, which every family physician should know

For first time in India, 540 General Practitioners participated in a Video CME from 23 different locations on the subject ‘Management of Diabetes at family practice level’ in the ongoing ICON 2015, organized by the Indian Medical Association (IMA) Headquarters.

Inaugurating the CME, Padma Shri Awardee, Dr A Marthanda Pillai, National President, IMA said that IMA is going to come out with 25 points about 100 common diseases, which every family physician should know. These will be communicated to all 2.5 lakh doctors.

Interacting with the audience Dr Banshi Saboo, Diabetologist said that diabetes is no more a disease of the obese, even lean persons can develop lifestyle diabetes. Uncontrolled diabetes can damage the lungs, eyes, heart and brain. Instead of fasting blood sugar, more emphasis is given on A1c test, which calculates the average blood sugar over the last three months.

Delivering the Dr V Parameshvara Oration Padma Shri Awardee, Dr K K Aggarwal, Honorary Secretary General, IMA said that every family doctor should earn ethically. An honorable profession does not mean that you are not supposed to earn, but your earnings should be ethical. The family physician should aim to be ethically, morally, legally and scientifically correct.

Talking about Dengue fever, a panel of experts including Dr NK Yadav, Dr Vinay Aggarwal, Dr VK Monga, Dr Sharad Aggarwal, Dr BB Wadhwa, Dr DR Rai, Dr Narendra Saini said that every dengue death should be preventable. The current guidelines do not recommend transfusion of platelets unless there is active bleeding.

Those who spoke on the occasion were Dr Sanjay Jain, Dr VK Jain, Dr HM Bajaj, Dr Durgatosh Pandey and Dr Babita Gupta.

Dr Nimesh Desai, Director, IBHAS talked about the importance of psychiatric knowledge for a General Practitioner. He emphasized that a family physician should be able to diagnose early depression and start counseling and treatment at the very initial stage so as to avoid complications.