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EDITORIAL

Kidney disease due to hyperglycemia starts early in prediabetic state itself

Prediabetes might be a target for early treatment to prevent chronic kidney disease in chronic hyperglycemia. A study of 1,261 nondiabetic people aged 50 to 62 years has suggested that apparently healthy persons who have blood sugar levels higher than normal, but not yet in the diabetic range are still at risk of developing kidney damage. Such individuals are more likely to have glomerular hyperfiltration and albuminuria.

In the study, 595 people were found to have slightly abnormal blood glucose levels. And these individuals had higher probability of having glomerular hyperfiltration and albuminuria at 5-years follow up compared to those who had normal blood sugar levels, indicating early kidney damage.

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BREAKING NEWS

 

Government plans pharma technology upgradation fund

The Govt. is planning to set up a Rs 500-crore pharma technology upgradation fund to facilitate cheaper loans to entities looking to upgrade their manufacturing facilities. A proposal to establish a venture capital fund with a same corpus to provide cheaper loans to small and marginal companies planning to set up new units is also being worked out. Both these proposals are under consideration to rejuvenate the domestic pharma sector and make medicines more affordable. About 3000 outlets of the Jan Aushadi stores are being planned across the country - (ET Healthworld)

FDA issues safety communication about prescribing Posaconazole

The FDA has warned that clinicians cannot substitute two different oral formulations (delayed-release tablet and oral suspension) of the antifungal posaconazole (Noxafil, Merck) for each other on a milligram per milligram basis lest patients experience adverse events, including death. Prescribers should specify the dosage form, strength, and frequency on all scripts for posaconazole, and pharmacists should request this information when it is not specified. The delayed-release tablet has a higher bioavailability than its oral suspension counterpart. Direct milligram to milligram substitution can result in underdoses or overdoses (Medscape)

 

 
IMA JIMA

http://module.ima-india.org/ima/jima/2015/September/
 

SPECIALTY UPDATES

  • Pregnant women who take the oral antifungal drug fluconazole for vaginal candidiasis are at a significantly increased risk for miscarriage, suggests new research published in JAMA.
  • Depression in early childhood is associated with reductions in gray matter development in the brain during early adolescence, with the reductions linked to the number of depressive symptoms, suggests a longitudinal study published online in JAMA Psychiatry.
  • A new study, scheduled to be presented at the Genitourinary Cancers Symposium (GUCS), suggests that in men with prostate cancer, regular aspirin use is associated with a slower rate of disease progression and a reduced risk of dying from the disease.
  • Use of a simple filtration mask could reduce the adverse endothelial effects and increase in natriuretic peptides caused by some forms of air pollution in patients with heart failure, suggests a small randomized controlled pilot trial published in the January 2016 issue ofJACC: Heart Failure.
  • Obese young people can avoid developing life threatening illness if they change before middle age, suggests new research published in BMJ Open. Researchers noted that men who had high BMI levels at 21, but had lowered their BMI by the age of 50, had similar or lower rates of diabetes as people who were normal weight when younger.
  • Intracerebral hemorrhage patients can present with rapidly resolving symptoms that imitate transient ischemic attack (TIA), pointing towards a need for rigorous evaluation of suspected TIA, suggests new research published inJAMA Neurology.
  • Robotic and single-incision minimally invasive gallbladder surgery offer substantially less surgical value than traditional laparoscopic cholecystectomy, reported a new study published online in the Journal of the American College of Surgeons.
  • Joint best practice recommendations from American College of Surgeons and American Geriatrics Society, published online in the Journal of the American College of Surgeons, address unique care required for older adults facing surgery. The guideline was released for optimal care of older adults immediately before, during, and after surgical operations.
  • A wearable device appears to be just as good at measuring lactate thresholds for endurance runners as older, more complicated methods, suggested a new study published online in the Journal of Strength and Conditioning Research. The wearable device sleeve fits on the lower leg and is non-invasive.
  • The odds of major depressive disorder and generalized anxiety disorder were markedly greater among women who earned less than their male counterparts, with whom they were matched on education and years of experience, suggested new research published online in the journalSocial Science & Medicine.
 

eSPIRITUAL

Vedanta Laws

  • For every action, there is an equal and opposite reaction.
  • Knowledge proceeds from the known to the unknown. This is the basic law of learning.
  • Yesterday's miracles are today's science and today's miracles will be tomorrow's science.
  • Reality: Objects continue to exist whether or not we think about them.
  • You sow an action and reap a habit. You sow a habit and reap a character. You sow a character and reap your culture. You sow your culture and reap your destiny.
  • As are the experiences, so is the life.
  • You are what you are because of the indwelling personality determined by the nature of your mind and the intellect.
  • Change or perish is the law of nature.
  • The world is cruel only to be kind.
  • Ignorance manifests in three different stages: Lack of information, lack of understanding and lack of experience
  • The law of life proclaims that none can remain, even for a moment, without performing activity. Even the maintenance of your body will be impaired by inaction.
  • Desires are like bacteria.
  • Fear and love are the only two true emotions of nature.
  • Love is the law.
  • Everybody is born with a unique talent. Search for it and respect it.
  • The Universe is the macrocosm, man is the microcosm' (Return of the Rishi, p. 113).

There's an ancient saying in Ayurveda: As is the atom, so is the Universe. As is the microcosm, so is the macrocosm. As is the human body, so is the cosmic body. As is the human mind, so is the cosmic mind.

 

LEGAL QUOTE

Samira Kohli vs Dr. Prabha Manchanda and Anr, SCI, Civil Appeal No. 1949 of 2004, 16.01.2008

Consent in the context of a doctor-patient relationship, means the grant of permission by the patient for an act to be carried out by the doctor, such as a diagnostic, surgical or therapeutic procedure. Consent can be implied in some circumstances from the action of the patient. For example, when a patient enters a Dentist's clinic and sits in the Dental chair, his consent is implied for examination, diagnosis and consultation.

 

 

THE YEAR IN MEDICINE 2015: NEWS THAT MADE A-DIFFERENCE

Medical licensing exam to ask questions about military medicine

The medical licensing exam will now include questions about military medicine. The move was spearheaded by a small group of medical professionals who wanted to ensure that in the future physicians will at least be aware of the possible medical problems of veterans. Brian Baird, PhD, a former Democratic member of Congress from Washington and a licensed clinical psychologist, said he was inspired by some of his own patients who returned from duty in need of helpŠ(Medscape)

 

1. IMA Rare Blood Group Online Blood Bank Directory: ima-india.org/Rare
2.IMA Online TB Notification initiative: ima-india.org/tbnotify
3.IMA Online Events Reporting initiative: http://www.ima-india.org/ima/left-side-bar.php?scid=228
4. Proforma for Hypertension Screening: http://module.ima-india.org/
5. IMA Online Sentinel Events Reporting Initiative: ima-india.org/sentinel
6. IMA Disease Notification: http://disnotif.ima-india.org/
7. IMA RISE and SHINE: http://imariseandshine.com/
12. IMA Slide Share: http://www.ima-india.org/ima/free-way-page.php?scid=287
13. I Pledge My Organ: http://module.ima-india.org/ipmo/
14. IMA Weekly Live: http://www.ima-india.org/imalive/
17. IMA ART: http://ima-india.org/artbill
18. IMA Satyagraha: http://ima-india.org/satyagraha
19. IMA Daily Webcast: http://ima-india.org/ima/
20. CC Slides: http://www.ima-india.org/ima/left-side-bar.php?scid=417
21. NATCON Photos: IMA Natcon 2015 - Day 2 - Camera 1, IMA Natcon 2015 - Day 2 - Camera 2,

 

IMA SATYAGRAHA

https://www.youtube.com/watch?v=UV1zCH33BlU

IMA POLL

http://www.ima-india.org/ima/ima-poll.php

 

Skin Often a 'Window' Into Underlying Endocrine Disorders

Two separate studies published online December 23 inJAMA Dermatology have provided new insights into cutaneous manifestations of common endocrine disorders that, if they are present, should prompt clinicians to explore patients for underlying metabolic abnormalities that could be a harbinger for future serious complications.

  • Timothy Schmidt, MD, PhD, from the University of California, San Francisco, discovered that hirsutism and the skin pigmentation disorder acanthosis nigricans, especially if located in the axillae, are the most reliable cutaneous markers of the polycystic ovary syndrome (PCOS) in women; when present, such findings should trigger further diagnostic evaluation for metabolic comorbidities that can lead to long-term complications in PCOS.
  • Mohit Nagpal, MD, from the Postgraduate Institute of Medical Education and Research, Chandigarh, India, and colleagues found that postadolescent males with acne are more likely to have insulin resistance and that they, too, should be followed up for a period of time in order to detect any conditions that might develop because of the current state of insulin resistance.

(Medscape)

 

Breast cancer develops earlier in Indians than their western counterparts

A study conducted by the Institute of Post-Graduate Medical Education and Research (IPGMER) in collaboration with the Royal Free Hospital, London has shown that breast cancer affects Indian women at least 10-15 years earlier than their counterparts in the West. The revelation was significant, said experts who believed that rather than screening, awareness was needed to curb the cases in India. According to the study, Indian solutions are needed for Indian problems. The study also revealed that the reason behind the early onset of breast cancer in India was a sub-type, which was more common here than in the West. Basal subtypes is frequent n India, the luminal subtype was prevalent n the West. (Times of India - Prithvijit Mitra)

 

First-of-a-kind drug approvals continued rise in 2015

Approvals for first-of-a-kind drugs climbed last year, pushing the annual tally of new U.S. drugs to its highest level in 19 years. The rising figures reflect an industry-wide focus on drugs for rare and hard-to-treat diseases, which often come with streamlined reviews, extra patent protections and higher price tags. The Food and Drug Administration approved 45 drugs with never-before-sold ingredients in 2015, edging past the previous year's tally of 41, which had been the highest number since 1996 (ET Healthworld)

 

START-UP India Launch

The Government of India is launching the Start-up India, a non-stop day long global workshop on Start-up Entrepreneurship on January 16th, 2016 in New Delhi to celebrate the entrepreneurship spirit of country's youth and will be attended by CEOs and founders of top Start-ups (over 1500) from across the country. The Honorable Prime Minister of India, Shri Narendra Modi will formally launch the initiative and unveil the Start-up Action Plan (PIB)

 
 
Media
eMediPics

IMA PVPI Programme

 

WP(C) No.8706/2015 titled ԉndian Medical Association Vs. Union of India & Anr (NCERT)ԠDelhi High Court, New Delhi

Click here to read the proposed changes

 

BIOETHICAL ISSUES IN MEDICAL PRACTICE

Parent's dilemma in choosing sex of their intersex child

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

A and Shave one child. The second, born three months ago, had indeterminate sexual genitalia. He doctor opines that the child will need one operation so that sex is clear. The operation can be done in the future once the child grows up and decides which sex s/he wants to belong to. They are worried because they feel that growing up with a confusing sexual identity will not be good for the child. Moreover the other sibling may face stigma. Finally the child does not even need to know about the operation. As their doctor what should you advise?

  1. What would you do, as a parent?
  2. Is such a surgery necessary at all? Can the child not go through life with indeterminate sex if s/he wants?
  3. What other social issues would such a child face?

Any suggestions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013): http://www.eubios.info/

 

eWELLNESS

Negative stress may lead to heart disease

Marital disharmony and job dissatisfaction are the two main mental risk factors for the causation of heart attack. Many studies in the past have linked that there is a strong correlation between a nagging wife and early heart attacks in men. Similarly, literature has shown that work related stress is related to early onset of high blood pressure, diabetes, stroke and heart attacks. A study from University College, London has shown that chronically stressed workers have a 68% of higher risk of developing heart disease especially in people under the age of 50. Whether it is stress-related chemical changes or stress-related behavior linked to heart disease, is yet to be answered.

Stress-related lifestyle involves eating unhealthy food, smoking, drinking and skipping exercises. Chemical changes related to chronic stress are increased levels of cortisol, epinephrine and norepinephrine. Amongst stress, negative stress is more dangerous than positive stress and amongst negative stress it is jealousy, anger and cynicism which are associated with heart attack. The answer lies in managing stress by acting on a personal situation and not reacting to it. In children the same type of stress, especially during exam days, can end up with anxiety, insomnia and suicidal attempts.

 

IMA Live Webcast

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INSPIRATIONAL STORY

Once upon a time a very strong woodcutter asked for a job in a timber merchant, and he got it. The pay was really good and so were the work conditions. For that reason, the woodcutter was determined to do his best. His boss gave him an axe and showed him the area where he was supposed to work. The first day, the woodcutter brought 18 trees. "Congratulations," the boss said. "Go on that way!" Very motivated by the boss words, the woodcutter tried harder the next day, but he could only bring 15 trees. The third day he tried even harder, but he could only bring 10 trees. Day after day he was bringing less and less trees. "I must be losing my strength", the woodcutter thought. He went to the boss and apologized, saying that he could not understand what was going on. "When was the last time you sharpened your axe?" the boss asked. "Sharpen? I had no time to sharpen my axe. I have been very busy trying to cut trees."

Our lives are like that. We sometimes get so busy that we don't take time to sharpen the axe." In today's world, it seems that everyone is busier than ever, but less happy than ever. Why is that? Could it be that we have forgotten how to stay sharp? There's nothing wrong with activity and hard work. But God doesn't want us to get so busy that we neglect the truly important things in life, like taking time to pray, to read. We all need time to relax, to think and meditate, to learn and grow.

If we don't take time to sharpen the axe, we will become dull and lose our effectiveness. So start today. Think about the ways by which you could do your job more effectively and add a lot of value to it.

 

eMEDI QUIZ

Cinnarizine is known to perform which of these functions
a. Improve labyrinthine blood flow
b. Vestibular sedation
c. Reduction in irritability of vestibular labyrinth
d. All of above

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&dgree;C.
2. The sample should be incubated at 37&dgree;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&dgree;C.

Answer for Yesterday's Mind Teaser: 1. The sample should be kept at 4у.
Answers received from: Dr Jainendra Upadhyay,Dr.K.Raju,Dr Poonam Chablani,DrKVSarma,Daivadheenam Jella,Dr Avtar Krishan.
Answer for 4th January Mind Teaser: 4. Superior vena caval obstruction.
Answers received from: Dr K.Raju, Dr K V Sarma, Daivadheenam Jella

 

READER'S COLUMN

Dear Sir, reading emedinews is very informative to us. Regards: Dr Jyoti

 

HUMOR

Dream of a necklace

After she woke up, a woman told her husband, "I just dreamed that you gave me a pearl necklace for our anniversary. What do you think it means?" "YouӬl know tonight." he said. That evening, the man came home with a small package and gave it to his wife. Delighted, she opened it to find a book entitled "The Meaning of Dreams."

 

PRESSRELEASE

Air pollution-specifically fine particulate matter, is associated with increased cardiovascular disease mortality

Air pollution has emerged as a potentially modifiable risk factor for the development of CVD.Multiple observational studies have demonstrated an association between fine particulate air pollution (primarily from the use of fossil fuels in automobiles, power plants, and for heating purposes) and cardiovascular and cardiopulmonary mortality as well as an increased risk for the development of acute coronary syndromes.

In fact both the American Heart Association (2010) and the European Society of Cardiology (2015) have issued official statements discussing the association between long-term exposure to fine particulate air pollution and increased risk of developing cardiovascular disease.

Speaking about the associated risks with the increasing pollution levels of Delhi,Dr. S.S Agarwal ֠National President and Padma Shri Awardee Dr. KK Aggarwal, Honorary Secretary General of IMAin a joint statement said, ԁir pollution is a major environmental risk to health. By reducing air pollution levels, countries can reduce the burden of disease from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma. The lower the levels of air pollution, the better the cardiovascular and respiratory health of the population will be, both long- and short-term.Լ/span>

Ambient (outdoor air pollution) in both cities and rural areas was estimated to cause 3.7 million premature deaths worldwide in 2012. Some 88% of those premature deaths occurred in low- and middle-income countries, and the greatest number in the WHO Western Pacific and South-East Asia regions.

In addition to long-term risk, short-term exposure to air pollutants (both ozone and fine particulate matter) has been associated with acute coronary ischemic events.

The association betweenair pollution and episodes of AF was evaluated in a 2013 study of 176 patients with dual chamber implantable cardioverter-defibrillators that were capable of detecting episodes of AF. After follow-up of nearly two years, there were 328 episodes of AF lasting 30 seconds or more found in 49 patients. The potential impact of multiple parameters of air pollution, (measured hourly) on the development of AF was examined. The odds of AF increased significantly as the concentration of particulate matter increased in the two hours prior to the event.

It is thus important that heart patients stay indoors or wear a mask when in places with high pollution levels. It is the responsibility of each one of us to ensure that we reduce environmental pollution for our own long-term health and that of others. Delhi air quality is a matter of grave concern for the medical fraternity and awareness generation and prevention is crucial.

 
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