July 11  2015, Saturday
To control TB, prevent diabetes in the community
Dr KK AggarwalIf 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 in The 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.
28th June 2015: Monsoon Marathon was organized as a part of Doctor’s Day celebrations. More than 100 IMA Mumbai Branch members participated.
The 3rd Annual meeting of the Endocrine Society of Tamil Nadu and Puducherry will be held in Kodaikanal on 11th and 12th of July 2015. TRENDO 2015 is proposed to address latest updates, emerging concepts, clinical applications and controversies in diabetes, thyroid disorders, gonadal problems, pituitary disorders, metabolic bone disease and adrenal diseases.
  • Incident stroke is associated with acute decline in cognitive function and also accelerated and persistent cognitive decline over 6 years, suggested new research published in the July 7 issue of JAMA.
  • New research published in Nature suggests that adding the common hormone progesterone to the treatment could benefit around half of breast cancer patients. Researchers noted that progesterone could slow cancer cell growth by changing estrogen receptor interaction with DNA.
  • A phase II trial comparing guselkumab (CNTO 1959), an anti-interleukin-23 monoclonal antibody, with adalimumab in patients with moderate-to-severe plaque psoriasis suggests that guselkumab may be an effective therapy for plaque psoriasis. The findings are published in the New England Journal of Medicine.
  • A phase III multicenter study has found that patients with early rheumatoid arthritis who had poor prognostic factors had less radiographic progression over a year if they were treated with certolizumab pegol plus methotrexate as compared to methotrexate alone. The findings are published online in Annals of the Rheumatic Diseases.
  • Percutaneous sclerotherapy is safe and highly effective for treating orbital lymphatic malformations, suggests new research published online in the British Journal of Ophthalmology.
Top News from ADA 2015
TECOS: No Heart Failure with Sitagliptin in High-Risk Diabetic Patients

In patients with type 2 diabetes and cardiovascular disease, the use of the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin (Januvia) did not increase risk of cardiovascular events in a large outcomes trial designed specifically to answer this question. There was no increase in the number of patients hospitalized for heart failure with sitagliptin, a critically watched secondary end point, given that other drugs in the class, most notably saxagliptin (Onglyza), showed an increase in heart-failure events in one study. "Given the size of our study, the long duration of follow-up, as well as the higher risk of our population, we feel that this very adequately addresses and puts to bed the question that there is any risk for heart failure with this drug," said Eric Peterson, MD, from Duke Clinical Research Institute, Durham, North Carolina, cochair of the TECOS executive committee. (Source: Medscape)
Cardiology eMedinewS
  • Adopting moderate exercise and controlling weight, even late in life, can cut one's risk of developing heart failure by about 45%, suggests a new analysis from a cohort of people aged 65 or older who were initially without heart failure in the community-based Cardiovascular Health Study. The findings are published in the July issue of JACC: Heart Failure.
  • In patients with diabetes mellitus and multivessel disease, PCI with a current-generation stent is associated with a lower risk of death and stroke in early follow-up, but an equivalent risk of death and a higher rate of MI and need for repeat revascularizations in the long-term when compared with CABG surgery, suggests a new analysis published July 8 in Circulation: Cardiovascular Interventions.
Pediatrics eMedinewS
  • A new study reveals that women who used certain selective serotonin reuptake inhibitors (SSRIs), particularly paroxetine and fluoxetine, in early pregnancy were more likely to have offspring with heart problems and abnormal brain and skull formation, among other birth defects. The study is published in The BMJ.
  • Children with a rare type of cancer called Wilms' tumor who are at low risk of relapsing can be given less intensive treatment, avoiding a type of chemotherapy that can cause irreversible heart problems in later life, suggests new research published in the Lancet. Researchers suggested that the drug doxorubicin can be safely omitted from treatment without affecting patients' chances of survival.
Dr KK Spiritual Blog
Do not tell others, it’s a Secret

Most Asians are known for two habits, firstly a ‘crab’ nature and secondly the habit of telling others that "I am telling you a secret and please do not tell others."

Crab nature mean pulling each other’s legs and not allowing any one to rise. Most people, especially women, will gossip and tell all secrets that they know. For clearing their own consciousness they will add a sentence “I am telling you the secret and do not tell others.” The very fact you have told it to someone, it no more remains a secret.

In India we do not respect confidentiality laws and do not sign a non disclosure agreement. In hospitals you will hear the names of the hospitalized person being shouted loud outside the ICU; the list of operation theatre is displayed at every corner of the hospital.
Make Sure
Situation: A 62–year–old–diabetic with coronary artery disease, on treatment for the same, comes for follow up.

Reaction: Oh my God! Why did not you put him on antioxidants?

Lesson: Make Sure to add antioxi dants to the prescription because of their free radical scavenging and other beneficial effects.
Dr Good Dr Bad
Situation: A patient with normal LDL and high CRP wanted to know his risk of CAD.

Dr Bad: You are not at risk.

Dr Good: Get cardiac 64 CT test done.

Lesson: Among asymptomatic individuals with normal LDL cholesterol levels and elevated high–sensitivity C–reactive protein, measuring the burden of calcium in the coronary arteries with cardiac CT appears to stratify the risk of cardiovascular disease (Lancet. 2011 Aug 20;378(9792):684-92).

(Copyright IJCP)
eMedi Quiz
The following are true regarding Lyme's Disease, except:

1. It is transmitted by ixodes tick.
2. Erythema chronicum migrans may be a clinical feature.
3. Borrelia recurrentis is the etiological agent.
4. Rodents act as natural hosts.

Yesterday’s Mind Teaser: The earliest immunoglobulin to be synthesized by the fetus is:

1. IgA.
2. IgG.
3. IgE.
4. IgM.

Answer for yesterday’s Mind Teaser: 4. IgM.

Correct Answers received from: Dr Sushma Chawla, Dr Jainendra Upadhyay, Dr K Raju, Dr Poonam Chablani, Dr K V Sarma, Dr Shangarpawar, Dr Nikhil Mohanty.

Answer for 9th July Mind Teaser: 4. Practice proper hand washing.

Correct Answers received: Dr Nikhil Mohanty, Dr Sharavana.
eMedinewS Humor
After a Bad Accident

Patient: I'm in a hospital! Why am I in here?

Doctor: You've had an accident involving a train.

Patient: What happened?

Doctor: Well, I've got some good news and some bad news. Which would you like to hear first?

Patient: Well... The bad news first...

Doctor: Your legs were injured so badly that we had to amputate both of them.

Patient: That's terrible! What's the good news?

Doctor: There's a guy in the next ward who made a very good offer on your slippers.
Rabies News (Dr A K Gupta)
What are the most common modes of exposures of rabies virus?

Human exposures to rabies can generally be categorized as bite, open wound, mucous membrane, or other types of exposure:
  • Bite exposure: Any penetration of the skin of a person by the teeth of a rabid or potentially rabid animal.
  • Open wound exposure: Introduction of saliva or other potentially infectious material (cerebrospinal fluid, spinal cord, or brain tissue) from a rabid or potentially rabid animal into an open wound (e.g., broken skin that bled within the past 24 hours).
  • Mucous membrane exposure: Introduction of saliva or other potentially infectious material (cerebrospinal fluid, spinal cord, or brain tissue) from a rabid or potentially rabid animal onto any mucous membrane (eyes, nose, mouth).
  • Other exposure: Any interaction with a rabid or potentially rabid animal where a bite, open wound, or mucous membrane exposure cannot be definitively ruled out.
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
IMA White Paper on Health Friendly Homes
Dr A Marthanda Pillai, Dr K K Aggarwal

A health friendly home should comply with the following:

Control of air pollution: Health-friendly homes should maintain and adhere to WHO guidelines on air pollution. The parameters for particulate matter are as follows: PM2.5: 10 μg/m3 annual mean and 25 μg/m3 24-hour mean; PM10: 20 μg/m3 annual mean and 50 μg/m3 24-hour mean; O3: 100 μg/m3 8-hour mean and NO2: 40 µg/m3 annual mean & 200 μg/m3 1-hour mean. For this, the building should be oriented and directed for maximum natural breeze. There should be open areas and cross ventilation in all directions with plenty of windows, doors and balconies. A compartmentalized apartment allows for efficient summer cooling or winter heating. The Housing society or colony should be situated away from industrial areas. Instead, it should have in its vicinity, a green neighborhood or an artificial lake. The level of major pollutants should be prominently displayed in the society with an alarm when the levels cross the permissible limits.

Control of noise pollution: The maximum safe threshold for humans is 80 decibels (dB). The WHO guidelines for community noise recommend less than 30 A-weighted decibels (dB(A)) in bedrooms during the night for a good quality sleep and less than 35 dB(A) in classrooms to allow good teaching and learning conditions. For night noise, the WHO guidelines recommend less than 40 dB(A) of annual average (Night) outside of bedrooms to prevent adverse health effects from night noise.

The Noise Pollution (Regulation and Control) Rules, 2000, have set the standards for noise levels in various areas in our country as follows: Yours sincerely
Area Code
Category of area/zone
Limits in dB (A)
Day Time
Night Time
Industrial Area
Commercial Area
Residential Area
Silence Zone

To minimize the noise pollution, residential areas should be as far away as possible from major roads. They should be surrounded by greenery with no noise creating industry within at least 2 -3 km area. It should be a no honking zone with vehicular movement limited only to residential vehicles. The housing society should use fly ash bricks for construction which have proven high insulation qualities against external noise. And, it should allow only split AC and silent generators for power back up.

Vastu Compliance: The construction of the house should comply with vastu principles, for those who believe in vastu shastra.

Earthquake Resistant: Earthquake resistant buildings should be designed and constructed in areas that fall in Seismic Zone IV.

Mobile Tower Free: There should be no cell phone tower within the perimeters of the society. The minimum distance of the mobile tower from the nearest flat should be 500 meters.

IGBC/LEED Certified Eco friendly construction: The building should comply with the standards set by Indian Green Building Council (IGBC)/ Leadership in Energy and Environmental Design (LEED). There should be provisions for effective energy conservation for the residents.

Greenery and Plantation: There should be gardens and greenery within the housing society with the provision of a kitchen garden if possible. The individual houses in the society should have adequate space for indoor plants.

Drinking Water Supply & Water Treatment Provisions: Potable and safe water should be available 24×7.

Water Recycling: There should be a waste water treatment plant, where after certain chemical and physical processes, the wastewater can be converted to the water that either can be safely discharged to the environment or can be reused for the purposes like gardening, car wash etc.

Rain Water Harvesting Plant: The housing society should have a good rain water harvesting system in its premises to provide sufficient water required for managing the whole facility.

Sky Garden: If possible, there should be rooftop garden, which all residents should be able to access.

Security Provisions with Panic Alarm: Strict vigilance should be maintained with automatic boom barriers for traffic control, CCTV surveillance, Intercom and panic Alarm.

Garbage Disposal and Sewage System: The garbage should be collected at doorstep of each house. A sewage treatment plant within the society will remove contaminants from wastewater, including household sewage and runoffs and produce an environmentally safe treated wastewater.

Multireligion Worship place: There should be a dedicated single place of worship for many faiths and religions.

Open Area for Recreational activities: The housing society should have large open area for various recreational activities. If possible, there should be an Amphitheatre for group activities.

Outdoor Sports Facilities: There should be facilities for outdoor sports such as cricket, multipurpose ground for football and basketball, lawn tennis, volley ball, basketball or badminton courts.

Indoor Sports and Club Facilities: Adequate space should be provided for a dedicated Yoga Center for the residents; a multipurpose hall for table tennis/Billiards table, gymnastics and other indoor games like carrom, chess etc. and a swimming pool. If possible, the housing society should have a restaurant that serves healthy food.

Free Drinking Water: There should be drinking water taps in common areas of the society for the housekeeping and facility management staff.

Common Toilets: It should have clean public toilets for male, female, handicaps and third gender.

Wi-Fi: The housing society should be wi-fi enabled with pre-laid optical fiber network and provide unhindered Wi-Fi to the residents in the common areas of the complex.

First Aid Kit: A First-aid kit should be available in each flat and other common areas.

Fire Fighting and fire detection alarm systems: The housing society should have modern fire-fighting equipments in place in the common areas, on each floor and also in each flat.

Gas Supply: There should be provision for piped natural gas (PNG) as domestic fuel.

Lift Ratio: The lift ratio should high with separate lifts for residents and heavy loads with a lift lobby.

Nursing Home/Healthcare Centre: The housing society should have provision for a Nursing home cum healthcare center for the residents as well as nearby societies to take care of their basis health care needs.

Cable TV: There should be pre-laid Optic fiber network for cable TV.
7 ways to keep stress away (Harvard)
1. Get enough sleep
2. Learn relaxation techniques.
3. Strengthen your social network.
4. Hone your time-management skills.
5. Try to resolve stressful situations if you can.
6. Nurture yourself.
7. Ask for help.
CHANDIGARH: Taking umbrage at a derogatory description of private doctors in a National Council of Educational Research and Training (NCERT) social science textbook for Class VII students, the Chandigarh chapter of the Indian Medical Association (IMA) has written to NCERT officials to recall the textbook immediately. In a reference to private sector doctors, the book says they are "encouraging practices that are incorrect" to make profit. The IMA have sent a missive to the Union minster of health JP Nadda threatening to sue the NCERT as well as the authors if no action is taken. (TOI)
Inspirational Story
Keep moving!

A college class was graduating on a hot and humid day. As the graduates walked across the platform and received their diplomas from the president of the college, he smiled, shook their hands, and said loudly, “Congratulations!” Then, in a much lower voice, one that was firm and could be heard only by the graduates, he would say, “Keep moving.”

He was only trying to keep the line moving across the stage, but his words were good advice for a lifetime: “Keep moving.” After every achievement growing up, graduation, marriage, job promotion, even retirement the best advice is, “Keep moving. Don’t stop. Don’t stagnate.”

There is more to life than you have found thus far. This is not the end; it is only the beginning. “Keep moving.” When we approach life with this attitude, we look forward to the future and what God has in store for us.
Quote of the Day
Life is too complicated; don’t try to find the unnecessary answer…… because by the time you find the answer, life changes the questions.
IMA in Social Media
https://www.facebook.com/ima.national 28542 likes
https://www.facebook.com/imsaindia 46598 likes
https://www.facebook.com/imayoungdoctorswing 1701 likes
Twitter @IndianMedAssn 1036 followers
http://imahq.blogspot.com/ www.ima-ams.org
Reader Response
  • Sir, full-fledged high level inquiry must be held against the incident and death. Dr Anil Ohri
  • I congratulate Dr KK Aggarwal for the excellent E-bulletin. Every content of it is interesting. Your spiritual blog is an innovative idea in a medical newsletter, which is going to change lives of thousands of doctors. Kudos for wonderful work. Dr Sharad Lakhotia
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.

In a study, 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% 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%. And after 30 days of being fed pumpkin extract, diabetic rats had blood glucose levels similar to those of non-diabetic rats.
Over 30 doctors attended the IMA Rise & Shine CME on Vitamin D deficiency in Palakkad
IMA Videos
News on Maps
Press Release
NCERT contents on private healthcare services in class VII text book needs to be deleted

Indian Medical Association has strongly objected to the description of “Private Services” in NCERT Social Science Text book for Class VII students. The subject Social Political Life II In chapter 2 on "Role of Government in health" this controversial description is given under the sub head "Private health facilities". It says, "In order to earn more money, these private services encourage practices that are incorrect. At times cheaper methods, though available, are not used. For example, it is common to find doctors prescribing unnecessary medicines, injections or saline bottles when tablets or simple medicines can suffice."

In the book on page 22-23 a comic strip is also included which writes above the difference in treatment in public and private hospital. The same is also depicted wrongly. In this it has been shown that cost of the same illness is Rs. 3500/- in a private sector and Rs. 150/- in the government sector.

Padma Shri Awardee Dr. (Prof.) A. Marthanda Pillai, National President IMA and Padma Shri Awardee Dr K K Aggarwal, Hony. Secretary General, IMA said “the message which will go to the students is that "private sector flees money” However it does not take into account the cost of infrastructure, medical equipments, staff salary, doctors salary, cost of attached medical colleges etc. when calculating the cost of a government prescription. There is no way the cost of government sector can be compared with the cost of private sector without taking into consideration the above factors. Infact in one of preliminary study done by Delhi Medical Association in 2005 it was shown that per bed cost of the IMA member owned medical establishment was lower than per bed cost of the government medical college associated hospital in the city of Delhi.

In medical journalism and medical communication every doctor is taught a difference between violent and non violent communication. In the phrase "in order to earn more money, these private services encourage practices that are incorrect”. The phrase is judgmental and is violence in nature. Sentence should have been “in order to earn more money some private services encourage communication practices that are incorrect.

Today the violence against medical profession is increasing day-by-day to the effect that Medical Protection Act has been introduced in 17 states.

These types of phrases in NCERT Text book will brain wash the mind of the students and their faith in the private services will go away. At a stage when they are still not in a position to take their own decisions and judgement, these types of teachings will spoil the patient doctor relationship.

The matter should be taken seriously and NCERT should be directed to delete this chapter and rewrite this chapter before it is included in the text book.

IMA has written a letter to Shri Narendra Modi, Hon’ble Prime Minister of India with copy marked to:

-Shri Pranab Mukherjee, Hon’ble President of India,
-Shri Mohd. Hamid Ansari, Hon’ble Vice President of India,
-Shri J.P.Nadda, Hon’ble Minister of H& FW,
-Smt. Smriti Zubin Irani, Hon’ble Minister, Human Resources Development &
-Director, N.C.E.R.T.

NCERT - Chapter 2 - Role of Govt. in Health