(incorporating eIMA News)
13th March 2016
Editorial (Dr S S Agarwal, Dr K K Aggarwal)
One in four people worldwide have fatty liver
In a meta-analysis published online February 22 in the journal Hepatology by Dr. Younossi and colleagues, the pooled worldwide prevalence of nonalcoholic fatty liver disease, diagnosed through imaging, was found to be 25.24%. The Middle East and South America had the highest prevalence, while Africa had the lowest prevalence. The incidence of NAFLD in Asia (China and Japan) was 52.34 per 1,000 person years and 28.01 per 1,000 for Israel.
The pooled overall nonalcoholic steatohepatitis, NASH prevalence among biopsied NAFLD patients came to 59.10%. By region, prevalence came to 64.45% for Asia, 69.25% for Europe, and 60.64% for North America. The most common medical comorbidities identified in the meta-analysis were obesity (51.34% NAFLD and NASH), type 2 diabetes (22.51% NAFLD, 43.63% NASH), hyperlipidemia (69.16% NAFLD, 72.13% NASH), hypertension (39.34% NAFLD, 67.97% NASH), and metabolic syndrome (42.54% NAFLD, 70.65% NASH).

The incidence of hepatocellular carcinoma in the NAFLD group was estimated at 0.44 per 1,000 person-years and for NASH 5.29 per 1,000. Liver-specific mortality rates for NAFLD came to 0.77 per 1,000, and 15.44 per 1,000 person years for NASH.
Obesity is a major public health problem and is associated with an increased risk of NAFLD among other metabolic disorders. Even a 5% weight loss can be enough, but we should aim for at least a 10% decrease in weight to reduce risk for metabolic syndrome. As physicians we must encourage lifestyle changes in our patients and help them make the right choices about food and exercise.(Source: Medscape)
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Top News
Practice Updates
Journal of Clinical Endocrinology and Metabolism Update: Long term use of metformin may increase risk of B12 deficiency
Lighter Reading
Medicolegal Corner
eMedi Quiz
A. Develop a teaching plan
B. Facilitate psychologic adjustment
C. Maintain the present muscle strength 
D. Prepare for the appearance of myasthenic crisis
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Lifestyle Updates
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Questions Answered By KOL's
Second Opinion Required

Dr Ankit Sahni - Pt with heart failure and gout. Gout has settled. Should I treat any asymptomatic hyperuricaemia? Should I treat to a target serum uric acid level? 

Dr Vikram Sanghi - 70 yr  male with type 2 diabetes since 6 years. On metformin extended release 2.0 grs daily. No major cardiovascular disease. Last 2 routine HBA1C levels, within a 4 month period by his GP were stable at 9.1%. Would you alter the anti-diabetic treatment? 
Press Release
Difference in the management of heart disease in men and women
New Delhi, March 12, 2016: It has been observed for some time now that the management of Coronary Artery Disease differs in men and women. The differences exist right from the stage of interpretation of symptoms, non-invasive investigative procedures, cardiac catheterization and finally balloon therapy and bypass surgery if required. 

It is a statistical fact that although the incidence of coronary disease is very high in today's day and age days, comparatively less number of women go for cardiac catheterization. The number is less than one fourth. The number of women who undergo interventional treatments like balloon therapy and bypass surgery is even lesser. 

It was reported some time ago that women under 60 years of age with symptoms of angina have better prognosis than men under 60 years with history of angina where as women with angina between 60-69 years have a worse prognosis. The mortality rate in this group for women was comparable to that of men with angina regardless of their age.
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IMA Updates
IMA Polio Dates
  • April 1st: tOPV would not be available after this date.
  • April 11th: bOPV would be available in private market but it is not to be opened or used before 25th April.
  • April 25: IMA Polio Switch Day, when tOPV would be completely withdrawn and replaced by bOPV in both routine immunization and polio campaigns.
  • 9th May: IMA National Validation Day when India would be declared free of tOPV. 

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

Dr Good Dr Bad And Make Sure
eIMA News Update
Digital IMA
The Indian Medical Association (IMA) presents a series of weekly webcasts for the benefit of the Indian medical profession, engaging you with the latest in advocacy efforts for doctors, through an interactive exclusive digital webcast partnership with eMediNexus.

Next Webcast: 17th
 March 2016