Albuminuria linked to mental decline in diabetics

A simple urine test may be able to identify type 2 diabetes patients at increased risk for mental decline. A new study of nearly 3,000 type 2 diabetes patients, average age 62, found that those who had persistent protein in their urine over four to five years had greater declines in their brain's information-processing speed than those with no protein in their urine. The decline in patients with persistent protein in the urine was greater than 5 percent.

The findings suggest that protein in the urine -- a condition called albuminuria -- may be an early warning sign of future mental decline, according to the study, which was published online Aug. 29 in the Clinical Journal of the American Society of Nephrology.

People with diabetes are 50 percent to 60 percent more likely to suffer mental decline than those without diabetes

Most elderly patients with chronic dementia have Alzheimer’s disease (approximately 60 to 80 percent). The vascular dementias account for 10 to 20 percent, and Parkinson disease for 5 percent. The prevalence of vascular dementia is relatively high in blacks, hypertensive persons, and patients with diabetes; some of the reversible dementias (metabolic dementias) tend to occur in younger individuals.

Consumption of Certain Fruits Linked to Lower Diabetes Risk

Eating certain whole fruits may reduce the risk for type 2 diabetes, according to the results of 3 combined prospective longitudinal cohort studies, by Isao Muraki, PhD, MD, from the Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts and published in online August 29 in BMJ.

However, juice consumption may up the risk for diabetes. To get a better assessment of the role fruit might have in diabetes risk, the investigators combined data from 3 studies: the Nurses' Health Study (n = 66,105), Nurses' Health Study II (n = 85,104), and Health Professionals Follow-up Study (n = 36,173).

Over the course of 3,464,641 person-years of follow-up, 12,198 participants developed type 2 diabetes. In a multivariate analysis adjusted for personal, lifestyle, and dietary risk factors for diabetes, every 3 servings of fruit per week were associated with a lower risk for type 2 diabetes.

When the researchers looked at individual types of fruit in a multivariate analysis, adjusted for the same factors, they found that 3 servings per week of some fruits were more closely associated with reduced risk than others: blueberries, grapes and raisins, apples and pears, bananas and grapefruit. Conversely, the intake of cantaloupe or fruit juice was associated with an increase in the risk for type 2 diabetes.

In a secondary analysis, the investigators found that the consumption of high glycemic load fruits was linked to a lower risk for type 2 diabetes, as was consumption of moderate glycemic index fruits.

Use of phosphate-binding agents can reduce mortality

The use of phosphate-binding agents, singly or in combination, is associated with reduced mortality in patients with chronic kidney disease as per the results of COSMOS trial (Current management Of Secondary hyperparathyroidism: A Multicenter Observational Study).

COSMOS was a 3-year follow-up, multicenter, open-cohort, prospective study of adult chronic hemodialysis patients with no previous kidney transplant from 227 dialysis centers from 20 European countries.

The analysis, published in the July 3, 2013 issue of Kidney International, included 6,300 patients.

Patients prescribed phosphate-binding agents were found to have 29% lower all-cause mortality and 22% lower cardiovascular mortality.

All types of phosphate-binding agents were effective with three exceptions: aluminum-containing phosphate binder on its own, combinations of calcium-containing binders with aluminum, and combinations of calcium-containing binders with other phosphate binders.

In mild strokes, ultra-early treatment may eliminate risk of disability

1. Patients with mild-to-moderate strokes who received care within 90 minutes of stroke symptoms were less likely to have permanent disability.

2. Early treatment also helped those with minor strokes, but the likelihood of disability is already very low in these patients.

In the case of mild or moderate strokes, getting treatment ultra-fast – within 90 minutes of experiencing symptoms – greatly reduces the risk of suffering disability, according to a new study reported in the American Heart Association’s journal Stroke.

According to guidelines, clot-busting drugs may be given to treat stroke up to 4.5 hours after the onset of symptoms.

The study found that survivors with mild to moderate strokes who were given the clot-busting drugs in the first 90 minutes of the recommended time window had little or no disability three months later compared to those who were treated between 90 and 270 minutes.

The study included more than 6,800 stroke patients at 10 stroke centers in Europe over 14 years. They were treated intravenously with Alteplase, a clot-busting drug that is given IV in the vein. 

Early treatment also helped those with minor strokes, but the likelihood of disability is already very low in these patients.

Those with severe stroke did not benefit as much from the ultra-early treatment because they had severe artery blockage.

FAST is an easy way to remember the sudden signs of stroke.

F: Face drooping, A - Arm weakness, S- Speech difficulty and T-Time (Act fast)

Cardiac Autonomic Dysfunction Predicts Outcomes in Diabetes

Among patients with stable CAD and type 2 diabetes, measures of autonomic function--such as heart-rate recovery after exercise--may help predict the risk of short-term adverse cardiovascular events as per a study.

A second study reports that autonomic dysfunction is strongly linked with a greater risk of severe hypoglycemia in patients with type 2 diabetes.

The best way to avoid it is to have intensive glucose control with hemoglobin A1cs that are definitely below 7.5 and ideally below 7. On the other hand, if you have [HbA1c] levels above 8, certainly above 9, you have a very high likelihood of having the problem [within] 10 or more years.

The two studies were published online August 19, 2013 in Diabetes Care.

Test

· The patients performed a test on an exercise bicycle, which allowed the researchers to determine their heart-rate recovery, defined as the drop in heart rate from the rate at maximal exercise to the rate one minute after stopping the exercise.

· Blunted heart-rate recovery after exercise: defined as a drop in heart rate of less than 21 beats per minute--had a 1.69-fold greater risk having a cardiovascular event than their peers.

· Holter: Blunted heart-rate turbulence (<3.4 ms/R-R interval) had a 2.08-fold increased risk of an event

· Low heart-rate variability (<110 ms) had a 1.96-fold greater risk of having a cardiovascular event.

· Heart-rate variability at three times: during a Valsalva maneuver, deep breathing, and going from lying down to standing. 

How safe are anti obesity drugs?

Obesity is a major health problem. The long-term success rate is low of diet and physical activity. Therefore, antiobesity drugs are of great interest, especially when lifestyle modification has failed. As obesity is not an immediate life-threatening disease, these drugs are required to be safe. 

Drugs developed so far have limited efficacies and considerable adverse effects affecting tolerability and safety. Therefore, most antiobesity drugs have been withdrawn. 

·        Fenfluramine and dexfenfluramine were withdrawn because of the potential damage to heart valves.

·        Sibutramine was associated with an increase in major adverse cardiovascular events in the Sibutramine Cardiovascular Outcomes (SCOUT) trial and it was withdrawn from the market in 2010. 

·        Rimonabant was withdrawn because of significant psychiatric adverse effects. 

·        Orlistat was approved for long-term treatment of obesity, but many patients cannot tolerate its gastrointestinal side effects. 

·        Phentermine and diethylpropion can only be used for less than 12 weeks because the long-term safety of these drugs is unknown. 

·        Ephedrine and caffeine are natural substances but the effects on weight reduction are modest. 

·        Recently lorcaserin and topiramate plus phentermine have been approved for the treatment of obesity but long-term safety data are lacking. [Ther Adv in Drug Safe 2013;4(4):171-181]

eMedinews Editorial

·         A 12-month exercise training and lifestyle intervention in patients with chronic kidney disease is linked to better cardiorespiratory fitness, body composition and diastolic functions. According to a randomized trial published in August edition of Clinical Journal of the American Society of Nephrology, the exercise involves 150 minutes per week moderate intensive aerobic and resistance and group behavior and lifestyle modification session.

·         A case-control study from Australia has proved that vaccination against flu virus reduces the risk of future heart attacks. In the study, it was shown that influenza vaccination was significantly protective against acute heart attack with infected people almost twice as likely as vaccinated to have acute heart attack. The study was published in August issue of journal Heart. 

·         Bharat Biotech has launched world's first clinically proven typhoid conjugate vaccine, Typbar - TCV, for infants above six-months as well as adults. The newly launched typhoid conjugate vaccine would help make the vaccinated immune to the disease for a longer period of time as against the existing vaccines in the market that provide protection only for two to three years.

·         Liver cancer — the third most frequent cause of cancer death in India, mostly could be prevented with simple lifestyle changes such as avoiding excess alcohol, having protected sex and getting vaccinated against the hepatitis B virus. 

·         Rajya Sabha passed a bill on Monday making it mandatory for the wife to get a share of her husband’s immovable property over divorce. The Marriage Laws (Amend-ment) Bill now needs to be passed by the Lok Sabha to become law. The bill provides for a three year deadline within which marriages can be dissolved on the new ground of “irretrievable breakdown” which will allow the party to file for divorce either jointly or separately in cases where the marriage has broken down for all practical purposes.

 

Fecal Microbiota Transplantation (FMT)

Fecal Microbiota Transplantation (FMT) has emerged as highly effective treatment of C. difficile.  FMT as emerged as a highly effective treatment for recurrent C. difficile infection.  The transplantation refers to the infusion of a suspension of fecal matter from a healthy individual into the GI tract of another person to cure a specific disease through a colonoscopy.  It is based on the concept that stool is a biologically active, complex mixture of living organisms with great therapeutic potential for C. difficile infection. 

Most patients with C. difficile infection respond to metronidazole, vancomycin but 15-35% may have recurrence.  Patients who have one recurrence have 45% chances of a second recurrence, and after a second recurrence, 65% will have a third recurrence. The current treatment of recurrence is additional course of metronidazole, oral vancomycin, or prolonged oral vancomycin.   FMT is commonly performed by colonoscopy but doctors have used nasogastric tube or nasoenteric tube, gastroduodenoscopy and enema. 

How to keep your memory sharp?

- Manage your stress especially deadline pressure and petty arguments.

- The biggest stress is ongoing sense of extreme anxiety.  The stress can be managed by deep breathing, meditation, yoga and by mindful approach to living.

- Get a goodnight sleep.  The most common reason for poor sleep is difficulty in falling asleep and staying asleep.  Many drugs used to treat insomnia which can also impair memory.

- If you need a sleeping medicine, it should be used in the lowest dose for the shortest period of time. 

- Get up at the same time in the morning.

- If you smoke, quit.

- If you do not drink, do not start.

- Alcohol makes it difficult to perform short term memory tasks such as memorizing list.

- Alcohol induces vitamin B1 deficiency, which can cause dementia.

 - Protect your brain from injury as repeated minor head trauma can cause brain damage.

 - Wear seat belt when riding in motor vehicle.

- Wear helmet while driving or riding motorcycle.

There is insufficient evidence linking diabetes drugs with increase risk of cancer and as per FDA, doctors can continue to confidently prescribe all approved drugs for the management of the diabetes, as per a joint consensus statement released by American College of Endocrinology and American Association of Clinical Endocrinologist.  The statement was released on 20^th August, 2013.  Recently some reports have linked incretin drugs with pancreatic cancer and lantus insulin with cancer.  As per the statement both diabetes and obesity may increase the risk of certain cancer, therefore, it is difficult to say that the drugs are linked to it.  

Low-heat cooking may reduce insulin resistance

Traditional Ayurveda cooking has been recommending low heat cooking and now a western study endorses it.

Low-temperature cooking reduces insulin resistance among overweight women as per a 4-week study published online August 19 in Diabetes Care by Alicja B. Mark, PhD, from the department of nutrition, exercise and sports, faculty of science, University of Copenhagen, Denmark, and colleagues.

Cooking at high temperature — such as with baking, roasting and frying — induces formation of advanced glycation end products (AGEs), which are associated with inflammation and believed to impair glucose metabolism in patients with type 2 diabetes. Common high-AGE foods include bakery products, cooked meat, and roasted coffee.

In the study patients randomized to a high-AGE diet were instructed to fry, bake, roast, or grill their food; eat bread with the crust; and choose other high-AGE foods from a list. The low-AGE group was told to boil or steam their food, eat bread without the crust, and choose lower-AGE foods from a list. They were also randomized to supplements of either fructose or glucose.

At 4 weeks, no effect was seen from the fructose or glucose on insulin resistance, as assessed by the homeostasis model assessment of insulin resistance (HOMA-IR) and the calculated insulin sensitivity index (ISI) or on any secondary measures. But the AGE content of the diet did make a difference. Weight, BMI, and waist circumference all decreased in both the high- and low-AGE groups, but to a greater degree among those in the low-AGE group compared with the high-AGE group. Overall, the low-AGE group consumed about 15% more protein, 10% more carbohydrates, and 22% less fat than did the high-AGE group.

Exercise can safely help patients with moderate CKD become fitter and lose weight

In a study of 83 patients with moderate CKD, those who participated in a structured exercise and lifestyle program for 12 months became significantly fitter—with an 11% increase in their maximal aerobic capacity compared with a 1% decrease in patients receiving usual care. Patients in the program also achieved a small but significant amount of weight loss and heart function improved. The CJASN findings suggest that exercise can be safe in patients with kidney disease even if they have various other medical problems. (as in IN THE LOOP)

Do not ignore vaccination in the adults

The need for vaccination does not end in childhood. It is recommended that throughout our life based on our lifestyle, occupation, medical condition and previous vaccination history. In the elderly, people may need vaccines depending upon their jobs, hobbies or chronic health condition.

A tribute to Dr. Narendra Dabholkar

Dr Narendra Dabholkar, born on November 1, 1945, gave up his lucrative profession to devote himself to social service. He did his MBBS degree from Medical College in Miraj. After working as a general practitioner for nearly 12 years he entered into social service. In 1983, after noticing that society at large was very superstitious — especially the rural masses, he decided to work towards eradicating such social evils, reports TOI.

In 1989, Dabholkar founded the Maharashtra Andhashraddha Nirmulan Samiti, a social organization aimed at weeding out superstition. The MANS network has currently has over 180 branches all over Maharastra. In the past two decades, he openly challenged several godmen and self-styled gurus who he felt were exploiting the masses. He was staunchly against animal sacrifice, a ritual which arises from superstition itself.

He wrote around 11 books which throw light on different superstitions prevailing in society. 

They contain a lot of scientific knowledge in order to break down the believer's superstitions.

He was one of us and we should all prey tribute to him.

Coffee protects from liver cancer

Coffee consumption is inversely related to the risk of cirrhosis or hepatocellular carcinoma (HCC). However, the protective effect of coffee drinking against the risk of HCC was not established in HBV-prevalent region.

A hospital-based case–control study was performed in 1364 subjects. A total of 258 HCC patients, 480 health-check examinees (control 1, HCE) and 626 patients with chronic liver disease other than HCC (control 2, CLD) were interviewed on smoking, alcohol and coffee drinking using a standardized questionnaire. HBV e-antigen (HBeAg) status and serum HBV DNA levels were measured in patients infected with HBV.

After adjustment for age, gender, obesity, DM, presence of hepatitis virus (except for HCE) and lifetime alcohol drinking/smoking, a high lifetime coffee consumption (≥20 000 cups) was an independent protective factor against HCC, in each analyses using healthy and risky control groups respectively.

However, the high coffee consumption did not affect the HCC risk in patients with HBV after adjustment for HBeAg status, serum HBV DNA level and antiviral therapy.

A high lifetime coffee consumption was negatively associated with a HCC development. However, this difference of coffee exposure with the HCC group was reduced in chronic hepatitis B patients by the dominant role of viral replication (Liver International 2013;33(7):1092-1099).

Diastolic blood pressure below 70 mm Hg associated with higher mortality in chronic kidney disease

Achieving ideal systolic blood pressure (SBP) at the expense of lower-than-ideal diastolic blood pressure (DBP) could be harmful in adults with chronic kidney disease.

A review of U.S. veterans with CKD found that SBP of 130 to 159 mm Hg and DBP of 70 to 89 mm Hg were associated with the lowest mortality rates as per results appeared in the Aug. 20 Annals of Internal Medicine.

Those in whom both SBP and DBP were concomitantly very high or very low had the highest mortality rates.

Patients with moderately elevated SBP combined with DBP no less than 70 mm Hg had consistently lower mortality rates than did patients with ideal SBP combined with DBP less than 70 mm Hg. Results were consistent in subgroups of patients with normal and elevated urinary microalbumin-creatinine ratios.

Nearly one-third (32.5%) of the patients in the study cohort had SBP greater than 140 mm Hg and DBP less than 70 mmHg.

Fish oil and cardiovascular mortality

The Risk and Prevention Study enrolled patients with multiple cardiovascular risk factors or known vascular disease and, after a median follow–up of five years, found no reduction in coronary heart disease death with n–3 polyunsaturated fatty acid supplementation compared with placebo.

This result contrasts with early trials of fish oil but is consistent with more recent studies. Additional large trials with long–term follow–up are needed to clarify whether n-3 fatty acid supplementation might have different effects on cardiac mortality depending on whether patients are also receiving aggressive treatment for primary or secondary prevention of CHD (Source Uptodate)

Chief Minister of Delhi Inaugurates Centenary Celebrations of DMA

Inaugurating centenary year of Delhi Medical Association Mrs Sheila Dikshit Honb'le Chief Minister of Delhi said that all doctors should provide extra care for the oldest old population.  No better pledge to take than making Delhi age friendly.

Prof. Kiran Walia Education Minister Delhi said “My Delhi I Care” is city's program which should also be adopted by the association.  She said that our CM got commonwealth award for Bhagidari Scheme.

Others who spoke on the occasion were Dr Anil Aggarwal, Dr Anil Goel, Dr Prem Aggarwal, Dr N Saini. The association also launched an elderly free program: “Hamare Dilli Age Friendly”.

Others who were also present on the occasion were Dr K S Reddy, Dr Ashok Seth, Dr K K Aggarwal, Dr D Tempe, Dr Anupam Sibal, Dr Rajiv Sood, Dr O P Kalra, Dr Girish Tyagi, Dr Ramesh Datta and Dr Vinod Khetrapal.

The association also honored eighty plus doctors.  DMA centenary institution awards were given to Bara Hindu Rao Hospital, Sir Ganga Ram Hospital, Patel Chest Institute, MAMC, UCMS, NBE, Apollo Hospitals, Escorts Heart Institute, AIIMS.

Obesity's causes 1 in 5 Deaths

Obesity is associated with nearly 1 in 5 US deaths, according to a study published online August 15 in the American Journal of Public Health.

In research that counters previous studies of the effect of obesity on American life spans, Ryan K. Masters, PhD, a Robert Wood Johnson Foundation Health and Society Scholar at Columbia University's Mailman School of Public Health in New York City, and colleagues report that overweight and obesity were associated with 18.2% of all deaths among adults from 1986 through 2006 in the United States. Previous estimates of the effect of obesity on mortality, published in Demography in 2009, established an obesity-related death rate of approximately 5%.

The study also showed that the more recent the birth year, the greater effect obesity has on mortality rates. Further, contrary to claims in much public health literature, obesity is not protective for the elderly.

Harvard’s 5 ways to dodge incontinence

1.       Watch your weight. Excess weight and incontinence can go hand in hand, particularly for women. One theory is that extra abdominal fat can weaken the pelvic floor muscles and lead to stress incontinence (leaking urine when coughing, laughing, sneezing, etc). In some cases, simply losing weight can improve incontinence.

2.        Don’t smoke. Smoking doubles the likelihood that a woman will develop stress incontinence. Nicotine has also been linked to urge incontinence.

3.        Stay active. In the Nurses’ Health Study, middle-aged women who were most physically active were least likely to develop incontinence.

4.        Minimize bladder irritants. Caffeine and alcohol have been linked to urge incontinence (the feeling you need to urinate even when the bladder isn't full). Carbonated drinks, the artificial sweetener aspartame (NutraSweet), spicy foods, and citrus fruits and juices cause urge incontinence in some people.

5.        Don’t strain with bowel movements. This can weaken the pelvic floor muscles. If your stools are frequently hard or take considerable effort to pass, talk with your doctor. In a study involving people ages 65 and older, treating constipation improved a variety of urinary symptoms, including frequency, urgency, and burning. Increasing the fiber in your diet and drinking enough fluid can help prevent constipation.

Tiranga Uncha Rahe Hamara

The Indian National flag is symbolic representation of the rich Vedantic heritage of our country. Different colors with a chakra in the center are the gist of Vedas. The flag has three colors: saffron (orange) at the top, white in the middle and green at the bottom. In the center of the white color, there is a chakra with 24 lines.

To be successful in life, one needs a combination of inner happiness, spiritual knowledge and protection from the evil. One also needs to learn to concentrate on the present moment awareness. This is true not only for an individual but also for a family, community or nation as a whole.

The saffron or orange color represents enthusiasm, wealth, inner happiness and vigor. Traditionally all Gods in India are shown to wear yellow clothes. Yellow is also the color of Sun. It is also the color of beautiful blooming flowers representing agriculture status of the country and agriculture as the main source of income. Yellow also represents one of the three Goddesses, ‘Lakshmi’ signifying inner happiness. It also reminds an individual that he is capable of doing anything in life. It reminds him of his inherent qualities and also of his existing strength and vigor.

The white color is a symbolic representation of Saraswati, the Goddess of knowledge. It also represents the color of Cow, the Universal Giver, and of the color of milk, which is a complete food by itself and represents pure Sattva. White is also the color of swan, the vehicle of Brahma, the Creator. Swan has a typical quality of removing water from milk mixed with water. It signifies ‘vivek’ or discrimination which helps to remove negativity and selecting positive things in life. The white color also means the path of truthfulness and purity.

The green color indicates protection, safety, security and greenery. It tells about the status of the country being free of pollution. Green plants give oxygen to the atmosphere, which gives life and is a protector as oxygen protects life.

The central chakra means hard work, meditation, concentration, contemplation, etc. as without hard work, nothing is successful in life.

The whole flag signifies that India is full of people who are hard working and sincere in their efforts and are keen in acquiring pure satvik spiritual knowledge through hard work and self-protection.

The flag also represents the 3 Goddesses of India - Laxmi, Saraswati and Durga. Laxmi represents wealth; Saraswati represents knowledge and Durga the protector.

Low blood testosterone linked with poor outcomes in dialysis

Higher serum testosterone levels are linked with significantly reduced risk of death, with a 42% reduced risk per 10-ng/dL increase as per a study of 623 men initiating dialysis. In the study patients were followed for a median of 20 months. Higher levels of testosterone were also associated with significantly higher health-related quality of life scores. The findings are published in the American Journal of Kidney Diseases.

 Dr Sanjay Gupta changes stance on medical marijuana

In an op-ed written for the CNN website, Dr. Sanjay Gupta apologizes for his anti-marijuana stance and says that he now endorses the medicinal use of the drug, which “doesn’t have a high potential for abuse” and has “very legitimate medical applications.”

Pio is back, update

1. THE GAZETTE OF INDIA EXTRAORDINARY: Pioglitazone and all formulations containing Pioglitazone for human use is allowed to be manufactured for sale, sale and distribution subject to the condition that the manufacturers shall mention the following on their package insert and promotional literature of the drug;

1. The drug should not be used as first line therapy for diabetes,

2. The manufacturer should clearly mention following box warning in bold red letters.

Advice for healthcare professional:
•   Patient with active bladder cancer or with a history of bladder cancer and those with uninvestigated haematuria should not receive pioglitazone.
•  Prescribers should review the safety and efficacy of pioglitazone in individuals after 3-6 months of treatment to ensure that only patient who are deriving benefit continue to be treated. Pioglitazone should be stopped in patients who do not respond adequately to treatment (e.g. reduction in glycosylated haemoglobin, HbA1C.
•  Before starting pioglitazone, the following known risk factors for development of bladder cancer should be assessed in individuals: age, current or past history of smoking, exposure to some occupation or chemotherapy agents such as cyclophosphamide, or previous irradiation of the pelvic region.

• Use in elderly patients should be considered carefully before and during treatment because the risk of bladder cancer increases with age. Elderly patients should start on the lowest possible dose and be regularly monitored because of the risks of bladder cancer and heart failure associated with pioglitazone. [F.NO. 4-01/2011-DC/Piogl, ARUN K. PANDA, Jt. Secy]
 
2. MINISTRY OF HEALTH AND FAMILY WELFARE, Department of Health and Family Welfare, NOTIFICATION, New Delhi, the 31st July 2013
G.S.R. 520(E)-Whereas the Central Government was satisfied that the use of the drug Pioglitazone and all drug formulations containing Pioglitazone was likely to involve risk to human beings and whereas safer alternatives to the said drug are available;
Whereas the Central Government was satisfied that it was necessary and expedient to regulate by way of suspension, the manufacture for sale, sale and distribution of the said drug in the country in public interest, and accordingly in exercise of the powers conferred by section 26A of the Drug and Cosmetic Act, 1940 (23 of 1940) the Central Government suspended the manufacture for sale, sale and distribution of  Pioglitazone and all formulations containing Pioglitazone for human use through the notification number G.S.R. 379 (E) dated 18TH June 2013;
Whereas, the Drug Technical Advisory Board has examined the issue of suspension of manufacture and sale of the said drug on 19th July, 2013 and has recommended that the suspension of the drug should be revoked and allowed to be marketed subject to certain conditions the manufacturers shall mention on their package insert and promotional literature of the drug;
Now, therefore, on the basis of the recommendations of the Drugs Technical Advisory Board, the Central Government hereby revokes the notification G.S.R. 379(E) DATED 18TH June 2013 subject to the following condition as recommended by the Drugs Technical Advisory Board.

Antihypertensive and cardioprotective effects of pumpkin seed oil

·        Pumpkin seed oil is a natural product commonly used in folk medicine for treatment of prostatic hypertrophy. 

·        The pumpkin seed oil exhibits an antihypertensive and cardioprotective effects through a mechanism that may involve generation of NO. (El-Mosallamy AE, Sleem AA, Abdel-Salam OM, et al. J Med Food. 2012 Feb;15(2):180-9).

·        Telfairia occidentalis (fluted pumpkin) is one of the commonly consumed leafy vegetables in Nigeria. In a study on rats supplemented diets containing 3% and 6%, T. occidentalis decreased plasma and PMF cholesterol levels by 20% and 30% and by 30% and 45%, respectively. (Adaramoye OA, Achem J, Akintayo OO, et al. Hypolipidemic effect of Telfairia occidentalis (fluted pumpkin) in rats fed a cholesterol-rich diet. J Med Food 2007 Jun;10(2):330-6).

·        Natural products like pumpkin-seed oil (PSO) may modify the potency of the calcium antagonist felodipine (FEL) or angiotensin-converting enzyme inhibitor (ACE-inhibitor), captopril (CPT) in modulating the biochemical derangement in blood, heart and kidney as well as blood pressure and heart rate of spontaneously hypertensive rats. (Zuhair HA, Abd El-Fattah AA, El-Sayed MI. Pumpkin-seed oil modulates the effect of felodipine and captopril in spontaneously hypertensive rats. Pharmacol Res. 2000 May;41(5):555-63)

Vitamin may have no role in hypertension

Supplementation with high doses of oral vitamin D3 every 3 months did not have a significant effect on blood pressure in older patients with isolated systolic hypertension as per a small randomized trial reported online in JAMA Internal Medicine. At both 3 months and 1 year, there were no differences in office blood pressure between the supplementation and placebo groups. And there were no effects seen on nearly all of the secondary outcomes, with the exception of parathyroid hormone levels, which dropped by 3.8 ng/mL with supplementation relative to placebo.

In coma the patient is listening

The Indian Upanishads have been saying that one can hear even while in coma and so one should not talk bad or ill in front of a comatose patient and now another western study has proved this.

Researchers led by Lorina Naci, PhD, and Adrian Owen, PhD, of Western University in London, Ontario have established a primitive type of communication with two nonresponsive patients using fMRI to measure their attention to certain words, serving as responses to questions. The study is published in online in JAMA Neurology.

The technique in future may be useful in establishing basic communication with patients who appear unresponsive to bedside examinations and cannot respond with existing neuroimaging methods.

Brain activity measured by fMRI in one patient with minimal consciousness and one in a persistent vegetative state demonstrated not only that they heard words spoken to them, but also could use their attention to the words to give "Yes" or "No" answers to questions about their names and location.

The second patient, who had been in a persistent vegetative state for 12 years after a head injury, was able to "answer" in the negative when asked if he was in a supermarket, but affirmatively when asked if he was in a hospital. The patient also gave correct answers to yes-no questions about his name.

These "answers" were in the form of increased activity in brain regions that had previously been activated during a training period in which patients were instructed either to count occurrences of the words "Yes" or "No" when spoken to them or to ignore them.

With functional magnetic resonance imaging it is possible that behaviorally nonresponsive patients can use selective auditory attention to convey their ability to follow commands and communicate.

 Earlier studies

·        Some apparently comatose patients retain some cognitive ability despite being unable to move or speak.

·        In one study, fMRI showed distinctive patterns of brain activity when patients were told to imagine certain images.

·        Former Israeli Prime Minister Ariel Sharon, in a vegetative state for 6 years following a stroke, was found to show a unique pattern of brain activity in response to the voice of his son.

(Source MedPage)

Reduce liquids to reduce weight

When it comes to losing weight cutting down on liquid calories is equally important 

"Weight loss from liquid calories is greater than loss of calorie intake from solid food, as per Dr. Liwei Chen, an assistant professor of epidemiology at the School of Public Health at the LSU Health Science Center in New Orleans, in American Journal of Clinical Nutrition.

Body is able to self–regulate its intake of solid food. If you eat too much solid food at lunch, you’ll tend to eat less at dinner. But the same self–regulation is not evident for what you drink. The body does not adjust to liquid calories, so over time, you gain more weight.

Cutting back on calories from sugary drinks – by only one serving per day –can account for nearly two–and–a–half pounds of lost weight over 18 months.

Beverages are categorized into eight categories as follows:

1. Sugar–sweetened beverages (including soft drinks, fruit drinks, fruit punch, or high–calorie beverages sweetened with sugar)
2. Diet drinks such as diet soda and other diet drinks that are artificially sweetened
3. Milk (including whole milk, 2 percent milk, 1 percent and skim)
4. 100 percent fruit and vegetable juice
5. Coffee and tea with sugar
6. Coffee and tea without sugar
7. Alcoholic beverages.
8. Water with no calories.

The best drinks are water, plain soda and tea coffer with no sugar.

I Like You vs I Love You

The word “Like” is used at the level of physical body, mind, intellect or ego and the word “Love” at the level of soul. 

Examples are “I like this shirt”; “I like this car”; “I like his personality”; “I like his intelligence” etc. 

The word “Love” is expressed for a person (I love you) or for Food (I love this food).  In ancient Vedic philosophy human body and food shares the same consciousness. 

Therefore, food is often symbolized as ‘I love my food’ e.g. I love mangoes or I love apples, etc.

When you are trying to say yes or no to a matrimonial offer, a question is often asked to you, “Do you like him or do you love him?”  Like is at a superficial level and 

Love is at a deeper level.

In an arranged marriage, Love may take time to develop but in a love marriage, by the time you get married you are in love with each other.  One should never marry at the stage of liking in love marriage. 

In Vedic philosophy, there are stages of Love and they are Euphoria, Reaction, Adjustment, Liking and Love.  When you get married, which is an arranged one, you are in a phase of Euphoria, which is the period of honeymoon.  Once the honeymoon is over, you start reacting to each other’s habits then over a period of time you start getting adjusted as there is no other alternative.  This phase is followed by the phase of liking and then the last phase of loving and this liking-loving phase may take up to 7 years. Then is the 7-year itch as it is described. 

The initial phase of infatuation involves adrenaline and nor adrenaline chemicals and the later phase of love involves endorphins. 

When you lose a partner at the stage of liking the mourning period is less but when your loved one departs at the stage of love, the mourning period may be prolonged and even may be forever.

The word “Love” is also sometimes used for materialistic things.  Some people say ‘I love my car’ or ‘I love my computer’.  This terminology is used for people who from their heart love a materialistic object. But more often the word “Like” is used for materialistic things other than food and human being. 

Besides human beings and food, the world “Love” is often used for pet animals and that is expected as they also have consciousness.  

To summarize, for anything which has consciousness we use the word “Love” and for anything else we use the word “Like”. 

Spontaneous human combustion

Rahul has been virtually in flames four times since he was born two-and-a-half months ago because of a rare condition called spontaneous human combustion reports TOI. The disease is seen only in 200 people across the world in the past 300 years.

Rahul was nine days old when he first developed spontaneous burns. The baby emitted some highly combustible gas through the pores of his skin, which made him catch fire.

There are many theories about the poorly understood condition, ranging from high acetone content in the body to the paranormal. Some doctors say everyone has certain amount of alcohol present in their blood and when its content is high, it combines with the gases in the body; resulting in burns. Though there is no special cure for the condition, it can be treated like a regular burn injury.

A plausible hypothesis for SHC is that some bacteria, such as the methanogenic micro-organism-archaebacteria, in the intestine convert the food into methane, which is a combustible substance.

A small spark, which need not be an obvious one, anywhere nearby, can trigger the fire.  If the child is covered with a silk cloth which can generate static electricity, the combustible gas and the electricity can cause fire. The boy should not be near inflammable substances.

Deep frying potatoes can cause cancer but soaking potatoes in water before frying can nullify these effects

Deep frying of potato can cause cancer but soaking potatoes in water before frying can nullify these effects. Soaking potatoes in water before frying cuts down the formation of the suspected carcinogen acrylamide. Acrylamide is created when starch–rich foods are cooked at high temperatures (120⁰C) such as frying, baking, grilling, broiling or roasting.

Raw or even boiled potatoes test negative for the chemical.

Boiling and microwaving appear less likely to form acrylamide as the cooking does not involve very high temperatures. Longer cooking times increase the amount of acrylamide produced when the temperature is high enough.

Potato chips and French fries contain high levels of acrylamide compared to other foods, with lower levels also present in bread and cereals. Acrylamide is harmful to health and may cause cancer in animals.

In a study published in Journal of the Science of Food and Agriculture, it has been found that simply soaking potatoes before frying can significantly reduce the formation of acrylamide.

The researchers tried three different approaches. They washed raw French fries, soaked them for 30 minutes, and soaked them for two hours. This reduced acrylamide levels by up to 23 percent, 38 percent and 48 percent, respectively, but only if the fries were cooked to a light color. It's not clear whether the same reductions could be achieved if French fries are cooked to a deep, dark brown.

The cooking and re–cooking of fried foods in the same frying pan or broiler is the main cause. Even the thoroughly washed iron skillet can continue to contain submerged carcinogens collected from previous use. Most restaurants uses the same rancid cooking oil for days or even weeks and even reusing it after washing the pot.

Traditional Ayurveda has been advocating against deep frying and has been advocating low temperature cooking for centuries. It has also been suggesting not consuming raw foods grown under the ground but soaking them before use or frying them.

High blood glucose linked to dementia even without diabetes

Higher blood glucose levels, shy of the diabetic range, increase the risk for dementia in adults, new data from the longitudinal Adult Changes in Thought (ACT) study suggest by Paul K. Crane, MD, associate professor of medicine at the University of Washington School of Medicine, Seattle. The study is published in the August 8 issue of the New England Journal of Medicine.

Among participants without diabetes, higher average glucose levels within the preceding 5 years were associated with increased risk for dementia.

At a glucose level of 115 mg/dL, as compared with 100 mg/dL, the adjusted hazard ratio for dementia was 1.18.

Higher average glucose levels were also related to an increased risk for dementia in those with diabetes. At a glucose level of 190 mg/dL, as compared with 160 mg/dL, the adjusted hazard ratio for dementia risk was 1.40.

Just 2 weeks of mindfulness meditation training help reduce smoking and craving for cigarettes

Results from a study conducted by investigators at the University of Oregon in Eugene showed that integrative body-mind training (IBMT) helped curtail cigarette consumption by up to 60% in smokers who underwent 5 hours of training during a 2-week period. In comparison, a control group who underwent relaxation therapy showed no reduction in smoking. The study was published online August 5 in the Proceedings of the National Academy of Sciences.

One reason for substance abuse and addiction may involve a lack of self-control, which raises the question of whether an intervention to improve self-control could change smoking behavior. Mindfulness training has shown some proof of efficacy in substance abuse, but a lack of adequate control conditions, failure to randomize participants, and a failure to assess biological markers of change have limited the research.

IBMT has been shown to reduce stress, increase positive emotion, and improve attention and self-control after a few hours of practice compared with the same amount of relaxation training.

Right Move or Wrong Move

In the yesterday’s Dharna, my presence was criticized by many of the doctors who said that why IMA is always against whatever new the Ministry of Health wants to start.

IMA is not anti-government but represents the best interests of the medical professionals. IMA has appreciated the way Ministry of Health is fighting for the cause of medical students by bringing NEET examination and now deciding to file a review petition in the Supreme Court against the Supreme Court decision of abolishing NEET examination.

IMA also has appreciated the move of Ministry of Health from the media reports where they have conveyed that they may go even up to the extent of bringing a legislation to bring NEET back.

As far as making rural posting compulsory before getting a PG is concerned, it is not practical and will end up with more corruption.

Bringing NEET examination is a clear indication that the present health minister is against any type of corruption but we feel that making rural posting compulsory before PG examination will add more corruption as the number of government jobs are lesser than the number of doctors who are ready to appear for PG examination.  There are 1 lakh doctors we have for PG entrance with only 12000 clinical PG seats.

We apprehend if this is made compulsory to get a rural posting there will be an unofficial capitation fee also.

We also fail to understand as to why a rural posting is not made compulsory for persons who do PG from outside India and only for PG students who want to do PG in India. Why this discrimination?

We are sure that the present Board of Governor and the Ministry of Health, Government of India will rethink about their decision of rural posting on merit.