Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 17 th April, 2019

Medtalks with Dr KK

1. The High Court has asked the Jammu and Kashmir government to respond to a Public Interest Litigation seeking directions to allow sale and usage of e-cigarettes in the state. A division bench of Chief Justice Gita Mittal and Justice Tashi Rabstan granted six weeks to the government to file the response after states additional advocate General Shah Aamir sought the time.

2. Vitamin D has been reported to have a wide range of benefits. However, a recent case study indicates that excessive use of vitamin D can cause kidney damage in people who are not deficient in the vitamin. The article was published online April 8 in the Canadian Medical Association Journal.

3. Revealing the added sugars in packaged foods and beverages would prevent nearly one million cases of type 2 diabetes and cardiovascular disease in the United States and save about $62 billion in societal costs, new research suggests. The study is published online April 15 in Circulation and is the first to assess the health impacts and costs of the FDA's added-sugar labeling policy

4. A new scientific statement from the American Heart Association (AHA) lays out the rationale and specifics for multimodal cardiac rehabilitation (CR) for patients with cancer, with a clear eye toward gaining equal footing for these services among third-party payers.

Canagliflozin the wonder drug

A new landmark clinical trial shows that canagliflozin lowers the risk of kidney failure by a third in people with Type 2 diabetes and kidney disease. The trial involved 4,401 participants in 34 countries. Canagliflozin also was found to reduce the risk of major cardiovascular events.

Canagliflozin increases the excretion of glucose through the kidneys. It has already been approved by the Food and Drug Administration to lower blood glucose in patients with Type 2 diabetes and to reduce the risk of major adverse cardiovascular events in patients with Type 2 diabetes and existing heart disease.

A paper describing the findings of the CREDENCE trial was published today in The New England Journal of Medicine and presented at the International Society of Nephrology's World Congress of Nephrology in Melbourne.

Beware Drug Interactions With Supplements

Over 67% of patients with cancer and 77% of patients with osteoporosis take supplements.

Over 34% of people who take a prescription medication also take at least one dietary supplement, a rate that increases to 61% in adults older than 60 years.

In some cases, supplements have pharmacologic effects similar to those of drugs prescribed to patients. Adding a supplement may then result in increased side effects of the drug in the form of pharmacodynamic interactions.

Several supplements marketed for diabetes or blood sugar control have hypoglycemic effects.

Glucosamine and turmeric are frequently used for osteoarthritis but can interact with drugs such as anticoagulants, which are used for other indications.

Drug(s) Affected Supplement Ingredients Potential Effect
Antiplatelet and anticoagulant drugs Chondroitin
Fish oil
Increased risk of bleeding
Antihypertensive drugs Goldenseal
Increased risk for hypotension
Hypoglycemic drugs Banaba
Bitter melon
Increased risk for hypoglycemia
Sedative/Hypnotic drugs Chamomile
Lemon balm
Increased drowsiness or sedation
Serotonergic drugs 5-HTP
SAMe (S-adenosyl-L-methionine)
St. John's wort
Increased risk for serotonergic side effects

Can we combine benzodiazepines, opioids, and muscle relaxants?

It can be

deadly. Never prescribe all three to one patient. If a patient overdoses on opioids, the doctor who prescribed can expect that records can be reviewed. Prescribing two of the three drugs is even more risky. If the combination is truly medically necessary, include in documentation your rationale for prescribing them. Never prescribe even one of these medications without performing and documenting a thorough assessment and diagnosing a condition that necessitates the prescription. Remember an individual may be receiving an opioid from one provider, a benzodiazepine from another provider, and a muscle relaxant from a third provider.

Answer these questions before prescribing any of these medications:

1. Does my patient have a medical diagnosis that calls for this medication?

2. Could the benefit be achieved with nonsteroidal drug, or through physical therapy or other nonpharmacologic treatment?

3. Is there a risk of abuse in my patient?

4. Have I done urine drug screen?

5. Do I have a written agreement with this patient about the goals of care and the conditions under which I will prescribe this medication?

6. Am I prepared to follow-up and assess whether the medication is effective? Will I stop prescribing the medication and taper it off if the patient is not improving?

7. Am I following opioid prescribing guidelines, and am I following them?

Dated: 17th April, 2019

Current Temperature Status and Warning for next 24 hours

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 16th April to 0830 hrs IST of 17th April, 2019)

Heat Wave:

Nil (Annexures 1 & 2).

Maximum Temperature

Maximum Temperature more than 40.0C was recorded at many places over Rayalaseema and Telangana; at a few places over Tamilnadu & Puducherry; at isolated places over Odish, East Uttar Pradesh, Madhya Maharashtra, North Interior Karnataka, Gangetic West Bengal, Coastal Andhra Pradesh, Jharkhand, Chhattisgarh, East Madhya Pradesh and Kerala.

Maximum temperature departures as on 16-04-2019: Maximum temperatures were appreciably above normal (3.1C to 5.0C) at a few places over Rayalaseema, Tamilnadu & Puducherry and Kerala and at isolated places over Odisha and Assam & Meghalaya; above normal (1.6C to 3.0C) at most places over Konkan & Goa and Nagaland, Manipur, Mizoram & Tripura; at many places over Jharkhand; at a few places over South interior Karnataka, Gangetic West Bengal and Coastal Andhra Pradesh and at isolated places over Coastal Karnataka and Sub-Himalayan West Bengal & Sikkim.They were markedly below normal (-5.1C or less) at most places over West Uttar Pradesh; at many places over Uttarakhand and West Rajasthan; at a few places over East Uttar Pradesh, East Rajasthan, Haryana, Chandigarh & Delhi and East Madhya Pradesh; and at isolated places over West Madhya Pradesh; appreciably below normal (-3.1C to -5.0C) at most places over Jammu & Kashmir, Himachal Pradesh and Punjab; at many places over Vidarbha and Gujarat region; and at isolated places over Madhya Maharashtra and Saurashtra & Kutch; below normal (-1.6C to -3.0C) at most places over Marathawada; at many places over Andaman & Nicobar Islands and near normal over rest parts of the country.

The highest maximum temperature of 43.7C was recorded at Bhubneshwar (Odisha) over the country.

Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 17th to 0830 hrs IST of 18th April 2019):-


Who is a specialist?

In the Allahabad High Court
Petition :The petitioner Dr N Rastogi has filed this writ petition challenging the order dated 16.01.2017 passed by MCI holding the petitioner to be guilty of professional misconduct, and her name has been directed to be removed from the State Medical register and Indian Medical register for a period of one year.
That the specialised qualification DGO has been incorrectly construed not to be based on a valid certificate. The Diploma was obtained in 2007. There is no requirement of any additional registration of recognized and registerable degrees. He cited a decision of the Apex Court in case of Dr. B.L. Asawa Vs. State of Rajasthan and others, (1982) 2 Supreme Court Cases 55.....read more

Can VOT be a feasible alternative strategy to DOT for treatment of TB?

DOTS (Directly Observed Therapy Short Term) as a strategy (where the patient has to take the TB medication in the presence of a DOTS agent) has been successfully adapted in TB control programs worldwide, including India. Although, it can be administered in home settings as well, there is still some inconvenience involved with DOTS, both to the patient and the healthcare provider, which may affect adherence to treatment.
Video-observed therapy (VOT) has been explored as a possible alternative to DOT. The World Health Organization (WHO) also recommends VOT as an alternative to DOT to improve treatment adherence when the video communication technology is available and can be appropriately organized and operated by health-care providers and patients....read more


Why do we not offer onions to God?