Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 28 th March, 2019

Morning Medtalks With Dr KK

New England Journal of Medicine:

1. Building on the ACA to Achieve Universal Coverage: U.S. universal coverage can be achieved by expanding Medicaid in all states, increasing assistance for buying coverage in the marketplace, ensuring that people enroll in affordable coverage for which theyre eligible, and addressing coverage for undocumented immigrants.

2. Testing for H. pylori, either directly on biopsy specimens or by means of stool antigen or urea breath testing, is recommended in persons at increased risk for this infection. Treatment choice depends on whether there is penicillin allergy, previous exposure to macrolides, and macrolide resistance. Testing for cure is recommended after treatment.

3. Changes in Practice after Malpractice Claims: In analyses of a national database of paid malpractice claims from 2003 through 2015, 89% of physicians had no claims, 9% had one claim, and the remaining 2% had two or more claims and were responsible for 39% of all claims. Physicians with multiple claims were not more likely to relocate geographically, but they were more likely to switch to smaller practices.

4. Mucinous ovarian cancer accounts for 3% of epithelial ovarian cancers and must be distinguished from mucinous carcinomas that have metastasized to the ovary. Most cases manifest as large, localized masses; resection is associated with a good prognosis

5. In persons with rifampin-resistant tuberculosis that was susceptible to fluoroquinolones and aminoglycosides, a short regimen was noninferior to a long regimen with respect to the primary efficacy outcome and was similar to the long regimen in terms of safety. (Funded by the U.S. Agency for International Development and others; Current Controlled Trials number, ISRCTN78372190; ClinicalTrials.gov number, NCT02409290.

Food and mood connection?

Excerpts Harvard Women's Health Watch

Research using data from large observational studies like the Nurses' Health Study and the Women's Health Initiative, which included middle-aged to older and mostly postmenopausal women has found links. This includes a 2005 study in the International Journal of Obesity, which found associations between obesity and depression and dietary factors. Also, a 2011 study in the American Journal of Clinical Nutrition found that women who ate more vitamin Drich foods had a lower risk of depression than women who got less vitamin D in their diets.

But conclusively linking your diet with your risk of depression is another story. It's not yet possible to identify a single nutritional factor that increases or decreases the risk of depression.

A 2014 study in Brain, Behavior, and Immunity that used data from the Nurses' Health study did find an association between depression and a diet rich in sugar-sweetened soft drinks, refined grains, and red meat.

Similarly, a 2018 meta-analysis published in the European Journal of Nutrition suggested that high consumption of meat could be associated with risk of developing depression. However, at this point, there are so many different factors associated with depression it's not possible to tease out exactly how much a specific food or dietary pattern affects risk, she says.

A Mediterranean diet is rich in fruits, vegetables, olive oil, whole grains, and lean protein such as chicken and fish, and low in red meat and unhealthy fats.

Even if future research determines that a Mediterranean diet doesn't have an effect on depression risk, there are still numerous other reasons to adopt this eating plan.

The Mediterranean diet has also been associated with lower blood pressure, better cognitive function, and lower incidence of diabetes and cardiovascular events.

CKD and plant based diet

Medscape Excerpts: Patients with CKD should be encouraged to consume more plant-based proteins as opposed to meat-based proteins. Meat-based diets are typically much more acidic than plant-based diets.

As background, growing evidence supports the health benefits of plant-based diets, such as the DASH diet, which are high in fiber and low in saturated fat; contain sources of potassium, phosphorus, magnesium, calcium; and have low levels of sodium for preventing heart disease and hypertension.

In contrast to meat-based diets, which are high in full-fat dairy foods as well as higher in sulfur-containing amino acids and phosphate, plant-based diets are lower in these amino acids and lower in bioavailable phosphorus, both of which have been associated with reductions in cardiovascular disease and CKD.

The acid-base balance in the body is a vital aspect of homeostasis.

You can affect the acid-base status of your body with the foods you eat. What determines a food's acidity or alkalinity is how it breaks down when digested. Most of the foods that contain exclusively protein tend to be high in sulfur-containing amino acids, and therefore are considered acidic.

Most plant-based foods don't contain high levels of sulfur-containing amino acids and are generally alkaline-forming. The alkaline-forming plant foods help to neutralize the acid-forming protein foods.

We benefit from having an even distribution of acid-forming and alkaline-forming foods in the diet. Even consuming slightly more plant-based/alkaline-forming foods (versus acid-forming foods) may be beneficial for long-term health outcomes.

Plant-based diets encourage people to eat less processed foods.

Meat products are also loaded with added citrates, nitrates, and phosphorus. These ingredients are unhealthy for everyone, including people with failing kidneys.

Dated: 28 th March, 2019

Current Temperature Status and Warning for next 24 hours

Heat Wave and Temperatures Observed Yesterday (Past 24 hours from 0830 hrs IST of 27 th March to 0830 hrs IST of 28 th March, 2019)

Heat Wave:

Yesterday, heat wave conditions were observed at isolated places over Saurashtra & Kutch.

Maximum Temperatures Recorded at 1730 Hours IST of 27th March, 2019:

Maximum Temperature more than 40.0C was recorded at few places over Gujarat state, Vidarbha and at isolated places over Marathwada, Telangana, and Rayalaseema. (Annexure-1).

Maximum temperature departures as on 27-03-2019: Maximum temperatures were markedly above normal (5.1C or more) at a few places over Jammu & Kashmir; at isolated places over Saurashtra & Kutch; appreciably above normal (3.1C to 5.0C) at a few places over Madhya Maharashtra; at isolated places Kerala; above normal (1.6C to 3.0C) at most places over West Rajasthan, Gujarat Region, Vidarbha, Marathwada and Rayalaseema; at many places over South Interior Karnataka and Lakshadweep; at a few places over Assam & Meghalaya, Uttarakhand, West Madhya Pradesh, Telangana, Tamilnadu & Pudducherry and at isolated places over Konkan & Goa. They were below normal (-1.6C to -3.0C) at most places over Gangetic West Bengal; East Uttar Pradesh; at many places over Andaman & Nicobar Islands, Jharkhand, Bihar, West Uttar Pradesh; at a few places over Sub-Himalayan West Bengal & Sikkim, Himachal Pradesh; at isolated places over East Uttar Pradesh and near normal over rest parts of the country. (Annexure-2).

Yesterday, the highest maximum temperature of 42.2C recorded at Amraoti (Vidarbha) over the country.

Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 28th to 0830 hrs IST of 29 th March 2019):-

Heat wave conditions are very likely to prevail at isolated pockets over coastal areas of Saurashtra and south Gujarat region.

Hon'ble Supreme Court: Death due to mosquito bite is not an accident under insurance policy

On Tuesday i.e. 26th March, 2019, the Hon'ble Supreme Court in the matter titled as "The Branch Manager, National Insurance Co. versus Smt. Mousmi Bhattacharjee & Others, Civil Appeal No. 2614 of 2019 has held that in a policy of insurance which covers death due to accident, the peril insured against is an accident: an untoward happening or occurrence which is unforeseen and unexpected in the normal course of human events. The death of the insured in the present case was caused by encephalitis malaria and insured was based in Mozambique which malaria prone area as per WHO. Thus, the illness of encephalitis malaria through a mosquito bite cannot be considered as an accident. It was neither unexpected nor unforeseen. It was not a peril insured against in the policy of accident insurance.
A person who suffers from flu or a viral fever cannot say that it is an accident. Of course, there is an element of chance or probability in contracting any illness.....read more

A1c is an unreliable diagnostic test for diabetes

Using the hemoglobin A1c to diagnose diabetes tends to underestimate the prevalence of the disease, suggests a study presented at ENDO 2019, the Endocrine Society's annual meeting in New Orleans, Louisiana.
In the study, 9,000 adults without a diabetes diagnosis were randomized to an A1c test and an oral glucose tolerance test (OGTT). Comparison of the results showed that using A1c as a diagnostic test....read more


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