The Making and Story of a Rural Physician

Asbestos Use in Rural India

noreply@blogger.com (Bipin Kumar) — Mon, 14 Nov 2011 09:20:52 PST

This is a guest post by Samantha Harris.

Asbestos Use in Rural India

While many developed nations have banned or at least severely restricted the use of asbestos in manufacturing and other industries, the dangerous mineral continues to be a serious health hazard in many Asian countries, particularly India. According to a 2009 U.S. Geological Survey report, India was the second-largest consumer of asbestos, behind only China, with a use of 340,544 tons of the material. And, unfortunately, that rate of use continues to grow.

Asbestos is dangerous because tiny, needle-like fibers of the mineral can break away, floating into the air where they can be inhaled into the lungs. When these fibers build up over time, they can cause lung scarring, asbestosis, and mesothelioma, a cancer of the lining of the lungs. Mesothelioma symptoms can take between 20 and 50 years to appear, so those in charge of the asbestos industry in India deny that there is a connection between asbestos and the cancer. However, U.S. and U.K. scientists call the link irrefutable – about 80% of mesothelioma cases can be linked back directly to asbestos exposure earlier in life.

Unfortunately, most states and territories in India lack the funding that would be necessary to prove to their own government that asbestos is harmful. It represents a big business in the country – the shipbreaking industry, where large quantities of asbestos are routinely ripped out as the vessels are disassembled, provides many jobs in India’s growing economy. The Alang shipyard in Gujarat is the largest shipbreaking yard in the world, employing about 55,000 workers. Another hotspot for asbestos is the construction industry, where the mineral is still used in the manufacturing of cement sheeting. The demand for these construction materials is highest in rural areas with growing populations, which means that even more people are being exposed to the hazardous substance.

If the industries that make heavy use of asbestos are not able to shut down completely – and for the sake of India’s economy, they largely cannot – employers must provide proper safety gear for their workers, including a mask and respirator to filter the deadly fibers from the air. Groups like the Ban Asbestos Network India (BANI) are hard at work to make on-the-job conditions safer for asbestos workers. Sadly, mesothelioma life expectancy is very low, with the average patient surviving for only 9 to 12 months after diagnosis. In other countries, when workers became aware of the hazards they faced, the government and national companies could no longer deny them their basic rights to health and safety. Hopefully, once awareness spreads through India of this dangerous substance, Indian workers will no longer have to face this preventable threat.

Socially Accountable MedEd

noreply@blogger.com (Bipin Kumar) — Mon, 14 Nov 2011 04:09:52 PST

Principles of social accountability should be incorporated in the regulation and accreditation process in medical education to ensure that medical colleges are involved in service, training and research in their respective local communities. This was one of the key recommendations made at the ‘National Conference on Health Professions Education (NCHPE) 2011,' organised by the Medical Education Unit of the Christian Medical College in Vellore recently.

The conference, which brought together policy makers, institutions offering medical education and health care providers, sought to strengthen the inter-professional linkages among doctors, nurses, dentists and allied health professionals.

After deliberation on a host of issues pertaining to health care, experts recommended that a new Act for the NCHRH explicitly include a mandate to align education in the health professions to the health conditions and needs of the country.

http://www.thehindu.com/education/issues/article2499771.ece

The article further writes:

The colleges should train multi-competent family physicians, equipping them to provide primary and secondary level health care. A period of compulsory rural service should be required of all medical graduates to meet health care deficiencies, the recommendations added.

It is seen that it is only CMC, Vellore among the Indian medical schools which is pushing very hard for the case of family medicine in India.

Social accountability is a big deal. Ask any medical graduate, especially those passing from private medical colleges, if s/he wants to pursue a carer in remote rural set-up; and the answer is usually no! The argument given is usually: 'I/my parents wasted so much (in terms of money and/or years) on my education; how will I recover that?'

Well, that is correct, but who is going to take care of India, if not the Indians!? Majority of the medical graduates in north India just after finishing their education rush to Delhi for joining coaching institutions to prepare themselves for post-graduate entrance tests. Few only work during their internship. And almost none returns to their home towns to work. Even if they return after higher education; their consultation fees and other costs for undergoing treatment from them is usually much higher for the common man to afford leading to perpetuating health status of the common Indians.

Somewhere I had read that India and Indians in general do not have the very concept of social responsibility; the basic reason we do not have a strong health care system like that in UK, Australia or Canada. Indians believe and feel proud to believe in the concept of Main aur mera (me and mine).

A friend of mine (right now anesthesiologist in New Delhi) used to cite a colloquial Bhad mein jaaye duniya, hum bajayen harmonia (Let the world perish, I am playing my harmonica!

Fenofibrate and its 'no effect'

noreply@blogger.com (Bipin Kumar) — Sat, 12 Nov 2011 17:43:53 PST

US FDA issued an alert on 9th November 2011 about the drug Fenofibric Acid. The alert says:

FDA notified healthcare professionals the cholesterol-lowering medicine Trilipix (fenofibric acid) may not lower a patient's risk of having a heart attack or stroke. FDA reviewed the data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid trial. The ACCORD Lipid trial found no significant difference in the risk of experiencing a major adverse cardiac event between the group treated with fenofibrate plus simvastatin compared with simvastatin alone.

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm279185.htm

So, there is no benefit from giving fenofibrate to the patients and all the money wasted on buying it has gone just waste! Wow! This is what I call Evidenced Based Medicine.

I know only one or two patients who are on Statin plus Fenofibrate. Am happy to know that many did not waste their hard earned money for a drug which does no good! But, this may be because the patients were not affordable buying two lipid lowering agents, the pharmaceutical companies did not promote their drug here (as the hospital I work in does not entertain them).

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Content warning: Some posts and/or pictures may be disturbing to the common people! All rights reserved.

Healthcare costs making Indians poorer

noreply@blogger.com (Bipin Kumar) — Mon, 07 Nov 2011 03:33:56 PST

The Economic Times published an interesting article quoting WHO regional advisor Kathleen A. Halloway. According to the article 3.2% of Indians will fall below poverty line due to out-of-pocket expenditure for health care services.

An interesting read:

http://articles.economictimes.indiatimes.com/2011-11-01/news/30345823_1_poverty-line-healthcare-medical-council

Not enough psychiatrists

noreply@blogger.com (Bipin Kumar) — Mon, 07 Nov 2011 03:25:29 PST

The Zee News website published an article:

India may take solace in its relatively moderate mental illness level but appalling doctor to patient ratio for the disease has set alarm bells ringing. The World Health Organization (WHO) has estimated that one in four people will suffer mental health problems at some point in their lives but India has total of only 4,500 psychiatrists to serve its billion plus population.

http://zeenews.india.com/news/exclusive/not-enough-doctors-to-treat-mentally-sick_738773.html

The article further writes:
Stress and anxiety disorders were the commonest forms of mental illnesses and the disease spread uniformly in rural and urban areas with the WHO estimating that every 40 seconds globally someone commits suicide.

Well, why do you need psychiatrists to treat these? Use your family physicians or primary care providers! Train them in basic psychiatry and use them! What is big deal? It is in the community that these problems are; so let the community doctors deal with them.

Primary care psychiatry should find its place in India.

The earlier, the better.

Content warning: Some posts and/or pictures may be disturbing to the common people! All rights reserved.

One physician worth many

noreply@blogger.com (Bipin Kumar) — Mon, 07 Nov 2011 03:18:32 PST

Attention of the media persons towards the concept of family medicine and / or primary care has started to grow. And it is reassuring at the least. I had read Mr. Jug Suraiya writing his column in the Times of India about his childhood doctor who used to take care of the whole family.

Today, Sanchita Sharma of the Hindustan Times also published about the virtues of a family physician and the need to be first seen by him/her instead of visiting the specialist on our own. India, unlike developed nations like UK, Canada, Australia, Germany Switzerland etc does not have a system of well established primary care. Indians are free to go to any doctor they wish to. This can be a pharmacist or a community health worker (I do not prefer use the word 'quack'; as they do form a big part of our Indian health care system), a doctor in the government clinic or hospital or anyone in the private health care services. This is in addition and extra to the advices that we Indians receive from our family members and friends.

Sanchita writes in her article 'One physician is worth many specialists':

http://www.hindustantimes.com/News-Feed/Health/One-physician-is-worth-many-specialists/Article1-765354.aspx

Most Batman fans know this already, but it's worth repeating: "Super" does not always mean better. All superspecialists are internists first -- they do an MD in medicine before they become specialists -- but quite a few get rusty on the basics as they increasingly see patients with disorders related to one branch of medicine. It makes little sense to go to a superspecialist at the first appearance of a symptom because they may just have become wired to focus on their own specialty.

An old-style family physician, on the other hand, treats symptoms holistically and refers you to a specialist only if necessary. Going to the same physician for ailments also adds to his understanding of your medical history - such as past diseases, other medications you are on, allergies, etc - which makes continuing care personalised and easier for both you and your physician. Your family physician is also more likely to take calls and discuss your over-all medical history with a specialist, if needed.

Most hospitals do recognise the role of a general physician and have a department of internal medicine. Still, patients usually end up going to a specialist who they assume will know better, or simply because they want to save on consultation fee.

Content warning: Some posts and/or pictures may be disturbing to the common people! All rights reserved.

Intestinal parasitic infestation among children in a semi-urban Indian population

noreply@blogger.com (Bipin Kumar) — Mon, 07 Nov 2011 03:15:08 PST

An interesting article is available now:

Bisht D, Verma AK, Bharadwaj HD. Intestinal parasitic infestation among children in a semi-urban Indian population. Trop Parasitol [serial online] 2011 [cited 2011 Nov 7];1:104-7. Available from: http://www.tropicalparasitology.org/text.asp?2011/1/2/104/86946

Am posting some images from the article. They worth noting and tell how significant intestinal parasites are in today's India and re-emphasize the burden of easily treatable neglected tropical diseases (NTD)

Another one:

Vaccine policy under scanner

noreply@blogger.com (Bipin Kumar) — Mon, 07 Nov 2011 02:52:48 PST

There is an article on the India Today which writes about the favour being given by the National Vaccine Policy.
The article writes:

The draft national vaccine policy, which is supposed to lay down the framework for the introduction of new vaccines in the immunisation programmes, has come under scanner for its tilt in favour of vaccine manufacturers rather than sound public health.
Experts feel the policy is designed to guard the interests of vaccine manufacturers. The draft states: "During setting up of the policy framework, the industry may be provided a channel to voice their opinion and experience and their concern could be utilised in framing the policy". It also talks of an "independent and speedy" redressal mechanism, if a decision has been made to the industry's detriment.

To read more, please click on the link in the caption of the picture:

http://indiatoday.intoday.in/articlePrint.jsp?aid=158925

Yoga Vs Britain Vs Research

noreply@blogger.com (Bipin Kumar) — Wed, 02 Nov 2011 09:20:24 PDT

Well, the ancient Indian practice of Yogasanas have been subject to many controversies since time immemorial. Things became more prevalent in recent years with even many Indians disowning Yoga and criticizing it.

It is only recently over the last few years that people from all walks of life have started realizing the benefits offered by this ancient practice. Things are becoming more popular after simplifications offered by some of the practitioners of 21st centuries, namely Baba Ramdev, Sri Sri Ravishankar, Bharat Thakur and others.

When it comes to Britain, the vicars had disregarded the practice, interestingly offered by the churches. For the full report please read the article:
Brit vicars say no to yoga, say it's not Christian

where as Sri Sri Ravishankar is quoted to say: "Yoga is just a healthier way of life".

Recently, on November 1, 2011; the famous medical journal Annals of Internal Medicine came up with an interesting article suiting the Britishers as the study was done there.
Yoga for Chronic Low Back Pain.

The article writes in its conclusion:
Offering a 12-week yoga program to adults with chronic or recurrent low back pain led to greater improvements in back function than did usual care.

It is an interesting article to read and just says that India still has much to give to the world when it comes to quality.
Jai Bharat!

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Family Health Unit in Brazil

noreply@blogger.com (Bipin Kumar) — Mon, 31 Oct 2011 15:43:00 PDT

This is an excellent video depicting the family health system of Brazil providing good quality health care to the people there.

If a developing country with a profile very much similar to India can do this; I hope we should also do the similar something.

If we see, India has an excellent system of public sector banks and postal services. If they have served the whole nation and its remotest corners; I presume we can do it for the health care of Indians as well. Let us make this nation's health care on the lines of banking services; widely available, almost 100% reliable and dependable and of course free or at least appears to be free to the end user. I never saw anyone bribing a bank officer (at least in front of others/me). but when it comes to health care there are many problems. Should the government with the help of other agencies bring out reforms as it did by nationalizing the banks decades back and made everyone realize the need and demand as well as making the banking services widely available both in public sector banks and postal banking.

Towards a healthy India

noreply@blogger.com (Bipin Kumar) — Sun, 30 Oct 2011 17:33:29 PDT

India should boldly embrace the idea of universal health coverage Health and rising health costs affect all Indians, not just the poor.

Frankness and honesty, two admirable features of the 12th Plan’s Approach Paper, are unfortunately not sufficient to address the many shortcomings in guaranteeing health security to Indians. Imbedded in the subtext of the Approach Paper is an inexplicable reluctance, if not lack of courage, to embrace universal health coverage.

Photo: Bloomberg

That India is far from attaining the Millennium Development Goals (MDG) relating to health is well-known. We were assured (or asked to believe) that, over the 11th Plan period, seven health goals relating to infant mortality, maternal mortality, fertility, under-nutrition among children 0–3 years, anaemia among women and girls, clean drinking water, and the sex ratio among children 0-6 years would be realized. We have failed to achieve all seven. In fact, the child sex-ratio which was to increase to 935 by 2011–12 sadly fell to 914 by 2011. Public expenditures on health was to be stepped up from around one to at least 2% to 3% of the gross domestic product (GDP). Even here, despite economic growth and the potential it generates for additional resource mobilization, we have been let down. Public expenditure on health hovers around 1.2% -- still among the lowest inthe world. This has led to an extremely high burden of private out-of-pocket health expenditures, which a huge part of the population cannot afford.

Illegal drug trials report goes missing

noreply@blogger.com (Bipin Kumar) — Wed, 26 Oct 2011 00:13:38 PDT

Did they say the corruption is rampant in India! And if they did, they are right. Recent upcoming clinical trials and India becoming a fertile soil for clinical research as well as mushrooming clinical research institutions luring young graduates who may do things which pharmaceutical companies may want for their vested interests. And as the ethics is fragile and the laws of the land are very lightly implemented things may worsen in the coming future.

Here is a news article saying that the investigation report against some corrupt doctors doing unethical trial on poor patients in a Madhya Pradesh has gone missing!

http://daily.bhaskar.com/article/MP-IND-illegal-drug-trials-report-goes-missing-2515553.html

Read the report by clicking on the link.

Content warning: Some posts and/or pictures may be disturbing to the common people! All rights reserved.

Anorexia Nervosa

noreply@blogger.com (Bipin Kumar) — Tue, 25 Oct 2011 23:19:35 PDT

An excellent article by Dr. Jane Morris on Anorexia Nervosa by the BMJ. The full text available on the PubMedCentral.

Content warning: Some posts and/or pictures may be disturbing to the common people! All rights reserved.

Futility of drotrecogin alfa

noreply@blogger.com (Bipin Kumar) — Tue, 25 Oct 2011 22:40:05 PDT

Septic shock is one of the often seen complication of many infectious diseases seen in the emergency room. Some time back Activated Drotrecogin alfa (Activated Protein C) was promoted to be used in the refractory septic shock patients. Recently, through an email I came to know that this molecule is ineffective in doing so. This is proved by PROWESS-SHOCK study.

The FDA alert regarding the same:

FDA Drug Safety Communication: Voluntary market withdrawal of Xigris [drotrecogin alfa (activated)] due to failure to show a survival benefit

Similar alert from the European Medicines Agency:

Xigris (drotrecogin alfa (activated)) to be withdrawn due to lack of efficacy

ST elevation but not MI

noreply@blogger.com (Bipin Kumar) — Tue, 25 Oct 2011 09:14:13 PDT

Inferior ST elevation but not MI

This is a great video by Dr. Stephen Smith, Emergency Physician and an ECG expert (great one, personal opinion) where he teaches us why ST segment elevation in inferior leads viz. II, III and aVF are not suggestive of acute myocardial infarction in the absence of reciprocal changes in the lead aVL or similar changes in lateral leads.

Good learning point for those working in the ER.

Inferior ST Elevation from hqmeded.com on Vimeo.

Such clinical tips are especially important in Indian context of emergency care as there are very few cath labs (in the periphery). And it is for the upcoming physicians to decide about care of suspected MI patients.

Content warning: Some posts and/or pictures may be disturbing to the common people! All rights reserved.

uOttawa budget allocation

noreply@blogger.com (Bipin Kumar) — Mon, 24 Oct 2011 18:31:37 PDT

This image is from the University of Ottawa allocation of budgets to its clinical departments and how interesting to see that it is Family Medicine which got the maximum chunk! Great !

Courtsey: University of Iowa
It is an evidence that putting more funds towards family medicine or primary care will be foe the greater good of the public.

Content warning: Some posts and/or pictures may be disturbing to the common people! All rights reserved.

Diabetes Course and Controversy

noreply@blogger.com (Bipin Kumar) — Tue, 11 Oct 2011 10:37:21 PDT

While reading a post on the blog Indian Medicos on PIL filed by other doctors on a distance learning course on diabetes, made a comment.

Read here:
http://indian-medicos.blogspot.com/2008/08/doctors-file-pil-in-hc-against-diabetes.html

Content warning: Some posts and/or pictures may be disturbing to the common people! All rights reserved.

Hospital-acquired infections in India

noreply@blogger.com (Bipin Kumar) — Wed, 05 Oct 2011 05:11:17 PDT

11-83 per cent hospital-acquired infections in India: report

http://news.in.msn.com/national/article.aspx?cp-documentid=5488075

The level of infection control in hospitals in India is quite low, according to a global finding which says hospitalised patients acquired 11-83 per cent of these infections.

The research by Global Antibiotic Resistance Partnership (GARP) in India also revealed that that 30 per cent of 1.9 lakh neo-natal deaths due to sepsis, a bacterial infection that overwhelms the bloodstream, are due to antibiotic resistance. Only 58,319 deaths or just 30 per cent of total sepsis deaths are attributable to antibiotic resistance.

Wow! At least people started looking at India critically. Am glad to hear about these developments. Hope we doctors learn about hand washing and saving our patients.

For full report, please click on the image.

Content warning: Some posts and/or pictures may be disturbing to the common people! All rights reserved.

Right to Public Services Act

noreply@blogger.com (Bipin Kumar) — Mon, 03 Oct 2011 04:31:01 PDT

What is usually seen that most of the acts and regulations become toys in the hand of peole with power, especially in the government sector.

A recent Indian Express article reports about the teeth of the newly introduced Right to Public Services (RTPS) Act by the Governement of Bihar.

As per the article:

Chief Minister Nitish Kumar on Friday took serious note of touts offering services provided under new Right to Public Services (RTPS) Act for a “price” following which the Patna police conducted raids at various offices and arrested 11 middlemen. The action came after The Indian Express carried a report, ‘Bihar’s showpiece law faces its first test’ on Friday.

http://www.indianexpress.com/news/Right-to-services--Crackdown-begins--11-arrested-in-Bihar/854214/

CM House sources said that Nitish, due to start his seva yatra from November first week to assess RTPS Act progress, was “displeased” at revelations on how touts went about “their business” of luring common people to render services at a cost all across Bihar including at three Patna offices. “As the CM is embarking on an important yatra, he will not accept any let down in new Act implementation,” said a source.

This news shows the rising Bihar and the effects it will have on he development of the state. Hope others learn from this and do accordingly.

Well, one of the respondents of the artile says that CCTV should be installed to fight corrupation in government offices. Let us accept that it is in 'us' that the corrupattion has to go and not just from the 'offices'.

Whatever measures we take to regulate 'others' the tougher it will get and people will find other different ways to indulge in banned activities. Let us become more truthful, god fearing and dedicated ourselves than willing to regulate others.

Content warning: Some posts and/or pictures may be disturbing to the common people! All rights reserved.

Family Medicine & Corporate Sector

noreply@blogger.com (Bipin Kumar) — Sun, 02 Oct 2011 02:04:21 PDT

India is amazing! Isn't it!

Am talking here in the context of primary care in India and the recent interest in it shown by corporate sector. In a previous post there was some information about emerging/increasing interest in family medicine in India.

In the year 2011, we came to know about three companies who are interested in establishing and running primary care set-ups / clinics with a team of doctors and other health-care professionals and allied workers to help run the clinic well. These are:

Health Spring: Healthspring is a doctor-centric institution, with a vision to create the most trusted healthcare brand in India, through a combination of excellence in both quality of care and customer service, and in so doing, revolutionize healthcare delivery in India. Our Chairman, Dr. Gautam Sen, is one of the best-known and best-regarded doctors in India, and our senior advisory panel are nationally and internationally famous doctors and business leaders. Our principal funders are Catamarn Ventures and Reliance Ventures. The senior team at Healthspring brings together the best medical and operational minds, with deep experience in the field, as well as a “patient first” conviction. In all our efforts, we are guided by outstanding ethics and a commitment to transparency.
Nation Wide:

NationWide Primary Healthcare Services Pvt. Ltd. (NationWide) was founded by 2 doctors just like you, with a very humble background. After completing their medical degree and residency from reputed institutes, such as PGI, Chandigarh, they moved to the UK for higher studies and career progression. Working in the National Health Service (NHS) they realized that primary care constitutes the backbone of healthcare infrastructure in the developed world. They started envisioning creating something similar in India.

With this dream, one of them, Dr Santanu Chattopadhyay, decided to develop expertise in management by pursuing an MBA from one of the best Business Schools of the world, viz INSEAD in France. Subsequently, he worked in large healthcare companies such as Johnson and Johnson, and later managed start-up companies for several years. On the other hand, the other doctor, Dr Shantanu Rahman, decided to switch from hospital medicine to General Practice (GP) in the UK to understand the nuances of running a GP practice. After gaining a decade of experience in their chosen fields they decided to join hands to give birth to a new revolution called NationWide. They are well supported by a highly professional management team and medical team with international experience in Family Medicine. In fact many of our managers are dually qualified in management and medicine.
Pathfinder Health India Pvt. Ltd: Health India's vision is to dramatically reduce ill health events for all, with special emphasis on the aspiring urban communities via a high impact Primary Health solution and to set up an effective scalable health business, delivering high quality, low cost primary health care. Working with partners and training institutions to establish a workforce of general practitioners, nurses and healthcare assistants.'

So, these three companies are based in different towns of India viz Mumbai, Bangalore and New Delhi and plan to target "URBAN people". Basically, no health care to the rural and the poor. But anyway, at least a good start. These companies are some of the areas where a common and increasing interest of medical graduates can arise.

I recently had a talk with one family medicine resident from Pune. He informed me that many are there in the hospital he works. Good! Keep it up and tell the world and the people of India that there are some doctors in training which will take care of them from womb to grave, there are some doctors in training who will be with them when they need a hand to hold and a professional to talk to for making important decisions in life.

These initiatives by corporate world should open the eyes of the government and the bureaucrats helping them realize that it is through primary health care the realization of better health status of the nation can be achieved at the lowest possible cost and best possible practices and highest level of ethical behavior.

ICMR-INDIAB study

noreply@blogger.com (Bipin Kumar) — Sat, 01 Oct 2011 21:27:26 PDT

An interesting study has recently been published (currently Epub ahead of print) in the journal Diabetologia. It is an interesting study.

http://www.ncbi.nlm.nih.gov/pubmed/2195995

Abstract

AIMS/HYPOTHESIS:

This study reports the results of the first phase of a national study to determine the prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in India.

METHODS:

A total of 363 primary sampling units (188 urban, 175 rural), in three states (Tamilnadu, Maharashtra and Jharkhand) and one union territory (Chandigarh) of India were sampled using a stratified multistage sampling design to survey individuals aged ≥20 years. The prevalence rates of diabetes and prediabetes were assessed by measurement of fasting and 2 h post glucose load capillary blood glucose.

RESULTS:

Of the 16,607 individuals selected for the study, 14,277 (86%) participated, of whom 13,055 gave blood samples. The weighted prevalence of diabetes (both known and newly diagnosed) was 10.4% in Tamilnadu, 8.4% in Maharashtra, 5.3% in Jharkhand, and 13.6% in Chandigarh. The prevalences of prediabetes (impaired fasting glucose and/or impaired glucose tolerance) were 8.3%, 12.8%, 8.1% and 14.6% respectively. Multiple logistic regression analysis showed that age, male sex, family history of diabetes, urban residence, abdominal obesity, generalised obesity, hypertension and income status were significantly associated with diabetes. Significant risk factors for prediabetes were age, family history of diabetes, abdominal obesity, hypertension and income status.

CONCLUSIONS/INTERPRETATIONS:

We estimate that, in 2011, Maharashtra will have 6 million individuals with diabetes and 9.2 million with prediabetes, Tamilnadu will have 4.8 million with diabetes and 3.9 million with prediabetes, Jharkhand will have 0.96 million with diabetes and 1.5 million with prediabetes, and Chandigarh will have 0.12 million with diabetes and 0.13 million with prediabetes. Projections for the whole of India would be 62.4 million people with diabetes and 77.2 million people with prediabetes.

For my state of Jharkhand:

Jharkhand has a population of around 3.29 Crore (32.9 million) with these images making things clearer:

Picture courtsey: http://www.census2011.co.in/census/state/jharkhand.html

And out of 33 million people 1 million is diagnosed to have diabetes and 1.5 million are prediabetic! So, basically 2 in 100 are diabetic! Compare this to the average for India which is approximately 5 in 100. So, if good public health and health education activities are initiated, a large portion of people can be saved from falling in the jaws of diabetes and its aftermath!

I highly recommend the new ICMR-INDIAB study and take it as a positive start for the common good.

Congratulations to Dr. Ajana and the whole ICMR-INDIAB team! It is a great opportunity for us all Indians to realize the threat of this life-style disease looming over our heads.

As much of the diabetes can be managed for the most part in primary care, let us work together both to prevent and manage it better for a better health of the whole society and not just affordable ones.

Albuminuria and Diabetic Retinopathy

noreply@blogger.com (Bipin Kumar) — Sat, 01 Oct 2011 21:18:20 PDT

Albuminuria and Diabetic Retinopathy in Type 2 Diabetes Mellitus Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular Genetic Study (SN-DREAMS, report 12)

The prevalence of microalbuminuria in the study subjects was 15.9% (226/1414), and that of macroalbuminuria, 2.7% (38/1414). Individuals with macroalbuminuria in comparison to micro- or normoalbuminuria showed a greater prevalence of DR (60.5% vs. 31.0% vs. 14.1%, p < 0.001), and also a greater severity of the disease (60.9% vs. 21.4 vs. 9.9, p < 0.001).

http://www.springerlink.com/content/e15511r4913q7103/

The full text is available here.
This study is highly relevant in the current state of affairs. Especially because according to The Hindu article quoting an study published in recent issue of the journal Diabetogiaby Indian Council of Medical Research, the prevalence of Diabetes in India is around 62 million! Yes, you read correctly. The PubMed abstract of the ICMR-INDIAB study.

Content warning: Some posts and/or pictures may be disturbing to the common people! All rights reserved.

A doctor's touch

noreply@blogger.com (Bipin Kumar) — Thu, 29 Sep 2011 07:59:25 PDT

I did know about Dr. Abraham Verghese till I saw his video on the www.TED.com. Later, I got interested and came to learn that he is a child of Indian parents and now lives in the USA.

More can be learned about him from his website:

http://www.abrahamverghese.com/biography.asp
His video is really inspiring.

Content warning: Some posts and/or pictures may be disturbing to the common people! All rights reserved.

For Colored Girls

noreply@blogger.com (Bipin Kumar) — Sun, 25 Sep 2011 12:14:43 PDT

This is the movie I watched today! Loved it! The story describes how do some colored (read black) women are living in the world (world because it has been happening to many in developing world as well).

The IMDb details of the movie are here.

You can watch the trailer of the movie on YouTube:

http://youtu.be/sDWU_cFU9ZA

And this is
for colored girls
who have considered
suicide but are
moving to the
ends of their
own rainbows.

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Medical Teachers of yesterday

noreply@blogger.com (Bipin Kumar) — Sun, 25 Sep 2011 10:03:46 PDT

In one of the Open Pages of The Hindu, a national daily, Dr. Shankar describes his teacher Dr. Venugopal (aka VG by his students). Medical teachers of this repute and dedication were NOT scarce in the era of yesteryears. While at my medical school there were enough stories told by our teachers about the great teachers they had!

But to be frank, we could not find those great qualities among the teachers we got! My question is why? Where did those qualities vanish?

Is it that the would be such teachers went either to developed nations for better prospects in the name of better academic career and to corporate sector for personal benefit leaving the (government medical) colleges and hospitals in their own state. Is it that they became some of those Never Return to India (NRIs) and do talk about their India on the Internet!

http://www.thehindu.com/opinion/open-page/article2482366.ece

A good article.