Good morning. Wedding season opens next month, and the injections are already being sold against the date. We start there, with the half hour that has to happen before the first prescription. Further down: what a crowd of 150 people decided before any inquiry had begun.
— DR. ADITYA SETH, EDITOR-IN-CHIEF
01 · THE LEAD
CLINICAL
She will ask you if three months is enough. It isn't.
She was 23, she weighed 108 kg, and she had a wedding coming. A clinic in Ludhiana took her money and started her the same visit, before anyone had taken a history. Twenty kilos came off in forty days. When a Delhi endocrinologist finally examined her, two months before the wedding, she was nauseated and exhausted, her hair was falling out, her periods had gone irregular and her thyroid was abnormal. She had lost, in his words, a massive amount of muscle. Nobody had told her that diet and exercise were half of the treatment.
Her case ran in The Indian Express on Wednesday, in a long read following several of these Mounjaro brides. It leaves the rest of us with the version that arrives in OPD, from a patient or a cousin who has usually already paid. Ambrish Mithal's group at Max Saket went back through their own patients on semaglutide and tirzepatide and asked exactly that. Half of them needed nine and a half months to lose a tenth of their body weight.
WHY IT MATTERS
A three-month package ends two dose steps short of the regimen the trials were built on.
Appetite returns when the drug stops. That is pharmacology, not a failure of will, and she should hear it before she starts rather than in February.
Sugar, HbA1c, lipids, liver, kidney and thyroid before the first dose. Nobody in Ludhiana did any of them.
02 · CLINICAL
27 trials, 88,830 patients: the eGFR fell faster on the tighter target, and the dialysis rate never followed
You take a CKD patient from 148 systolic to 128, and three months later the eGFR has slid from 44 to 33. Almost everyone eases off there. Sustained falls of 30% or more did run 42% higher in the intensive arms. Then five of the trials kept following the same patients for up to ten years.
ACP puts estrogen back at the front of the queue for hot flashes
Estrogen with a progestogen if she has a uterus, estrogen alone if she does not. Then venlafaxine or desvenlafaxine. Then the SSRIs, gabapentin and the neurokinin antagonists. Every one of them was graded, and on severity rather than frequency only one came out ahead.
03 · EXAMS AND ADMISSIONS
Free MD Radiology ran out at rank 2,920 last year. Paid seats went on to 65,193.
Every seat MCC gave out in Round 1 over three years, 2,737 of them, turned into the one thing a candidate needs before choice filling: what their rank and their category actually got, college by college. Half the open seats were gone by rank 479. Between 2,921 and 10,000 there was no free MD seat at all, and 217 open DNB ones.
Know someone filling choices this year? Forward this to them.
04 · DOCTORS
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Doctors
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Beaten in his own OPD, by a crowd that had already decided
Bikaner, Wednesday night. A woman admitted two days earlier for gallstones died after surgery, and within hours 100 to 150 people had gathered on the premises. Some of them assaulted the treating surgeon before bystanders pulled him out. The family's allegations, as reported, are serious and so far unverified: that she walked in on her own feet, that she was called critical the previous day and never referred up, that her file could not be produced afterwards. An inquiry can establish all of that. The crowd did not wait for one.
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08 · QUICK HITS
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