DMC Update: From the desk of President and Vice President
1.Dr A K Aggarwal, Dean MAMC as the president for the second term
2.Dr. Vinay Aggarwal, Past General Secretary and Senior Vice-president Indian Medical Association, on the Statutory Committees of ESI corporation and Vice President Delhi Medical Council
Our priority should be to look into the issue of re-registration and revalidation of membership and the fees attached to it. We will also like that we should make registration so simple that every doctor practicing in Delhi would be able to register in Delhi Medical Council. Continuing medical education will be our main concern whether it is via technological advances like telemedicine, distant learning or by way of helping in organisation of conference and seminars. We will also like our members updated with the latest technology.
Another main issue is quackery. We have not been able to resolve this issue. We will also very actively pursue this issue to ensure that non qualified doctors practicing in the capital are banned and disciplinary action is taken against them. At Delhi Medical Council, we will also like to make a proper office/building of our own.
Simultaneously, we will like to improve patient-doctor relationship and being a statutory body build the confidence of the public in medical council. We will make protocols for our members. We will also work for accreditation of hospitals.
These are the main issues for which we will work and develop a very very successful medical council. We have very talented council members. We will utilize their expertise in all aspects.
News and views from Kidney Daily (Dr Brahm vasudeva)
Quitting smoking may increase risk for developing type 2 diabetes.
Former smokers have a greater risk of developing diabetes than smokers or nonsmokers. Johns Hopkins University doctors published a study in the Jan. 5 issue of Annals of Internal Medicine enrolling 10,892 middle aged adults. The study determined their risk of atherosclerosis for an average of about nine years, during which time 1,254 developed type 2 diabetes. The team found that the 380 people who quit smoking were as much as 80 percent more likely to develop diabetes than those who never took up the habit.The increased risk may be related to the weight smokers add while quitting. This risk is highest in the first three years after quitting.
Childhood factors may predict future likelihood of type 2 diabetes.
According to a study published in the Jan. issue of the Archives of Pediatrics & Adolescent Medicine, body measurements and laboratory tests may predict the likelihood that a child will develop type 2 diabetes later in life.Participants were more likely to have diabetes at the age of 39 if they had high childhood levels of blood pressure, body-mass index, glucose, and triglycerides,or at age 19 if they had parents with diabetes and higher levels of systolic blood pressure and insulin concentration. Conversely, if childhood BMI, systolic blood pressure, and diastolic blood pressure were all lower than the 75th percentile, the chance of having type 2 diabetes at age 19 was only 0.2 percent (Source MedPage Today)
n-3 PUFA levels associated with increased insulin sensitivity in type 2 diabetes.
According to a study published online in the journal Molecular Nutrition & Food Research, increased plasma levels of n-3 polyunsaturated fatty acids (PUFAs) are associated with improved insulin sensitivity.Among diabetics both insulin resistance and blood glucose levels were negatively correlated with total n-3 and ratios of 20:5n-3 and n-3:n6 PUFAs, and positively correlated with n-6 PUFAs and saturated fatty acids.
Physically active CVD patients less likely to develop type 2 diabetes.
According to a study published online Jan. 4 in Diabetes Research and Clinical Practice, patients with cardiovascular disease (CVD) who are physically active have a significantly reduced risk for developing type 2 diabetes, compared with those who are inactive. Those "who were sufficiently physically active were 45 percent less likely to develop type 2 diabetes over the study period than those who were inactive.
Expert recommends treating people over 80 less aggressively for hypertension.
According to an editorial published in BMJ Clinical Evidence, people over 80 years of age should be treated less aggressively fo hypertension than the target blood pressure of <140/90 mmHg that is currently recommended.
A lack of difference in total mortality between groups could still suggest that aggressive treatment leads to an increase in other fatal events, with the magnitude of harm similar to that of the benefit.
Dr Good Dr Bad:
Situation: A 34-year-old male was found to have a BP of 122/84 mmHg.
Dr Bad: It is normal
Dr Good: You need to bring it to <120/80 mmHg
Lesson: In general, epidemiologic studies of treated and untreated patients reveal that there is a gradually increasing incidence of both coronary disease and stroke as the blood pressure rises above 110/75 mmHg. (JAMA 2003;289:2560)
What is the role of consent in negligence?
A medical practitioner may also be legally liable if a patient does not give informed consent to a medical procedure that results in harm to the patient, even if the procedure is performed properly. For example, if a doctor does not tell a patient that a surgical procedure has a 50% chance of causing paralysis, the patient does not have the necessary information to make an informed choice to either have or refuse the operation. If the patient has the operation, and is paralyzed as a result, the doctor may be liable even if the operation was performed flawlessly, as the patient might have refused the surgery.
Situation: A terminally ill patient, who develops bed sores, is given systemic antibiotics only.
Reaction: Oh My God! Please change the position of the patient frequently and keep the skin clean and dry.
Make sure good nursing care and maintenance of skin hygiene should be advised first to patients with bed sores, along with topical antibiotics.
Mile Stone: John Hopps
John Hopps, a Canadian, invented the first cardiac pacemaker, in 1950. His device was far too large to be implanted inside of the human body. It was an external pacemaker.
Laughter the best medicine
The doctor was off teaching a class, so one of his new students answered the phone in his office. The call was from the school's football coach.
"Doc, it's Sonu, he is in extreme pain" said the coach, "He broke his arm in the fourth quarter."
"I see," said the aspiring doctor. "Exactly what part of the arm is that?"
Formula to Practice:
Family history of diabetes (i.e., parents or siblings with diabetes)
Obesity (> 20% over desired body weight or BMI >27 kg/m2)
Race/ethnicity (e.g., African-Americans, Hispanic-Americans, Native
Americans, Asian-Americans, and Pacific Islanders)
Previously identified IFG or IGT
Hypertension (> 140/90 mmHg in adults)
HDL cholesterol < 40 mg/dl and/or triglyceride level ³250 mg/dl
History of GDM or delivery of a baby weighing >9 lbs
Age >45 years old
CAD, Cerebro Vascular Disease, Peripheral Vascular Disease
Mnemonic to Know: Basic management of acute heart attack: BOOMAR
Reduce clot size
Quote: There is no monument dedicated to the memory of a committee. [Lester J. Pourciau]
Tip from other systems of medicine: Cholesterol content in food
Quite often patients ask which food to avoid reducing their cholesterol. There is a simple formula. Food of plant in origin contains no cholesterol
Finance Tip: Can one pay cash expense of more than Rs. 20,000 in a day.
A: Cash expenses of more than Rs. 20,000 to one party in one day are not allowed in income tax. It can be 19900/- but not 20,000.
Letter to the editor
Dear Dr. K K, It is good to hear that emedinews: revisiting 2009 will be available live on the net on www.docconnect.com for those doctors who cannot make it to the live conference on 10th Jan. I would also request you to make it available as a downloadable format on either www.docconnect.com or www.emedinews.in for users who would wish to access it on a later date. Its probably safe to say that this (Video CME on-the-net) is truly a unique initiative on your part & maybe the first one of its kind in India; atleast to my knowledge! Dr. Kapil Aggarwal
Dr. Praveen Chandra (emedinews revisiting 09)
Treatment of Coronary Artery disease has changed and has been evolving in the last several years. Earlier, the treatment of multiple vessel disease and left main disease was done with the help of bypass surgery only, but now, with the advent of drug eluting stents, about 30-40% of such patients can be treated by stent implantation which is a far simpler procedure both for the patients and the treating physician. This has been proven by recent trials, especially, the SYNTAX trials.
The treatment of heart failure patients was limited to digoxin and diuretics with a high degree of mortality and morbidity, but now, with the new studies showing the benefits of beta blockers and Ace-inhibitors, the survival of such patients has improved. Further improvement has been shown in such patients with the use of cardiac re-synchronization therapy, commonly also known as Biventricular pacing.