emedinews
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Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Member Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


12th June, 2010, Saturday

Is there a role of industry–sponsored education in India?

Dear Colleague,

The term ‘profession’ is applied to those persons who have specialized and technical skills or knowledge which they apply, for a fee, to certain tasks that ordinary and unqualified people cannot ordinarily undertake.

The job of a cardiac specialist involves office consultations, rounds in the hospital, prescribing drugs and diagnostic tests, interpreting non–invasive and cardiac imaging tests and invasive electrophysiology and cath lab tests. Their job is also to programme and implant devices in patients. As interventional cardiologists, they perform life–saving procedures.

Over the years, the practice in the field of cardiology has totally changed. Recent new avenues have been appropriate use of ACE–inhibitors and beta–blockers in heart failure and statins in coronary artery disease. The cardiovascular cardiology all over the world is on decline because of rapidly changing advances in the field of cardiovascular cardiology. Fifty percent of this decline is due to application of evidence-based treatments.

The pharmaceutical technologies and device industry, therefore, has been part and parcel of cardiovascular growth in the community. The cardiac industry is doing an enormous amount of public good through its investments in drug and device discovery, developments and research.

Upgraded technology cannot be used by doctors unless they are trained in the same. Most cardiac clinicians are required to be familiar with the latest developments and advances in cardiac care. All over the world, updating the knowledge of doctors and training them for skills as a trend has been initiated by the respective industry which has been sponsoring doctors all over the world for their training in the latest advances in cardiac devices. No institution or the government has money to send these doctors to learn every six months.

Recently, the Medical Council of India (MCI) has come out with guidelines in which they prohibit doctors from accepting any favors from the healthcare industry, be it a part of education, training or skill enhancement.

The medical profession is under Consumer Protection Act (CPA) where patient is being treated as a consumer and a doctor as a shopkeeper but doctors are still not allowed to advertise or behave or practice like a shopkeeper.

Here is one suggestion:

There should be a centralized non–governmental, not-for-profit society, with key industry stake holder’s investments. Medical education, undergraduate to postgraduate, is to be considered as a social benefit, therefore, they (industry) must invest in this centralized pool.

The groups who benefit from a well–educated healthcare community including medical professionals, the medical product industry, the government, the private foundations, academic medical science college should contribute to this pool to enhance the medical education in the country. By a common funding, the doctors will be trained in a particular technology and not in a particular device. All industry competitors will benefit with this format.

Similarly, medical associations, trusts, societies, newspapers should become a nodal point for medical education to be funded by industry in a transparent manner.

The independent medical education group will ensure independence of content development, faculty selection and delivery methods.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From HCFI file)

Dance for Environment Protection

Dance creates a space for the voice of a local community, and popular figures in dancing to express a statement about the world around them. Dance forms have been expressing concerns, love for environment, and are rooted through age-old Indian tradition. Heart Care Foundation of India (HCFI) has involved famous dancers to express its concern for environment and possible subsequent health hazards.

In the Photo: World–renowned Kuchipudi dancer, Raja Reddy demonstrating the harmful effects on plastic on our planet. Also in the picture, Kaushalya Reddy and Padma Shri and Dr BC Roy Awardee Dr KK Aggarwal

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): New FDA Drug Update

Bortezomib

Bortezomib is a proteosome inhibitor used for the treatment of multiple myeloma. Metabolism of bortezomib is decreased in patients with moderate to severe liver disease, resulting in higher drug levels, and increased toxicity. US FDA has revised product information for bortezomib indicating the need for a reduced starting dose in such patients, and close monitoring for toxicities.

References

United States Food and Drug Administration (http:// www.fda.gov/ Safety/ MedWatch/ SafetyInformation/ Safety Alerts for Human Medical Products / ucm198424.htm). Accessed on February 1, 2010.

Mnemonic of the Day ( Dr Maj Prachi Garg)

Treatment of Malignant hyperthermia – "Some Hot Dude Better Give Iced Fluids Fast (Hot dude = hypothermia)

Stop triggering agents
Hyperventilate/ Hundred percent oxygen
Dantrolene (2.5mg/kg)
Bicarbonate
Glucose and insulin
IV fluids and cooling blanket
Fluid output monitoring/ Furosemide/ Fast heart (tachycardia)

News and views (Dr Monica and Brahm Vasudeva)

1. Combining treatments prolongs survival in locally advanced prostate cancer

Combining radiotherapy with the regular hormone treatments significantly improves survival in cases of locally advanced prostate cancer. In a study, 1,200 men were given hormone treatment plus radiation or hormones alone. After 7 years, 74 % of men receiving both treatments were alive compared to 66 % receiving hormones alone.

2. Avastin may extend progression–free survival in ovarian cancer patients

A study presented at the meeting of the American Society of Clinical Oncology in Chicago reports that the cancer drug Avastin (bevacizumab) increases progression–free survival in patients with ovarian cancer by 39%. This is also the first study to use bevacizumab as first–line therapy for ovarian cancer.

3. Investigational drug may improve survival in advanced breast cancer

Results of the Phase III EMBRACE study (Eisai Metastatic Breast Cancer Study Assessing Physician’s Choice Versus Eribulin E7389) presented at the American Society of Clinical Oncology (ASCO) Annual Meeting show that Eribulin mesylate met its primary endpoint of overall survival i.e. survival in patients with metastatic breast cancer was prolonged by a median of 2.5 months than in patients who received Treatment of Physician’s Choice (TPC).

4. Erbitux may provide no benefit to patients with early–stage colon cancer

Erbitux (cetuximab), a drug that is approved for treating advanced cancer of the colon, showed no benefits when given to patients in the early stage of the disease. Erbitux added to the side effects of chemotherapy, according to a study reported at the American Society of Clinical Oncology Annual Meeting.

Interesting tips in Hepatology & Gastroenterology (Dr Neelam Mohan)

Foreign bodies in GIT

Esophageal foreign bodies

  • All foreign bodies lodged in esophagus should be managed on an urgent basis.

  • An esophageal dwell time of longer than 24 hours is the most important contributor to complications from esophageal foreign bodies.

Stomach and intestinal foreign bodies

  • Once foreign body has reached stomach, the risk of complication is greatly diminished and conservative management is indicated in most cases.

  • Most foreign bodies pass through intestine in 4–6 days (3–4 weeks occasionally).

  • Endoscopic retrieval is indicated for
    • Large objects >20mm in diameter as they cannot pass through pylorus

    • Long objects >3cm in infants and young children, >5 cm in older children and adolescents as they cannot pass through pylorus

    • Thin objects >10 cm in length as they fail to negotiate duodenal sweep.

    • Open safety pins

    • Coins and other small blunt objects that fail to leave stomach in 3–4 weeks.

Rectal foreign bodies

  • Small blunt objects usually pass spontaneously.

  • Large and sharp objects need to be retrieve.

Conference Calendar

CME on Paediatric Otorhinolaryngology
Date: June 20, 2010
Venue: KMC Manipal, Udupi, Karnataka

Quote of the day (Dr Santosh Sahi)

"Remember, Happiness doesn’t depend upon who you are or what you have, it depends solely upon what you think" Dale Carnegie

Question of the Day

What is the role of ambulatory BP monitoring?

The role of ambulatory monitoring of BP is necessary not only in India but elsewhere also because when the patient attends the clinic for the first time, the unfamiliarity with the doctor to the clinic environment is bound to unnerve the patient and raise his BP. This is what termed as ‘white-coat HT’. To evaluate such patients ambulatory monitoring is necessary. The ambulatory BP will tell whether such individuals truly have high BP or not.

Also, 24–hour BP monitoring is required in patients at the brink of HT or clinical conditions such as pheochromocytoma where excessive adrenaline secretion from the tumor of the adrenal gland, can shoot up the BP and show very high episodic BP readings. To evaluate such patients, recording BP in different environments is important, which is also called ambulatory BP monitoring.

The possible clinical indications for ambulatory BP measurement include:

  • Exclusion of white coat hypertension
  • Deciding diagnosis in borderline hypertension
  • Elderly patients for treatment
  • To identify nocturnal hypertension
  • Hypertensive patients resistant to treatment
  • As a guide to antihypertensive drug treatment
  • Hypertension of pregnancy
  • To diagnose hypotension
  • Autonomic neuropathy
  • Orthostatic hypotension

Ambulatory BP monitoring may not be necessary in each and every patient but when you suspect clinically that this patient could have high BP, but the same is not evident when you examine him or her, it is worth asking for this test.

Suggested reading

  1. O‘Brien E, Beevers G, Lip GLH. ABC of hypertension. BMJ 2001;322:1110–1114.

  2. Marchiando RJ, Elston MP. Automated ambulatory blood pressure monitoring: clinical utility in the family practice setting. Am Fam Physician 2003;67:2343–2350.

MedinewS Try this it Works

Sip helps locate the thyroid gland

When you are checking out a lump in a patient’s neck, it is sometimes difficult to delineate the thyroid gland. Having the patient swallow a sip of water is often helpful in locating the thyroid gland and defining the anatomy more precisely.

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eMedinewS–revisiting 2010

The second eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, cultural hungama and live webcast. Suggestions are invited .

 

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Dr Good Dr Bad

Situation: A patient on CAD regression therapy with statins came for follow up at three months.
Dr Bad: Get repeat MRI and Carotid Doppler done.
Dr Good: Wait for another nine months.
Lesson: There are limited data on the exact timing of regression of atherosclerosis, particularly coronary atherosclerosis, after statin therapy. This issue was addressed using high-resolution MRI to assess aortic and carotid artery plaques. No changes were seen at six months, but progressive regression was noted at 12 and 24 months. The earliest change, seen at 12 months, was a reduction in plaque size followed by an increase in luminal area due to arterial remodeling. (Circulation 2001;104:249 & Circulation 2002;106:2884)

Make Sure

Situation: A patient intolerant to penicillin and sulfa was denied rheumatic prophylaxis.
Reaction: Oh my God! Why was he not put on azithromycin?
Lasson: Make sure that patients who cannot tolerate penicillin or sulfa drugs are given azithromycin.

Humor Section

IMADNB Joke of the Day (Dr Tarun)

Santa Claus inserted an upright piano, a fur dolman, a Ford, and a few like knick–knacks in the Chicago girl’s stocking. When he saw that it was not yet half filled, he withdrew to the roof, plumped down on the snow, and wept bitterly.

Funny definitions

Bachelor – a fellow that can take women or leave them, and prefers to do both.

Formulae in Clinical Practice

Pounds & Kg

Pounds are equal to kilograms multiplied by 2.2. (Kg × 2.2 = lbs)

Milestones in Urology

1757–1833: Alexis Boyer was a French surgeon, born in Corrsze. Boyer specialized in urological pathology, especially disorders of micturition. His two masterworks are Trait complet de l’anatomie (in 4 volumes, 1797–1799), of which a fourth edition appeared in 1815, and Trait des maladies chirurgicales et des operations qui leur conviennent (in 2 volumes, 1814–1826), of which a newer edition in seven volumes was published in 1844–1853.

 

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Respiratory Syncytial Virus (RSV) Antigen

Direct testing for RSV antigen is rapid, sensitive, and specific when compared to cell culture methods. With the availability of ribavirin therapy for serious RSV infections, rapid diagnostic tests for this virus have become increasingly important.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Levosulpiride ER Tablet 100/150/200mg

For the treatment of depression and schizophrenia in adults

27.10.2009



Public Forum (Press Release for use by the newspapers)

Carbohydrates as substitute to saturated fats not the answer

More than 20 prospective studies have addressed components of diet and the risk of heart disease, stated by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

The type of fat consumed appears to be more important than the amount of total fat. Trans fatty acids increase risk of heart disease while polyunsaturated and monounsaturated fats decrease risk.

There is controversy about whether it is optimal to substitute saturated fat with carbohydrate. An increase in carbohydrate tends to reduce the level of good high density lipoprotein (HDL) cholesterol in addition to total and low density lipoprotein (LDL) cholesterol. Thus, the reduction in heart disease risk may be less than predicted by the reduction of saturated fat alone.

Observational studies have consistently shown that individuals consuming diets high in vegetables and fruits (which are rich in antioxidant vitamins) had a reduced risk of heart disease.

Results of a number of randomized trials are now available and show largely no significant clinical benefits of antioxidant vitamins on heart disease.

Supplemental vitamin C, E, and beta carotene cannot be recommended in the primary prevention of CHD.

Taking supplements without clinical benefits could, in theory, increase the risk, if individuals mistakenly avoid therapeutic lifestyle changes or drug therapies with proven benefits.


Forthcoming eMedinewS Events: Register at emedinews@gmail.com

13th June: IMSA workshop on cardiac first aid and BCLS course, 8-10am Moolchand Medcity.

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – A day-long interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from
8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses

  1. Students of Delhi, who want to pursue MBBS after completing their Class XII, take primarily two entrance exams. The first is the DUMET for admissions to Medical colleges of Delhi University. The second is the CET: MBBS – 2010 conducted by Guru Gobind Singh Indraprastha University. The DUMET exam this year was held on 23 May 2010 and the CET (Stage1) of IPU on 22 May 2010. This year, it has been observed that there are about 20 students among top 250 ranked students of DUMETwho have performed miserably in the CET: MBBS – 2010, (Stage 1). These students have even failed to qualify for the second stage of the CET exam. Some of them have even got negative marks in some subjects of the CET exam while scoring brilliantly in the same subject in the DUMET exam. It is difficult to understand the reason behind this huge difference in the scores in just one day. What could be reason for this difference in performance on consecutive days. Can it be explained as a matter of chance? Thanking you. K K Kanodia

  2. There is an error in eMedinews dated 11th June, 2010 where schedule of administration for Inactivated Polio Vaccine (IPV) is given (by Dr Harish Pemde). As per the recommendations of Indian Academy of Pediatrics (IAP), only one booster of IPV at 15–18 months is recommended. At 5 years of age, only OPV is given. For further details, one can log on to: http://www.iapcoi.com/ipv.htm. Dr. Puneet Kumar, Kumar Child Clinic, Dwarka