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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
emedinews is now available online on www.emedinews.in or www.emedinews.org
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


14th May, Friday, 2010

MCI TO BE DISSOLVED (see below)

Commonwealth Games 2010 … Taking Care of Health

Traveler’s diarrhea (Part II)

Dear Colleague

Traveler’s diarrhea is the most common of travel–related diseases. The major sources of the ailment are contaminated food and drink. Poor sanitation is also a contributory factor. Though traveler’s diarrhea is usually a mild illness, it can cause considerable morbidity and pose difficulties to travelers. Avoidance of potentially contaminated food or drink can reduce the risk of traveler’s diarrhea and also its impact. Prevention and treatment of dehydration is essential.

Prevention of Traveler’s diarrhea

  1. Freezing does not kill diarrhea causing organisms.

  2. Ice in drinks is not safe unless made from adequately boiled or filtered water.

  3. Alcohol does not sterilize water or ice.

  4. Bottle water may not be 100% safe.

  5. Carbonated drinks with insufficient carbonation may not be safe. Presence of carbonation upon opening the bottle is a marker of safety.

  6. Fruit salad, lettuce or chicken salads are not a healthy choice.

  7. Condiments on table can frequently become contaminated.

  8. Hot coffee or tea is safe.

  9. Bottled water or drink should be taken without ice and should be drunk from the bottle or with a straw.

  10. Fruits which can be peeled are safe as long as they are peeled just prior to eating.

  11. Boiling water for three minutes followed by cooling to room temperature is sufficient to kill bacteria, virus and parasites. Do not add ice.

  12. Adding two drops of 5% bleach to a quarter of water will kill most bacteria in 30 minutes.

  13. Adding 5 drops of tincture iodine to a quarter of water will kill most bacteria within 30 minutes.

  14. Cost of a food product does not ensure its safety. Food products served in the best of hotels may yet be unhygienic.

  15. Raw unpasteurized milk is not safe.

  16. Wash fruits, vegetables thoroughly with clean water before eating.

  17. The average temperature should be 44 degree or lower and freezing temperature should be 17.18 degree or lower.

  18. Pre–cooked perishable food should be eaten as soon as possible.

  19. One should keep meat, fish, chicken etc. separate from other food.

  20. Wash hands, knifes before or after cutting uncooked food or raw fish, meat etc.

  21. Ground beef should be cooked at a special internal temperature of 71 degree; chicken at 77 degree; turkey at 82 degree and pork at 71 degree.

  22. Eating raw fish is not safe. Frozen fish is also not 100% safe.

  23. Egg should be cooked until the yolk is firm.

  24. Never leave cooked food at room temperature for more than 2 hours.

  25. Cooked food should not be kept for more than 1 hour if the room temperature is above 32°C.

  26. Microwave heat is not a proper way of heating.

  27. Pregnant woman should not eat hotdogs or other delicacies unless they are reheated till steamy hot.

  28. Some travelers may require antibiotic prophylaxis. These include those with severe inflammatory bowel disease, cardiac, renal or hepatic diseases which could worsen with dehydration or patients who are HIV–positive or are on immunosuppressant drugs. Earlier, it was common to use drugs like Trimethoprim + Sulfamethoxazole (TMP+ SMX) or Doxycycline; however, these are not used these days. The current recommendation is to use a quinolone or Rifaximin. The drugs used are ciprofloxacin 500 mg or norfloxacin 200 mg daily.

  29. C. jejuni is common in South East Asia and is resistant to ciprofloxacin.

  30. The signs of sever dehydration are rise in pulse rate, low volume pulse, fall in systolic blood pressure, dry armpits etc.

  31. The rough formula for diarrhea is one loose motion or one vomiting is equal to 250 ml of fluid loss. For every one loose motion, give one glass of oral rehydration solution (ORS) should be given.

  32. Not passing urine for 8 hours indicates acute kidney involvement.

  33. Fluid replacement should be rapid till the patient passes urine.

  34. In conventional diarrhea practice amongst Indians, loose motions up to 8 can be treated by OPD treatment; 8 to 40 episodes can be treated in a ward and more than 40 episodes will require ICU care.

  35. Any patient who is above the age of 70 or has other underlying medical illnesses may require hospitalization.

  36. Any eatable which contains starch can be given with salt. Examples: boiled salads and cereals, vegetables, wheat, rice, oat with salt etc.

  37. Crackers, banana soup and vegetables can also be given.

  38. If the body temperature is more than 101.30F, one should consult a doctor immediately.

  39. Diarrhea is always infectious; hence, personal precautions including hand and toilet hygiene need to be followed which includes care with diapering.

Remember the formula – Heat it, boil it, peel it, cook it or forget it.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From file)

Fashion Models in Heath Advocacy

Fashion models are idolized by people as they represent the much coveted combination of beautiful skin and perfect body shape. To achieve that dream body, people, mostly women, follow them for their fitness regimes and emulate similar dietary practices. The Heart Care foundation of India, has involved models in many health programs, The photo shows Ms. Sonalika Sahay, a well–known ramp model, as a part of "Mr and Mrs Tobacco" campaign at a press conference on the occasion of World No Tobacco Day.

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): Practice Changing Updates

Anticoagulation

A new anticoagulant, dabigatran, will change how internists manage patients with atrial fibrillation. Articles have established safety and efficacy, and the Food and Drug Administration is considering approval. (N Engl J Med 2009;361:1139–51)

 


Breaking news

MCI to be dissolved

The central government has decided on principle to dissolve Medical Council of India (MCI) after arrest of its chief Dr Ketan Desai in graft charges. The government will bring ordinance to dissolve MCI soon. According to the health minister, Sh Ghulam Nabi Azad, Cabinet has decided in principle to dissolve Medical Council as of now. Seven doctor panel to take over for now and advise the government and the prime minister. As per sources former AIIMS Director Dr Venugopal, Dr Anil Kohli President DCI, Dr Sanjiv Malik Past President IMA, Dr Deka are among the members. It is likely that a five member committe may take over the control of all councils (pharmacy, medical, nursing, dental, ISM). These five membrs committee will have all the autonomous powers. 

NABH, ISO, JCI Vs MCI

The medical tourism in the country is ensuring quality control practices in various hospitals in the country. Every hospital sooner or later will be required to comply with NABH requirements or will lose its license to run. Same will be true for Joint Commission International (JCI) accreditation which will be required if a hospital wants to admit patients from other countries. Whether it is NABH, ISO of JCI, the inspection team’s job is to facilitate getting recognition and not finding faults and derecognizing them.  There are consultants available who can help filling these deficiencies. The job of the inspection teams is not only to list the deficiencies but also suggest how to get rid of these deficiencies and give time for the same. We have not heard of any hospital which had applied for NABH recognition and did not get it.

The same system should be adopted by the new MCI once constituted. The fee for recognition can be increased specially for the non-government hospitals and the money can be used for improving the standards of education in the country and promoting more continuing medical education programmes.

In the present system, where there was fault finding linked with non-recognition, the hospital/college businessman owners had no option than to find a middleman who can get their work done by paying some money at various levels.

Being hardcore businessmen, to recover their money, they used to hike the capitation fee. Can one think that a postgraduate seat is being sold at a rate over a crore?

When the government is trying to clean the inspection system, they must also ensure that no capitation fee is charged in cash or the basic purpose of cleaning the system will be lost. 

DMC Update

Does a legal notice to a doctor constitute a complaint in DMC?

No. as per DMC/DC/F.14/Comp.666/2010 order dated 19th April, 2010; The DMC examined a legal notice from Shri S.N. B Advocate, Supreme Court of India, on behalf of Shri V K addressed to Dr. BSB New Delhi with a copy to Delhi Medical Council. On perusal of the legal notice addressed to Dr. BSB the DMC observes that a legal notice does not constitute a proper complaint in terms of Rule 32 of the Delhi Medical Council Rules 2003 and the same stands rejected.

News and Views (Dr Brahm and Monica Vasudeva)

LDL cholesterol levels associated With presence of preclinical CKD

According to a study published in the journal Internal Medicine, low–density lipoprotein (LDL) cholesterol levels are independently associated with the presence of preclinical chronic kidney disease (CKD). After analyzing cross–sectional data on 2,449 men and 1,448 women, researchers found that participants with CKD tended to have significantly higher age, body mass index, blood pressure, fasting glucose, and LDL cholesterol, and significantly lower high–density lipoprotein cholesterol than those without CKD.

Researchers call on FDA to halt Avandia trial

The Canadian physician whose research escalated safety concerns about the type 2 diabetes drug rosiglitazone (marketed as Avandia) is urging the US FDA to call a halt to a major international trial designed to compare the safety of Avandia against another diabetes drug in the same class.

Paper sparks debate about overdiagnosis of cancer

A paper recently published in the Journal of the National Cancer Institute suggests that approximately 25% of breast cancers detected by mammography, 50% of lung cancers detected by chest x–ray and/or sputum, and 60% of prostate cancers detected by prostate-specific antigen are overdiagnosed.

Type of antidepressant doesn't seem to affect suicide/suicide attempts in adults

Risk for suicide and/or suicide attempts does not differ among different types of antidepressants. In 2004, the FDA issued an advisory warning of possible increased suicide risk in children and adolescents taking antidepressants. While a subsequent meta–analysis of trials in adults found no such increase in risk, individual drugs could not be studied.

Quote of the Day

The most selfish letter.
"I" : Avoid It.
Most Satisfactory 2 letters.
"WE" : Use It.
Most Poisonous 3 letters.
"EGO" : Kill It.
Most used 4 letters.
"LOVE" : Value It.
Most Pleasing 5 letters.
"SMILE" : Keep It.
Fastest Spreading 6 letters.
"RUMOUR" : Ignore It.
Hard Working 7 letters.
"SUCCESS" : Achieve It.
Most Enviable 8 letters.
"JEALOUSY" : Distance It.
Most Essential 9 letters.
"PRINCIPLE" : Have It.
Most Divine 10 Letters.
"FRIENDSHIP" : Maintain It.

Question of the Day

Can testing of non–HDL cholesterol replace testing of triglycerides in our country?

Non–HDL–C encompasses all cholesterol present in potentially atherogenic lipoprotein particles {VLDL, intermediate–density lipoproptein (IDL), LDL and lipoprotein (a)}.

At present, the concentration of LDL–C is estimated using the Friedewald equation: LDL–C=TC–HDL–C–TG/5 mg/dl. This equation requires measurement of TC, TG and HDL–C. Although the LDL–C concentration estimated by this method provides a reasonable estimate of the amount of LDL–C, it also encompasses IDL–C and lipoprotein (a).

The Friedwald equation is generally considered to be less accurate with increasing TG levels and inapplicable at TG concentration >400 mg/dl. The advantages of using non–HDL–C as a screening tool include the fact that it requires measurement of only TC and HDL–C, both of which can be measured reasonably accurately in a non–fasting sample, as opposed to LDL–C measurement, which requires a fasting sample.

eMedinewS Try this it Works: Another approach to dermabrasion

Patient can treat their scaly feet with 120–grit drywall sanding screens. Have patients cut two 2 × 4–in pieces, place them together, and brush them across the dead skin with short back–and–forth strokes.

Dr Good Dr Bad

Situation: A 50–year–male was found to have 40% carotid artery stenosis.
Dr Bad: Stenosis should be opened surgically.
Dr Good: Surgery will not help.
Lesson: Surgery is of no benefit when the carotid artery stenosis is <50%.

Make Sure

Situation: A 60–year–old male having recent MI complained of non–productive cough, fever and minimal findings on chest ausculatation.
Reaction: Oh my God! Why was he not immediately put on macrolide?
Lesson: Make sure to remember that in patient with recent MI, macrolide antibiotics (either erythromycin or azithromycin) reduce subsequent untoward cardiac events.

IMANDB Joke of the Day (Dr Tarun Gupta)

BRIBERY

A thriving baseball club is one of the features of a boy’s organization connected with a prominent church. The team was recently challenged by a rival club. The pastor gave a special contribution of five dollars to the captain, with the direction that the money should be used to buy bats, balls, gloves, or anything else that might help to win the game. On the day of the game, the pastor was somewhat surprised to observe nothing new in the club’s paraphernalia. He called the captain to him.

"I don’t see any new bats, or balls, or gloves," he said. "We haven�t anything like that," the captain admitted.

"But I gave you five dollars to buy them," the pastor exclaimed.

"Well, you see," came the explanation, "you told us to spend it for bats, or balls, or gloves, or anything that we thought might help to win the game, so we gave it to the umpire."

Formulae in clinical practice

Partial Pressure of Carbon Dioxide in Arterial Blood (PaCO2)

Formula:
PaCO2 = 0.863 × Vco2/VA Vco2 – CO2 produced/min.
VA – Alveolar ventilation.

Evidence Based Medicine:[Dr NP Singh (Nanu), Professor, MAMC]

Working too much is bad for the heart

Working 3 to 4 extra hours a day is associated with increased risk for coronary heart disease (CHD), according to a study in the European Heart Journal. Some 6000 British civil servants underwent clinical exams and completed lifestyle questionnaires, and then were followed for an average of 11 years. During that time, their rate of new CHD was 5.5 per 1000 person–years. After adjustment for lifestyle, conventional cardiac risk factors, and other potential confounders, participants who worked 3 to 4 hours of overtime a day (beyond the standard 7–8 hours/day) faced a 60% increase in risk for CHD, compared with those who didn’t work any overtime. Less overtime (1–2 hours/day) was not associated with increased risk.

Myth of the Day: Dr.Gurinder Mohan Singh

Myth: Doing eye exercises will delay the need for glasses

Fact: Eye exercises will not improve or preserve vision or reduce the need for glasses. Your vision depends on many factors, including the shape of your eye and the health of the eye tissues, none of which can be significantly altered with eye exercises.

Milestones in Dermatology

The first case of Pseudomamma on the foot: An unusual presentation of supernumerary breast tissue was reported by Délio Marques Conde MD, PhD et al in the Dermatology Online Journal in 2006. A 22–year–old woman sought medical care for a lesion in the plantar region of her left foot, a well–formed nipple surrounded by areola and hair. Microscopic examination of the dermis showed hair follicles, eccrine glands, and sebaceous glands. Fat tissue was noted at the base of the lesion. Clinical and histopathologic findings were consistent with the diagnosis of supernumerary breast tissue, also known as pseudomamma.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

BRCA–1 and BRCA–2

Also known as: BRCA; Breast Cancer Susceptibility Genes 1 and 2; To assess the risk of developing breast or ovarian cancer associated with inheriting mutations in the BRCA–1 or BRCA–2 genes

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Sucralose

For use as sweetener in drug formulations

09.05.2009

MCI Update

Dr. Ketan Desai resigns

Dr. Ketan Desai, MCI President, accused in a corruption case, has tendered his resignation from the post. He had forwarded his resignation to the Union Health Ministry. According to the Indian Medical Council Act, the vice president of MCI is entitled to preside over meetings in the absence of the president. In this case too, the vice president Keshavkutti Nair will preside over the meetings. Later in the day the cabinet has decided to dissolve th MCI ( see above)

 

Public Forum (Press Release for use by the newspapers)

Women who eat lot of meat prone to weight gain

Women who eat a lot of meat are apt to weigh more than those who do not, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India. Previous studies have consistently shown that vegetarians are lighter and have a lower body mass index than their omnivorous counterparts.

A study from Brigham Young, evaluated 284 premenopausal women, an average of 40 years old and did not smoke. The researchers separated the women into groups classified by low, moderate, and high meat intake per 1,000 calories consumed per day. Over the 7–day study, the investigators found that the low–intake group ate less than 1.9 three–ounce servings of meat per day, as opposed to more than 3.18 servings for the high–intake group. More than half (52.8%) of the women classified as having a high meat intake were obese, defined in this study as having greater than 35% body fat. Conversely, 37.3% of women in the moderate meat intake group were obese and only 15.6% of those in the low meat intake group were obese.

This was a cross–sectional study. The findings do not show that meat causes obesity, While that could be the case, it could also be that obesity caused women to eat more meat –– like more obese women following the Atkins diet, which is rich in meat. There are a number of physiological mechanisms by which meat could fuel weight gain. Meat proteins, may elevate insulin levels, and thereby growth factors, that could influence weight and percent body fat. It has also been shown that consumption of saturated fat, most of which comes from animal products, is associated with obesity.

To sum up, it may be worth recognizing that eating less meat may be beneficial in a weight management program. It is possible to eat a healthy diet that is limited in meat. Alternative protein sources such as, lentils, nuts and legumes can provide sufficient protein and actually be beneficial in dieting.

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Contact: drkk@ijcp.com emedinews@gmail.com

 
 

eMedinewS–Padma Con 2010

Will be organized at
Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

 
 

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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Readers Responses

  1. Dear Collegues, Warm Greetings from Indian Medical Association, India 

    Many issues are threatening the profession as on date:

    a. MCI Ruling on Doctor Pharma relationship. Must be rewritten. Personal gain, NO. Scientific updates, YES. Government and Public must be convinced to repose confidence and belief on Doctors.

    b. BHRC is still not settled. We should stress to MOH, GOI that only MBBS Doctors must be posted to offer Rural Health Care too. "Equitable Rural Health" is our viewpoint.

    c. The current Clinical Establishment Bill has many areas to be redefined for effective implementation and Monitoring.

    Doctors are not against registration but want the law to be both Doctor– and Patient–friendly. Our National President must give a deep thought to this new threat. We all support the National President to progress positively on this issue. Many more professional issues are on the anvil. The forthcoming CWC is the ideal platform for all of us to discuss and conclude on the above issues. Friends, IMA election are at the nearby.

    Dr. S. Arulrhaj, MD., FRCP (Glasgow); President, Commonwealth Medical Association

Open letter to Health Minsiter

IMA COLLEGE OF GENERAL PRACTITIONERS
NATIONAL HQ CHENNAI, 13,VI Cross Street, New Colony Chrompet, Chennai–44
Dr. J.A. Jayalal, Hon. Secretary IMA CGP

To, Hon. Gulam Nabi Azad, Minister for Health and Family Welfare.
Hon. Sir: Sub: Introduction of Clinical Establishment Bill 2010 – Emergency Medical Service made Mandatory – regarding.

On behalf of IMA College of General Practitioners, the Academic wing of IMA, Sir, I express my gratitude and thanks for the Introduction of Clinical Establishment Bill 2010 in the Parliament and passing it. I am sure this will pave the way to upgrade and standardize the Health care delivery system and root out quackery in our Country if fully implemented. Sir, with this sense of optimism I wish to bring to your kind notice the following facts.

1) The proposed National Council of Clinical establishment is constituted with 18 elected Members. In which only one representative from IMA is included. However, Unani System of Medicine with only 18 colleges, 100 clinics and 1400 beds is also permitted to have one representative. The alternative systems of Medicine all put together have 50% lesser hospitals than allopathy Health Care Institution. But Alternative System will have 4 representatives (Unani, Sidda, Ayurveda, Homeopathy). Sir, Kindly provide proportionate membership in this Council for Modern Medicine.

2) Family Physician Concept/CLINIC

The uncontrolled growth of corporate hospitals has resulted in the extinction of Family Physician concept. A Family Physician used to provide competent, comprehensive community-oriented continuity of care to the masses in a cost effective way. Unless the Family Physicians are encouraged, Family Medicine recognized as specialty and adequate training is given, more and more corporate hospitals will percolate the rural area resulting in escalation of Medical Expenses. Hence I appeal Sir, to enable the IMA to provide training to all the General Practitioners of our Country, empowering them with the Family Physician approach and provide healthcare at a reasonable and affordable cost. When the proposed council classifies the hospital, special care must be provided for Family Physician clinics.

3) EMERGENCY MEDICAL SERVICE: Sir, it is a welcome move, by law to ensure Emergency Medical Care is provided to all who need it. However:

I) Emergency Medicine encompasses a large amount of General Medicine but involves virtually all fields of Medicine and surgery including surgical subspecialty. Emergency Physician requires a broad field of knowledge and advanced procedural skills often including surgical procedures, trauma resuscitation, cardiac life support, airway management, intrapartum care etc. In majority of times of emergency, it is the General Practitioner who will be the first contact person called to attend these emergencies. However, most of them are not trained in Emergency Medicine in true sense. WHEN WE DO NOT HAVE AN UNDERGRADUATE CURRICULAM OR DEPARTMENT IT IS NOT EXPECTED FOR A GRADUATE TO LEARN THIS ART. Hence I appeal Sir, as a priority.

1) All Medical Institutions must have Emergency Medicine and Family Medicine Undergraduate Departments.

2) For the more than 5 Lakhs of existing General Practitioners, Special short term training on Emergency Medicine must be provided.

3) IMA College of GP has the modules, curriculum and infrastructure to train these General Practitioners, provided this is supported by Ministry of Health and Family Welfare.

II) The second grey area will be the cost involved. It is true as a social responsibility every doctor will be happy to do free-of-cost service on few occasions. However, if it is made as mandatory, every citizen will expect free-of-cost Emergency care and mechanism of compensation or reimbursement shall be worked out, to make it a more viable action, without burdening the hospitals.

4) HOSPITAL AS SERVICE SECTOR: Hospitals are Temples of Health and place of Service to millions of needy population. Though Art of Medicine is proclaimed as Noble Service, right from Electrical tariff to pollution control fee, we are charged at par with Industry. Let this clinical establishment bill provide some relief to the hospital who fit in to the standards prescribed in terms of Electric bill, Municipal tax, soft loan etc which I am sure will be translated to the community health care.

Summation

1) IMA CGP requests more proportionate representation for modern medicine doctors in the National Council for clinical establishment.

2) Family Medicine and Emergency Medicine departments shall be encouraged in all Medical Colleges.

3) Recognition of Family Physician as a specialist and training for General Practitioners on Emergency Medicine to be implemented.

4) Emergency Medical Care Service cost shall be reimbursed by the public sector.

5) Hospitals shall be declared as special service sector.