emedinews
Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
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


YOU CAN DOWNLOAD EMEDINEWS AT www.emedinews.in

Dear Colleague

21st March 2010, Sunday

Medical Council of India: Professional Conduct, Etiquette and Ethics Amendments Revisited 

In exercise of the powers conferred by Section 33 of the Indian Medical Council Act, 1956 (102 of 1956), with the previous sanction of the Central Government, MCI via notification number MCI–211(1)/2009(Ethics)/55667, dated 10th December 2009 has amended the "Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulations, 2002".

In the IMC Professional Conduct Etiquette and Ethics Regulations, 2002 clause 6.8 has been added to make it Regulations 2009.

The 6.8 deals with the code of conduct for doctors and professional association of doctors in their relationship with pharmaceutical and allied health sector industry.

The clause 6.8.1 clarifies that in dealing with pharmaceutical and allied health sector industry, a medical practitioner shall follow and adhere to the stipulations given below:–

(a) Gifts: A medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives.

My comments: What is the definition of gift? Do academic books, scientific materials, conference proceedings, distribution of guidelines come under gift?

(b) Travel Facilities: A medical practitioner shall not accept any travel facility inside the country or outside, including rail, air, ship, cruise tickets, paid vacations, etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME programme etc. as a delegate.

My Comments: Are hospitals and medical establishments not allied health care industry? All of them give commissions, travel grants, incentives etc under the pretext of professional services charges. Advertising by doctors is prohibited then why not the same for the health care establishments.

(C) Hospitality: A medical practitioner shall not accept individually any hospitality like hotel accommodation for self and family members under any pretext.

My comments: As above

(d) Cash or Monetary Grants: A medical practitioner shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pretext. Funding for medical research, study etc. can only be received through approved institutions by modalities laid down by law/rules/guidelines adopted by such approved institutions, in a transparent manner. It shall always be fully disclosed.

My comments: Most medical establishments give cash incentives. They have official marketing departments with a marketing staff of 30–45 persons. Most national and international health care business today is procured from business agents. If a doctors accepts money he is booked under IMC act what about the establishments who offer money? Who will take action against them?

(e) Medical Research: A medical practitioner may carry out, participate in, work in research projects funded by pharmaceutical and allied healthcare industries.

A medical practitioner is obliged to know that the fulfillment of the following items (i) to (vii), will be an imperative for undertaking any research assignment/project funded by industry for being proper and ethical.

Thus, in accepting such a position a medical practitioner shall:–

(i) Ensure that the particular research proposal (s) has the due permission from the competent concerned authorities;

(ii) Ensure that such a research project (s) has the clearance of national/state/institutional ethics committee/bodies;

(iii) Ensure that it fulfills all the legal requirements prescribed for medical research;

(iv) Ensure that the source and amount of funding is publically disclosed at the beginning itself;

(v) Ensure that proper care and facilities are provided to human volunteers, if they are necessary for the research project (s);

(vi) Ensure that undue animal experimentations are not done and when these are necessary they are done in a scientific and a humane way;

(vii) Ensure that while accepting such an assignment a medical practitioner shall have the freedom to publish the results of the research in the greater interest of the society by inserting such a clause in the MoU or any other document/agreement for any such assignment.

(f) Maintaining Professional Autonomy: In dealing with pharmaceutical and allied healthcare.

Dr KK Aggarwal
Chief Editor


News and Views (Dr G M Singh)

What are the systemic therapies currently available? What are their indications, efficacy and limits – especially ones that require close monitoring by GPs?

Methotrexate is an effective treatment that has stood the test of time and some patients do very well on it in the long term. It works by slowing cell division, so may affect liver and bone marrow. Methotrexate is an abortifacient and also teratogenic and men taking it should not father children. It may cause nausea.

Acitretin is a retinoid – like isotretinoin and has comparable side-effects, including nosebleeds, dry skin and headaches. It is teratogenic up to two years after stopping – pregnancy must be avoided as with all systemic psoriasis therapies – but it is a good treatment for men and women who have been sterilized or are postmenopausal.

Ciclosporin is very effective and works quickly. It particularly suits fit young adults, as possible side–effects include hypertension and renal function impairment – less of a worry in this group. Mycophenhylate and fumaric acid esters are less commonly used.

The ‘biologicals’ currently licensed are etanercept, adalimumab and ustekinamab – they are generally only available when all else has failed, but can be life-transforming for the right patients.

All these drugs work well but careful patient selection and the need for monitoring means they must be initiated by dermatologists and managed with written local shared–care protocols.

Scalp psoriasis is a common presentation in primary care. Can you describe your step–by–step approach?

First, differentiate from seborrhoeic dermatitis, which has much thinner scales and often affects eyebrows, nasolabial folds and sternum. It lacks the classic red scaly plaques of psoriasis and nail involvement. The approach to scalp psoriasis depends on the thickness of scale, which can sometimes be several millimetres. Thick scale must be physically removed after initial treatment with softeners and keratolytics such as coconut oil–salicylic acid compounds. A nurse can remove scale with vegetable oil and a nylon comb. Once the scale is removed, tar and/or topical steroid scalp preparations or one of the proprietary combinations such as Xamiol or Etrivex can be used to tackle the underlying inflammation.

What is the relationship between psoriasis and arthropathy?

Some patients with psoriasis develop an inflammatory polyarthropathy, clinically similar to rheumatoid arthritis. Recent research suggests the true figure may be higher than the 5% often cited . There is currently no way to predict who will develop psoriatic arthritis, or to prevent it. In view of the prevalence of ordinary ‘wear and tear’ arthritis in the elderly, some of whom will have psoriasis, patients may be anxious that their osteoarthritic aches and pains are due to psoriatic arthritis. They should be reassured, but anything like an inflammatory arthritis affecting multiple joints in a psoriatic patient deserves prompt rheumatology referral for investigation and consideration of systemic disease modifying therapy.

Palpable breast cancers are more common in women not undergoing annual mammography

New research findings published in the March issue of the Journal of the American College of Surgeons indicate that some breast cancers continue to be detected as a palpable lump rather than being found through mammographic screening. Patients who presented with palpable tumors –– those detected as a result of breast complaint or during examination –– had larger tumors and were at a more advanced stage at diagnosis.

New insight on how fast nicotine peaks in the brain

Nicotine takes much longer than previously thought to reach peak levels in the brains of smokers, according to new research conducted at Duke University Medical Center. Traditionally, It has been believed that nicotine inhaled in a puff of cigarette smoke took a mere seven seconds to be taken up by the brain, and that each puff produced a spike of nicotine. PET imaging, illustrateD that cigarette smokers actually experience a steady rise of brain nicotine levels during the course of smoking a whole cigarette.(Proceedings of the National Academy of Sciences)

Conference Calendar

4th Annual Conference of IPARM, on Lifestyle disorders
Date:11th April 2010 (Time: 9 AM). Venue: LT II, AIIMS

Contact: Dr S L Yadav Ph: 26594374

What’s New

Specific antidepressants associated with an increased risk of diabetes

Specific antidepressants may be associated with an increased risk of diabetes. A nested case-control study in patients with depression found that long–term use (>24 months) of some antidepressants (amitriptyline, fluvoxamine, paroxetine, and venlafaxine) in moderate to high doses was associated with a significantly increased risk of diabetes. Andersohn F, Schade R, Suissa,S, et al. Long–term use of antidepressants for depressive disorders and the risk of diabetes mellitus. Am J Psychiatry 2009;166:591.

Quote of the Day

Courage is the discovery that you may not win, and trying when you know you can lose." Tom Krause

Diabetes Fact

Insulin indications: type 1 diabetes, pregnancy, acute complications of diabetes, primary or secondary failure of Sulfonylurea

Public Forum (Press Release)

Apples during pregnancy and asthma

Quoting a study published in the Journal Thorax, Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor, eMedinewS, said that women who eat apples while pregnant may protect their child from developing asthma.

The study showed that children of moms who munched on more than 4 apples per week were 37 percent less likely to have a history of wheezing and 53 percent less likely to have doctor–confirmed asthma, compared to moms who ate one or no apples per week while pregnant. The effect may be due to apple’s phytochemical content, such as flavonoids, which have been shown to have beneficial effects on adult lung function.

The study also found that eating fish during pregnancy may curb the risk of eczema in offspring. Children of mothers who ate fish once per week or more while pregnant had a 43 percent lower risk of eczema compared to children whose mothers avoided fish altogether.

High Fat Diet and Breast

Quoting another study from the National Cancer Institute in Bethesda, Maryland, Dr. Aggarwal said that in middle–aged women, eating a high–fat diet raises the risk of developing invasive breast cancer. There was 32% increased risk of breast cancer among women with a high level of fats in their diet. The risk was seen for all types of fat (saturated, monounsaturated and polyunsaturated) and seemed to be confined to women who were not using hormone replacement therapy. The higher the fat intake, the higher was the risk for breast cancer.

Eat More Fruits

People who eat a diet high in fruit and low in meat reduce their risk of developing colon cancer said Dr. Aggarwal. A team from University of North Carolina in Chapel Hill observed three groups – people who ate a lot of fruit but little meat, people who ate a lot of vegetables and a moderate amount of meat, and people who simply ate a lot of meat. The people who recalled eating large or moderate amounts of meat were 70 percent more likely to have had a polyp than those who said they ate a lot of fruit but little meat.

Just 18 percent of the people who said they ate a lot of fruit but little meat had a polyp, compared to 30 percent of the moderate meat–eaters and 32 percent of people in the high meat–eating group.

Question of the day

How do you treat complications in atopic dermatitis (AD)?

Complications may be encountered in all patients with AD. However, they are more common in patients with extensive eczema. Various complications encountered are:

  1. Extensive staphylococcal pyoderma

  2. Kaposi’s varicelliform eruptions from disseminated herpes infection

  3. Extensive molluscum contagiosum lesions.

  4. Extensive verruca vulgaris

  5. Disseminated dermatophytic and candidal infections

  6. Psychological implications

Disseminated staphylococcal pyoderma is the most common complication of AD. It is controlled with oral cloxacillin and ampicillin combination, clavulanic acid and amoxicillin combination, 3rd generation cephalosporins etc for 7–10 days. Kaposi’s varicelliform eruptions or disseminated herpes simplex infections are controlled by oral acyclovir or famcyclovir for 7–10 days. Extensive molluscum and verruca vulgaris need cauterization either with 20% KOH, 20–40% trichloracetic acid or by electrofulguration. Treatment of disseminated dermatophyte infection is done by oral administration of terbinafine, fluconazole or itraconazole. Disseminated candidal infection usually respond to oral fluconazole or itraconazole. Patients suffering from AD for long time, often experience depression, anxiety, irritability, lack of confidence, social rejection etc. To address all these issues, psychological counseling and reassurance should be done from time to time.

Quote of the Day

Enthusiasm is excitement with inspiration, motivation, and a pinch of creativity. Bo Bennett quotes

eMedinewS Try this it Works

Abdominal wall tenderness test

While the patient is supine with abdominal muscles relaxed, the examiner palpates the tender spot. The patient is then asked to tense the abdominal muscles, and the tender spot is palpated once again. If the tenderness is worse, the abdominal wall muscles are most likely the source of the pain, rather than the underlying abdominal cavity.

Dr Good Dr Bad

Situation: A diabetic patient came for routine evaluation.
Dr Bad: Get fasting sugar done.
Dr Good: Also get a 10 g – monofilament test done .
Lesson: More than 2% of community-based diabetic patients develop new foot ulcers each year. As per the North–West Diabetes Foot Care Study, the neuropathy disability score, 10 g monofilament and palpation of foot pulses are recommended as screening tools in general practice. (Diabet Med 2002;19 (5):377–84)

Make Sure

Situation: A known patient of NIDDM taking oral hypoglycemic presents with hyperglycemic crisis.
Reaction: Oh, my God! I did not manage the patient aggressively
Make sure that patients with impaired glucose tolerance or NIDDM are fully evaluated for complications at the first visit. Present approach to therapy of NIDDM is characterized by approach to therapy of NIDDM is characterized by proactive shifts to agents that may be combined or prescribed in maximal doses to achieve normal or near normal glycemia from the time of diagnoses of NIDDM or impaired glucose tolerance, in order to prevent complications.

Medi Finance: Others

  • Endeavour to introduce Direct Tax Code from April, 2011

  • Endeavour to introduce GST by April, 2011

  • Disinvestment of PSU’ to continue.
Punjab & Sind Bank
 
action
docconnect
 
Central Bank of India
 
Nestle
 
nuspera
 
Docconnect

Laughter the best medicine

Actual medical record

Patient has neck veins distended down to ankles. A 35–year–old male was transported to our Emergency Department by rescue unit from his doctor’s office.

Formulae in Critical Care

Cardiac index (CI)
Formula: CI = CO/BSA Comment: Indicates amount of blood being pumped relative to body size (surface area).
Normal value: 2.5–4.2 (L/min)/m2.

Milestones in Orthopedics

Sir John Charnley (1911–1982) was a British orthopaedic surgeon. He pioneered the hip replacement operation, which is now one of the most common operations both in the UK and elsewhere in the world. The hip implant pioneered by Charnley comprised a stainless steel stem and 22mm head fitting into a polymer socket, both parts being fixed into position by PMMA cement. His eminent textbook on conservative fracture treatment that was first published in 1950 has influenced generations of orthopaedic surgeons.

Mistakes in Clinical Practice

MgSO4 or MSO4or MS. – The abbreviations for magnesium sulfate (MgSO4) and morphine sulfate (MSO4 or MS), which can look similar or be misinterpreted. It is best to write out "magnesium sulfate" or "morphine sulfate".

SMS of the Day (Dr Ingole)

"Every new idea is a joke, Until one man achieves it; and Every new thought is silly, Until you try and believe it.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Oxcarbazepine 150/300/600mg Tablet (Addl. Indication)

Treatment of generalized tonic-clonic seizures in adults and children

13.08.2009


(Advertorial section)

ZEN IMMUNE–FACT SHEET

Zen immune beauty helps improve the brittleness of nails, helps increase the hair tensile strength, thus prevents hair loss, and stimulates regeneration of hair roots. Helps prevention of comedone formation and post comedone skin scarring in acne vulgaris.

Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month. Contact: drkk@ijcp.com or emedinews@gmail.com

eMedinewS–PadmaCon 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.

NATIONAL SEMINAR ON STRESS PREVENTION (17–18 April). Over 400 registrations already done.

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch, IMSA (Delhi Chapter)

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2 pm onwards) and Sunday 18th April (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards

Readers Responses
 

  1. Dear Dr KK, Greetings! I am really proud of you and wish you many more laurels at achieving the prestigious Padma as well the B.C Roy Awards at the hands of the President of India. May God give you long ongoing successful life The success of EMEDINEWS --FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA under your editorship is a living reality. My good wishes to you. Ahmed Qureshi, Consultant and Head, ENT & HN Department, Medinat Zayed Hospital, Ministry of Health, AbuDhabi.

  2. Congratulations of truly well deserved award and God bless. Dr. Harsh and Ritu Mahajan