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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


26th May, 2010, Wednesday

Tackling quackery

Dear Colleague

There is a shortage of at least 8 lakh doctors, 6 lakh dentists and 12 lakh nurses in the country. The net result is mushrooming of paramedical workers and others practicing in the guise of a doctor by adding ‘Dr’ as a prefix to their names and submitting fake certificates and degrees.

There are less than 7 lakh allopathic doctors in the country. What is required is a centralized register on a website which anybody should be able to access, click the required "State" and enter the state registration number. This way, any hospital, nursing home or even a patient should be able to verify the credentials of his or her doctor, including his or her photograph. A good IT should not need more than a month to work out a system of Centralizing registration. If it is difficult for the government to find such a solution, it can create a centralized website for registration with a facility of self–registration where all the doctors should be able to enter their details, upload their photograph and scanned copy of their registration. In this way, no two people of the same registration will be able to register. People, who have died will automatically be eliminated and anybody who is not registered should not be allowed to practice anywhere in the country. Once the process of registration is centralized, one can verify anyone practicing anywhere in India.

Quacks practicing in Delhi are usually arrested by the Police but released on bail after a few days. They can be seen practicing in their area even while on bail. This simply means that the council lawyer did not oppose the bail and, even if did, he did not ask for a conditional bail. The bail should specifically be conditional that the person released on bail cannot practice till the case is decided. If he or she still practices, it will amount to contempt of court and the bailable offence becomes a non–bailable offence.

It is also argued that quacks charge less fee, therefore, public goes to them for consultation. They may be charging less under "consultation head" but their bill per day invariably is much more than the bill of a general practitioner. Their bill includes medicines, injections and drips. You will never come across a quack who does not give one or two drips to his patient. So, a patient may end up paying Rs. 200–300 per consultation.

The concept of the 'nurse practitioner' is not prevalent in India. In the West, nurses are allowed to practice as 'nurse practitioners’ under restricted conditions. Qualified nurses can provide better care than a quack and the services of the nurse practitioner can be utilized in those areas where doctors are not available. To practice is not difficult as about 85% of the diseases are self–limiting and the patients will become alright despite treatment. A quack only needs to know the following:

  1. Cough means a cough syrup.

  2. Allergy means any anti–allergic drug CPM or cetrizine.

  3. Malaria means 4 tablets of chloroquine.

  4. Fever means a combination of paracetamol, antibiotic and steroids.

  5. Wheezing means a combination of oral/IM steroid + nebulizer.

  6. A non–responding wheezing means add Lasix.

  7. Not passing urine means Lasix.

  8. High TLC (total leukocyte count) means adding antibiotics to their prescription.

  9. Low hemoglobin means iron–folic acid, B–complex.

  10. Any skin condition means any skin ointment containing antibiotic, anti fungal and steroid
     
  11. Weakness means IV drip.

  12. Loose motions or diarrhea mean IV drip

This is how most of the ‘quacks’ practice and if the patient is not responding in three days, they will refer him to the nearest hospital.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From file): Creating Health Awareness

Sumptuous Inaugural Functions

An inauguration function needs to leave impact to make the event colossal and to draw interest of the crowd. Heart Care foundation of India (HCFI) has emphasized on having sumptuous inaugural functions involving VIPs, for all its activities. In the photo, Late Sri Sahib Singh Verma, then Chief Minister of Delhi can be seen inaugurating Perfect Health Mela. Also in the photo, Dr. K K Aggarwal, President HCFI.

Dr k k Aggarwal

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

Pentoxifylline for severe alcoholic hepatitis
Updated guidelines suggest pentoxifylline as an alternative to glucocorticoids in selected patients with severe alcoholic hepatitis.

 

Mnemonics of the Day (Dr Varesh Nagrath)

Treatment of recurrent furunculosis MACRT

  • Mupirocin (Locally Ant nares)
  • Amoxycillin + Clavulanic Acid
  • Clindamycin 
  • Rifampicin
  • Triclosan soap

News and Views

1. Baxter recalls Hyaluronidase injections

Baxter International is voluntarily recalling all lots of its Hylenex recombinant (hyaluronidase human injection) after some vials were discovered to contain small flake–like particles. The FDA has said that there have been no medical events or customer complaints associated with this. The recall is a precautionary measure, it further added.

2. Doctor’s advice key to sex Life after heart attack

Whether or not a patient resumes sexual activity after a heart attack may depend on the discharge instructions from the patient’s physician. A study has found that failure to discuss sex at post–myocardial infarction (MI) hospital discharge was associated with significant loss of sexual activity over the following year. In an analysis of the prospective TRIUMPH (Translational Research Investigating Underlying Disparities in Recovery from Acute Myocardial Infarction: Patients’ Health Status) study, this factor raised the risk of no sex or less sex over the next year by 32% for men (95% confidence interval 14% to 54%) and 41% for women (95% CI 16% to 72%). The study findings were presented at the American Heart Association’s Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke conference. According to Dr Stacy Tessler Lindau, of the University of Chicago in Chicago, this topic should be a part of routine counseling, even though short, for each patient.

3. Patients at high risk of recurrences of heart disease

A major clinical study on VIA–2291, carried out at the Montreal Heart Institute by Dr. Jean–Claude Tardif, has found encouraging results. VIA–2291 can effectively decrease inflammation, which contributes to the formation and progression of atherosclerosis plaque and infarct. It is developed by Via Pharmaceuticals, a San Francisco–based biotechnology firm. The study is published in the journal Circulation Cardiovascular Imaging.

4. FDA to consider approving pill designed to boost women’s sex lives

Flibanserin, a drug developed by Germany’s Boehringer Ingelheim, may become the first prescription medication to boost women’s sex lives and to tap what some have estimated could be a $2 billion market in the United States alone.

Quote of the Day (Dr. Arun Phophalia MS)

How a Corporate World Works

Every day, a small ant arrives at work very early and starts work immediately.
She produces a lot and she was happy.
The Chief, a lion, was surprised to see that the ant was working without supervision.
He thought if the ant can produce so much without supervision, wouldn’t she produce even more if she had supervisor!

So he recruited a cockroach who had extensive experience as supervisor and who was famous for writing excellent reports.
The cockroach’s first decision was to set up a clocking in attendance system.
He also needed a secretary to help write and type his reports and……
he recruited a spider, who managed the archives and monitored all phone calls.

The lion was delighted with the cockroach’s reports and asked him to produce graphs to describe production rates and to analyse trends, so that he could use them for presentations at Board's meetings.
So the cockroach had to by a new computer and a laser printer and……
recruited a fly to manage the IT department.

The ant, who has once been so productive and relaxed, hated this new plethora of paperwork and meetings which used up most of her time…!
The lion came to the conclusion that it was high time to nominate a person in charge of the department where the ant worked.

The position was given to the cicada, whose first decision was to by a carpet and an ergonomic chair for his office. The new person in charge, the cicada, also needed a computer and a personal assistant, who he brought form his previous department, to help him prepare a Work and Budget Control Strategic Optimisation Plan…

The Department where the ant works is now a sad place, where nobody laughs anymore and everybody has become upset…

It was at that time that the cicada convinced the boss, the lion, of the absolute necessity to start a climatic study of the environment.

Having reviewed the charges for running the ant’s department, the lion found out that the production was much less than before. Se he recruited the owl, a prestigious and renowned consultant to carry out an audit and suggest solutions. The owl spent three months in the department and came up with an enormous report, in several volumes, that concluded: "The department is overstaffed…"

Guess who the lion fires first?

The ant, of course, because she "showed lack of motivation and had a negative attitude".

Question of the Day : How is giardiasis diagnosed?

under the microscope for cysts or trophozoites; however, it takes three samples of stool to diagnose 90% of cases. Despite requiring three samples of stool, microscopical examination of stool identifies other parasites in addition to Giardia that can cause diarrheal illness.

Liver Fact

SGOT can be more than SGPT in NASH, Hepatitis C cirrhosis, dengue, acute muscle injury, H1N1 and Wilson's disease.

World No Tobacco Day 31st May

Islam: The harmful health effects of tobacco make its consumption a contraindication in Islam teachings.

eMedinewS Try this it Works : Eliciting deep breaths in children

Most children are familiar with the fairy tale about the three little pigs and the big, bad wolf. Have your pediatric patients play the part of the huffing and puffing wolf when eliciting deep inspirations for auscultation.

Dr Good Dr Bad

Situation: A diabetic child failed on lifestyle therapy and metformin.
Dr Bad: Add another oral drug.
Dr Good: Add insulin.
Lesson: In children initially treated with both non pharmacologic therapy and metformin who fail to achieve glycemic targets, use insulin glargine, a long–acting insulin analogue, as the next therapeutic agent. Although others have suggested that sulfonylureas can be considered as an alternative to insulin therapy. Sulfonylureas are not currently FDA approved for use in pediatric patients. (Source: Plotnick L. Diabetes Mellitus. In: Principles and Practice of Pediatric Endocrinology, Kappy, SM, Allen, DB, Geffner, ME (Eds), Charles C. Thomsa, Springfield, 2005. p. 635.)

Make Sure

Situation: A patient intolerant to penicillin was denied rheumatic prophylaxis. Reaction: Oh my god! Why was he not put on sulfa.
Lasson: Make sure that patients who cannot tolerate penicillin are put on sulfadiazine or sulfisoxazole. This antibiotic class is effective for preventing group A streptococcal (GAS) infection although it cannot be used to achieve eradication.

IMANDB Joke of the Day  (Dr Prachi Garg)

Kid: I want a baby brother.
Mom Child ur father is overseas when he comes back we’ll talk abt it
Kid: Why don’t you just surprise him.

Formulae in clinical practice

Oxygen Uptake Index (Vo2I)

Formula: Vo2I = Vo2 BSA (BSA – body surface area)
Normal value = 115–165 (ml/min)/m2

Milestones in Gabapentin

Garry A. Mellick discovered the pain relieving property of Gabapentin for the very first time.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Copper

Also known as Copper (24–hour urine, total and free blood, and hepatic)
To measure the amount of copper in the blood, urine, or liver; to help diagnose and monitor Wilson’s disease; sometimes to identify copper deficiencies and excesses.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Cetirizine 10 mg + Ambroxol 75 mg SR Tablet

For symptomatic relief of productive cough associated with allergic rhinitis, when both anti–histamine and mucolytic agents are desired

13.04.2009

 

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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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Public Forum (Press Release for use by the newspapers)

Drinking 4 or More Cups of Coffee a Day May Help Prevent Gout

Among its complex effects on the body, coffee has been linked to lower insulin and uric acid levels on a short–term basis or cross–sectionally, said   Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Researchers at the Arthritis Research Centre of Canada, University of British Columbia in Canada, Brigham and Women’s Hospital, Harvard Medical School, and Harvard School of Public Health in Boston conducted a prospective study on 45,869 men over age 40 with no history of gout at baseline. Over 12 years of follow–up data published in June 2007 issue of Arthritis & Rheumatism shows that drinking 4 or more cups of coffee a day dramatically reduces the risk of gout for men.

The risk of gout was 40 percent lower for men who drank 4 to 5 cups a day and 59 percent lower for men who drank 6 or more cups a day than for men who never drank coffee.

There was also a modest inverse association with decaffeinated coffee consumption.

Components of coffee other than caffeine may be responsible for the beverage’s gout–prevention benefits. Among the possibilities, coffee contains the phenol chlorogenic acid, a strong antioxidant.

The findings are most directly generalizable to men age 40 years and older, the most gout–prevalent population, with no history of gout.

MCI update

MCI panel holds its first meeting A six-member panel held its first meeting to discuss the functioning of the dissolved regulatory body. The panel, headed by eminent doctor S K Sarin, met senior officials of the dissolved MCI, set up 76 years ago to regulate medical education in the country, and wanted to know about the roles and procedures followed for giving approval to colleges (PTI).

Court allows ED to question Desai (A Age)
A Delhi court has facilitated the Enforcement Directorate (ED) to interrogate the former President of Medical Council of India (MCI) Dr Ketan Desai and two others to ascertain the magnitude of the scam and trail of their ill-gotten wealth. Allowing the plea of special prosecutor of the ED, Naveen Kumar Matta, for interrogation, Special CBI judge O.P. Saini said, 'ED is permitted to interrogate Desai, Sukhwinder Singh and J.P. Singh in the Tihar Jail premises by the officers of the department.' They have been booked by the ED in a fresh case lodged under recently promulgated Prevention of Money Laundering Act (PMLA). 

Readers Responses

  1. Charlie Chaplin’s 3 Heart touching Statements (Dr K K Arora)

    (1) Nothing is permanent in this world, not even our troubles...!
    (2) The most wasted day in life, the day in which we have not laughed.
    (3) I like walking in the rain, becoz nobody can see my tears.

     
  2. Dear Dr KKA: Your points on Pharma companies and doctors are absolutely correct. Most of the time MCI is acting as double face. Regarding ethics they will talk in high standards but when it comes to their personal lives they think differently. As long the consumer law controls medical profession we have all the right of a shop owner, it cannot be both ways and double standard for doctors alone: Dr.Alex Franklin

  3. Dear Dr KK, wrt Typhoid Fever Treatment, it was reported in the article that " Resistance to azithromycin is not reported so far. I would like to point out that there have been cases of Azithromycin-resistant Salmonella from Thailand; also there is co-resistance between quinolones and azithromycin among salmonellae. Dr Kapil Aggarwal

 

     4. As far as B12 deficiency in those on Metformin; the trial relies on serum vitamin B12   concentrations while evidence suggests that serum vitamin B12 concentrations might not accurately reflect intracellular concentrations of Vit B12. An elevated serum homocysteine level (values >13 micromol/L) might also suggest a vitamin B12 deficiency. However, this indicator has poor specificity because it is influenced by other factors, such as low vitamin B6 or folate levels. Elevated methylmalonic acid levels (values >0.4 micromol/L) might be a more reliable indicator of vitamin B12 status because they indicate a metabolic change that is highly specific to vitamin B12 deficiency. Warm regards: Dr Kapil Aggarwal
 

      5. Thank u sir, very good articl: Anand Shukla
 

      6. Sir: The Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002  were notified on 11th March 2002 (Published in Part – III, Section (4) of the Gazette of India on 6th April, 2002) and were amended by notifications in 2003 (Published in Part III, Section 4 of the Gazette of India, dated 22nd February, 2003) and 2004 (Published in Part III, Section 4 of the Gazette of India, Extraordinary dated 27th May, 2004). The MCI has notified amendments to these regulations again on 10th December 2009 and shall come into force from the date of their publication in the Official Gazette. Please let us know whether these amendmentments have been published in Official Gazette or not, if yes than when. Thanks and regards: Dr K K Kanodia
eMedinewS Responds: It has been published in official Gazette and we had also published it in eMedinewS.

 

7. we apologize for the joke on sardar and Pakistani. It was an unintentional error on the part of our team. It was sent by a doctor colleague. Got published by mistake. Error is regretted: Editor in response to the right objection by Dr. Raja Ivan Singh