emedinews
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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

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; Chairman Ethical Committee 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

 

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  Editorial …

27th July 2011, Wednesday

Code of Marketing Practice for Indian Pharmaceutical Industry

The Dept. of Pharmaceuticals (DoP), on the lines of MCI, has come out with guidelines regarding Doctor-Pharma relationship.

The ‘Uniform Code of Pharmaceutical Marketing Practices (UCMP) for the pharmaceutical industry in India is a voluntary code at present and the implementation would be reviewed after a period of six months from the date of its coming into force. The Government would consider making it a statutory code if it finds that the code has not been implemented effectively by the Pharma Associations/Companies.

  1. General Points

    1.1 A medicinal product must not be promoted prior to receipt of the product authorization, authorizing its sale or supply.

    1.2 The promotion of a medicinal product must be consistent with the terms of the product authorization.

    1.3 Information about medicinal products must be up-to-date, verifiable and accurately reflect current knowledge or responsible opinion.

    1.4 Information about medicinal products must be accurate, balanced, fair, objective, and must not mislead either directly or by implication.

    1.5 Information must be capable of substantiation.

    1.6 Substantiation that is requested pursuant to para 1.5 above must be provided without delay at the request of members of the medical and pharmacy professions including the members of those professions employed in the pharmaceutical industry.
     
  2. Claims & Comparisons

    2.1 Claims for the usefulness of a medicinal product must be based on an up-to-date evaluation of all the evidence.

    2.2 The word “safe” must not be used without qualification and it must not be stated categorically that a medicine has no side effects, toxic hazards or risk of addiction

    2.3 The word “new” must not be used to describe any medicinal product which has been generally available, or therapeutic indication which has been generally promoted, in India for more than 12 months.

    2.4 Comparisons of medicinal products must be factual, fair and capable of substantiation. In presenting a comparison, care must be taken to ensure that it does not mislead by distortion, by undue emphasis, omission or in any other way.

    2.5 Brand names of products of other companies must not be used in comparison unless the prior consent of the companies concerned has been obtained.

    2.6 Other companies, their products, services or promotions must not be disparaged either directly or by implication.

    2.7 The clinical and/or scientific opinions of members of healthcare professionals must not be disparaged either directly or by implication.
     
  3. Textual and Audio-Visual Promotional Material

    3.1 All promotional material issued by a product authorisation holder or with his authority, must be consistent with the requirements of this Code.

    3.2 Where the purpose of promotional material is to provide persons qualified to prescribe or supply with sufficient information upon which to reach a decision for prescribing or for use, then the following minimum information, must be given clearly and legibly and must be an integral part of the advertisement: (i) The relevant product authorisation number and the name and address of the holder of the authorisation or the business name and address of the part of the business responsible for placing the medicinal product on the market; (ii) The name of the product, and a list of the active ingredients, using the common name, placed immediately adjacent to the most prominent display of the name of the product; (iii) Recommended dosage, method of use and, where not obvious, method of administration; (iv) Adverse reactions, warnings and precautions for use and relevant contraindications of the product; (v) A statement that additional information is available on request; (vi) The date on which the above particulars were generated or last updated.

    3.3 Promotional material such as mailings and journal advertisements must not be designed to disguise their real nature. Where a pharmaceutical company pays for or otherwise secures or arranges the publication of promotional material in journals, such promotional material must not resemble editorial matter.

    3.4 All promotional materials appearing in journals, the publication of which is paid for or secured or arranged by a company and referring by brand name to any product of that company, must comply with Clause 3.3 of this Code as appropriate, irrespective of the editorial control of the material published.

    3.5 Promotional material must conform, both in text and illustration, to canons of good taste and must be expressed so as to recognize the professional standing of the recipients and not be likely to cause offence.

    3.6 The names or photographs of healthcare professionals must not be used in promotional material.

    3.7 Promotional material must not imitate the devices, copy, slogans or general layout adopted by other companies in a way that is likely to mislead or confuse.

    3.8 Where appropriate (for example, in technical and other informative material), the date of printing or of the last review of promotional material must be stated.

    3.9 Extremes of format, size or cost of promotional material must be avoided.

    3.10 Postcards, other exposed mailings, envelopes or wrappers must not carry matter which might be regarded as advertising to the lay public or which could be considered unsuitable for public view.

    3.11 Audio-visual material must be accompanied by all appropriate printed material so that all relevant requirements of the Code are complied with.
     
  4. Medical representatives

    4.1 The term “medical representative” means sales representatives, including personnel retained by way of contract with third parties, and any other company representatives who call on healthcare professionals, pharmacies, hospitals or other healthcare facilities in connection with the promotion of medicinal products.

    4.2 Medical representatives must at all times maintain a high standard of ethical conduct in the discharge of their duties. They must comply with all relevant requirements of the Code.

    4.3 Medical representatives must not employ any inducement or subterfuge to gain an interview. They must not pay, under any guise, for access to a healthcare professional.

    4.4 Companies are responsible for the activities of all their employees and must ensure that employees who are concerned in any way with the drafting or approval of promotional material (including employees of third parties contracted on behalf of the company) are fully conversant and compliant with the requirements of the Code.

    4.5 Other third parties working for or on behalf of pharmaceutical companies, (including advertising companies executives, business consultants and market research companies), and those that do not act on behalf of companies (such as joint ventures and licensees) commissioned to engage in activities covered by the Code should also have a good working knowledge of the Code.
     
  5. Samples

    5.1 Free samples of medicinal products shall not be supplied to any person who is not qualified to prescribe such product.

    5.2 Where samples of products are distributed by a medical representative, the sample must be handed directly to a person qualified to prescribe such product or to a person authorised to receive the sample on their behalf.

    5.3 The following conditions shall be observed in the provision of samples to a person qualified to prescribe such product: (i) Such samples are provided on an exceptional basis only (see (ii) to (vii) below) and for the purpose of acquiring experience in dealing with such a product; (ii) Such sample packs shall be limited to prescribed dosages for three patients; (iii) Any supply of such samples must be in response to a signed and dated request from the recipient; (iv) An adequate system of control and accountability must be maintained in respect of the supply of such samples; (v) Each sample pack shall not be larger than the smallest pack presented in the market; (vi) Each sample shall be marked “free medical sample – not for sale” or bear another legend of analogous meaning; (vii) Each sample shall be accompanied by a copy of the most up-to-date version of the Product Characteristics relating to that product.

    5.4 A person shall not supply a sample of a medicinal product which is an antidepressant, hypnotic, sedative or tranquillizer.

    5.5 The companies will maintain a detail record of free samples distributed to Healthcare practitioners.
     
  6. Gifts

    6.1 No gifts, pecuniary advantages or benefits in kind may be supplied, offered or promised to persons qualified to prescribe or supply by a pharmaceutical Company.

    6.2 Gifts for the personal benefit of healthcare professionals (such as tickets to entertainment events) also are not be offered or provided.
     
  7. Hospitality, Sponsorship & Meetings

    7.1 Companies may legitimately provide assistance that is directly related to the bona fide continuing education of the healthcare professionals and which genuinely facilitates attendance of the healthcare professional for the duration of the educational aspect of the event held in India. Such support and assistance must however, always be such as to leave healthcare professionals’ independence of judgment.

    7.2 Where appropriate and depending on the time, location and length of the meeting, support to healthcare professionals may cover actual travel expenses, meals, refreshments, accommodation and registration fees. The events have to be organized in India only and all expenses mentioned above, must be incurred only for the events held in India.

    7.3 Companies must not organise meetings to coincide with sporting, entertainment or other leisure events or activities. Venues that are renowned for their entertainment or leisure facilities or are extravagant must not be used.

    7.4 Any hospitality offered to healthcare professionals must: (i) Be reasonable in level and be likely to appear to independent third parties, to be reasonable; (ii) Be secondary and strictly limited to the main purpose of the event at which it is offered; (iii) Not exceed the level that recipients would normally be prepared to pay for themselves; (iv) Not be extended to spouses or other accompanying persons, unless they are healthcare professionals who qualify as participants in their own right. Travel expenses are not to be paid for spouses or other accompanying persons, unless they are healthcare professionals who qualify as participants in their own right; (v) Not include sponsoring, securing, organising directly or indirectly any entertainment, sporting or leisure events.

    7.5 Funding of healthcare professionals to compensate them for the time spent in attending the event is not permitted.

    7.6 All promotional, scientific or professional meetings, congresses, conferences, symposia, and other similar events (including, for example, advisory board meetings, visits to research or manufacturing facilities, and planning, training or investigator meetings for clinical trials and non-interventional studies) (each, an “event”) organized or sponsored by or on behalf of a company must be held at an appropriate venue in the country that is conducive to the main purpose of the event.

    7.7 The companies must maintain a detail record of expenditure incurred on these events.
     
  8. Mode of Operation

    8.1 All the Indian Pharmaceutical Manufacturer associations will have UCMP uploaded on their website.

    8.2 All the associations will upload the detail procedure (as stated in Para 10) of lodging complaints.

    8.3 All the associations will have a detail of complaints received i.e. the nature of complaint, the company against whom the complaint has been made, the action taken by the association including the present status in the complaint , uploaded on their web site for three years. Whenever proceedings in a complaint are completed, a copy of proceedings and decisions will be sent by the concerned Association to the Department of Pharmaceuticals, on following address: Under Secretary(PI), Room No-347, A-wing, Shastri Bhawan, New Delhi 110001.

    8.4 If a complaint received in a particular association is not concerned to its member, the receiving associations will input the details of the complaint but in the column of action taken, it will mention that the complaint has been transferred to such and such association as the respondent company is not its member.
     
  9. Committee for Complaint Handling

    9.1 There will be a complaint handling committee named “Committee for Pharma Marketing Practices” in all the associations.

    9.2 The committee will have a panel of 5 member companies, represented by the Executive head of the companies or a nominee from the Executive Head, but not below the rank of Director in the Board of Company.

    9.3 Based on the complaint, specially, the company involved (either as complainant or as respondent), the Secretary General/Chairman/President (to be decided by the Executive Body of the Association) of the association will decide three members from the panel of 5 for handling the complaint.

    9.4 There will be a review committee for which there will be a panel of seven member companies of the association and based on the company involved, Secretary General/Chairman/President of the Association will nominate five members for review committee including the three members of the complaint committee, who dealt with the complaint.
     
  10. Procedure of lodging a complaint

    10.1 All correspondences should be addressed to the “Committee for Code of Pharma Marketing”, Secretary General/Chairman/President, “Name of Association”.

    10.2 All complaints about any one activity should to the extent practicable be made at one time.

    10.3 Complaints must be in writing and for each case THE COMPLAINANT should: i) identify himself (whether a company or an individual) with a full mailing address (fax number, if possible, mobile telephone nos.). When the complaint is from a pharmaceutical company, the complaint must be signed or authorized in writing by the company’s managing director or chief executive or equivalent and must state those clauses of the Code which are alleged to have been breached. ii) Identify the company which is alleged to be in breach of the Code, and the name of any company personnel, product or products which are specifically involved. iii) Give the details of the activity which is alleged to be in breach of the Code. iv) Give the date of the alleged breach of the Code which must have occurred during the last two months of the date of making the complaint. v) Provide supporting evidence of the alleged breach (es).

    10.4 A non-refundable charge of Rs.1,000/- by any complainant. The associations will elaborate how this payment is to be made.

    10.5 The name of the complainant has to be kept confidential by the association.

    10.6 When it appears from media reports (other than letters to the editor of a publication) that a company may have breached the Code, the matter will be treated as a complaint. The author of the article, or the editor where no author is named, will be treated as the complainant not the person who has brought this report in the notice of the committee. If the editor or author declines involvement, this is stated in the case report.

    10.7 A published letter from which it appears that a company may have breached the Code will be dealt with as a complaint with the author being treated as the complainant. The procedure set out in Paragraph (10.6) above shall be followed.

    10.8 Any complaint received by the Department of Pharmaceuticals will also be forwarded to the concerned Association for necessary action. In such cases, the concerned association will further take up the matter with the complainant directly.
     
  11. Procedure of handling of complaint

    11.1 Once lodged a complaint, the complainant cannot withdraw it and it has to be dealt with by the committee.

    11.2 The complaints will be received by the Secretary General/Chairman/President of the concerned associations.

    11.3 The Secretary General/Chairman/President will mark the complaint to the senior most (by designation) member of the panel as Chairman, also indicate the names of other two members of the committee.

    11.4 The decision will be made by majority.

    11.5 When the committee receives information from which it appears that a company may have contravened the Code, the managing director or chief executive or equivalent of the company concerned will be requested to provide a complete response to the matters of complaint.

    11.6 To assist companies in ensuring that a complete response is submitted the committee may suggest relevant supporting material to be supplied. It is the responsibility of the respondent to ensure that a full response is submitted.

    11.7 The company against which the complaint is made should provide supporting evidence if it thinks that the Code has not been breached.

    11.8 Upon receipt of information from the committee, the respondent company has ten working days in which to submit its comments and supporting documents to the committee.

    11.9 The Committee shall render a decision within 30 days of receipt of the complaint with supporting documentation and shall promptly notify the parties of its decision, and the reasons therefore, in writing and by registered mail.

    11.10 Where the committee rules no breach of the Code because it considers the matter of complaint is not within the scope of the Code the complainant will be so advised in writing. .

    11.11 Where the committee rules that there is a breach of the Code, the complainant and the respondent company are so advised in writing and are given the reasons for the decision.

    11.12 If a party to the complaint is dissatisfied with the decision of the Committee, it may request for review its decision. Any party requesting a review of a decision of the Committee shall notify the Secretary General/Chairman/President of the Association as per the guidelines for review given in clause 12.

    11.13 If no request for a review of the Committee’s decision is made within the period specified, the decision of the Committee shall be final and binding, and adherence to the decision shall be a condition of continued membership of the Association.

    11.14 Once it is established that a breach of code has been made by a company, the committee can take one of the following decisions against the alleged company: (i) To suspend or expel the company from the Association. (ii) To reprimand the company and publish details of that reprimand. (iii) To require the company to issue a corrective statement; details of the proposed content and mode and timing of dissemination of the corrective statement must be provided to the committee for approval and the same shall be put on the website of the Association. (iv) To ask the company to take steps to recover items given in connection with the promotion of a medicine provided to health professionals and members of the public and the like; details of the action taken must be provided in writing to the Committee which will be uploaded on the website of the Association.
     
  12. Review of Decisions of the Complaints

    12.1 The complainant or the respondent company may go for review against a ruling of the committee.

    12.2 Once asked for a review, the complainant/respondent cannot ask for the withdrawal

    12.3 A review by the complainant must be lodged within ten working days of notification of the ruling of the Committee.

    12.4 Where the respondent company appeals, it must give notice of appeal within five working days of notification of the ruling of the committee and must lodge the review within ten working days of notification of the ruling of the Committee.

    12.5 If a complaint concerns a matter closely similar to one which has been the subject of a previous adjudication, it may be allowed to proceed at the discretion of the committee if new evidence is adduced by the complainant or if the passage of time or a change in circumstances raises doubts as to whether the same decision would be made in respect of the current complaint. If a complainant does not accept a decision of the committee, he may ask for the matter to be referred to the review committee and the decision of the review committee will be final.

    12.6 If, in the view of the committee, a complaint does not show that there may have been a breach of the Code, the complainant shall be so advised. If the complainant does not accept that view, he may ask for review.

    12.7 Where review is asked by the complainant, the respondent company has five working days to comment on the reasons given by the complainant for the review.

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Dr KK Aggarwal
Group Editor in Chief

 
    eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Code of Marketing Practice for Indian Pharmaceutical Industry

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

National Conference on Insight on
Medico Legal Issue

Dr Rajesh Chawla, was felicitated at the National Conference on Insight on Medico legal issues.

 
Dr K K Aggarwal
 
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter

http://blogs.kkaggarwal.com/?p=1134
http://twitter.com/#!/search/medicolegal
https://www.facebook.com/pages/Insight–on–Medicolegal–Issues/247091668637671

Ayurveda in insurance ambit

Till some time back, health insurance policies used to cover only allopathy treatment while ayurveda, homoeopathy, naturopathy and unani treatments were left out of the ambit. Despite comprehensive health insurance plans in place, individuals who preferred such systems had to pay out of their own pockets. These policyholders can now breathe easy as some insurance companies have started including such alternative forms of treatment under their cover, especially ayurveda. “Ayurveda being the most prevalent of the alternative systems, we have designed a product to cover treatments under ayurvedic hospitalization,” says S S Gopalarathnam, MD, Cholamandalam MS General Insurance. (Source: The Times of India, Jul 25, 2011).

For comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    International News

(Dr Monica and Brahm Vasudev)

Stroke patients treated with IV clot dissolving therapy not at risk with IV contrast

Stroke patients treated with intravenous thrombolysis did not have an increased incidence of cerebral hemorrhage when exposed to iodinated contrast media. About 4% to 6% of patients developed post-thrombolysis brain hemorrhage, regardless of whether they received intravenous iodinated contrast. This has been reported by Niall J.J. MacDougall, MRCP, of the University of Glasgow, in Glasgow, Scotland, and colleagues in the Journal of American Heart Association. (2011).

For comments and archives

In some patients of stroke the risk of bleeding is more after thrombolysis

According to a study published in Journal of the American Heart Association 2011 pretreatment blood glucose levels predicts the risk of symptomatic intracranial hemorrhage after clot dissolving therapy.

For comments and archives

Dose-rounding guidance for pediatric meds developed

Researchers have developed evidence-based and expert-validated dose-rounding recommendations for more than 100 medications commonly prescribed to children. The information can be used by existing and developing electronic prescribing systems to automatically calculate safe doses of these medications for young children, Kevin B. Johnson, MD, from Vanderbilt University School of Medicine, Nashville, Tennessee, and colleagues write in an article published online July 25 and in the August issue of Pediatrics. (Source: Medscape Medical News)

For comments and archives

 
    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

People born in economic booms live longer

Because of lower mortality from heart disease, a person who is born during an economic boom and survives to age 40 lives 10 months longer than an otherwise identical individual born during a recession, according to researchers led by Gerard J. van den Berg of the University of Mannheim in Germany. Their study of records on 6,000 Danes born from 1873 through 1906 shows that a mother's nutrition during the last months of pregnancy is crucial for her child's long-term cardiovascular health.

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: #IJMD The levels of the enzyme alkaline phosphatase have proved to be a good indicator gingival health and... http://fb.me/XzlR1VSM

@DeepakChopra: Recognize and question your limiting beliefs. Self-reflection on the illusionary nature of limiting beliefs sets you free.

 
    Dr KK Answers

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Dr KK Answers: Should I take enteric or sustained release tablets of iron?

Iron is not absorbed in the stomach and is absorbed best from the small intestine (duodenum and proximal jejunum). Enteric-coated or sustained-release capsules, which release iron further down in the intestinal tract, are much less efficient sources of iron.

For comments and archives

 
    Spiritual Update

Understanding Your Personality: Vata, Pitta, Kapha

Ayurveda classifies human personality and body into different types scientifically. As per the concept the universe is made up of five elements: space, air, fire, water and earth.As is the macrocosm so is the microcosm is a common Vedic saying. Human body according to Ayurveda is also made up of the.... more

 
    An Inspirational Story

(Ms Ritu Sinha)

A little Monkey and Man

Once upon a time, a man was passing through a jungle. He saw a monkey and was attracted to it. He called the monkey and to his surprise, the monkey came near him. The man told the monkey that it was his ancestor and so they should cultivate friendship. With different kinds of gestures, he was able to establish friendship with it.

The man was just trying to kill time using the monkey as company while crossing the jungle. Suddenly unexpectedly, a lion roared fiercely and pounced in front of them. They scarcely had time to escape. The monkey ran and the man followed suit. They found a very huge tree and soon climbed it. Though they were breathless, they did not stop until they climbed to a safe height.
The lion continued to prowl here and there, hoping to catch them when they climbed down. The lion was angry and hungry and awaiting his prey finally sat down under the tree. The man was clinging to one of the strong branches, while the monkey was sitting on a branch with ease, as if nothing had happened.

After a prolonged wait, the lion lost patience and proposed to let one of them go scot-free if the other was offered to him as 'food’. The man and the monkey consulted each other. They even offered to sacrifice their lives for each other, but ultimately concluded that they would live and die together.
The lion was disappointed, but not dissuaded. He continued his vigil. Nevertheless, the wait on the tree proved a testing time for both the monkey and the man. They were feeling drowsy. They were both faced with the danger of falling down while dozing on the tree. Ultimately they decided to take turns to sleep.

The monkey would sit wide-awake while the man slept and the man would keep vigil while the monkey had his share of sleep. As decided, it was the man's turn to sleep first, while the monkey kept guard. The monkey slept in the other half of the night, while the man held forth. When the monkey was fast asleep, the man started contemplating. He thought that if he pushed away the sleeping monkey, the lion, as promised, would allow him to go scot-free.

Immediately, he translated his thoughts into action. The monkey was in deep slumber. The man pushed him down. As the monkey was accustomed to such things, he immediately caught hold of the branches halfway and was back to his place in a moment. Without uttering a single word, he went back to sleep as if nothing had happened. In the morning, the monkey led the man to safety. The lion was still on prowl under the tree.

When they reached at the safer place, the monkey made a special request to the man. "Please do not allege that monkeys are ancestors of mankind."

Man without humanity is inferior to animals.

For comments and archives

 
    Idioms

(Ritu Sinha)

Actions speak louder than words: It's better to actually do something than just talk about it.

 
    Pediatric Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity)

What are the clinical manifestations of Wilson’s disease?

Hepatic

  • Asymptomatic hepatomegaly,
  • Isolated splenomegaly
  • Persistently elevated serum aminotransferase activity (AST, ALT)
  • Fatty liver
  • Acute hepatitis
  • Mimicking autoimmune hepatitis
  • Cirrhosis: compensated or decompensated
  • Acute liver failure

Neurological

  • Movement disorders (tremor, involuntary movements)
  • Drooling, dysarthria, dysautonomia
  • Rigid dystonia
  • Pseudobulbar palsy
  • Migraine headaches
  • Insomnia
  • Seizures

Psychiatric

  • Depression
  • Neurotic behaviors
  • Personality changes
  • Psychosis

Other systems

  • Ocular: Kayser-Fleischer rings, sunflower cataracts
  • Cutaneous: lunulae ceruleae
  • Renal abnormalities: aminoaciduria and nephrolithiasis
  • Skeletal abnormalities: premature osteoporosis and arthritis
  • Cardiomyopathy, dysrhythmias
  • Pancreatitis
  • Hypoparathyroidism
  • Menstrual irregularities; infertility, repeated miscarriages

    For comments and archives
 
 
  Lab Update

(Dr Navin Dang and Dr Arpan Gandhi)

Plasminogen

This test is used to evaluate thromboembolic disorders, including ligneous conjuctivitis (a type of mucous membrane abnormality).

High levels of plasminogen can be seen in:

  • Pregnancy (peak of 165% of normal in third trimester)
  • Increased triglyceride and/or cholesterol levels

Low levels of plasminogen can be seen in:


For comments and archives
  • Liver disease
  • Consumptive coagulopathies
  • Fibrinolytic therapy
  • DIC
  • Advanced age
 
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    IJCP Special

Dr Good Dr Bad

Situation: An elderly obese diabetic was put on metformin therapy.
Dr. Good: It cannot be prescribed to the elderly.
Dr. Bad : Continue it.
Lesson: For elderly patients who do not have contraindication to metformin (severe renal impairment or heart failure), one should initiate therapy with metformin.
(American Geriatric Society, American Diabetes Association, European Diabetes working Party and Guidelines)

For comments and archives

Make Sure

Situation:A patient with gallbladder colic pain  of more than 5 hours duration developed complications
Reaction: Oh my God!! Why was a diagnosis of acute cholecystitis not considered?
Lesson: Make sure that in all patients with gallbladder pain of more than five hours duration, a diagnosis of acute cholecystitis is made unless proved otherwise.

For comments and archives

 
  Quote of the Day

(Dr GM Singh)

The true measure of a man is not how he behaves in moments of comfort and convenience but how he stands at times of controversy and challenges. Martin Luther King Jr

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

In 2002, the Supreme Court of Mississippi affirmed a summary judgment in favor of physician in the case of Martha K. Ekornes-Duncan v. Rankin Medical Center and Steven L. Chouteau


Ref: American College of Legal Medicine, The Medical Malpractice Survival Handbook)

For comments and archives

  • The Rankin Country Circuit Court, Mississippi, gave the judgment in favor of physician and medical center, in the case of the mother of a victim alleging medical negligence in the treatment of her son. The mother alleged that the trial court erred in granting summary judgment to the medical center and also found error with the trial court’s decisions to deny her motions for continuance, prohibit introduction of demonstrative evidence, allow the introduction of undisclosed business records, limit cross-examination of a medical expert and permit improper closing arguments.
  • The appellate court found that the mother failed to show any negligence on the part of the medical center by appropriate expert medical testimony. Even if the affidavits were allowed, the negligence assigned had already been provisionally diagnosed. There was nothing to substantiate the mother’s claim that she suffered injustice or prejudice from the denial of her motions for continuance.
  • The mother’s claims that she was prejudiced by the trial court’s allowing the physician to use a log book were not properly before the appellate court. Defendant’s closing argument was not improper as an objection was made and sustained, the statement was rephrased, and counsel took the opportunity to further address the statement during his closing. Short jury deliberations did not automatically evidence bias or prejudice.
  • The judgment was affirmed by the Supreme Court of Mississippi
 
    Mind Teaser

Read this…………………

Type I hypersensitivity is mediated by which of the following immunoglobulins?

a. Ig A
b. Ig G
c. Ig M
d. Ig E

Yesterday’s Mind Teaser: Enlarged corneal nerves may be seen in all of the following except:
1. Keratoconus
2. Herpes simplex keratitis
3. Leprosy
4. Neurofibromatosis

Answer for yesterday’s Mind Teaser: 2. Herpes simplex keratitis

Correct answers received from: Dr Rosario Menezes, Dr Sanjit Saha, Dr Shikha Jain, Dr Y J Vasavada, Dr Deepali Chatterjee, Dr Nikunj Garia, Dr K Raju, Dr Priyanka Sharma, Dr Muthumperumal Thirumalpilla, Dr Jainendra Upadhyay, Dr Anil Bairaria

Answer for 25th July Mind Teaser: 2. Retinoblastoma
Correct answers received from: Dr Muthumperumal Thirumalpillai, Dr S K Verma, Dr Neelam Nath, Dr Jainendra Upadhyay, valluri ramarao, Abid Ahmed, Dr Ragavan,

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Sudesh Nirwan)

Eyes
Do you know the relation between two eyes?
They never see each other....... ... BUT 1. They blink together. 2. They move together. 3. They cry together. 4. They see things together. 5. They sleep together. They share a very deep bonded relationship. However, when they see a woman, one will blink and another will not.
Moral of the story: Woman can break any kind of relationship! !!

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    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name

Indication

DCI Approval Date

Ferric Carboxymaltose equivalent to elemental Iron…50mg/ml Injection

For the treatment of iron deficiency in adults when oral iron preparations are ineffective or cannot be used.

11.02.11

 
    Public Forum

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Differentiate Different types of Fever

Different types of fever can be differentiated clinically said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

Following are few tips:

  1. If a patient comes with fever with chills and rigors, think of malaria in north and filaria in Vidarbha region in India.
  2. In malaria, chills occur in the afternoon and in filarial, chills are in the evening.
  3. Fever with joint pains on extension often is due to Chikungunya (flexion improves the pain).
  4. Think of dengue if there is fever with itching, rash and periorbital pain.
  5. In presence of fever with single chills, think of pneumonia.
  6. Fever with sore throat, no cough, no nasal discharge: Think of streptococcal sore throat, especially in the children
  7. Fever with red angry looking throat: Think of streptococcal sore throat
  8. Fever with red epiglottis: Think of Hemophilus infection
  9. Fever with cough and/or nasal discharge: Think of common flu
  10. Fever with cough, nasal discharge, nausea and vomiting: Think of H1N1 flu
  11. Fever with toxic look, persistent fever: Look for typhoid
  12. Fever with no or low rise in pulse : Look for typhoid
  13. Fever with urinary symptoms (burning, frequency): Rule out urinary infection
  14. Fever with high TLC (White cell count) and liver pain: Rule out liver abscess
  15. Fever with loose motions (watery, no blood, no mucous): Rule out acute gastroenteritis
  16. Jaundice that occurs after the fever is over: Its viral hepatitis
  17. If after the fever is over one feels very weak: Rule our dengue hemorrhagic fever.

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    Readers Responses
  1. Medico legal updates by Dr Sudhir Gupta & Dr MC Gupta are very informative. My suggestion is to add & give some judgements of medicolegal cases given by various Consumer Courts & Medical Councils . This will make the doctors wiser in patient-dealing: Dr V K Goyal.
 
    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & National Icons in the field of Cardiology & Echocardiography will form the teaching faculty.

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