Election of one member to Medical Council of India from Delhi

The election of one member to Medical Council of India has been announced and approximately 54000 members of Delhi Medical Council will be voting for their candidate to the Medical Council of India.

Dr. Vinay Aggarwal has filed his nomination and I know him personally for the last two decades. I have been working with him in Delhi Medical Council for the last four years and have worked with him in Indian Medical Association where he has worked as Past National President.

Dr Vinay is also a Dr. BC Roy National Awardee and Dr. PN Behl Community Service Awardee by Delhi Medical Association. He has been both the Secretary and President of DMA and Secretary General of IMA. At Branch level, he has been President of IMA East Delhi Branch.

In the recently held CMAAO conference, where again I worked closely with him, he took over as the President of CMAAO.

I personally feel that Medical Council of India needs people who are grass-root workers, medical activists working for the welfare of the society.

Today IMA has been able to make its presence felt in issues like Clinical Establishment Act, one-year Rural Service linked to education, re-institution of Medical Council of India. If it was not for the IMA, the MCI by now would have been dissolved permanently and a democratic body would have been converted into a sub-department of Ministry of Health. But because of the pressure by IMA and its activists, the Ministry of Health has been forced to re-elect MCI, a process which will complete on 9^th November this year.

MCI is not only about medical education but it also controls the registration and both protection and taking disciplinary action against doctors. Only grass-root workers can understand and provide significant inputs to MCI.

MCI today needs substantial change. There is a need for the capitation fees to come down; change in the UG and PG curricula; for PG examination immediately after MBBS and before internship; to have common entrance and exit examinations; of transparency in medical education admissions and to change the law by which a Russian doctor with MD Physician degree which is not even actually equivalent to MBBS degree in India is denied permission to write MD against their name. 

Finally there is a need to prepare a uniform and standard medical education programme across the country.

I wish him all the success.

Coronary-Stenting Abuse

A recent article highlights high-profile cases of alleged coronary-stenting overuse. It’s just the tip of the iceberg.

"When stents are used to restore blood flow in heart-attack patients, few dispute they are beneficial," writes Peter Waldman, David Armstrong, and Sydney P Freedberg  in Bloomberg BusinessWeek .  But heart attacks account for only about half of stenting procedures.

Among the other half —elective-surgery patients in stable condition—overuse, death, injury, and fraud have accompanied the devices use. The article cites thousands of pages of court documents and regulatory filings, interviews with 37 cardiologists and 33 heart patients or their survivors, and more than a dozen medical studies.

As per Texas Medical Board, Dr Samuel DeMaio is said to have implanted 21 coronary stents in one patient over an eight-month period. The patient's later death was related to the placement of unneeded stents.

Dr John McLean of Salisbury, MD, was convicted of billing for unwarranted stenting. He argued that inappropriate usage is widespread, and [he] was prosecuted for behavior that’s the industry norm.

Baltimore cardiologist Dr Mark Midei, license was revoked in 2011 when the Maryland Board of Physicians found he falsified records to justify unwarranted stents. The hospital where Midei worked, St Joseph Medical Center in Towson, MD, paid the government $22 million without admitting liability as a part of settlement.

Apart five other hospitals settled with the Justice Department over allegations that they paid illegal kickbacks to doctors for patient referrals to their cath labs. [Medscape Cardiology]

Antibiotics still overprescribed in sore throat and bronchitis

Even today antibiotics are still drastically overprescribed for two common complaints -- sore throat and bronchitis. Doctors order antibiotics for about 60% of patients who complain of a sore throat, according to Jeffrey Linder, MD, of Brigham and Women's Hospital in Boston.

The problem is that only about one sore throat in 10 is caused by a pathogen -- group A streptococcus -- that responds to antimicrobial agents. The picture is even worse for bronchitis, Linder said -- some 73% of complaints result in an antibiotic prescription, but the condition never responds to the drugs.

The data come just weeks after the CDC warned that antibiotic resistance -- fueled by inappropriate use of the drugs -- is reaching a crisis.

People should be tiled that antibiotics not going to help you and there's a very real chance they're going to hurt you.

Harvard commonly held myths about end-of-life issues

Myth: More care is always better.

Truth: Not necessarily. Sometimes more care prolongs the dying process without respect for quality of life or comfort. It’s important to know what interventions are truly important. It’s often impossible to know that in advance. That’s where the advice of a healthcare team is invaluable.

 Myth: Refusing life support invalidates your life insurance, because you are committing suicide.

Truth: Refusing life support does not mean that you are committing suicide. Instead, the underlying medical problem is considered to be the cause of death.

 Myth: If medical treatment is started, it cannot be stopped.

Truth: Not starting a medical treatment and stopping a treatment are the same in the eyes of the law. So you or your health care agent can approve a treatment for a trial period that you think may be helpful without fear that you can’t change your mind later. However, be aware that stopping treatment can be more emotionally difficult than not starting it in the first place.

 Myth: If you refuse life-extending treatments, you’re refusing all treatments.

Truth: No matter what treatments you refuse, you should still expect to receive any other care you need or want — especially the pain and symptom management sometimes called intensive comfort care.

 Myth: Stopping or refusing artificial nutrition and hydration causes pain for someone who is dying.

Truth: Unlike keeping food or water from a healthy person, for someone who is dying, declining artificial nutrition or intravenous hydration does not cause pain.

Hand, mouth, foot disease update

     ·        Person can remain infective for one week

·        No antibiotics are required

·        Can occur in adults

·        Rash is itchy as against dengue non itchy rash

·        Painful sores in mouth make swallowing difficult

Hand, foot and mouth disease

We have been seeing a rise in the number of cases of hand, foot and mouth disease in Delhi among school children. These may be mistaken for chicken pox.

Hand, foot and mouth disease: Salient facts

• Hand, foot and mouth disease is a viral illness most commonly caused by the Coxsackie virus A6.
• Enteroviruses 71 (EV71) can also cause hand, foot and mouth disease.
• Both adults and children can develop this infection. But young children below 5 years old are more susceptible.
• It is a moderately contagious illness.
• The incubation period is 5 days.
• The illness begins with fever, which lasts for 24-48 hours.
• Fever is followed by appearance of painful sores in mouth. They begin as small red spots that blister and then often become ulcers. Tongue is involved.
• There are peripherally distributed small tender non itchy rash with blisters on palms of the hands, and soles of feet and buttocks.
• The sores hurt on touch and swallowing is difficult.
• There is proximal separation of nail from the nail bed.
• The virus is present in mucus from nose, saliva, fluid from sores and traces of bowel movements.
• The virus spreads in the first week of infection.
• The infection spreads from person to person by direct contact with nasal discharge, saliva or blister fluid or from stool of infected persons.
• The virus can persist in the stool for weeks.
• The illness is not transmitted to or from pets or other animals
• The illness stays for 2-3 days. It is usually mild and self limited.
• Entero 71 virus is associated with brain involvement (meningitis and encephalitis), lungs and the heart.
• The patient remains infectious after the symptoms have gone.
• Test is not necessary.
• There is no specific treatment.
• Paracetamol tablet can be taken to relieve pain and fever.
• Aspirin is to be avoided in children.
• Dehydration should be avoided.
• Eat ice cream to numb the pain.
• Using mouthwashes or sprays that numb mouth
• Regularly wash your hands with soap and water.
• Avoid exposure to infected person.
• Maintain touch hygiene to reduce your risk of acquiring the infection.
• During first week of illness, the child should be kept in isolation.
• Schools should be closed.
• There is no vaccine currently available

Statins clear cholesterol at the risk of cataract

In the primary analysis of 6,972 matched pairs of statin users and nonusers, those taking the cholesterol-lowering medication had a 9% increased risk of developing cataracts said Dr Ishak Mansi, of the VA North Texas Health System at the University of Texas Southwestern in Dallas, and colleagues in JAMA Ophthalmology. In a secondary subgroup analysis of 33,513 patients (6,113 on statins) who had no comorbidity, based on the Charlson comorbidity index, the use of statins remained significantly associated with cataracts.