Emedinews thanks all the delegates, speakers, moderators, awardees who attended the emedinews-revisiting 2009 conference on 10th Jan at MAMC. 946 doctors attended the conference and the rest watched the webcast at www.docconnect.com
News and view
1. Consumption and plasma levels of three micronutrients had no clear association with diabetic retinopathy, according to a meta-analysis involving 4,100 patients. The studies included in the analysis showed no association between vitamin E and retinopathy and inconsistent results for vitamin C and magnesium. [January issue of Ophthalmology]
2. Patients who were maltreated as children, physically, emotionally, or both, have a higher prevalence of migraine. They are also more likely to have more comorbid pain conditions than people without a history of maltreatment [Dr. Gretchen E. Tietjen, of the University of Toledo in Ohio, January issue of Headache: Journal of Head and Face Pain.]
Is a No Fault Medical Negligence a Negligence?
To err is human. However, to commit faults in practicing the skills which a professional is expected to have due to hasty, unmindful, rash decisions while being ignorant to the consequences is negligence! The answer is well placed in Suresh Gupta vs. NCT of Delhi 2004 case.
"If A causes miscarriage to Z, not intending to cause Z's death, nor thinking it likely that he shall cause Z's death, but so rashly or negligently as to cause her death, A is guilty of culpable homicide not voluntary, and will be liable to the punishment provided for the causing of miscarriage, increased by imprisonment for a term not exceeding 2 years.
Lastly, if A took such precautions that there was no reasonable probability that Z's death would be caused, and if the medicines were rendered deadly by some accident which no human sagacity could have foreseen, or by some peculiarity in Z's constitution such as there was no ground whatever to expect, 'A' will be liable to no punishment whatever on account of her death, but will of course be liable to the punishment provided for causing miscarriage".
Thus, it would therefore be safe to assume that no fault negligence is negligence so long as it can be attributed to the doctor concerned depending on whether or not he took precautions in administering any treatment with application of mind and skill which he is presumed to possess.[Dr Suresh Gupta vs. Govt. of N.C.T. of Delhi and Anr.: SC 778/2004 (Arising out of SLP(Crl.) No. 2931 of 2003): Jacob Mathew vs. Respondent: State of Punjab and Anr.: SC: 144-145 of 2004: 05.08.2005].
Medi finance: Is getting of permanent account number (PAN) compulsory?
Ans. Yes, it is. If a doctor does not have PAN, then he has to quote GIR No.
Dr Good Dr Bad:
Situation: a diabetic came for routine evaluation
Dr Bad: Get fasting sugar done
Dr Good: Get fasting sugar ad urine microalbumin done
Lesson: All diabetics should have once a year urine checked for the presence of albumin in micro amounts.
Situation: A terminally ill patient, develops bed sores on systemic antibiotics.
Reaction: Oh My God! Why was the position of the patient not frequently changed, skin cleaned and kept dry and topical antibiotics given.
Make sure good nursing care and maintenance of skin hygiene is advised to all patients with bed sores, along with topical antibiotics.
Question of the day: What is the management of methyl alcohol poisoning?
Methyl alcohol (methanol) is used as a denaturant and is a component of varnishes, paint removers, windshield washers, copy-machine fluid, anti-freeze solutions and as solvent. The toxic dose is small; 30 ml of a 40% solution can be fatal. Ingestion of methyl alcohol usually occurs with ingestion of cheap illicit liquor (hooch). People of lower socioeconomic strata most often suffer from hooch tragedies. Following ingestion, methyl alcohol is found in the liver, GI tract, eyes and kidneys. In the liver, it is metabolized to formaldehyde and formic acid by alcohol dehydrogenase. Both these metabolites are toxic, the latter causing the more serious delayed effects.
Unabsorbed methanol should be removed by gastric lavage. Supportive measures involve the correction of acidosis, control of seizures and maintenance of nutrition. Alkalization of urine enhances excretion of formic acid. Specific measures involve administration of ethanol to saturate alcohol dehydrogenase in the liver so as to prevent the formation of the toxic metabolite, formaldehyde. A 5% solution of ethanol is prepared and 15 ml/kg is given as loading dose and then 2-3 ml/kg/hour as maintenance dose orally. It can also be given intravenously. Hemodialysis enhances elimination of methanol and formic acid and is indicated when methanol levels exceed 50 mg/dl. In the absence of serum methanol level measurements, the osmolar gap is useful to assess the indication for and duration of hemodialysis in methanol-poisoned patients. Folic acid has been used to enhance conversion of formate to carbon dioxide and water. The dose is 50 mg IV 4 hourly for 24 hours. 4-methylpyrazole, an inhibitor of alcohol dehydrogenase, has been successfully used as an alternative to ethanol and dialysis.
[ Clancy C, Litovitz TL. Poisoning. In: Textbook of Critical Care, 3rd edition, Ayres SM, Grenvik A, Holbrook PR, Shoemaker WC, (Eds.), WB Saunders Company, Philadelphia 1995:1186-210]
Letters to the editor
1.By mistake, you have mentioned Hb of 9 mg%, which should be 9 Gm%. Vasdev Bhagia ( Thanks for the correction: editor)
2. Dear Sir, I agree with what Dr Girish Kumar has posted. We already have ASHA and all these nurses already have 3 year diploma certificate + some of them 1dditional 1 yr mid-wifery certification. A 3 year BRMS would not have any experience of a labour-room practice. If we are thinking of posting 3 year BRMS to villages, why not rope in thousands qualified abroad but awaiting registration to practice? they will prove better than 3 year BRMS. What will they be labeled as Drs? In that situation why oppose Physiotherapists, occupational Therapists, Optometrists, Nurses with BSc degree, and other similarly placed persons in prefixing Dr ; to the best of my knowledge matter with regard to pre-fixing Dr by Physiotherapists is pending adjudication before the court of Law. In any case many Nutritionists, Physiotherapists, Nature Cure persons are already pre-fixing "Dr." to their name. I think the policy decision of 3 year BRMS needs a rethinking. All the same your effort in bringing out Daily-Emedinews is an excellent job. Thanks with regards. Dr Krishan Kumar Arora
3. Hello Sir, I guess u must be having a peaceful sleep by now aftr a long & exhausting day at MAMC! Well firstly i wud like to thank u to give me an opportunity to be a part of such an esteemed gathering today at MAMC. It was wonderful to hear from the likes of Dr. Vanita Arora, Dr. Naresh Trehan,Dr. Kriplani & others & gather such useful information regarding medical advancements. Congrats sir for putting up such a grt show!!Secondly, wud like to thank u once again for keeping all of us updated with the new happenings in the medical profession by the means of emedinews! Dr. Mayank Mawar.
H: Hopes for a bright future
A: Affection and love
P: Peace for the heart
P: Prosperity that is unlimited
Y: Year round fun
Foods to be avoided in pregnancy (Dr G M Singh)
Avoid seafood high in mercury
Avoid raw, undercooked or contaminated seafood
Avoid undercooked meat, poultry and eggs
Avoid unpasteurized foods
Avoid unwashed fruits and vegetables
Avoid large quantities of liver
Avoid excess caffeine
Avoid herbal tea
Watch Aamir Khan's 'Taare Zameen Par'.
This is what the Delhi High Court advised a petitioner who described dyslexia, a learning disorder, as a mental disorder. Perceiving that the petitioner did not have a clear understanding of dyslexia, a bench headed by Chief Justice Ajit Prakash Shah asked him to see the film, which is about a boy suffering from the learning disorder.
'You must have VCD at home. See 'Taare Zameen Par' to understand about the problem of dyslexia,' the court said. The court also pulled up the petitioner, S.C. Jain, for terming dyslexia a mental disorder. The court also pulled up the petitioner's counsel for filing a frivolous petition. [DR.G.M.SINGH]
ADA updates its Standards of Medical Care in Diabetes
In its annual updation of Standards of Medical Care in Diabetes in 2010, the ADA has officially endorsed HbA1c also as an option for diagnosing diabetes. The cut-off point is 6.5% or greater. Its recommendations for the earlier diagnostic criteria remain the same. The ADA criteria for the diagnosis of diabetes include the following:
1. Hemoglobin A1c 6.5% or greater
2. Fasting blood glucose 126 mg/dL or above
3. 2 hour plasma glucose of 200 mg/dL or greater following a 75 g oral glucose tolerance test (GTT)
4. Random plasma glucose of 200 mg/dL in a patient with classic symptoms of hyperglycemia
(In the absence of unequivocal hyperglycemia, criteria 1-3 should be confirmed by repeat testing.)
The other new recommendations are: To consider aspirin therapy as a primary prevention strategy in diabetics at increased cardiovascular risk (10 year risk greater than 10%) & Use of fundus photography for screening and treatment of retinopathy. A new section on cystic fibrosis related diabetes has been added in the updated standards.(Source: Diabetes Care 2010[suppl 1]:S11-S61)
A device to treat adolescent obesity
A computer device used to treat patients with anorexia has shown encouraging results against adolescent obesity. According to a study published in the BMJ, the Mandometer effectively reduced the body mass index of the patients and rate of food consumption even six months after the completion of treatment and monitoring. The study involved 106 obese patients between the ages of 9 and 17 years at the Bristol (England) Royal Hospital for Children.
NAMS updates its guidelines on management of osteoporosis
The updated position statement of NAMS (North American Menopause Society) released on Jan. 4, 2010 on the management of osteoporosis in post menopausal women recommends the use of the FRAX tool to calculate the risk of major osteoporotic fracture. It also recommends that postmenopausal women obtain 800-1,000 IU/day of vitamin D3, up from the recommended dosage of 400-600 IU/day contained in the 2006 statement. www.menopause.org/aboutmeno/consensus.aspx.