Aug-sep 2008

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An interaction with Michael Reiter By Dr Saurabh Bhatia, Editor

Michael Reiter, M.A. is the Editor-in-chief of Hospital Post Europe. He lives in Germany. His publications are extensively read by hospitals all over Europe. I had the chance to meet him and take him around while he was touring India on a personal visit. Michael was keen to know how was the Indian health sector reacting to the call of automation and c ompu te ri zation . We discussed the Indian situation with the perspective of an infant health insurance sector which is, as yet, unable to drive computerization. I took Michael Reiter and

Upcoming CMEs ∗ August 22nd 2008 ∗ Sept 05th 2008 Venue: Hotel Coronet Elegance Opp Shivarkar Garden, Fatima Nagar, Pune 2130 Hrs Details inside

Full Colour version at KWMPA.co.cc

2008 3rd Edition

Michael Waldbrenner, Director Healthcare & Welfare, TietoEnator, to see S a d h u Vasvani Mission Cardiology Institute and the Inlaks & Budhrani where Dr Ritu Bhatia and Dr Sanjay Salunkhe had kindly arranged a guided tour of the facility. S u bs equ en tl y we also visited Jeh an g ir Ho sp it al where Ms. Monica from the PR division showed us the various aspects of care that they provide. The idea was to show

DOUBLE Bonanza

him a charity hospital which works on very different financial equations and a commercial hospital so as to give an overview. Michael was highly impressed with the facilities av ailable here and expressed his keenness to do an article about our healthcare set up. Photos Clockwise from right top: M. Reiter, Dr Bhatia, Dr Prasad (Jehangir), Monica, Dr Salunkhe, Dr Ritu Bhatia (SVM) & ICCU Snap of SVM cardiac centre with Ms. Lachchmi.

Inside this issue Website revamped for better user experience

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Upcoming CME Details

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CME report May 2008

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Back

Medical Myths Shattered Smoking in Movies linked to smoking in children

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CMEs

Brushing teeth may cause endocarditis in susceptible?

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KWMPA Newsletter

Website Revamped for better user experience By Dr Saurabh Bhatia

which were available in the earlier site are also available on this site. So you may easily contact us, choose your CME, fill peer We have revamped the review forms etc

form from the revamped site (Kwmpa.co.cc) to let me know about this.

It was felt that NEW FEATURE: our website is perhaps a little too website completely. Ask your problems. complicated for an CME reports The new version is a This is a Free Service. Citizens average computer and latest news will simpler version are welcome to send us their quesuser within our now be provided ustions regarding health problems. We association. As a ing the power of blogspot. Link is will answer them to the best of our result people were facing issues in available at the site and filters have ability and as soon as possible. Presregistration, logging in and in genbeen provided ently I will answer all eral, navigation was perhaps not as whether you would Ask your problems queries myself but I intuitive as it should have been. like to read news or would appreciate if A free service for some of you can volunreports. Therefore, as an experiment residents of our teer to answer queries to ease your web experience, I have I'll continue from residents of our area started revamped the website completely. to add more features areas. The new version is a simpler version to this new simpler You are also welcome to mail me at where you will not enjoy the beneversion of website. But what I need [email protected] fits of forums, wiki, calendar etc. to know from all of you is whether Or Call me at +91-9881148282 but the page is static and is much you prefer this new simpler, less hifaster to load. Further, tech version or Please remember that the address it should function the old version of our website remains the same i.e. equally well in both which had more You don't need to register KWMPA.CO.CC Internet explorer and tech possibilior log-in. Everything is Firefox. simply available at a click. ties but some restriction As an added about the ease benefit, you don't need to register or of use. PEACE & log-in. Everything is simply availPROSPERITY able at a click. All those forms You can fill in the feedback

GPCON 2008 IMA COLLEGE OF GENERAL PRACTITIONERS - PUNE SUB-FACULTY & GENERAL PRACTITIONERS ASSOCIATION, PUNE Cordially invite you to

GPCON 2008 "PRACTICE ENHANCEMENT THROUGH QUALITY CARE" Saturday 6th & Sunday 7thDecember 2008, TILAK SMARAK MANDIR Enjoy an Academic Feast served by family physicians for family physicians. Delegate fees Rs.600/- Payable by cash or cheque to GPCON. For further details contact Organizing Chairman DR.VIVEK BILLAMPELlY at 9822894963 or IMA PUNE office at 020-24464771 between 3 & 6pm

2008 3rd Edition

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Maternal Weight Gain Appears to Raise Risk of Cleft Palate As reported in the June issue of the leagues studied data on more than American Journal of 220,000 Swedish Epidemiology. Subwomen. In women whose stantial weight gain In women whose BMI BMI rose by 3 or more between pregnancies units in this interval, rose by 3 or more seems to be a factor the adjusted risk of isounits in interincreasing the risk lated cleft palate was 2.3 pregnancy interval, of oral clefts in offtimes higher than in spring, according to those who had no subthe risk of isolated US and Swedish restantial BMI change. cleft palate was 2.3 searchers. However, change in BMI times higher. was not related to the Dr. Villamor of the risk of cleft lip. Harvard School of Public Health,

Boston

and col-

ciation between isolated cleft palate risk and longer inter-pregnancy interval. Dr. Villamor added that "although the mechanisms to explain this association are still uncertain, this finding contributes additional evidence to the importance of keeping a healthy weight throughout life." Re ad t his articl e fully at Www.Medscape.com/Viewarticle/5758 99

An unexpected finding was an asso-

Upcoming CME details 22nd Aug 2008 Speaker: Dr Shashi Apte Topic: Management of patients who

are on anticoagulants and/ or immunosuppressant, coming to GPs & physicians for unrelated problems Dr. Shashi is a hematologist with an in house BMT in the private sector. He has huge experience in management of patients with coagulopathy & immunosuppression 5th September 2008 Speaker: Dr Romesh Joshi; the Medical Specialist, Pfizer. Topic: New challenges in smoking cessation

Achievements

Pooja Gandhi, Daughter of Dr Ravindra Gandhi has cleared Professional Competence Course Examination Of the Chartered Accountants Course. She stood 47th in All India Merit List. KWMPA Congratulates her and their family.

Watch out for an article on KWMPA in the upcoming edition of Street Guardian

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KWMPA Newsletter

CME May 2008 Report The KWMPA concluded its second CME of 2008 on 17th May 2008 at the same old location of Hotel Coronet Elegance, Fat Nag, Pune.

The CME in May was designed to co-incide with

The topic was "Asthma-COPD overlap" and the speaker was Dr Nitin Abhyankar. The event was sponsored by CIPLA It was heartening to see Dr Abhyankar laid stress on that the members had realised from our previous spirometry & expected it to way of working that CME would start bang on time be done more regularly on and no delays would be done. So by 2130 hrs, we respiratory patients. had the quorum to begin on time. Dr Abhyankar gave a lucid made interesting by some and video. Subsequently, dience asked questions for utes which Dr. Abhyankar tiently.

the World Asthma day

talk which was very good slides the animated auover twenty minans wered pa-

This was followed by Dinner.

Clockwise from top: Dr Abhyankar, Audience, Dr Vivek, Dr Salunkhe & Dr Bhatia

A Peer review report is given below. Please fill up the peer review form for the CME directly from the website.

Peer Review Contributed by Dr G V Jog “The take home message of his talk was to MEASURE i.e. Perform spirometry regularly to diagnose and detect improvement/ deterioration and transition from bronchial asthma to COPD. When we perform a haemo-

gram as a routine investigation ( most of which are redundant!), Dr Abhyankar’s message of performing Spirometry more often on patients of Bronchial asthma and COPD, should be taken seriously. All attempts should be made at the primary care level, to follow up patients of Bronchial Asthma regu-

larly, so as to prevent/ delay the transition of a reversible to an irreversible condition.”

2008 3rd Edition

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Shattering Medical Myths Research ref to all the points herein can be seen at http://www.montana.edu/wwwebm/ myths.htm

Myth: Academic review articles are a reliable source of unbiased information.

temperature measured at the rectum to be relied on in clinical situations where accurate measurement is important. Myth: Oral antihistamines are the first-line treatment for allergic rhinitis.

Myth: Insulin must be injected using sterile technique. Truth: It is safe and convenient to inject insulin through clothing. Myth: Serum iron is the best diagnostic test for iron deficiency anemia.

Truth: Intranasal corticosteroids produce signifiTruth: The serum ferritin performed cantly greater dramatically better than any other Thi s a relief than oral diagnostic test or combination r ticl of t antihistae w tests for iron deficiency. he ill b pop mines of the u s ular t so Doc nasal me myt Myth: Corneal abrators hs blockage, let h sions should be covt a hat ve; the Myth: Practice guidelines provide nasal ir p a ered by an eye patch n d t aff rac h well-developed, high quality recom- disto improve healing and ect e t ice y ed charge, g mendations for practice. decrease pain. e b t y th sneezing, nasal em. itch, postnasal drip, Truth: Guidelines published in the Truth: Eye patching was and total nasal symptoms in peer-reviewed medical literature dur- allergic rhinitis. not found to improve healing the past decade do not adhere ing rates or reduce pain in well to established methodological patients with corneal abrasions. standards. While all areas of guideline Myth: Short courses of prednisolone development need improvement, must be tapered and not stopped Myth: "Figure-of-Eight" dressings or greatest improvement is needed in abruptly. is similar appliances are the preferred tion r a c the identification, evaluation, and synu o d i treatment for clavicle fractures. e v a g h Truth: thesis of the scientific evidence. inuin sician be t n o A 10 day l c hy tiona hange p n e v course of Truth: No statistical difference was c on ay to Myth: Bedrest C s a : found in the speed of recovery when h h . t is a useful ad- My fective w utcome , suc ma- 40mg/d clavicle fractures were treated by eis e i f o g of ted rate junctive therapy. an e atient c ther a figure-of-eight bandage or ly st unsolici ges in p n d o n a tion iling of o chan outbroad arm sling. a n i ssem r the ma tle or n r health Truth: A metai D : th o r o e lit analysis of 39 stud- Tru rences Myth: In acute asthma, a nebulizer is strat behavio e n f o n ies of the use of bed co dem sional , a more effective way to deliver medis l rest versus early mo- teria rofes p cation than is a metered dose inhaler h t bilization for preven- heal prednisolone may (MDI) with spacer. . e tion and treatment of a com be stopped abruptly in asthvariety of medical conmatics. Tapering is unnecessary. ditions showed bed rest t o Truth: MDIs with accessory devices be at best not beneficial and at worst Myth: Hypertensive urgency (diastolic are at least as effective as nebulizers harmful BP>120 without evidence of CNS, for treating acute asthma in children. cardiac, pulmonary, vascular or renal A MDI with a spacer for the adminiMyth: Rectal temperature can be end-organ damage) requires rapid BP stration of albuterol was an effective accurately estimated by adding 1°C to reduction, preferably by sublingual alternative to a nebuliser in children the temperature measured at the nifedipine. with acute asthma and resulted in axilla. both shorter treatment time spent in Truth: Hypertensive urgency is gen- the emergency department and fewer Truth: Temperature measured at the erally treated over 24 to 48 hours in a side effects. axilla does not agree sufficiently with closely monitored outpatient setting. Truth: The conclusions of review articles are strongly associated with the affiliations of their authors. Clinical trials with positive results are published more frequently and more quickly than are those with negative results.

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KWMPA Newsletter

Antibiotic Prophylaxis of Endocarditis During Dental Procedures Questioned June 13, 2008 — The practice of giv- Dr Peter Lockhart (Carolinas ing antibiotics to prevent infective Medical Center, Charlotte, NC). endocarditis in susceptible individuals undergoing invaDon't Stop Brushing. sive dental procedures has Lockhart said the unintenbeen called into question by tional message from this the results of a new study paper is that brushing teeth showing that the risk of is bad, but actually the opbacteremia over the long posite is true. "We need to te r m i s h igh er w i th focus our efforts more totoothbrushing than with ward better dental hygiene. tooth extraction . The study, Shall I brush at If the teeth and gums are published online June 9, nite? kept clean with regular 2008 in Circulation, was brushing and the dentist conducted by a group led by dentist fixes any problems, this will reduce

bacteremia and the associated risk of endocarditis,". Antibiotics Not 100% Effective The authors point out that although amoxicillin has a significant impact on bacteremia from a dental extraction, a notable number of the extraction patients who received prophylaxis in this study nonetheless showed evidence of bacteremia; this lack of 100% efficacy alters the perdose risk/benefit ratio, increasing the number needed to treat to avert a distant site infection.

Smoking in Movies Linked to Smoking in Children? William T. Basco, Jr., MD, FAAP

mentary school and to update movie smoking exposure longitudinally,

This study evaluated the effect of tobacco use in movies on smoking behavior in a younger age group of children than has been previously evaluated in the literature. CONCLUSION: Our study, which is the first to enroll children in ele-

“Shah Rukh Khan v/s Ramadoss war may have some basis, after all” indicates that early exposure has as much influence on smoking risk as

does exposure nearer the outcome. Overall, movie smoking may be responsible for at least one third of smoking initiation for children in this age group. The abstract can be read at http://www.medscape.com/medline/a bstract/18166552

Biomarkers Linked to Severe Falciparum Malaria By C. Vidya Shankar, MD CHENNAI, I n d i a ( R e u t e r s Health) Jun 12 - High levLet’s have a higher els of inflammatory media- vascular endothelial tors including growth factor (VEGF)

interferon inducible protein (IP10), soluble tumor necrosis factor receptor 2 (sTNF-R2) and soluble Fas (sFas) are associated with increased mortality in cerebral malaria, while vascular endothelial growth factor (VEGF) is protective, according to the results of a study from India.

eleven biomarkers selected from an initial panel of thirty were measured in all the patients and correlated with the severity of disease. The plasma levels of sTNF-R2, IP-10 and sFAS were significantly elevated among cerebral malaria non-survivors.

After a pilot study, the levels of

viewarticle/575994

More at

http://www.medscape .com/

ee Management Committ

2008 3rd Edition

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Kondhwa-Wanowrie Medical Practitioners' Association, Pune. (KWMPA)

PRESIDENT DR.SANJAY SALUNKHE

Established over a decade ago, KWMPA boasts of vibrant membership with ove r 150 members who make it one of the most act ive medical associations.

VICE PRESIDENT DR SWATI SANGHVI HON.SECRETARY DR VAISHALI PARAB HON JT. SECRETARY DR SUBROTO ROY HON. TREASURER DR.NAVEEN RAINA EDITOR DR SAURABH BHATIA GOV. BODY MEMBERS DR BAFNA SANJAY

is in th rtise e v d To A wsletter To Join the KWMPA, you need to ne t c a t n Fill membership form (downl Co oad from website) atia h B S r D Or contact us 2 4828 1 1 8 through 98 ail pho Or m ne/ mail l.com gmai @ c c . o pa.c D Kwm

DR CEMENTWALA A DR CHAVAN V. DR DIGHE AMOL DR KAMTHE K. DR.MANDLIK V. DR. NAZIR NAZIMA DR. SIAMWALA Z.

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Humour in Medicine A List of Things You Don't Want to Hear During Surgery: Oops! Has anyone seen my watch? Come back with that! Bad Dog! Wait a minute, if this is his spleen, then what's that? Hand me that...uh...that uh.....thingy What do you mean he wasn't in for a sex change! Damn, there go the lights again... Everybody stand back! I lost my contact lens! Well folks, this will be an experiment for all of us. What do you mean, he's not insured? Let's hurry, I don't want to miss "Bay Watch" What do you mean "You want a divorce"! FIRE! FIRE! Everyone get out!

A famous psychiatrist told his wife: "I feel down today, I am going to see my colleague." Wife: " But! you are the best psychiatrist, aren't you?" Psychiatrist: " Yes! I know! But my colleague charges less than I do!"

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