March 2008 Newsletter Kwmpa

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KWMPA

Vol:11 Issue:2008-01 Page:1

Newsletter

The Kondhwa-Wanowrie Medical Practitioners’ Association, Pune. This newsletter belongs to

New Management Committee elected On the eve of 03rd January 2008, the erstwhile president of our association, Dr Raj Chavan hosted a presidential dinner at Shiv-Sagar Restaurant, Wanowrie, Pune. This was preceded by elections for the new management committee, conducted by Dr Priya Rajadhyaksha. After due deliberations, a new committee was elected under the leadership of Dr Sanjay Salunkhe.

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The New Members elected are: President : Dr Sanjay Salunkhe Vice president & President elect: Dr Swati Sanghvi Secretary: Dr Vaishali Parab Joint Secretary : Dr Subroto Roy Treasurer: Dr Naveen Raina Editor : Dr Saurabh Bhatia Editorial board: Dr Alifia Cementwala; Dr Zohra Siamwala Immediate past president : Dr Raj Chavan Members of committee : Drs. V Mandlik, Kunal Kamthe, Nazima Nazir, Sanjay Bafna, Amul Dighe & Vaishali Chavan

From the President’s desk Dr Sanjay Salunkhe With the ushering in of a new team in January 2008, we found our task cut out for the year. Our first MC meeting allowed us to determine that the KWMPA had enrolled 161 members till date; While 6 had left Pune for good, the contact details of 6 others had changed entirely. We presently have current mailing addresses of 149 members who will get newsletters by courier henceforth. We will intimate all but 57 members about CMEs/ meetings by email, all but 32 by an SMS 24 hours before the CMEs; But we are concerned about 24 members who, if they do not receive the newsletter have neither an email nor a declared cell phone number. So for those who cannot physically attend we may organize a webcast . For making the above statements possible, let's applaud the "KWMPA Call Center"(!) V Mandlik, A Cementwala, N Raina, Kunal Kamthe, Zubbin, Vaishali Parab, Saurabh Bhatia, Raj Chavan & Nazima; overseen by PP Priya who was the last one to compile the list three years ago.They followed-up 15 members each to help create an Excel sheet (now available on our website kwmpa.co.cc) where all members' current contact details are available for view. We request all members to peruse a print copy of this sheet during the 15 March meeting and make corrections, if any. Specifically, please update three new columns. Everyone knows your degree. We now want to know in case you have a Special niche area in practice (panchakarma, or anterior segment ophthalmology these are two examples already on). There is a separate column for Non Medical interests eg gardening; who knows we may then be able to network & form common (non medical) interest groups amongst us. One column will be devoted to Hospital Attachments. I'm sure you will make that exhaustive; your business interests will dictate that! .......................Cont’d on page 2

KWMPA Newsletter

Upcoming events "What's New in Medical Oncology_ Targeted Therapy in Cancer" Dr Shona Nag, Medical Oncologist, Jehangir Hospital, Pune. on Saturday, 15th March, 2008 at 9.30 pm Venue: The Coronet Elegance, 6th Floor opp Shivarkar Garden, City International School; Fatima Nagar, Pune (2681 1500) CME will be followed by Dinner

KWMPA now has a website While 2008 paved the way for a new Management committee, it also ushered in the web era for KWMPA. We now have a full fledged website. Please pay us a visit at KWMPA.co.cc What can you do there: The website has been made using MOODLE, a popular learning content management system. This has allowed us to bring you feature rich content. You must create your free account by visiting and clicking login. New members can also join us online. You will be able to send messages to any other member. The Rules and Regulations of KWMPA are available online for your ready reference. We have also uploaded a database of members with their contact numbers. Not only will this ensure that other members can access your data freely, it will also be possible that GOOGLE will show your data to public searching for relevant doctors. For learning and knowledge sharing, we have put a WIKI on the site. It is a collaborative system of document creation. Anyone can edit and contribute. So if you see a topic of interest and wish to add something to the info, then just add it there. Or, may be, start your own topic and share knowledge. We can put medical quizzes there and on polls, you may vote for the topics highlighted. Further, the website has News Forum which allows you to post any news which automatically gets e-mailed to all members. There are social forums/discussion boards where you can start topics close to your heart and discuss them with others. Or just read around about what others are discussing. An upcoming event section allows you to immediately see the details of upcoming CME, picnics etc. Further, this newsletter will also be available onsite for online reading. Lastly, you may chat online with other members who are also online. Since the website is still experimental, please provide feedback at [email protected] or call 09881148282.

Copyright KWMPA. For Members only. Not for sale. Sponsored by Ruby Hall Clinic, Pune

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Family Get Together

From the president’s desk (cont’d)

On 20th Jan 2008, Dr Raj Chavan, the outgoing President of our association, and his wife Vaishali, organised a family get together for the members at Green Valley. The event was hosted in the green environs of the lawn and had a DJ playing music right from the beginning. As members started trickling in, the party picked up the Josh and soon we had musical chair and dance being organized for children. Sometime after that, the outgoing committee started the handing over process of the various charges to the new committee. The outgoing members were duly felicitated for their active contribution during the past year. This was followed by a short initial speech by the incoming President Dr Sanjay Salunkhe who shared his vision for activities that he planned in the coming year for the association members. He went on to formally introduce his team members. An announcement was made about the launching of KWMPA website and a lot of members appeared visibly excited at the prospect of better and prompt communication. Following this the President mentioned the Key Result Areas where he’d lay stress on, in the coming year. One of the top things on the agenda was to prepare a comprehensive list of members along with accurate contact details so that we may promptly communicate with each other. In the past, this has been seen as a pain point. Dr Salunkhe created an action team on this and each member of the committee, including Dr. Priya and Dr. Zubbin were involved in ensuring the definitive status of each members’ contact details. The president also announced his continued efforts in getting sponsorship for the Newsletter from Ruby Hall. Once the ceremony was over, the Master of the ceremony paved way for Dance and Dinner. The members could be seen enjoying both alternately. The fiesta ended around ten-thirty at night with everyone appearing to have had an enjoyable weekend that had charged the batteries for the working week ahead.

The Managing Committee (MC) met twice and the minutes of all meetings will soon be available for view on the website.

Dr S Bhatia (Send feedback on [email protected])

Saurabh's editorial team with Alifia, Zohara & Zubbin have set deadlines for themselves to see you get the newsletter in time. Vaishali Chavan helped liaison with Ruby Hall for the sponsorship of the Newsletter. Swati & Shekhar Sanghvi helped liaison with Coronet Hotel for the venue; and lead a core team of Amol Dighe, Nazima, Alifia, Subroto Roy & Sanjay Bafna to make the first meeting a success. The names of the MC members (emails, cellphones, etc.) will be permanently available for view on the website for this year. However, the print space devoted for this in newsletters shall be used to acknowledge contribution of members who actually worked for the association (MC members or otherwise). Working & suggesting projects/events for KWMPA need not be the prerogative of MC members. So feel free to send me an SMS (9822051735) if you have suggestions & want to participate in “MC" meetings; I will ensure that you are invited. I think none of us is more "respectable" than the other. KWMPA will grow rapidly only if each member wishing to contribute actually gets to do so. Call me Marxist if you like! but we should be a classless Society. We look forward to your incessant active participation and cooperation in making your KWMPA better .

Eye Surgery While my friend was working as a receptionist for an eye surgeon, a very angry woman stormed up to her desk. "Someone stole my wig while I was having surgery yesterday," she complained. The doctor came out and tried to calm her down. "I assure you that no one on my staff would have done such a thing," he said. "Why do you think it was taken here?" "After the operation, I noticed the wig I was wearing was cheaplooking and ugly." "I think" explained the surgeon gently, "that means your cataract operation was a success.” Get well message A motorcycle patrolman was rushed to the hospital with an inflamed appendix. The doctors operated and advised him that all was well. However, the patrolman kept feeling something pulling at the hairs on his chest. Worried that it might be a second surgery the doctors hadn't told him about, he finally got enough energy to pull his hospital gown down enough so he could look at what was making him so uncomfortable. Taped firmly across his hairy chest were three wide strips of adhesive tape, the kind that doesn't come off easily. Written in large black letters was the sentence. "Get well quick..... from the nurse whom you fined last week.”

Young achievers This space is for the kids of the members to highlight their talent; write a poem, short story, sketch, or share success stories like academic success, sports achievements, stage performance etc. Send contributions to Dr Saurabh Bhatia at [email protected]

Please send feedback to Sanjay Salunkhe on Mobile:98220 51735 Email: [email protected] ,

Advertising rates: Quarter page (1/4) - Rs. 500/Half Page - Rs. 1000/Full Page - Rs. 2000/Chemists/ doctors and other healthcare related businesses are welcome to advertise Please contact Dr Saurabh Bhatia, Editor Mob: 09881148282 Email: [email protected]

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Shardul Parab age 10 years, S/o Mr. Shailendra Parab and Dr. Vaishali Parab, was selected as the "KIDS IDOL", in the age group 9 to 14 years, for the year 2007-2008 by MAHARASHTRA HERALD. Sketches: House sketch By Lubaina Cementwala, Age: 9 St. Mary's School, Std. 4. Shin Chan By Saaz Bhatia Age 9 APS, Std-IV

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Breathe Your Weight Out Dr. Alifia Cementwala.

Where health for all is a reality, not a dream...

By Dr Amol Dighe A lot of people claim that their hectic schedule leaves In today's life we often end up neglecting our greatest them little time for a regular exercise regimen. For them, there is an easier technique involving Deep Breathing gift “our health”. A need for maintaining this gift is therefore Exercises. Deep breathing offers benefits that might make a the need of time. One such institute which caters to this is the Dr M.L.Dhawale Memorial Trust (MLDT). It is a not-for-profit major difference in health NGO formed by students and well wishers of late Dr The lungs are larger at the bottom than at the top but M.L.Dhawale, a renowned homoeopath and educationist most people in the world are top breathers, living on the after his demise in 1987. shallow breaths common to the sick and the sleeping. Deep It provides homoeopathic education, community breathing exercises increase the metabolism of the body medical care and research. The trust is having an existence and thus burn that extra fat. in Mumbai, Palghar, Pune, Vadodara, Bangalore and Breathing “from the gut”: If one can see the stomach move Kolhapur. The primary concern of MLDT is to make primary in and out, one is breathing from the diaphragm. If the only and secondary health care services available and thing that moves or expands is the chest, one is living on a accessible to the underprivileged rural population. The core shallow percentage of the divine potential for deep competency of all the doctors attached to the institute is breathing. Deep breathing literally “massages” & moves the homoeopathy and providing voluntary/ honorary services; soft internal organs inside the rib cage allowing the lymph they strive to serve the community through their profession. system to rid itself of collected toxins. Only deep breathing The institute has been functional in rural health care allows to tap the “bonus power” of the lower lungs. activity for over two decades, and has established Neonates instinctively breathe deeply; watch and operational health care models in the form of homoeopathic learn at the next opportunity. We actually “learn” how to hospitals and clinics at various locations. Community “shallow breathe” & rob ourselves of the breath of life. development activities in the above stated regions have Singers, stage performers, broadcast announcers & become an integral part of the rural services and are professional athletes pay large sums to voice and breathing undertaken with the help of a team of social scientists coaches to learn how to breathe, project the voice, & achieve representing the TISS (Tata Institute of Social Sciences) and MS University, Vadodara. maximum strength through diaphragm breathing. The educational activities include PG Training courses for qualified homoeopathic doctors. Smt. Malini Kishore Sanghvi hospital and college at Sumeru, district !Sit or lie down and relax. Vadodara is another proud achievement providing excellent !Place a hand on the abdomen to see if it expands as you and qualitative care at most cost effective rates. breathe. If only the chest moves with the breaths, then it is The Pune branch of the institute has been in action “shallow breathing”. since 1995 and the seed of the charitable activity sown in !Breathe deeply through the mouth, “all the way down to the 1995 in the form of the first charitable activity at Nigdi, has belly button”. The abdomen should rise with inhalation. Hold now grown into a huge tree and spread out all across Pune the breath for a few seconds, and then exhale slowly and district. The trust presently runs 3 charitable clinics in the fully. Learn to recognize the sounds and sensations of long, urban slums of pune, ICR homoeopathic specialty centre, a 10 bedded nursing home which was set up in April 2001 at slow, deep breaths. Pimpri & has since been serving the industrial working class !With practice, one may will relearn the natural process of and the lower income groups in the suburbs of Pimpri and breathing the way it happens in neonatal period boosting the Chinchwad. A semi-charitable homoeopathic clinic set up in immunity & increasing the metabolism thus controlling the Pirangut for the last 3 years has received excellent response and is source of reliable health care for many in the vicinity. weight. Here are a few steps to get started:

Editor’s remarks: Of course, it’s strongly recommended to consult your physician before embracing any type of therapy or exercise regimen. It must be understood that pregnant women breathe predominantly from the chest so as to make way for the expanding uterus in the abdominal cavity. Caution should be exercised if the patient has any respiratory illness or any situation where increasing the intraabdominal pressure is contraindicated. Further, negative intra-thoracic pressure improves blood flow to heart increasing the pre-load. Thus this should be avoided in related cardiac problems.

KWMPA Newsletter

A mobile clinic visits 5 villages on 3 routes every week, taking quality health care services to the doorstep of the poor villagers who cannot afford to travel to the city for treatment. Often patients requiring hospitalization have been treated at no cost in MLDT nursing homes and free homoeopathic camps, cataract surgery camps and the like are activities commonly taken up by the trust. All in all this is one trust which believes and implements the motto of WHO “Health for all” in toto. Contact Person: Dr. Amol Dighe [email protected]

Science and Sensibility: An Interview With Professor Rolf M. Zinkernagel, Nobel Prize Winner for Medicine 1996

Life in Basic Research

Do you believe that being in big institutions ( such as the Ivy League institutes) enhances the prospects of one Editor’s comments: I have included this piece not merely winning the Nobel Prize as against, say, being the head because of academic merit but also for the pleasure of of a smaller laboratory early in your life? reading a Nobel Laureate’s radical comments expressed There is no such standard rule, provided that you have the with conviction. facilities needed to carry out your research. At the end of the day, you simply need to be lucky. You can get lucky in a small Prof. Rolf M. Zinkernagel was institution or a big one. When Peter and I were working on awarded the Nobel Prize in solving the problems of MHC-restricted immune T-cell Medicine/Physiology in 1996, along recognition, the Eureka moment came in Canberra, with Prof. Peter C. Doherty, for Australia. It was so unexpected, so serendipitous, that the discovering the specificity of cell- most important thing we did was not to miss it! Had we not mediated immunity. They conclusively demonstrated that discovered it, somebody else would have surely done so recognition of microbial antigens by our immune system is sooner or later. Discoveries can occur anywhere. possible only in association with self-molecules, known as Is it necessary to strive for international scientific the major histocompatibility complex . exposure during one's formative years? Hrishikesh Kulkarni and Ajit Goenka, MBBS, spoke to him on his work, life, and beliefs after his lecture on "Why Do We Not Have a Vaccine?" at the 57th Meeting for Nobel Laureates and Students in Lindau, Germany, in July 2007. Dr. Zinkernagel, which arm of the human immune response has the potential to protect against diseases, such as HIV? Antibodies. They are the key. The course of any infection depends on the host's response, and I believe that this has to be through antibodies. What about the role of regulatory T cells then? In my opinion, there is no such thing as a regulatory T cell. HIV, SARS, multiple Drug-resistant tuberculosis, Ebola - the list is endless. We never had them until a few years ago. Why do we continue to grapple with all of these diseases despite our scientific prowess? This is simply because the life span of human beings has far exceeded what it was intended for. The main function of human beings in evolution is procreation, which is usually completed by the 25th year of age. With our scientific prowess, we have prolonged our age, thus inviting a host of new diseases. I would add autoimmune diseases to the ones that you have mentioned. However, from an evolutionary point of view, this is perfectly fine. Most of the diseases affect man after the age of 25, by which he has procreated in any case. So it doesn't really matter if you die after then; your contribution to evolution is complete! The irrational behavior of human beings has also significantly contributed to the above-mentioned predicaments.

Definitely. Being in one's own geographic niche is not enough. For example, I went all the way from Switzerland to Canberra because I wanted to compare cell-mediated immunity vs antibody-effector mechanisms in infectious disease models, such as Salmonella and Listeria. These weren't available in our laboratory back then. Dr. Robert Blanden was already working on this in the Department of Microbiology in Canberra, so I joined him. After that, I met Pete, who was working on immune responses to the lymphocytic choriomeningitis virus. While he did the immunopathologic analyses with the brain and the cerebrospinal fluid, I could do the cytotoxicity assays with the prior experience I had from Lausanne, Switzerland. Through our work, we discovered MHC restriction. Moreover, I met some of the people who influenced my life the most during my stint in the Scripps Clinic, La Jolla, California. Science is one of the most international activities there is. It can never be restricted to a single laboratory or even a nation, if progress is to occur. Life After the Nobel How does your life after the Nobel Prize compare with the earlier routine? It really hasn't changed anything for me, but that is because I haven't let it. I admit that there is pressure to come out with better results. We have done more research on immunologic memory, the role of the immune response in autoimmunity, and the development of better vaccines for hepatitis B and C and HIV, but none of them are as fundamental as the discovery [of MHC restriction] in itself. Our work with MHC restriction gave a biological role to this system, which till then was only associated with transplantation. Even Nobel Prize winners do not get better with age!

Dr. Zinkernagel, not many of us will be comfortable with (These are Excerpts only. If you are interested in the Full the idea of dying at around 25-30 years of age or, for that interview , you may access it at matter, not taking antibiotics for bacterial meningitis. http://www.medscape.com/viewarticle/564375) Well, that's what is in nature's best interests. Regardless, the fact remains that, with medical advancement, something like that isn't really going to happen and hence, we will keep suffering from such disease.

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Role of the Quality of Healthcare Providers in the Quality of Healthcare By Dr Saurabh Bhatia ([email protected])

When I was a child, I often used to hear about seriously ill acquaintances being taken to USA for advanced treatment. Over the past decade, we have witnessed a reverse influx in the f o r m o f M e d i c a l To u r i s m . India, among others, is a LCC or 'Low Cost Country' where almost anything can be done at a fraction of cost compared to west. Coupled with this, the health infrastructure of the west has been stretched to its limits; Medicare and Medicaid are facing cash crunch while NHS of UK has egregious waiting lists. Propelled by this patients have been driven in droves to India . The question is that while they do come for cheap treatment, do they also come for sub-standard treatment, knowing that our IMR is at 54.63(2006) (41st rank globally)? Though the answer to this question is perhaps 'no', because they still come to the best of hospitals of India, the overall quality of care in India remains questionable. Medical tourism can be seen as a new industry for the doctors to milk. But it will not work out unless we are able to provide doctors of international quality. Merely state of the art equipment cannot suffice. So are our doctors’ skill set and competence equivalent to that of international physicians, in general? Western high quality of care is partly delivered due to a continuously educated doctor. The doctors in west need to upgrade their skills continually. A compulsory need to maintain CME hours every year and periodical licensing exams have drilled quality consciousness among doctors. Compare this to our lackadaisical system where after doing medicine 35 years ago, doctors are left to their own devices to upgrade skills. Unfortunately this upgradation usually comes at the cost of biased education to the doctor, delivered through sponsorships with vested interests. Editor's quest: Should doctors in India be required to compulsorily appear for licensing exam every five years and maintain minimum CME credits for every year? You may cast your vote on our website KWMPA.co.cc or SMS "EQ-Y" or "EQ-N" at 09881148282. KWMPA Newsletter

Know your colleagues KWMPA has been in existence for over a decade. We have members of every age group and specialities. While the older members are well versed with each other the newer ones have not been able to make as many social inroads as they might have hoped for. In order to promote camaraderie and better acquaintance, we have decided to run this column where we’ll write 50-75 words about members of KWMPA; starting from newest members backwards. This will help everyone know who all have joined newly and the older members can take appropriate steps to not only initiate the new members into the community but to also make them feel welcome and comfortable.

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Continued Medical Education Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care Enid M Hunkeler,Wayne Katon, Lingqi Tang, John W Possible mechanisms of action Williams Jr, Kurt Kroenke, Elizabeth H B Lin, Linda H Harpole, Pat Arean, Stuart Levine, Lydia M Grypma, William IMPACT actively engaged an often reluctant population in A Hargreaves, Jürgen Unützer (Excerpts only) Full CME at effective depression treatments. Patients appreciated BMJ, doi:10.1136/bmj.38683.710255.BE (published 20 January 2006) receiving medical and psychological care in primary care.

To begin with, we ‘d request all those members who have joined us in last 2 years to send a small 50-75 word write up about themselves. This may include their professional capability/ interest as well as personal things like hobbies, societies, NGO involvement etc. (No political inclinations please). It’d be nice to include a passport size photograph for others to relate and identify the person immediately.

Objective To determine the long term effectiveness of collaborative care management for depression in late life. Design Two arm, randomised, clinical trial; intervention one year and follow-up two years.

We decided not to carry out any introductions in this edition because we had not been able to communicate this intention to all the members and therefore to keep it fair and free, we decided to publish them from next issue onwards. So hurry and send your profiles to the editor Dr Saurabh Bhatia at [email protected]

Among the one in 10 older primary care patients with depression, only a small fraction receives adequate treatment in primary care or sees a mental health specialist. Although treatment of depression in primary care has improved, few improvements deal with the specific needs of elderly patients.

Kamal Hospital Dr Vaishali Chavan, MD, DGO, DNB, DFP (Infertility and Laparoscopic surgery) Consultant Gynecologist, Ruby Hall Clinic

Dr Raj Chavan, MS, DNB (ENT) Micro ear surgery Endoscopic nasal surgery Consultant, Jehangir Hospital

Introduction

Open 24 Hours All Laparoscopic and Endoscopic surgery facilities available.

Perhaps because of IMPACT’s emphasis on relapse prevention, even 12 months after the intervention ended, IMPACT patients reported higher rates of antidepressant use, greater self efficacy in managing their depression, and better depression outcomes than controls. IMPACT’s NNT of 4 at 12 months shows a strong clinical effect. The later numbers needed to treat—6 at 18 months, and 9 at 24 months—although higher, show that the clinical effect was substantial and sustained.

In 2002, one year findings were published from the “Improving Mood Promoting Access to Collaborative Care What is already known on this topic Treatment” programme (IMPACT), an intervention designed specifically to tackle unmet needs of elderly !People over age 60 often receive inadequate treatment for depression in primary care depressed patients. !Organized, multifaceted, and tailored depression treatment programs are promising. We report the long term (18 month and 24 month) results of the IMPACT trial. Our hypothesis was that, even a year after !IMPACT produced favorable results during the one year the intervention ended, intervention patients would intervention. !It is not known if these promising results endure. experience more enduring health benefits than controls. Intervention

What this study adds

Acute depression care IMPACT care was delivered by a team: a depression care manager (usually a primary care nurse), the patient’s primary care doctor, a consulting psychiatrist, and a liaison primary care doctor. For 12 months, IMPACT patients received proactive depression treatment in primary care. Treatment options included pharmacotherapy, behavioural activation, and problem solving treatment (a brief, behaviour based psychotherapy). Treatment was adjusted according to a stepped care protocol during weekly reviews by the depression care manager and psychiatrist. Consulting psychiatrists saw about 10% of patients, typically treatment nonresponders.

!Tailored collaborative care actively engages people over

Balaji Shelter, 47/3, Wanowrie, Pune-40

Call: 26875752

They benefited from an ongoing, therapeutic relationship with a depression care manager, who followed a stepped care treatment protocol driven by clinical outcomes

Discussion IMPACT collaborative care delivered long term improvements in antidepressant use, patient satisfaction, and clinical outcomes. For two years, IMPACT patients were less depressed, functioned better physically, enjoyed a better quality of life, and were more satisfied with their depression care. This was true for both sexes, all age groups, ethnicities, degrees of depression, and physical comorbidities. Although the benefits of IMPACT attenuated at 18 and 24 months, significant health benefits endured even one year after IMPACT resources were withdrawn. KWMPA Newsletter

age 60 in depression treatment and delivers important benefits that persist at least one year after the completion of the intervention program. !IMPACT may show the way to less depression and healthier lives for millions. Other studies Two studies showed that IMPACT’s success may hinge on its seamless integration into primary care and, perhaps more importantly, the patient’s relationship with the depression care manager. The PRISMe study showed that older patients are more likely to engage in depression treatment when it is offered in primary care. The nurse telehealth study showed the importance of a therapeutic relationship with a skilled and empathetic care manager in primary care. Two trials in mixed aged populations show that collaborative care can reduce depression over the long term, two to five years. IMPACT extends these findings to elderly populations. IMPACT also improved physical functioning and quality of life.