IMA joins issue with health ministry on short-term medical course

November 2, 2011 Leave a comment

NEW DELHI: A day after TOI reported on the Union health ministry’s plans to roll out the 3.5-year medical degree, the Indian Medical Association (IMA) asked the Medical Council of India (MCI) not to compromise on patients’ safety.

Reacting to the three-week ultimatum given by Union health minister Ghulab Nabi Azad to the MCI on the BRM (Bachelor of Rural Medicine), national president of IMA Dr Vinay Aggarwal on Tuesday said the MCI would not bend before the government and refused to endorse the course. IMA called for more debates ahead of falling in line with the government’s directive. “IMA is willing to cooperate with the government to find a solution on rural health,” the letter said.

It added, “There are better ways to overcome the shortage of modern medicine professionals in rural area. Lowering the standard of medical education and producing low-quality professionals is not the solution.”

Dr Aggarwal said, the MCI is mandated to upkeep certain standards and cannot be bullied. “It is duty bound to consider patient safety and cannot obliviously reverse a process initiated by the Bhore Committee report of 1946 to abolish such mediocre short-term courses.” IMA says it is not convinced about the government’s intentions on BRM.

“The notion that over 30% of primary health centres do not have a MBBS doctor is not supported by statistics. Only 5.3% of PHCs are without a qualified doctor. For whatever small shortfall that exists, compulsory rural health posting of MBBS graduates for one-year after internship would make available 30,000 MBBS graduates every year. The National Human Rights Commission has come out against such a course, and has termed it as discrimination,” IMA said.

TOI on Tuesday had reported that Azad set the MCI a three-week deadline to endorse this new course, failing which the ministry will issue a directive to the MCI to recognize and roll out the course. Azad had said that the course had enjoyed the backing of all the state governments for long, and attributed the tardiness to MCI’s apathetic attitude.

“We have made up our mind to introduce the Bachelor of Rural Medicine degree. Sometimes the MCI gets influenced by its own fraternity. With doctors unwilling to serve in rural areas, even after being given incentives, we are left with no choice but to introduce a new cadre of health workers,” Azad had told TOI.

He had added, “We want an MCI stamp on the degree so that it is universally recognized. The syllabus of the course is ready and it is need based. If MCI endorses it, students will get the confidence that the degree has a standing. If MCI does not agree, we will send them a directive which they have to adhere to.”

Union health secretary P K Pradhan had added, “They will be rural public health officers and will look after primary and preventive healthcare. They will not carry out surgeries.”

Sources:- Times of India


Diabetes Mellitus

October 13, 2011 Leave a comment

By Dr. Chakshu
“The International Diabetes Foundation estimates there are 246 million adults worldwide suffering from diabetes today; by 2025, the figure is expected to reach 380 million.” Recent WHO calculations indicate that worldwide almost 3 million deaths per year are attributable to diabetes.

Diabetes Mellitus (DM) refers to a group of common metabolic disorders that share common phenotype of hyperglycemia. Several distinct types of DM exist and are caused by a complex interaction of genetics and environmental factors, Depending upon etiology of DM. factors contributing to hyperglycemia include reduced insulin secretions, decreased glucose utilization and increased glucose production.

The metabolic disorder associated with DM causes secondary pathophysiological  changes in multiple organ systems that impose a tremendous burden on individuals with diabetes. DM is the leading cause of end stage kidney disease, non traumatic lower extremity amputations and adult blindness. It also predisposes to cardio vascular disease.

DM is classified on the basis of pathogenic process that leads to hyperglycemia, as opposed to earlier criteria like age of onset or type of therapy. Two broad categories of DM are designated as type 1 and type 2. Type-1 DM is the result of complete or near total insulin deficiency. Type-2 DM is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion and increased glucose production.

Insulin is the hormone produced by pancreas and is the main regulator of glucose metabolism in the body. Other etiologies for DM include genetic disorders, gestational diabetes, drug induced etc.

Risk factors for developing type 2 DM include high cholesterol levels, high BP, high fat diet, high alcohol consumption, sedentary lifestyle, overweight, giving birth to a baby weighing 9 pounds and above. Ageing is significant risk factor for type 2 DM.

Diagnosis – Criteria for diagnosis of DM are (1) symptoms of diabetes + RBS equal to or greater than 200 mg/dl or (2) FBS equal to or grater than 126 mg/dl or (3) two hour plasma glucose equal to or greater than 200 mg/dl during an oral glucose tolerance test.

Symptoms of type – 1 are often dramatic and comes on very suddenly in childhood often in association with some illness like viral infection or urinary tract infections. But in case of type – 2 DM, symptom could be present a decade ago in the form of impaired glucose tolerance.

Common symptoms of diabetes are – fatigue, unexplained weight loss, excessive thirst, excessive urination, excessive eating, poor wound healing, infections, altered mental status, blurred vision etc.

Complications – both forms of DM ultimately lead to high blood sugar level, a condition called hyperglycemia. Over a long period of time, it damages the retina of the eye (diabetic retinopathy), which is the leading cause of blindness, the kidneys (diabetic nephropathy), a leading cause kidney failure, the nerves (diabetic neuropathy), leading cause of wounded foot ulcers which frequently lead to foot and leg amputations and the blood vessels because of usually associated high cholesterol levels and leads to increased risk of heart disease, raised blood pressure and stoke. Damage to nerves in autonomic nervous system can lead to gastro paresis or chronic constipation or chronic diarrhea and inability to control heart rate and blood pressure during postural changes.

Hypoglycemia or low blood sugar occurs from time to time in most people with diabetes who are on treatment. It may result from over treatment, missing a meal, doing excessive exertion, any acute illness. Common symptoms are headache, dizziness, poor concentration, tremors of hands and sweating.

Diabetic ketoacidosis is a serious acute complication in which uncontrolled hyperglycemia causes build up of waste products called ketones  in blood which can cause nausea, vomiting, altered mental state or even weakness of whole body. It is precipitated by infection, stress, trauma, other medical emergencies like stroke or heart attack.

Hyperosmolar hyperglycemic non ketosis syndrome is also an acute complication associated with very high level of blood glucose with severe dehydration.

Diabetes prevention – There is no proper way to prevent DM – 1 but DM – 2 can be prevented by controlling weight (normal/near normal weight), regular exercise for 20 minutes three times a week, quitting smoking and alcohol, decreased oil consumption. This is called lifestyle modification. Also some new drugs help in prevention up to some extent. If DM – 2 is diagnosed then 1st line of treatment is medical nutrition therapy I. E. diet as advised by a dietician and regular exercise. 2nd line of treatment is oral hypoglycemic agents like metformin, glimiperide etc.

3rd line is Insulin which is the 1st line of treatment for DM, type – I. Usually insulin are ultra short acting, short acting, intermediate, long and ultra long acting. Nowadays newer preparations are available which can be given once a day rather than 3 – 4 times a day.

Newer advancements – new drugs which may stop damage to insulin secreting cells and newer insulin like intranasal/oral. If patient has complications of diabetes (eye, kidney or nerves),it should be dealt accordingly. The skin should be taken care of by keeping it supple, hydrated to avoid sores and cracks that can become infected. See a dentist regularly to prevent gum disease. The feet should be washed and examine daily looking for small cuts, sores or blisters that may cause problems later. If you or someone you know already have diabetes, your focus should be on preventing the complications which can cause serious disabilities such as blindness, kidney failure requiring dialysis, amputation and death. Mainstay of treatment will be regular blood glucose monitoring and regular follow up with your physician.

Author is an MD (General Medicine)
Consultant Physician,
Shija Hospitals and Research Institute.

Sources:- Imphal Free Press

RIMS for the first time introduces Biometric Attendance Recording System

September 22, 2011 5 comments

Regional Institute of Medical Sciences (RIMS) has so far produced 845 specialist doctors to its credit and for the first time has introduced Biometric Attendance Recording System in the institute to create work ethics among its employees.

Earlier known as Regional Medical College (RMC), it was established in 1972 and came to be known as Regional Institute of Medical Sciences (RIMS) on April 1, 2007. It has so far produced 2533 doctors of which 845 are specialist doctors in different fields.

Official sources revealed that due to the advancement in the field of health care system, the institute has been able to produce another 22 M Phill in Clinical Psychology. The doctors and specialist doctors produced by this institute are serving in different parts of the state as well as outside the state.

The source further said that RIMS has for the first time introduced Biometric Attendance Recording System to basically create a work ethics among its employees. This will enable the employees to perform their work accurately. It will also help to streamline their works.

Two broad bands of 4mbps and 100 mbps have also been installed in the institute. Sixty four CT scanner, Anesthetic Work station, Urodynamic system, equipments of ERCP and 7 Blood Glass Analyzer has also been installed in the institute.… Read More

via 845 specialist doctors to RIMS’ credit

Womb Cancer Risk Linked to Cakes

September 9, 2011 Leave a comment

Cakes, biscuits and buns can significantly increase women’s chances of developing womb cancer reveals a study.

Women who indulge in sweets two to three times a week were at 33 percent higher risk of developing womb cancer. Study further revealed women who snack on cakes, biscuits and buns more than three times a week are 42 percent more likely to suffer from the disease.

However, people with sweet tooth need not be disappointed as the researchers describe this degree of effect to be modest and warrant further investigations.

Scientists of the Stockholms Karolinska Institute revealed that excess sugar release more insulin , this can result in excessive cell growth in the inner membrane of womb.

Swedish scientists studied thousands of women to know the link between sugary food and womb cancer. Between 1987 and 1990, women were asked dozens of question related to their general health, diet, lifestyle and weight. After 10 years, these women answered more extensive questions related to their eating habits and lifestyle. In 2008, all the information was matched with their medical records, especially the diagnoses of endometrial cancer (most common form of womb cancer).

Out of 61,226 women 729 developed cancer. Women who snacked on cakes, bun and biscuits were 42 per cent more likely to develop cancer than those who had less of them. High sugar items such as sweet, soft drinks, colas and marmalade pose little or no risk of womb cancer, researcher said.

According to British cancer experts it is too early to draw any firm conclusion.

India to have 6.4 cr cardiac patients by 2015

September 9, 2011 Leave a comment

New Delhi, Sept 8 (IBNS): The number of people affected by cardio-vascular diseases was about 3.8 crore in 2005 and may go up to 6.4 crore by 2015, according to Ministry of Health and Family Welfare.

In the recent years, there have been transitions in the healthcare sector, propelled by socio-economic and technological changes. Among these health transitions, the most pervasive change has been the rising prevalence of cardiovascular diseases (CVD).
However, what is more worrisome is the fact that a large chunk of Indian population does not have access to essential medicines to deal with the deadly diseases.

Dr. Nilanjan Banerjee, a general physician, said, “According to British medical journal Lancet, about 80% of Indians are averred from receiving essential drugs for the treatment of cardiovascular complications.

“The report highlights an average Indian suffering from heart attack or stroke was almost seven times less likely to receive common inexpensive anti-platelet drugs than people from developed countries.”

Moreover, heart disease is no longer confined to urban pockets any longer. It has already emerged as a major cause of death in rural areas.

According to Ministry of Health and Family Welfare, the number of people affected by cardio-vascular diseases was about 3.8 crore in 2005 and may go up to 6.4 crore by 2015.
 Other studies point out that the percentage of people aware of their condition is only 30 per cent in cities/towns and 10-12 per cent in villages.

Along with low access to the essential medicines, there are several other factors that have had a role to play in the increasing number of heart patients.

 Dr. A.K.Jhingan, Chairman DDRC, said: “The healthcare in India is becoming sordid as the day passes with dormant lifestyle habits such as excessive consumption of alcohol and smoking, irregular eating habits, lack of awareness about the lifestyle diseases such as diabetes, hypertension, obesity, cardiac diseases, arthritis, to name a few Arte leading to cardiovascular diseases.”

Access to quality healthcare for all in India has been a farfetched goal that has still not been achieved. With increasing number of patients suffering from cardiovascular diseases, it has become essential to find a way out.

According to industry reports, currently there are 1,350 new medicines in the making to tackle non- communicable diseases out of which 299 are for cardiac diseases.
These next generation medicines are expected to be far more superior and effective than the present variants and can make patients live longer, healthier and more productive lives.
However this process of drug development will be effective only if the medicines reach the patients who need them the most at the right time.


Every district in India will have a medical college within next five years

August 30, 2011 Leave a comment

In order to bring down the shortage of doctors and improve healthcare services at the minutest level, the government is planning to have medical colleges in each district.

It has plans to convert district hospitals into training institute the paramedical personnel as well.

Besides, the government also plans to integrate AYUSH doctors and have capacity building programmes for other traditional healthcare providers such as Registered Medical Practitioners (RMPs) and Traditional Birth Attendants (TBA) so that traditional care practices and local remedies are encouraged.

Health ministry sources indicated that the AYUSH doctors may be trained further to handle normal chidbirth cases in remote areas.

They will also be trained to take care of serious medical cases so that the patient is stabilised before he/she is sent to bigger hospital. Ministry officials said that this help will bring down maternal and infant mortalities.

Expressing concerns over the low density of doctors and paramedical staff in India the Planning Commission’s approach paper for the 12th Five Year Plan, has prescribed drastic reforms to improve healthcare.

As of now medical colleges are concentrated in only 193 districts of the country that have 640 medical colleges among them. The rest 447 districts do not have any medical college.

Against 335 colleges, there are about 319 Auxiliary nurses and midwives (ANM) training schools, 49 health and family welfare training schools and only 34 LHV (Lady Health Visitor) schools.

The present doctor patient ratio 0.6 per 1000 while the ratio of health workers (including midwives, nurses etc) is 2.5 per 1000.

“To fill the gap in training needs of paramedical professionals, the 12th Plan proposes to develop each of the district hospitals into knowledge centres, and 4,535 CHCs into training institutions,” says the Planning Commission report.

The government has already begun work on six All India Institute of Medical Sciences (AIIMS) -like medical institutions in different states.

The government has so far released Rs847 crore for the purpose. These AIIMS like institutions are coming up in Bihar (Patna), Chhattisgarh (Raipur), Madhya Pradesh (Bhopal), Orissa (Bhubaneswar), Rajasthan (Jodhpur) and Uttarakhand (Rishikesh) under the first phase of Pradhan Mantri Swasthya Suraksha Yojana .

Over the last three years, Ministry of Health and Family Welfare had announced to increase about 5,000 post graduate seats in medical colleges across the country in order to increase in the number of specialist doctors.

Sources:- DNA

Give doctors incentives to stay

August 18, 2011 Leave a comment

New Delhi–The Medical Council of India (MCI)’s latest figures point out a problem area for India – a brain drain of doctors. India has just one doctor for every 1,700 people, while the global ratio is one doctor for every 670 persons. It’s estimated that 60,000 Indian physicians work abroad, and the MCI says 767 more doctors left this year, till July 27. The potential for improving India’s doctor-patient ratio by retaining more medical personnel is obvious. But the best way to do so is not by making it tougher for trained medical professionals to make their living elsewhere; it is by giving them incentives to stay.

This can be done by providing financial incentives and improving working conditions, to cite just two possible measures. Vast swathes of rural India lack access to even the most basic healthcare. Why not provide adequate financial compensation to incentivise doctors to apply for such postings? Improving the condition of government health facilities – notoriously lacking in many states – is another way. Doctors move abroad not just in search of better compensation but also out of frustration at being unable to do what they are trained for due to a lack of proper infrastructure.

The problem also needs to be addressed from another angle – boosting the effectiveness of the supply chain that produces doctors, nurses and technicians. The higher education sector in the country is decaying and in urgent need of reform. That affects medical institutions too. There is no need to see the number of doctors in the country as a zero-sum game. We should produce more of them, and welcome it if some travel abroad and come back home with enhanced skills. Build the institutions, and they will come.