MPA N ewsl etter

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Full Colour version at KWMPA.co.cc
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Free Educative material only. Not for sale.
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T o w n, S An interaction with Michael Reiter
013
411 By Dr Saurabh Bhatia, Editor

Michael Waldbrenner,
Director
Michael Reiter, M.A. is the Edi-
Health-
tor-in-chief of Hospital Post
care &
Europe. He lives in Germany. His Welfare,
publications are extensively read
TietoEna-
by hospitals all over Europe. I tor, to see
had the chance to meet him and
S a d h u
take him around while he was
Vasvani Mission
touring India on a personal visit. Cardiology
Michael Institute and the Inlaks &
was keen to know Budhrani where Dr Ritu
how was the Indian Bhatia and Dr Sanjay
health sector react- Salunkhe had kindly ar-
ing to the call of ranged a guided tour of the
automation and facility.
c ompu te ri zation . S u bs equ en tl y
We discussed the
we also visited
Indian situation with the perspec-
Jeh an g ir Ho sp it al
tive of an infant health insurance where Ms. Monica from
sector which is, as yet, unable to
the PR division showed
drive computerization. us the various aspects of care that
I took Michael Reiter and they provide. The idea was to show
him a charity hospital
which works on very different
financial equations and a com-
mercial hospital so as to give
an overview. Michael was
highly impressed with the fa-
cilities
av ailable
here and
expressed
his keen-
ness 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.

Upcoming DOUBLE
Inside this issue
CMEs Bonanza Website revamped for better user experience 2
∗ August 22nd 2008
∗ Sept 05th 2008
Back Upcoming CME Details 3

Venue: 2 CME report May 2008 4

Hotel Coronet Elegance Medical Myths Shattered 5

Opp Shivarkar Garden, Back Smoking in Movies linked to smoking in children 6
Fatima Nagar, Pune Brushing teeth may cause endocarditis in suscep- 6
2130 Hrs
CMEs tible?

Details inside
Page 2 KWMPA Newsletter

Website Revamped for better user experience

By which were available in the earlier form from the revamped site
site are also available on this site. (Kwmpa.co.cc) to let me know about
Dr Saurabh Bhatia
So you may easily contact us, choose this.
It was felt that your CME, fill peer NEW FEATURE:
our website is per- We have revamped the review forms etc
haps a little too website completely. Ask your problems.
complicated for an The new version is a CME reports
average computer and latest news will This is a Free Service. Citizens
simpler version
user within our now be provided us- are welcome to send us their ques-
association. As a ing the power of blogspot. Link is tions regarding health problems. We
result people were facing issues in will answer them to the best of our
available at the site and filters have
ability and as soon as possible. Pres-
registration, logging in and in gen- been 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
reports. A free service for some of you can volun-
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
revamped the website completely. to add more features
area started
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 bene- version of website. But what I need
saurabhbhatia@saurabhbhatia.com
fits of forums, wiki, calendar etc. to know from all of you is whether
but the page is static and is much you prefer this new simpler, less hi- Or Call me at +91-9881148282
faster 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 You don't need to register which had more
Internet explorer and KWMPA.CO.CC
or log-in. Everything is tech possibili-
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 avail-
PROSPERITY
able at a click. All those forms You can fill in the feedback

GPCON 2008
IMA COLLEGE OF GENERAL PRACTITIONERS - PUNE SUB-FACULTY & GENERAL PRACTITIO-
NERS 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 Page 3

Maternal Weight Gain Appears to Raise Risk of Cleft Palate

As reported in the June issue of the leagues studied data on more than ciation between isolated cleft palate
American Journal of 220,000 Swedish risk and longer inter-pregnancy in-
Epidemiology. Sub- women. In women whose terval. Dr. Villamor added that
stantial weight gain In women whose BMI BMI rose by 3 or more "although the mechanisms to ex-
between pregnancies rose by 3 or more units in this interval, plain this association are still uncer-
seems to be a factor the adjusted risk of iso- tain, this finding contributes addi-
units in inter- tional evidence to the importance of
increasing the risk lated cleft palate was 2.3
of oral clefts in off- pregnancy interval, times higher than in keeping a healthy weight through-
out life."
spring, according to the risk of isolated those who had no sub-
US and Swedish re- stantial BMI change.
cleft palate was 2.3 Re ad t his articl e fully at
searchers. However, change in BMI
times higher. Www.Medscape.com/Viewarticle/5758
Dr. Villamor of the was not related to the
99
Harvard School of risk of cleft lip.
Public Health, Boston and col- An unexpected finding was an asso-

Upcoming CME details

22nd Aug 2008
Speaker: Achievements
Dr Shashi Apte Pooja Gandhi, Daughter of Dr Ravindra Gandhi has
cleared Professional Competence Course Examination
Topic: Management of patients who
Of the Chartered Accountants Course. She stood 47th
are on anticoagulants and/
in All India Merit List.
or immunosuppressant, coming to
GPs & physicians for unrelated KWMPA Congratulates her and their family.
problems

Dr. Shashi is a hematologist with an

in house BMT in the private sector. Watch out for an ar-
He has huge experience in manage-
ment of patients with coagulopathy ticle on KWMPA in
& immunosuppression the upcoming edi-
tion of Street
5th September 2008 Guardian
Speaker: Dr Romesh Joshi; the
Medical Specialist, Pfizer.

Topic: New challenges in smoking

cessation
Page 4 KWMPA Newsletter

CME May 2008 Report

The KWMPA concluded its second CME
of 2008 on 17th May 2008 at the same
The CME in May was
old location of Hotel Coronet Elegance, designed to co-incide with
Fat Nag, Pune.
the World Asthma day
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 re-
alised 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 talk which was

made interesting by some very good slides
and video. Subsequently, the animated au-
dience asked questions for over twenty min-
utes which Dr. Abhyankar ans wered pa-
tiently.

This was followed by Dinner.

Clockwise from top: Dr Abhyankar, Audience, Dr A Peer review report is given below. Please fill up the peer
Vivek, Dr Salunkhe & Dr Bhatia 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. Per-
form spirometry regularly to diag-
nose and detect improvement/ de-
terioration and transition from
bronchial asthma to COPD.
When we perform a haemo-
gram as a routine investigation larly, so as to prevent/ delay the
( most of which are redundant!), transition of a reversible to an irre-
Dr Abhyankar’s message of per- versible condition.”
forming 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-
2008 3rd Edition Page 5

Shattering Medical Myths

Research ref to all the points herein can be temperature measured at the rectum Myth: Insulin must be injected using
seen at http://www.montana.edu/wwwebm/ to be relied on in clinical situations sterile technique.
myths.htm
where accurate measurement is im-
portant. Truth: It is safe and convenient to
Myth: Academic review articles are a inject insulin through clothing.
reliable source of unbiased informa- Myth: Oral antihistamines are the
tion. first-line treatment for allergic rhinitis. Myth: Serum iron is the best diagnos-
tic test for iron deficiency anemia.
Truth: The conclusions of review arti- Truth: Intranasal corticoster-
cles are strongly associated with the oids produce signifi- Truth: The serum ferritin performed
affiliations of their authors. Clinical cantly greater Thi dramatically better than any other
s a
trials with positive results are pub- relief than oral
of t r ticl diagnostic test or combination
antihista- he e w
lished more frequently and more
the pop ill b tests for iron deficiency.
quickly than are those with negative mines of
ular u s t so
Doc myt me
results. nasal
tors hs
Myth: Corneal abra-
blockage, let h a t hat
the ve; sions should be cov-
Myth: Practice guidelines provide nasal ir p an d t
aff rac h
ered by an eye patch
well-developed, high quality recom- dis- ect t ice e y to improve healing and
charge, ed ge
mendations for practice. b y th t decrease pain.
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 heal-
ing 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
the identification, evaluation, and syn- uc ation r similar appliances are the preferred
g ed h avi o treatment for clavicle fractures.
thesis of the scientific evidence.
o n tinuin sician be Truth:
l c hy
tiona hange p
A 10 day
v e n c of Truth: No statistical difference was
Myth: Bedrest : C on ay to as course
th . h found in the speed of recovery when
is a useful ad- My fective w utcome ie s, suc ma- 40mg/d clavicle fractures were treated by ei-
f o g
junctive therapy. an e atient c rate ted
ly st unsolici ges in
of
n d p - o n ther a figure-of-eight bandage or
a a tion iling of o chan out-
i n broad arm sling.
Truth: A meta- :D issem r the ma tle or n r health
th
analysis of 39 stud- Tru rences
o e lit r o
nf e o n strat behavio Myth: In acute asthma, a nebulizer is
ies of the use of bed co s , dem sional
l a more effective way to deliver medi-
rest versus early mo- teria
h p rofes
bilization for preven- heal
t cation than is a metered dose inhaler
. prednisolone may (MDI) with spacer.
tion and treatment of a com e
be stopped abruptly in asth-
variety of medical con- matics. 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 admini-
Myth: 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.
Page 6 KWMPA Newsletter

Antibiotic Prophylaxis of Endocarditis During Dental Procedures Questioned

June 13, 2008 — The practice of giv- Dr Peter Lockhart (Carolinas bacteremia and the associated risk
ing antibiotics to prevent infective Medical Center, Charlotte, NC). of endocarditis,". Antibiotics Not
endocarditis in susceptible 100% Effective
individuals undergoing inva- Don't Stop Brushing.
sive dental procedures has Lockhart said the uninten- The authors point out that although
been called into question by tional message from this amoxicillin has a significant impact
the results of a new study paper is that brushing teeth on bacteremia from a dental extrac-
showing that the risk of is bad, but actually the op- tion, a notable number of the extrac-
bacteremia over the long posite is true. "We need to tion patients who received prophy-
te r m i s h igh er w i th focus our efforts more to- laxis in this study nonetheless
toothbrushing than with ward better dental hygiene. showed evidence of bacteremia; this
tooth extraction . The study, Shall I brush at If the teeth and gums are lack of 100% efficacy alters the per-
published online June 9, nite? kept clean with regular dose risk/benefit ratio, increasing
2008 in Circulation, was brushing and the dentist the number needed to treat to avert
conducted by a group led by dentist fixes any problems, this will reduce a distant site infection.

Smoking in Movies Linked to Smoking in Children?

William T. Basco, Jr., MD, FAAP
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-
mentary school and to update movie
smoking exposure longitudinally,
“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 re-
sponsible 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 interferon inducible protein (IP- eleven biomarkers selected from an
Shankar, MD 10), soluble tumor necrosis factor initial panel of thirty were meas-
receptor 2 (sTNF-R2) and soluble ured in all the patients and corre-
CHENNAI, Fas (sFas) are associated with lated with the severity of disease.
I n d i a increased mortality in cerebral The plasma levels of sTNF-R2,
( R e u t e r s malaria, while vascular endothe- IP-10 and sFAS were signifi-
Health) Jun lial growth factor (VEGF) is pro- cantly elevated among cerebral
12 - High lev- tective, according to the results of malaria non-survivors.
els of inflam- Let’s have a higher a study from India. More at http://www.medscape .com/
matory media- vascular endothelial After a pilot study, the levels of viewarticle/575994
tors including growth factor (VEGF)
 ee
Management Committ
2008 3rd Edition Page 7

Kondhwa-Wanowrie Medical
PRESIDENT
Practitioners' Associa-
tion, Pune. (KWMPA)
DR.SANJAY SALUNKHE

Established over a decade

VICE PRESIDENT
ago, KWMPA boasts of
vibrant membership with ove
DR SWATI SANGHVI
r 150 members who
make it one of the most act
HON.SECRETARY
is ive medical associations.
in th
DR VAISHALI PARAB
dve rtise
To A wsletter To Join the KWMPA, you
HON JT. SECRETARY
ne need to
ta ct
DR SUBROTO ROY
Co n Fill membership form (downl
oad from website)
HON. TREASURER B h atia
D r S Or contact us
2
4828
DR.NAVEEN RAINA
81 1 through
98
ail
EDITOR
Or m pho ne/ mail
l.com
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DR SAURABH BHATIA
o .c c@
pa.c
Kwm
GOV. BODY MEMBERS
D r San
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411

Humour in Medicine
A List of Things You Don't Want A famous psychiatrist told his wife: "I feel down today, I am going to see my
to Hear During Surgery: colleague."
Oops!
Has anyone seen my watch? Wife: " But! you are the best psychiatrist, aren't you?"
Come back with that! Bad Dog!
Wait a minute, if this is his spleen, Psychiatrist: " Yes! I know! But my colleague charges less than I do!"
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 con-
tact 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 di-
vorce"!
FIRE! FIRE! Everyone get out!
Stick address label here