Sunday, July 5, 2015

Liver transplants for HCV infection to become obsolete in 10-20 years

In 10 to 20 years, liver transplantation will no longer be performed for patients with hepatitis C as the infection is now curable with direct-acting antiviral (DAA) therapies, says an expert at the International Digestive Disease Forum (IDDF) 2015 held recently in Hong Kong.
“Hepatitis C virus [HCV] has been the hottest topic in gastroenterology. With the new DAAs, cure rates of up to 100 percent can be achieved, in some cases without interferons,” said Professor Michael Manns of the Hannover Medical School in Hannover, Germany.
A number of DAA regimens are currently available for the treatment of different HCV genotypes. As pharmaceutical companies continue to fight for an edge in the HCV market, the grazoprevir/elbasvir combination, asunaprevir/daclatasvir/beclabuvir combination, and sofosbuvir/GS5816 combination are expected to become available in 2016, while samatasvir, sovaprevir and other promising agents are in development.
“Chronic hepatitis C has become a curable disease. Although the cure rate remains low in many parts of the world, we will be able to eliminate HCV in the next 25 years,” suggested Manns. “I’m sure in 10 to 20 years, there will be no more liver transplantations due to HCV infection.”
“Companies and researchers are on the way to leave hepatitis C and go into hepatitis B,” he continued. “At present, we can stop the progression of hepatitis B virus [HBV] infection, but a cure is not available. We need to work on strategies that interact with the covalently closed circular DNA [cccDNA] to achieve a finite duration of treatment and cure the disease.”
HBV therapies in early phases of development include viral core inhibitors, cccDNA inhibitors, entry inhibitors and immune therapies, he added.
A common challenge in eliminating HCV and HBV is the cost of new therapies, which may be unaffordable for some patients.
As liver transplantation remains in demand for various conditions, researchers are looking into alternatives to address challenges such as organ shortage and increasing donor age. One such alternative is hepatocyte transplantation.
“The liver has a high regenerative potential. Hepatocyte transplantation can therefore be developed for conditions such as acute liver failure, inborn errors of metabolism, and genetic liver diseases where we only need to replace one gene,” explained Manns.
“In Europe, for example, hepatocyte transplantation has received orphan drug status for inborn errors of urea cycle defects. The study is almost completed, and the treatment will soon be approved for this genetic liver defect,” he said.

Why I will never allow my child to become a doctor in India


Guest article by Dr. Roshan Radhakrishnan
Increasingly, I find myself watching and talking to doctors across two generations and various specialties these days. And increasingly, a sense of despair and disillusionment is writ large in their words.

With 0.7 doctors per 1,000 Indians, the doctor to patient ratio is far below that of other comparable countries like China (1.9), the UK (2.8) and the US (2.5). Spain’s 4.9 seems like an absolute luxury in comparison.

What this means in layman’s terms is: In India, you are always going to be swamped with patients beyond the logical human capacity.

That, in a nutshell, is the reason why I will never allow you, my child, to become a doctor in India. Let me spell out all the reasons for you here.

You shall sacrifice your time, parents, spouse and child

Getting a 63-hour a week schedule (nine hours daily for seven days) is a blessing, and most of the young guns who join in fresh after post graduation know fully well that a 100-hour a week schedule is par for the course once you begin working.
And sadly, this is advocated, and encouraged by most hospitals, too. You would never allow a taxi driver to drive you for 24 hours continuously, but asking surgeons to do that every third day is fair game in India, apparently.

You might not be able to pay your rent in your 30s

A young surgeon working in one of the premier institutes in India spoke to me the other day. She had joined the hospital because of its awe-inspiring reputation across India, aware that the hard hours she put in would sharpen her skills and broaden her knowledge of the specialty. But a year later, the woman had lost that drive altogether.

Walking out of her home at 7 AM and returning home at 10 PM, just to fall into bed and then wake up again at 5 in the morning to restart the cycle, she wondered what was the point of it all. She was losing touch with her loved ones and had become a zombie, lost between the politics within the hospital and a total lack of social life.

All this for a handsome salary of Rs50,000 ($786) a month in Mumbai, which she knew would not buy her two nights in the ICU of the very hospital she was working in. There would be a pot of gold at the end of the rainbow, I wanted to tell her. She would earn more in her forties than her techie friends earned in their thirties, I could have consoled her. But I did not. Because I know how she feels.
Another doctor spoke out recently on a public forum, talking of his experience of doing six years of rural service for the government. When he finally left it two years ago, the man in his thirties had less than Rs15,000 ($236) in his bank balance with no extravagant purchases or trips to boast off.

He needed his parents’ help at that age to pay for his rent. It all came to a head when a shopkeeper revealed how his monthly takeaway was more than the doctor’s—without any risk whatsoever.

Your country has one of the lowest health budgets

In a country like ours where a major portion of the population hovers below or around the poverty line, having the support of the government is vital to our success. They need to make medicines more affordable at the very least.

Sadly, instead of supporting us, they decided to cut the budget allotted to health care by nearly 20%. This at a time when we spend a mere 1% on public health care in India, as opposed to 3% in China and 8% in the US.

You might have to die for your profession

This month, the Indian Medical Association confirmed that over 75% of doctors in India have faced some form of violence at the patient’s hands in India.

There are even instances of doctors being actually killed for following the law. When was the last time you saw a software techie being killed for not making an app properly?

The recent verdict in the Joseph Eye Hospital case brought the reality of the Indian mindset home to many doctors. Handing down verdicts of imprisonment to three doctors for the loss of vision of 66 patients, following an eye surgery camp, the judicial system showed an amazing lack of comprehension about what was going on. It does not need a rocket scientist to realise that a single trained doctor cannot make the same mistake 66 times in 66 different eyes on the same day.

The obvious answer to such incidence of mass endophthalmitis is in the use of unsterile solutions used—the unsterile part being a fault of the pharmaceutical company that manufactures the solution.
There is no way for a doctor to know (without opening every individual bottle and testing them) if the solution contains microscopic bacteria, just as there is no way for you to know if there are any in your coffee before drinking it. And yet, to please a crowd baying for blood and money, even though it was obvious the fault lay with the tainted solution, the doctors were sent to prison. Sounds familiar, does it not?

Remember the Chhattisgarh sterilisation deaths of 2014? Everyone knows the doctor’s name in that case. It was later proven that the fault was with the tainted medicines that were made in rodent-infested factories. So tell me, what was the name of the pharmaceutical company and what action has been taken against it since then?

You might not be able to deal with the malaise within

There are going to be doctors working beside you who will promote a medicine not necessarily because it is good, but because the pharmaceutical representative gives him a good incentive. And you will see that doctor taking home more than you do for doing the same work as you, and the devil on your shoulder will smile. He will positively grin, in fact, as you stare at the price of the new smartphone that is beyond your financial reach because social service and respect do not pay the bills.

There will be those who need to make back the money spent on getting an education—I hear certain post graduation seats now go for Rs4 crore ($0.6 million).
You will find doctors who are forced to do the extra procedure because, working in a private hospital, they need to answer to the heads above. They need to make a profit for their bosses who shrug as they remind you that if the hospital runs into losses and shuts down, the loser is the patient himself.

And when you think about it, they are right, are they not? Private hospitals (which still cater to a huge percentage of the population) need to make a profit to continue. If they shut down, the health care of the country would collapse in months simply because government hospitals would never be able to manage the volume.

You may not be able to deal with the imbecilic outsiders

You have ministers running tobacco empires who head committees on health and undo all the work of doctors by claiming that tobacco is good for health. You have self-proclaimed fakirs and saints telling you to raise the population manifold at a time when we are stretched at the seams due to overpopulation. You as a doctor are caught in the moral ineptitude of such politicians and film stars who never attend government hospitals themselves and yet decide how hospitals must be run.

As a father, you will find me as broadminded and tolerant as they get. You will have every opportunity to choose whether you want to retain your religion or change it based on what resonates within your mind. You will have every opportunity to choose the love of your life irrespective of caste, creed or even gender.

I will let you have every choice in life and I will be there to support you and guide you along the way. But I will never allow you to become a doctor in India. Because I did not raise my child for two decades just to watch her lose her sense of right and wrong, of humanity or worse, watch her die.

Sunday, June 28, 2015

The Indian Medical Association demands strict action against Ramdev


The Indian Medical Association has demanded strict and immediate action against yoga guru Baba Ramdev stating that his claims to cure heart diseases, diabetes and cancer were false.
“His claims are in violation of the Drugs and Magic Remedies (Objectionable Advertisement Act), 1954, which prohibits quackery. Baba Ramdev has a large fan following and though we appreciate his propagating yoga and its benefits, we will not allow anyone to make claims about helping cure cancer, diabetes and heart diseases,” said IMA joint secretary Dr. Anil Bansal.
“This is not the first time that we have complained against Baba Ramdev and his claims about offering cure. However, no action has been taken against him or his group so far. We now appeal to the Drug Controller of India and the Union Health Ministry to take action against Baba Ramdev,” added Dr. Bansal.
IMA has noted that Baba Ramdev’s action was in clear violation of the law.
“Baba Ramdev has advertised claiming to offer cure for several diseases including hypertension, arthritis and thyroid disorders. We are receiving a lot of complaints about the wrong treatment given by Baba Ramdev or his associates. A lot of people have suffered by taking his medicines. Diabetic patients have suffered a lot of complication by taking his treatment .Hypertension patients have suffered stroke because these patients had left their allopathic treatment and started taking Baba’s medicine in the hope of cure,” he added.
Chairman (Anti-Quackery Cell) Delhi Medical Association Dr. V.N. Sharma noted: “We have been asking the Government to take action but so far haven’t met with much success. The fact that the Western countries have refused to take ‘medicines’ made by the Baba Ramdev’s group should have been alarm bells enough for the Union Health Ministry to take action against what he is doing in his own country. Since Baba Ramdev has a large fan base, we need to urge the Government to take immediate action to ensure that more people don’t fall prey to his claims.”

Friday, June 26, 2015

DNB CET Strategy


Guest article by Dr. Ramgopal

I assume that almost everyone of you reading this is going to be writing the upcoming DNB CET exam in another week's time. 
That is coz the DNB CET is conducted by the NBE.....the same NBE which conduts the the Nov session of DNB CET (which has more seats) and of course the AIPGE (the mother of all PG entrance exams). Some 'repeats' from this exam maybe there in these two 'later' exams but more importantly this DNB CET will give you an idea of the type of questions to expect in these future exams.

Time wise - 300 qns in 3 hours is do-able...so far the DNB-CET has not had a history of "paragraph type" long questions ....its usually short questions with one word/one line answers. So it should be possible to complete the 300 qns.
Images are usually straightforward, where the image itself is obvious or the options below the questions should give a clue to the image.
The level of difficulty in DNB CET is "moderate" - this exam will also prepare you for the type of questions to expect in your state entrance exams (for states which still have entrances - like UPPG, TNPG, APPG, MHCET, Kerala CET etc).
I know that the timing of this exam in July is "odd" with most of you in the middle of your preparation for the year ending exams in November/December (like AIIMS, PGI, JIPMER, AIPGE and DNBCET Nov session). So if you are feeling a little "underprepared" or "partially prepared" also - it is worth going in with a positive attitude and writing the exam. (By November 2015 - you may have finished your revisions and feel "WELL Prepared" - example - you may have finished all theory and MCQs in Ophthal and still a question like "Malyugin ring!" may leave you stumped in the exam!).
Who knows - this time it maybe an excellent performance for you and you may end up with a high rank ?! Positive attitude is always necessary for any exam in life and this exam is no exception.
And some "small' BUT important things like - report on time; carry all essential documents!! - the authorities are very strict about all these; some ppl have missed the exams coz they couldnt locate the centre - so take note of these "small" things and of course AVOID silly mistakes.
Before signing off.....a small note ......Sure Success MAGIC (7th edn) has been a valuable book for earlier DNB CET's as evidenced by some previous reviews (in the photos attached)..........that's what inspired me to make this book even better for PG aspirants in the 8th (new) edn......so if you have that book - revise that also and pls go thru the images in each chapter also - and pls send in your reviews after the exams......Thnx
All the Best and God Bless
Ramgopal

Assam CM Tarun Gogoi orders recovery of Rs 20 lakh each from 244 PG doctors for not serving state govt

tarun gogoi, assam cm, journalist award, assam budget

The Assam government has initiated legal action to recover Rs 20 lakh each from as many as 244 doctors who had obtained their post-graduate medical degree in 2014 for violating a commitment for serving at least 10 years under the state government, Chief Minister Tarun Gogoi said in Guwahati on Thursday.

The chief minister also directed the state health and family welfare department to immediately initiate strict legal action against those PG doctors who have violated the terms and conditions of the agreement they had signed at the time of their admission.
Such cases of violation would also be taken up with the Medical Council of India, an official press release quoting the chief minister said.

Gogoi, who took the matter seriously, said these 244 post-graduate doctors had, prior to admission in the state’s medical colleges, committed to serve the state government for 10 years, for default of which they had also agreed to repay Rs 20 lakh each as compensation. 

According to the Assam Medical Colleges (Regulations of Admission into PG Course) Rules 2006, a doctor on completion of his/her PG course has to serve under the state government for at least 10 years. In case of any breach of terms and conditions, defaulting doctors are liable to pay Rs 20 lakh as compensation to the state government on account of expenses borne by it for doctors pursuing the post-graduate course. 

“Since the general public visiting government health institutions have been deprived of the services of PG doctors in spite of huge amount of public money invested on them by the state government, the public money would not be allowed to go waste,” chief minister Gogoi said. “In case of failure to pay the compensation, the government of Assam can file money suit and take any other legal action against the defaulting doctors,” the press release said. Gogoi on Thursday also directed officials to take steps to prevent such wilful neglect of responsibilities by some doctors and said henceforth all candidates seeking admission to PG courses in medical colleges of the state would have to furnish bank guarantee of sufficient amount so as to safeguard the interest of the people seeking medical care.

Tuesday, June 23, 2015

Kejriwal requests striking doctors to return, vows harsh steps if patients continue to suffer

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Delhi CM Arvind Kejriwal has once again appealed to the doctors on strike to return to work as all their demands were accepted by the Delhi government yesterday itself.
Kejriwal took to Twitter and tweeted the following
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Earlier in the day, Delhi government imposed ESMA act on resident doctors on strike, who failed to resume work by 11 am as ordered by the government.
On Monday evening, the Delhi government accepted all the demands of the resident doctors in the city who had called for an indefinite strike.
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Earlier on Monday, more than 2,000 doctors from 20 hospitals in the national capital, including Safdarjung Hospital, Lady Hardinge Medical College, Maulana Azad Medical College and Ram Manohar Lohia Hospital went on an indefinite strike. Several issues have been highlighted by the striking doctors, including adequate life saving and generic drugs. The other demands include security at workplace, drinking water supply and timely payment of their salaries.
According to the doctors, the government has failed to take steps to fulfil their demands. Reports said that the doctors had earlier written to the Union Health Ministry to look into their demands.
Delhi Health Minister Satyendar Jain stated that the strike was not a solution to any issue, adding that he had called the doctors for talks on Sunday, but they failed to make it. The minister further said that he had still invited the striking doctors for talks. Earlier in February, a similar strike was called by the resident doctors regarding the same set of demands.
The CM appealed that the doctors should keep in mind the suffering patients and their plight. He also stated that if there were more demands, then he and his government were ready to accept those too.

Sunday, June 21, 2015

Top 10 Benefits of Yoga in daily Life


Weight loss, a strong and flexible body, glowing beautiful skin, peaceful mind, good health – whatever you may be looking for, yoga has it on offer. However, very often, yoga is only partially understood as being limited to asanas (yoga poses). As such, its benefits are only perceived to be at the body level and we fail to realize the immense benefits yoga offers in uniting the body, mind and breath. When you are in harmony, the journey through life is calmer, happier and more fulfilling.
With all this and much more to offer, the benefits of yoga are felt in a profound yet subtle manner. Here, we look at the top 10 benefits of yoga practice.
1. All-round fitness. You are truly healthy when you are not just physically fit but also mentally and emotionally balanced. As Sri Sri Ravi Shankar puts it, “Health is not a mere absence of disease. It is a dynamic expression of life – in terms of how joyful, loving and enthusiastic you are.” This is where yoga helps: postures, pranayama (breathing techniques) and meditation are a holistic fitness package.
2. Weight loss. What many want! Yoga benefits here too. Sun Salutations and Kapal Bhati pranayama are some ways to help lose weight with yoga. Moreover, with regular practice of yoga, we tend to become more sensitive to the kind of food our body asks for and when. This can also help keep a check on weight.
3. Stress relief. A few minutes of yoga during the day can be a great way to get rid of stress that accumulates daily - in both the body and mind. Yoga postures, pranayama and meditation are effective techniques to release stress. You can also experience how yoga helps de-tox the body and de-stress the mind at the Art of Living Yoga Level 2 Course.
4. Inner peace. We all love to visit peaceful, serene spots, rich in natural beauty. Little do we realize that peace can be found right within us and we can take a mini-vacation to experience this any time of the day! Benefit from a small holiday every day with yoga and meditation. Yoga is also one of the best ways to calm a disturbed mind.
5. Improved immunity. Our system is a seamless blend of the body, mind and spirit. An irregularity in the body affects the mind and similarly unpleasantness or restlessness in the mind can manifest as an ailment in the body. Yoga poses massage organs and stregthen muscles; breathing techniques and meditation release stress and improve immunity.
6. Living with greater awareness. The mind is constantly involved in activity – swinging from the past to the future – but never staying in the present. By simply being aware of this tendency of the mind, we can actually save ourselves from getting stressed or worked up and relax the mind. Yoga and pranayama help create that awareness and bring the mind back to the present moment, where it can stay happy and focused.
7. Better relationships. Yoga can even help improve your relationship with your spouse, parents, friends or loved ones! A mind that is relaxed, happy and contented is better able to deal with sensitive relationship matters. Yoga and meditation work on keeping the mind happy and peaceful; benefit from the strengthened special bond you share with people close to you.
8. Increased energy. Do you feel completely drained out by the end of the day? Shuttling between multiple tasks through the day can sometimes be quite exhausting. A few minutes of yoga everyday provides the secret to feeling fresh and energetic even after a long day. A 10-minute online guided meditation benefits you immensely, leaving you refreshed and recharged in the middle of a hectic day.
9. Better flexibility & posture. You only need to include yoga in your daily routine to benefit from a body that is strong, supple and flexible. Regular yoga practice stretches and tones the body muscles and also makes them strong. It also helps improve your body posture when you stand, sit, sleep or walk. This would, in turn, help relieve you of body pain due to incorrect posture.
10. Better intuition. Yoga and meditation have the power to improve your intuitive ability so that you effortlessly realize what needs to be done, when and how, to yield positive results. It works. You only need to experience it yourself.
Remember, yoga is a continuous process. So keep practicing! The deeper you move into your yoga practice, the more profound are its benefits.