Wednesday, October 26, 2016

PG NEXT Question of the Day 26-10-2016


Ossification centre of the bone marked B is 

a. Birth
b. 2 years
c. 4 years
d. 6 years

Ans: c. 4 years

Ref: Gray's Anatomy, 41st edition, page – 869

Explanation :

Bones marked in the picture are:
A. Scaphoid
B. Lunate
C. Triquetral
D. Pisiform
E. Trapezium
F. Trapezoid
G. Capitate
H. Hamate

Ossification of carpals:
o Capitate-2nd month
o Hamate – 3rd month
o Triquetral – 3rd year
o Lunate – 4th year
o Scaphoid -4-5yrs
o Trapezium – 4-5yrs
o Trapezoid – 4-5 yrs
o Pisiform – 9-12 yrs

Remember the names of bones & for ossification, remember the age in reverse order starting from capitate.

Tuesday, October 25, 2016

PG NEXT Question of the Day 25-10-2016


Phase 4 clinical trial is also called as
a. Human pharmacology and safety
b. Post marketing surveillance
c. Therapeutic exploration & dose ranging
d. Therapeutic confirmation

Answer: b. Post marketing surveillance

Therapeutic use (post-licensing studies) – Surveillance foe safety and efficacy: further formal therapeutic trials, especially comparisons with other drugs, marketing studies and pharmacoeconomic studies.

1. Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12e, p. 1054
2. Bennett & Brown Clinical Pharmacology, 9e, p.56

NEET-MDS Notification

NEET-MDS will be conducted by NBE.

Monday, October 24, 2016

India's disappearing daughters: Child sex ratios continue to plummet all over the country

Exactly a month ago, Dr Mitu Khurana lost a 11-year-old court battle. This gutsy mother of twin daughters was the first woman in India to file a case under the Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act - the great legal tool which is supposed to protect the lives of our unborn daughters.  Her lengthy battle came to end in just five minutes when the Supreme Court dismissed it on a technicality.

Representational image. AFP/File photo
Representational image. AFP/File photo

Dr Khurana's case is a well documented one and has been covered quite extensively by the Indian and foreign press. She is a doctor, married into a family of doctors, and more importantly - a strong and determined woman who never gave up. She had said that in 2005 when she was under heavy sedation, her in-laws had got an illegal sex determination test done in a high-end clinic in Jaipur. She had proof that this was an unregistered clinic and that the crucial Form F which records the woman's consent to have an ultrasound had gone missing… all punishable offences under the PCPNDT Act.

And yet she lost.

Meanwhile in other parts of the country, sonographers or ultrasound specialists who do the very important task of scanning pregnant women to check fetal health, went on a one day strike in protest against what they called the draconian PCPNDT Act.  They wanted the Act amended because they said they were being persecuted for trivial reasons like a clerical error.

“Look at the piles of paperwork to be done for every single scan,” said an exasperated sonologist at a conference on sex selective abortion. “If I slip on even a single one, I can get arrested and my ultrasound machine can be locked. I came into this field because I was interested in fetal health. Now I regret it. This was once the most popular specialisation for gynaecologists. Now the youngsters are afraid to get into this field.”

At the same time Sabu George who has spent several decades researching and fighting against this form of gender discrimination pointed out to a newspaper that the child sex ratio has dropped drastically in a state like Karnataka, which was once considered comparatively “safe”. This he said is mainly because of poor implementation of the law against sex selective abortion. Today the child sex ratio in Karnataka is 943 per 1,000 males as compared to 973 in the 2001 census. And in thriving Bengaluru, the capital city the ratio is a pathetic 916 to 1,000.

But there are also districts in Karnataka where there are more girls than boys in the 0-6 age group. Udupi with 1,094 girls to 1,000 boys tops the list. Others included in this star list are Dakshina Kannada (1,020), Kodagu (1,019), Hassan (1,010) Chickamagaluru (1,008) and Raichur (1,000).  So, does this mean that the PCPNDT Act is enforced better in these districts, or is there something else? Something more intangible? A different mindset? A matrilineal tradition? No dowry?

So where does the problem lie?

By now it is a well-established fact that our daughters are disappearing not from the families of the poor and uneducated but from educated middle and upper middle class families who have access to illegal sex selection and abortion clinics. We all also know that the main culprit is our patriarchal society which has brainwashed several generations of families into believing women are commodities of trade in a marriage and a girl's life is better snuffed out before she is born, lest she grow into an expensive and unaffordable member of the family.

I have been investigating female infanticide and sex selective abortion for over 20 years now.  In 2005, I started researching my book Disappearing Daughters, on the alarming consequences of sex selective abortion.  At that time, the worst hit states were Punjab, Haryana, and Gujarat.  The PCPNDT Act was already in force and these states had “save the girl child” programmes, yet girls were disappearing by the thousands.  Today the virus has spread all over India as these maps (see right) indicate.

sex ratio map

Studies now indicate that Northeastern states like Tripura and Nagaland, and hitherto relatively unaffected states like Maharashtra and Andhra Pradesh have also got plunging child sex ratios.

The problem is that, like in a sinking ship, we don't know how to stop the downward descent.  Every time we plug one leak another one springs up.

Once upon a time the desire to have a male child was just that... a desire, an aspiration, maybe, or even a dream or a hope.  Advances in medical technology have made it possible to turn all those dreams into reality.

First it was amniocentesis, then the ultrasound and now the genetic blood test and embryo selection.  Every new advance was actually meant to ensure the safety of the child in the womb irrespective of its gender.  But these benign diagnostic tools have actually turned into killer weapons in the hands of a patriarchal society.

Gender selective destruction is not new to our society. Gruesome forms of female infanticide have existed in pockets of Punjab, Haryana, Rajasthan, Gujarat and even Tamil Nadu for a long time. As prenatal gender selection is possible now at a very early stage the female fetus is more endangered than ever.

Every gynaecologist I know has any number of stories of people in high places who tried to pressurise him or her into revealing the sex of the unborn child. I know women who have swallowed all sorts of herbal medicines to ensure the unborn foetus is male and ended up having a deformed child instead. I have been threatened by the doctor wife of an MP because I was investigating charges of sex selection against her. I have talked to weeping women who told me how they were pressured by their families into destroying their unborn daughters.

Disappearing Daughters came out in 2007 and I thought the situation was dire then. If anything, it has become much worse 10 years down the line.  Crimes against women have increased in states like Haryana where there is a huge deficit of young women. Child sex ratios continue to plummet all over the country.

One thing is for sure.  The change in thinking has to come from the very basic social unit, which is the family. As long as we have a 'son hungry' society, unscrupulous medical practitioners as well as quacks will continue to exploit the situation.

Gita Aravamudan is a journalist. She has authored the books Baby Makers: The Story of Indian Surrogacy and Disappearing Daughters: The Tragedy of Female Foeticide.

'PC PNDT amendments defeat PM Modi's dream of Beti Bachao'

Rising crime against women is one of the most visible outcomes of sex-selection. India realised the problem and formulated the Pre conception Pre Natal diagnostic Techniques Act in 1994. The implementation of the act could begin at the turn of century. Sixteen years since, the doctors lobby is pressing for amendment in the act by calling it too harsh for clerical errors. But Sabu George, the man who has been fighting for the cause of the unborn girls for the past two decades, differs. He spoke to TOI on the proposed amendment and its impact. Excerpts are: 

Q: How do you see the proposed amendment in PC PNDT Act? 

A: The ruling government launched Beti Bachao Beti Padhao with much fanfare and our prime minister Narendra Modi begged for the lives of the daughters. Proposed changes in the act would defeat our PM's dream of Beti Bachao. The amendment draft is a coup to convert cold blooded medical crime (read sex selection and elimination) into a mere clerical error and trivialise it. It is also a paradox in the country which worships women but doesn't let her breathe inside the mother's womb. 

Q: What is the biggest objection with the proposed amendment? 

A: The doctors' lobby is for simplification of documentation and wants to do away with Form-F (paper wherein all patient details need for the procedure have to be filed). The act without this paperwork turns redundant. Then, they also say that incomplete form-F are an outcome of typographical errors and it could not be seen as a crime. Discrepancies in the Form-F question the doctor's intention for undertaking the procedure and puts the onus on the him to prove innocence. The doctors booked under the act could be nabbed only because of Form-F. In this way, they are trying to steal the base of evidence gathering. 

Q: What are the other issues with the changes? 

A: The lobby has pressed for changing the nature of crime from 'Criminal' to 'Civil'. This will mellow down the severity of the crime which is a cold blooded murder. The doctors have offered to increase the penalty for violations in the act (raise it from existing Rs 50,000 to Rs 1 lakh) but the increment is useless when seen in the backdrop of the changes demanded. 

Q: What makes the doctors lobby oppose the existing act so strongly? 

A: The ultrasound business is an industry worth several crores. Regulation of the act is affecting their financial interests and that's why they are against it.

Q: The outcomes achieved from the PC PNDT act are too few. So, change or no change - what difference does it make? 

A: Though poorly implemented all over India except for Maharashtra and Haryana, the current legal framework acts a pressure on the doctors and scares them too. Had it not been for this, the doctors wouldn't have pressed for change. The biggest advantage of the act is that it has helped in identification of the centers through registration. In 2000, there were just 600 registered ultrasound centers in India whereas the number stands at 53,000.

Implementation of the act is the only problem in the system. The current legal framework is potent for saving millions of unborn girls who die. A study of census data showed that 72 lakh girls would have been killed in the womb in the past decade.

PNDT Authority fined Rs. 10k for illegal sealing of USG machine

Image result for fine penalty

Unique relief for Doctors in PCPNDT – The General Surgeon who was using Sonography Machine for diagnostic purpose received Rs.10,000/- from Appropriate authority for illegal sealing of sonography machines in a judgement delivered by Division bench of Bombay High Court. 

Facts of the case: 
1. The Appropriate Authority when visited the Petitioner’s (the surgeon) Clinic  in 2011 found that the room where the ultrasound Sonography machine was kept, was not put under lock and key. A show cause notice was therefore issued to the petitioner calling upon him to explain as to why the room where ultrasound Sonography machine was kept was not put under lock. On the same day, the Tahsildar, without waiting for receipt of explanation from the petitioner, proceeded to draw a panchanama and attached and sealed the machine.

2. The petitioner tendered his explanation informing that he uses the machine for diagnosis of cases for surgical purpose and does not put it to use for any other purpose. The explanation tendered by the petitioner was not considered and no further steps had been taken by the Respondents. The petitioner, approached the Bombay High Court seeking relief.

Their Lordships observed that it has not been brought to their notice , at any time in past, the Petitioner has been accused of violating the provisions of the PCPNDT Act, 1994 or Rules framed thereunder.
The action taken by the Appropriate Authority appears to be excessive for the reason that on 17.06.2011, the Appropriate Authority proceeded to issue notice to the petitioner calling upon him to tender his explanation in respect of the allegation recorded in the notice, within a period of eight days, however, without waiting for eight days prescribed under the notice, proceeded to draw a panchanama and sealed the ultrasound sonography machine.
It does appear that there is absolutely no material to come to the conclusion that the machine itself may furnish evidence of commission of offence punishable under the Act. It is also an admitted position that during inspection, the Appropriate Authority did not find any objectionable material to come to the conclusion that the petitioner has, in any way, contravened provisions of the Act or Rules framed thereunder.
It has been stated by the petitioner that he does not indulge in gynecological practice and has restricted his practice as a general surgeon.
The action taken by the Appropriate Authority is unsustainable. Though the machine is put under the seal since June 2011, no further steps have been taken till this date. Petitioner is not accused of commission of offence punishable under the provisions of the Act of 1994 or Rules of 1996 framed thereunder.

With these observations the High Court quashed the action of AA and saddled cost of Rs.10,000/-.

You can read the full judgement by clicking on the following link ( Harishchandra Madhavrao Wange vs The State Of Maharashtra & ors, Hon. bombay High Court, BENCH AT AURANGABAD WRIT PETITION NO.11217 OF 2014, decided on 09/06/2016)

Bombay High Court asks Law Department to look into the issue of unnecessarily calling doctors to give evidence

Image result for Bombay High Court
The Bombay High Court recently asked the principal secretary of the law and judiciary department of the state government to look into a study highlighting the issue of unnecessarily calling doctors to give evidence in courts and the “failure” of the state government to implement the suggestions given by the Supreme Court in 1989 regarding the same.
The move follows a 19-page study report prepared and submitted by Dr Indrajit Khandekar, professor and in-charge of Clinical Forensic Medicine Unit (CFMU) at Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha to the Bombay High Court on July 15.
In his report, Dr Khandekar had pointed out that treating doctors as well as autopsy doctors are routinely called to court to give evidence and testify the details of patients from the medical or medico-legal reports.
Even after attending the court, in around 45 to 50 percent of the cases, the evidence is not recorded as the evidence of the doctor was already admitted. In around 30 percent of the cases the evidence is not recorded because of adjournments and the doctors are asked to attend the court again after receipt of fresh summons even when they are called from other districts or states. This leads to unnecessary wastage of precious time of doctors, the report stated.
Due to unnecessary involvement of doctors in judicial process, doctors are reluctant to treat medico-legal cases, said Dr Khandekar.
The Supreme Court in Pt Parmanand Katara v/s Union of India (1989) had observed: “Doctors should not be called to give evidence unnecessarily, so that those patients who need doctors’ services utmost must receive it.”
The Punjab & Haryana High Court in Smt Parsanni v/s Shri Sube Singh (2011) had observed that “the procedure under the Motor Vehicles Act is summary in character and documents which are maintained in government hospitals in the regular course of business require no more proof and a mere copy produced at the trial shall be received as public documents and hence, the practice of summoning doctors by the tribunals even for merely marking the medico-legal reports must be stopped.”
In spite of such observations by the high court, doctors are routinely called to give evidence in motor accident claim tribunals to just identity or mark the hospital documents, according to Dr Khandekar.