eMedinewS Editorial

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Metformin Associated With Decreased B12 Levels

Dear Colleague

Patients on metformin may have a higher risk of decreased levels of vitamin B12 and increased homocysteine levels, according to research published in the May 20 issue of BMJ. In the study Dr Jolien de Jager, of the Academic Medical Center in Amsterdam, the Netherlands, and colleagues randomized 390 patients with type 2 diabetes receiving insulin to either 850 mg metformin or placebo three times daily over 4.3 years and found that metformin was associated with a mean decrease of 19 percent in B12 concentration compared to placebo. The absolute risk of B12 deficiency was 7.2 percentage points higher in the metformin group, the absolute risk of low B12 was 11.2 percentage points higher in the metformin group, and the mean levels of homocysteine were inversely correlated with B12 levels. The conclusion of the study was that long–term treatment with metformin increases the risk of vitamin B12 deficiency, which results in raised homocysteine concentrations. Regular measurement of vitamin B12 concentrations during long–term metformin treatment should be strongly considered.

Medical education to remain under Health Ministry

The Health Ministry has rejected the proposal of Ministry of HRD to bring the medical education under the proposed National Council for Higher Education and Research (NCHER). Medical education cannot be separated from the Health Ministry, said Union Health Minister Ghulam Nabi Azad said. The health ministry has proposed to set up a National Council for Human Resources in Health (NCHRH) as an overarching regulatory body to reform the current regulatory framework and enhance the supply of skilled personnel in the health sector. A task force was formed in June for setting up the NCHRH and the task force submitted its report in July 2009.  The report and draft Bill was circulated to the states for their comments and 13 states have already responded.
Azad has also advised the newly-constituted panel replacing the dissolved MCI to work fairly without fear. Azad asked them to judiciously take all decisions and maintain transparency, honesty and integrity.The new panel would be an autonomous body with double powers. It will include the powers of the MCI and the Health Ministry.  As used to happen earlier where the Ministry had a final say, now the panel’s decision will be considered final. (Source ENS)
Request by DMA

DMA has requested all members to inform DMA Office by email delhimedicalassociation@yahoo.com, or  telephonically 01123271726, 01123285727 or to Dr. Ashwini Dalmiya, Hony. State Secretary (9811542055) alongwith their complete addresses and branch number, in case they are not getting DMA news bulleting published fortnightly.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

eMedinewS Editorial

Health Care 2,095 Comments

Tips to Prevent Dementia

Dear Colleague

Recently, I came across a list of 20 points given by Dr. Paul Nussbaum, a neuropsychologist at the University of Pittsburgh School of Medicine to prevent dementia and I thought of sharing them with all readers.

Most of us start worrying about dementia after retirement – and that may be too little, too late. According to experts, one needs to start taking care of their brain while in the 30s and 40s to really want to ward off dementia, or even earlier. Increasing evidence points towards lifestyle as very important to your brain’s health. To live a long and healthy life, most of us need to start as early as we can. So what can you do to keep dementia at bay?

Here are 20 tips from Dr Nussbaum.

  1. Join clubs or organizations that need volunteers. If you start volunteering now, you won’t feel lost and unneeded after you retire.
  2. Develop a hobby or two. Hobbies help you develop a healthy brain because you’re trying something new and complex.
  3. Practise writing with your non–dominant hand several minutes everyday. This will exercise the opposite side of your brain and fire up those neurons.
  4. Take dance lessons. In a study of about 500 people, the only regular physical activity associated with a marked decline in the incidence of dementia, including Alzheimer’s disease was dancing. The people who danced three or four times a week showed 76% less incidence of dementia compared to those people who danced only once a week or not at all.
  5. Need a hobby? Start gardening. A study from New Zealand found that, of the 1,000 people, those who gardened regularly were less likely to suffer from dementia! Gardening reduces stress; at the same time, gardeners use their brains to plan gardens; they use visual and spatial reasoning to lay out a garden.
  6. Buy a pedometer and walk 10,000 steps a day. Walking daily can reduce the risk of dementia because cardiovascular health is important to maintain blood flow to the brain.
  7. Read and write daily. Reading stimulates a wide variety of brain areas that process and store information. Likewise, writing (not copying) stimulates many areas of the brain as well.
  8. Start knitting. Using both hands works both sides of your brain. It also reduces stress.
  9. Learn a new language. Whether it’s a foreign language or sign language, you are working your brain by making it go back and forth between one language and the other. Being bilingual may delay symptoms of Alzheimer’s disease for four years as observed by a researcher in England. And some research suggests that the earlier a child learns sign language, the higher his IQ – and people with high IQs are less likely to have dementia. So start them early.
  10. Play board games like Scrabble and Monopoly. Not only are you taxing your brain, you’re socializing too. Playing solo games, such as solitaire or online computer brain games can be helpful, but Dr Nussbaum recommends games that also encourage you to socialize.
  11. Take classes throughout your lifetime. Learning causes structural and chemical changes in the brain, and education appears to help people live longer. Brain researchers have found that people with advanced degrees live longer – and if they do have Alzheimer’s, it often becomes apparent only in the very later stages of the disease.
  12. Listen to classical music. A growing volume of research suggests that music may hardwire the brain, building links between the two hemispheres. Any kind of music may work, but some research has shown positive effects for classical music, though researchers don’t understand why.
  13. Learn a musical instrument. It may be harder than it was when you were a kid, but you’ll be developing a dormant part of your brain.
  14. Travel. When you travel (whether it’s to a distant vacation spot or on a different route across town), you’re forcing your brain to navigate a new and complex environment. In a study of London taxi drivers, experienced drivers had larger brains because they had to store lots of information about locations and how to navigate there.
  15. Pray. Daily prayer appears to help your immune system. And people who attend a formal worship service regularly live longer and report happier, healthier lives.
  16. Learn to meditate. It’s important for your brain that you learn to shut out the stresses of everyday life.
  17. Get adequate sleep. Studies have documented an association between dementia and interrupted sleep.
  18. Eat omega–3 fatty acids rich foods: Salmon, sardines, tuna, ocean trout, mackerel or herring, plus walnuts (which are higher in omega 3s than salmon) and flaxseed. Flaxseed oil, cod liver oil and walnut oil are good sources too.
  19. Eat more fruits and vegetables. Antioxidants in fruits and vegetables clean up some of the damage caused by free radicals, one of the leading killers of brain cells.
  20. Eat at least one meal a day with family and friends. You’ll slow down, socialize, and research shows you’ll eat healthier food than if you ate alone or on the go.

(With input from from Dr Santosh Sahi)

Dr KK Aggarwal

Padma Shri Awardee and Chief Editor

eMedinewS Editorial

Social Health Community 2,761 Comments

Tackling quackery

Dear Colleague

There is a shortage of at least 8 lakh doctors, 6 lakh dentists and 12 lakh nurses in the country. The net result is mushrooming of paramedical workers and others practicing in the guise of a doctor by adding ‘Dr’ as a prefix to their names and submitting fake certificates and degrees.

There are less than 7 lakh allopathic doctors in the country. What is required is a centralized register on a website which anybody should be able to access, click the required “State” and enter the state registration number. This way, any hospital, nursing home or even a patient should be able to verify the credentials of his or her doctor, including his or her photograph. A good IT should not need more than a month to work out a system of Centralizing registration. If it is difficult for the government to find such a solution, it can create a centralized website for registration with a facility of self–registration where all the doctors should be able to enter their details, upload their photograph and scanned copy of their registration. In this way, no two people of the same registration will be able to register. People, who have died will automatically be eliminated and anybody who is not registered should not be allowed to practice anywhere in the country. Once the process of registration is centralized, one can verify anyone practicing anywhere in India.

Quacks practicing in Delhi are usually arrested by the Police but released on bail after a few days. They can be seen practicing in their area even while on bail. This simply means that the council lawyer did not oppose the bail and, even if did, he did not ask for a conditional bail. The bail should specifically be conditional that the person released on bail cannot practice till the case is decided. If he or she still practices, it will amount to contempt of court and the bailable offence becomes a non–bailable offence.

It is also argued that quacks charge less fee, therefore, public goes to them for consultation. They may be charging less under “consultation head” but their bill per day invariably is much more than the bill of a general practitioner. Their bill includes medicines, injections and drips. You will never come across a quack who does not give one or two drips to his patient. So, a patient may end up paying Rs. 200–300 per consultation.

The concept of the ‘nurse practitioner’ is not prevalent in India. In the West, nurses are allowed to practice as ‘nurse practitioners’ under restricted conditions. Qualified nurses can provide better care than a quack and the services of the nurse practitioner can be utilized in those areas where doctors are not available. To practice is not difficult as about 85% of the diseases are self–limiting and the patients will become alright despite treatment. A quack only needs to know the following:

  1. Cough means a cough syrup.
  2. Allergy means any anti–allergic drug CPM or cetrizine.
  3. Malaria means 4 tablets of chloroquine.
  4. Fever means a combination of paracetamol, antibiotic and steroids.
  5. Wheezing means a combination of oral/IM steroid + nebulizer.
  6. A non–responding wheezing means add Lasix.
  7. Not passing urine means Lasix.
  8. High TLC (total leukocyte count) means adding antibiotics to their prescription.
  9. Low hemoglobin means iron–folic acid, B–complex.
  10. Any skin condition means any skin ointment containing antibiotic, anti fungal and steroid
  11. Weakness means IV drip.
  12. Loose motions or diarrhea mean IV drip

This is how most of the ‘quacks’ practice and if the patient is not responding in three days, they will refer him to the nearest hospital.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

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