Dr K K Aggarwal

eMedinewS Editorial

Revisiting MCI 2010

MBBS seats upped by 10,000

Medical Council of India has permitted an increase of nearly 10,000 MBBS seats in medical colleges from this year. After five to six years, the country will produce an additional 10,000 doctors, taking the yearly output to 45,000 from the present 35,000 MBBS passouts. MCI’s Board of Governors, also accorded sanction for 66 new medical colleges. MCI downsized the land requirement for starting a new medical college from 25 acres to 10 acres. But the building size on the 10 acres need not be any smaller than the one that was permitted to be built on 25 acres. To further increase the number of doctors available in remote and far flung areas, the Board has started discussions with Army, Railways and Employees State Insurance Corporation to start new medical colleges as they have vast tracts of land at their disposal. MCI has given an attractive proposal that the Army, Railways and ESIC, after starting the medical colleges, could add a stipulation that the MBBS passouts would have to work a minimum number of years in their service. This will need corresponding increase in faculty. To address this MCI has recommended increase in their retirement age from the present 65 years to 70 years. (Source: The Times of India, December 25, 2010 http:// timesofindia.indiatimes.com/ india/ MBBS–seats–upped–by–10000/articleshow/7160250.cms)

MCI pushes forensics into dark ages

Medical Council of India (MCI) has dealt a severe blow to the already–neglected discipline of forensic science and toxicology. Recently, the council slashed by one-third the requirement of qualified forensic teaching faculty in medical colleges across India apart from cutting by half the number of teaching hours required – from 200 hours over one–and–a– half years to 100. The move will cut over 300 teaching posts of forensic faculty in around 300 medical colleges given the earlier requirement of three teachers (one professor, one associate and one assistant professor) for each college comprising 100 undergraduate students. Now, only two MD (Forensic Science) teachers would do. One teaching post each has been cut across five slabs of student intake (50, 100, 150, 200 and 250).

India is short of over 5,000 medico–legal experts for criminal investigations. Unlike other countries, in India, 90 per cent medico–legal work (post–mortem examination, injury reports, sexual offences medical examination reports, alcohol examination and age estimation) is being done by simple MBBS doctors with no forensic expertise. The IPC and the CrPC don’t distinguish between MBBS doctors and forensic experts when it comes to medical investigations. Though, the courts have repeatedly sought strengthening of forensic medicine. The MCI move comes at a time when a leaked US cable mocks at India’s poor forensic investigation skills. It reads: “Indian police forces are hampered by bad police practices and an inability to conduct solid forensic investigations.” (Source: The Tribune News Service New Delhi, December 24. http://www.tribuneindia.com/2010/20101225/main7.htm )

Dr KK Aggarwal
Editor in Chief

eMedinewS Editorial

New food allergy guidelines from National Institute of Allergy and Infectious Diseases

• Food allergies should be considered in those presenting with anaphylaxis or symptoms that occur within minutes to hours of ingesting food, especially in young children and/or if symptoms have followed the ingestion of a specific food on more than one occasion.
• Following a detailed history and physical, a skin prick test may help identify foods at issue. It alone is not considered diagnostic.
• Intradermal tests and routine total serum IgE should not be used. Atopy patch test should not be used in noncontact food allergies.
• Food elimination diets may be useful in diagnosis, and double–blind, placebo–controlled food challenges are a gold standard.
• Management of allergy patients should include avoidance of the food that causes the allergy
• There is no need to avoid potentially allergenic foods as a means of managing eosinophilic esophagitis, food protein–induced allergic proctocolitis or asthma.
• There are no drugs recommended to prevent food allergies
• Antihistamines may be used to manage symptoms.
• Drugs are used when the allergen is difficult to avoid or results in nutritional deficiencies.
• There is no need to restrict maternal diet during pregnancy or lactation to prevent later food allergies.
• Treatment for food–induced anaphylaxis should be prompt and rapid, with intramuscular epinephrine as first–line therapy in all cases.
• Food allergy affects nearly 5% of children younger than 5 years old and 4% of teens and adults. Its prevalence appears to be on the rise, according to NIAID.

Dr KK Aggarwal
Editor in Chief

eMedinewS Editorial

New Guidelines issued for preventing first strokes

From the American Heart Association and the American Stroke Association (Dec. 6, Stroke)

• Family history is useful to identify those who may be at increased risk of stroke.
• Dosing with vitamin K antagonists on the basis of pharmacogenetics is not recommended.
• Genetic screening of the general population is not recommended, although referrals for genetic counseling may be considered for patients with rare genetic causes of stroke.
• Noninvasive screening for unruptured intracranial aneurysms in patients with a relative with subarachnoid hemorrhage or intracranial aneurysms is not recommended, except in certain patients with particularly high–risk family histories.
• Blood pressure goal is less than 140/90 mm Hg or 130/80 mm Hg in patients with diabetes or renal disease.
• Smoking should be addressed at every patient encounter.
• Physical activity should be 150 minutes of moderate exercise per week.
• Healthy eating such as the DASH diet is recommended.
• For patients with diabetes and hypertension, the guidelines suggest an angiotensin–converting enzyme inhibitor or an angiotensin II receptor blocker; statins, especially in those with additional risk factors, to lower risk of a first stroke, and possibly monotherapy with a fibrate to lower stroke risk.
• Adding a fibrate to a statin is not useful for decreasing stroke risk.
• Aspirin should be used for cardiovascular (including but not specific to stroke) prophylaxis in persons whose risk is sufficiently high for the benefits to outweigh the risks associated with treatment (a 10–year risk of cardiovascular events of 6% to 10%).
• Aspirin is not useful for preventing a first stroke in low–risk people or persons with diabetes or diabetes plus asymptomatic peripheral artery disease in the absence of other established cardiovascular disease.

Dr KK Aggarwal
Editor in Chief