Panel of 6 docs replaces tainted MCI
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MCI DISSOLVED
Panel of 6 docs replaces tainted MCI
Tainted with charges of corruption, the 76-year-old Medical Council of India was on Saturday dissolved and replaced by a six-member panel of eminent doctors to carry out its duties.
An ordinance dissolving the all-powerful body, formed to regulate medical education in the country, was signed by President Pratibha Patil and notified by the law ministry.
The Union Cabinet had discussed the ordinance on Thursday following which it had gone to the law ministry for consultations.
The six-member panel is headed by eminent gastroenterologist from Delhi Dr S K Sarin. The other five members are: former director of National Institute of Immunology Prof Ranjit Roy Chowdhary, Dr Sita Naik from SGPGIMS, Dr Gautam Sen, cardiac surgeon, Dr Devi Shetty and former head of Safdarjung hospital Dr R L Salhan.
Union health secretary K Sujatha Rao told TOI, "This committee will not have an advisory role but will actively run the MCI including issuing licences and permissions, conducting inspections and regulating medical education, for a maximum of one year. It will also suggest ways to reform MCI which will help in preparing the bill which we plan to introduce in the monsoon session of Parliament."
MCI till now was the sole body that granted recognition to medical degrees, gave accreditation to medical colleges, registered medical practitioners and monitored medical practice in the country.
However, allegations of corruption against the MCI have been rife for years now. On April 22, MCI's president Dr Ketan Desai was arrested by the CBI for allegedly taking a bribe of Rs 2 crore to recognize a medical college in Punjab though it did not meet MCI standards. The ministry said it plans to bring in a new law for the formation of an overarching body to regulate medical education in the country.
According to Rao, the draft law for the formation of such a body would be formulated within a month. Sources say MCI would be made a body to regulate medical professionals, which would be in line with the original mandate of the MCI.
An earlier effort by the ministry to amend the Indian Medical Council Act of 1956, giving more powers to the ministry, was turned down by the parliamentary standing committee on health, which argued that the move would destroy the council's autonomy. Health minister Ghulam Nabi Azad said the ordinance "was required as there is no law that empowers us to take action against MCI as it was created by an act of Parliament."
Saturday, May 15, 2010
Sunday, May 2, 2010
teriparatite- forteo
Teriparatide (trade name Forteo) is a medication to treat osteoporosis that works in a different way than other drugs for osteoporosis. It is the first drug to cause new bone to be formed. Teriparatide has been FDA approved to treat osteoporosis in postmenopausal women and in men with hypogonadal or idiopathic osteoporosis who are at high risk for fracture.
Osteoporosis-related fractures are a serious problem for older people. It is often a hip fracture that leads to decline in the health of the elderly. A third of all hip fractures occur in men, and almost 38% of those men will die in the following year. Osteoporosis in men is underdiagnosed. Generally defined as the thinning of bone tissue and decrease in density, osteoporosis is the most common type of bone disease.
The existing treatments for osteoporosis are medications that prevent bone resorption. Bisphosphonates alendronate (Fosamax) and risedronate (Actonel) are oral medications. Other treatments include salmon calcitonin (Miacalsin) which is available as a nasal spray or injection. Raloxifene (Evista) is a selective estrogen receptor modulator. By preventing bone resorption, these medications are used to prevent bone loss.
Teriparatide is a synthetic form of the naturally occuring parathyroid hormone. Unlike other osteoporosis drugs, it actually causes bone density to increase. In the body, parathyroid hormone is released by the parathyroid glands in the neck (behine the thyroid glands) and is an important regulator in the bloodstream's levels of calcium and phosphorus. Laboratory tests can determine the level of this hormone in the blood.
The most important endpoint for treatment with any of these drugs is prevention of fractures, especially hip and vertebral fractures.
Bone metabolism is a complex process. Bone remodels throughout a person’s life, so that there is new bone being made along with bone resorption. Among the substances that affect bone metabolism are vitamin D, calcium, estrogen, testosterone, and parathyroid hormone which regulates the calcium and bone formation in the body. Other external factors influence bone metabolism and increase the risk of osteoporosis, including prolonged use of corticosteroids, alcoholism, smoking, and in men, hypogonadism.
Early trials of teriparatide leading to its FDA approval were completed separately for men and women. Evaluation of drugs for osteoporosis are complicated by the difficulty of knowing how severe the bone loss is, and also because treatment is needed not just to prevent thinning bone but to definitively protect against fracture.
One randomized trial of postmenopausal women who had already fractured vertebra compared teriparatide at either 20 or 40 micrograms per day with placebo. After about 19 months, 14% of the women taking placebo had new vertebral fractures, as compared with 5% of the women taking 20 micrograms of teriparatide and 4% of the women taking 40 micrograms. There were also a statistically significant lower number of non-vertebral fractures in the teriparatide treated group. 20 micrograms of teriparatide increased spine and hip bone mineral density. However, this study had to be terminated because 1.6% of the women taking 40 micrograms of teriparatide and 0.2% of those taking 20 micrograms developed significant increases in serum calcium, the amount of calcium in the blood, which can be dangerous.
Another trial compared 40 micrograms of teriparatide to alendronate. After about 14 months later, bone density increased more in the spine and femoral neck (part of the hip) in the patients treated with teriparatide. Bone density in the wrist decreased with teriparatide. Fewer patients treated with teriparatide suffered nonvertebral fractures.
A randomized trial using teriparatide to treat men with osteoporosis (half of whom had low testosterone levels) showed that teriparatide doses of both 20 micrograms and 40 micrograms increased bone density in the lumbar spine and the femoral neck. In this study bone density in the wrist decreased.
Side Effects of Teriparatide
Generally, teriparatide is well tolerated.
The most common side effects, among others, are dizziness, nausea, heartburn, diarrhea, headache and leg cramps, pain, weakness, and depression. Lowered blood pressure (hypotension) when standing can occur with the first few doses but does go away in a matter of hours. Patients may be told to lie down after the injection. There have been some cases of slightly elevated serum calcium, and elevated calcium in the urine (which can lead to kidney stones). Ooccasionally transient hypercalcemia occurs 4 to 6 hours after injection, reducing blood serum calcium concentrations.
If any of these side effects persist or worsen, the prescribing doctor should be informed. More serious reactions have included chest pain, fainting, difficulty breathing, more severe nausea, vomiting, constipation, and muscle weakness. Allergic reactions can occur, from itching at the injection site to more serious symptoms of allergy including swelling, and difficulty breathing. Serious side effects warrant immediate medical attention.
When teriparatide was given to growing young rats, they developed osteogenic sarcoma, a very malignant tumor. The drug should not be given to anyone at risk for developing this bony cancer. That would include patients with Paget’s disease, those with elevated alkaline phosphatase (which could indicate a problem in bone), patients who had radiation therapy to their bones, or children and young adults whose bones are still growing.
At this time, the recommended length of treatment is two years. There are many ongoing clinical trials to determine the best way to use teriparatide, with other medicines like alendronate, how long treatment should last, and which patients with osteoporosis will benefit the most from it. There have been attempts to deliver the medication as a nasal spray instead of injection. It is also being tested for other conditions. One, called osteogenesis imperfecta is a genetic bone disease causing brittle bones. Teriparatide is being tried as a treatment for adults with osteogenesis imperfecta. It is also being tested as an aid to fracture healing. There are some 50 trials in various stages at this time, and new uses for teriparatide will probably be found.
The approved dose (20Fg daily by subcutaneous injection) and duration of treatment have not been found to be associated with an increased
Osteoporosis-related fractures are a serious problem for older people. It is often a hip fracture that leads to decline in the health of the elderly. A third of all hip fractures occur in men, and almost 38% of those men will die in the following year. Osteoporosis in men is underdiagnosed. Generally defined as the thinning of bone tissue and decrease in density, osteoporosis is the most common type of bone disease.
The existing treatments for osteoporosis are medications that prevent bone resorption. Bisphosphonates alendronate (Fosamax) and risedronate (Actonel) are oral medications. Other treatments include salmon calcitonin (Miacalsin) which is available as a nasal spray or injection. Raloxifene (Evista) is a selective estrogen receptor modulator. By preventing bone resorption, these medications are used to prevent bone loss.
Teriparatide is a synthetic form of the naturally occuring parathyroid hormone. Unlike other osteoporosis drugs, it actually causes bone density to increase. In the body, parathyroid hormone is released by the parathyroid glands in the neck (behine the thyroid glands) and is an important regulator in the bloodstream's levels of calcium and phosphorus. Laboratory tests can determine the level of this hormone in the blood.
The most important endpoint for treatment with any of these drugs is prevention of fractures, especially hip and vertebral fractures.
Bone metabolism is a complex process. Bone remodels throughout a person’s life, so that there is new bone being made along with bone resorption. Among the substances that affect bone metabolism are vitamin D, calcium, estrogen, testosterone, and parathyroid hormone which regulates the calcium and bone formation in the body. Other external factors influence bone metabolism and increase the risk of osteoporosis, including prolonged use of corticosteroids, alcoholism, smoking, and in men, hypogonadism.
Early trials of teriparatide leading to its FDA approval were completed separately for men and women. Evaluation of drugs for osteoporosis are complicated by the difficulty of knowing how severe the bone loss is, and also because treatment is needed not just to prevent thinning bone but to definitively protect against fracture.
One randomized trial of postmenopausal women who had already fractured vertebra compared teriparatide at either 20 or 40 micrograms per day with placebo. After about 19 months, 14% of the women taking placebo had new vertebral fractures, as compared with 5% of the women taking 20 micrograms of teriparatide and 4% of the women taking 40 micrograms. There were also a statistically significant lower number of non-vertebral fractures in the teriparatide treated group. 20 micrograms of teriparatide increased spine and hip bone mineral density. However, this study had to be terminated because 1.6% of the women taking 40 micrograms of teriparatide and 0.2% of those taking 20 micrograms developed significant increases in serum calcium, the amount of calcium in the blood, which can be dangerous.
Another trial compared 40 micrograms of teriparatide to alendronate. After about 14 months later, bone density increased more in the spine and femoral neck (part of the hip) in the patients treated with teriparatide. Bone density in the wrist decreased with teriparatide. Fewer patients treated with teriparatide suffered nonvertebral fractures.
A randomized trial using teriparatide to treat men with osteoporosis (half of whom had low testosterone levels) showed that teriparatide doses of both 20 micrograms and 40 micrograms increased bone density in the lumbar spine and the femoral neck. In this study bone density in the wrist decreased.
Side Effects of Teriparatide
Generally, teriparatide is well tolerated.
The most common side effects, among others, are dizziness, nausea, heartburn, diarrhea, headache and leg cramps, pain, weakness, and depression. Lowered blood pressure (hypotension) when standing can occur with the first few doses but does go away in a matter of hours. Patients may be told to lie down after the injection. There have been some cases of slightly elevated serum calcium, and elevated calcium in the urine (which can lead to kidney stones). Ooccasionally transient hypercalcemia occurs 4 to 6 hours after injection, reducing blood serum calcium concentrations.
If any of these side effects persist or worsen, the prescribing doctor should be informed. More serious reactions have included chest pain, fainting, difficulty breathing, more severe nausea, vomiting, constipation, and muscle weakness. Allergic reactions can occur, from itching at the injection site to more serious symptoms of allergy including swelling, and difficulty breathing. Serious side effects warrant immediate medical attention.
When teriparatide was given to growing young rats, they developed osteogenic sarcoma, a very malignant tumor. The drug should not be given to anyone at risk for developing this bony cancer. That would include patients with Paget’s disease, those with elevated alkaline phosphatase (which could indicate a problem in bone), patients who had radiation therapy to their bones, or children and young adults whose bones are still growing.
At this time, the recommended length of treatment is two years. There are many ongoing clinical trials to determine the best way to use teriparatide, with other medicines like alendronate, how long treatment should last, and which patients with osteoporosis will benefit the most from it. There have been attempts to deliver the medication as a nasal spray instead of injection. It is also being tested for other conditions. One, called osteogenesis imperfecta is a genetic bone disease causing brittle bones. Teriparatide is being tried as a treatment for adults with osteogenesis imperfecta. It is also being tested as an aid to fracture healing. There are some 50 trials in various stages at this time, and new uses for teriparatide will probably be found.
The approved dose (20Fg daily by subcutaneous injection) and duration of treatment have not been found to be associated with an increased
Massive Blood transfusion
Massive Transfusion is usually defined as the need to transfuse from one to two times the patient's normal blood volume. In a "normal" adult, this is the equivalent of 10-20 units. Potential complications from this include coagulopathy, citrate toxicity, hypothermia, acid-base disturbances and changes in serum potassium concentration.
________________________________________
Coagulopathy is common with massive transfusion. The most common cause of bleeding following a large volume transfusion is dilutional thrombocytopenia. This should be suspected and treated first before moving on to factor deficiencies as the cause of coagulopathy.
Citrate toxicity results when the citrate in the transfused blood begins to bind calcium in the patient's body. Clinically significant hypocalcemia does not usually occur unless the rate of transfusion exceeds one unit every five minutes or so. Citrate metabolism is primarily hepatic - so hepatic disease or dysfunction can cause this effect to be more pronounced. Treatment is with intravenous calcium administration - but identification of the problem requires a high index of suspicion.
Hypothermia should not occur on a regular basis. Massive transfusion is an absolute indication for the warming of all blood and fluid to body temperature as it is being given.
Acid-Base balance can be seen after massive transfusion. The most common abnormality is a metabolic alkalosis. Patients may initially be acidotic because the blood load itself is acidic and there may be a prevailing lactic acidosis from hypoperfusion. However, once normal perfusion is restored, any metabolic acidosis resolves and the citrate and lactate are then converted to bicarbonate in the liver.
Serum potassium can rise as blood is given. The potassium concentration in stored blood increases steadily with time. The amount of potassium is typically less than 4 milliequivalents per unit - so you can see that large amounts of blood at a high rate of delivery is required to raise serum levels of potassium.
________________________________________
Infectious Agents can be passed along with blood transfusion as well.
o Hepatitis
o AIDS
o Other viral agents (CMV, EBV, HTLV)
o Parasites and bacteria
Hepatitis has been an ongoing problem. Until recently, the incidence of hepatitis following transfusion was as high as 10% with the overwhelming majority of these infections caused by hepatitis C. Now that this virus is identified and tested for, the risk is decreased. Currently the risk from transfusion is estimated to be in the range of 1:1,000,000 for hepatitis A, 1:30,000 - 250,000 for hepatitis B and 1:30,000 - 150,000 for hepatitis C.
AIDS is a feared disease but the actual risk is quite low. All blood is tested for the anti-HIV-1 antibody which is a marker for infectivity. Unfortunately, there is a 6-8 week period required for a person to develop the antibody after they are infected with HIV and therefore infectious units can go undetected. The current risk for HIV infection due to transfusion is estimated to be 1:200,000 to 2,000,000.
CMV and EBV are usually the cause of only asymptomatic infection or mild systemic illness. Unfortunately, some of these people become asymptomatic carriers of the viruses and the white blood cells in blood units are capable of transmitting either virus. Immunocompromised and immunosuppressed patients are particularly susceptible to CMV and should receive CMV negative units only.
Human T cell Lymphocytic Viruses (HTLV-1 responsible for tropical spastic paresis and HTLV-II) are leukemia and lymphoma retro-viruses that have been reported to be transmitted via transfusion. Screening is done for these, but again those in the window before antibodies are made can be missed. Current risk is estimated at 1:250,000 - 2,000,000.
Parvovirus B19 has been reported to be transmitted by factor concentrates and occurs in approximately 1:10,000 transfusions. It is associated with aplastic anemia and liver failure, especially inimmunologically compromised children.
Parasitic diseases reported to be transmitted via blood transfusion include malaria, toxoplasmosis, and Chagas' disease. Fortunately, such cases are rare and the prevalence of these diseases is very low in the United States. Therefore, these are of very little concern in this country.
Both gram-positive and gram-negative bacteria can rarely contaminate blood transfusions. To avoid the possibility of significant bacterial contamination, blood should be administered over a period of shorter than four hours.
________________________________________
Coagulopathy is common with massive transfusion. The most common cause of bleeding following a large volume transfusion is dilutional thrombocytopenia. This should be suspected and treated first before moving on to factor deficiencies as the cause of coagulopathy.
Citrate toxicity results when the citrate in the transfused blood begins to bind calcium in the patient's body. Clinically significant hypocalcemia does not usually occur unless the rate of transfusion exceeds one unit every five minutes or so. Citrate metabolism is primarily hepatic - so hepatic disease or dysfunction can cause this effect to be more pronounced. Treatment is with intravenous calcium administration - but identification of the problem requires a high index of suspicion.
Hypothermia should not occur on a regular basis. Massive transfusion is an absolute indication for the warming of all blood and fluid to body temperature as it is being given.
Acid-Base balance can be seen after massive transfusion. The most common abnormality is a metabolic alkalosis. Patients may initially be acidotic because the blood load itself is acidic and there may be a prevailing lactic acidosis from hypoperfusion. However, once normal perfusion is restored, any metabolic acidosis resolves and the citrate and lactate are then converted to bicarbonate in the liver.
Serum potassium can rise as blood is given. The potassium concentration in stored blood increases steadily with time. The amount of potassium is typically less than 4 milliequivalents per unit - so you can see that large amounts of blood at a high rate of delivery is required to raise serum levels of potassium.
________________________________________
Infectious Agents can be passed along with blood transfusion as well.
o Hepatitis
o AIDS
o Other viral agents (CMV, EBV, HTLV)
o Parasites and bacteria
Hepatitis has been an ongoing problem. Until recently, the incidence of hepatitis following transfusion was as high as 10% with the overwhelming majority of these infections caused by hepatitis C. Now that this virus is identified and tested for, the risk is decreased. Currently the risk from transfusion is estimated to be in the range of 1:1,000,000 for hepatitis A, 1:30,000 - 250,000 for hepatitis B and 1:30,000 - 150,000 for hepatitis C.
AIDS is a feared disease but the actual risk is quite low. All blood is tested for the anti-HIV-1 antibody which is a marker for infectivity. Unfortunately, there is a 6-8 week period required for a person to develop the antibody after they are infected with HIV and therefore infectious units can go undetected. The current risk for HIV infection due to transfusion is estimated to be 1:200,000 to 2,000,000.
CMV and EBV are usually the cause of only asymptomatic infection or mild systemic illness. Unfortunately, some of these people become asymptomatic carriers of the viruses and the white blood cells in blood units are capable of transmitting either virus. Immunocompromised and immunosuppressed patients are particularly susceptible to CMV and should receive CMV negative units only.
Human T cell Lymphocytic Viruses (HTLV-1 responsible for tropical spastic paresis and HTLV-II) are leukemia and lymphoma retro-viruses that have been reported to be transmitted via transfusion. Screening is done for these, but again those in the window before antibodies are made can be missed. Current risk is estimated at 1:250,000 - 2,000,000.
Parvovirus B19 has been reported to be transmitted by factor concentrates and occurs in approximately 1:10,000 transfusions. It is associated with aplastic anemia and liver failure, especially inimmunologically compromised children.
Parasitic diseases reported to be transmitted via blood transfusion include malaria, toxoplasmosis, and Chagas' disease. Fortunately, such cases are rare and the prevalence of these diseases is very low in the United States. Therefore, these are of very little concern in this country.
Both gram-positive and gram-negative bacteria can rarely contaminate blood transfusions. To avoid the possibility of significant bacterial contamination, blood should be administered over a period of shorter than four hours.
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