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SUNDAY,05TH AUGUST 2012
SYMPOSIUM ONHIV / AIDS
WEDNESDAY,08TH AUGUST 2012
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WEDNESDAY,15TH AUGUST 2012
FLAG HOISTINGCEREMONY
CONTENTSPRESIDENT PEN ................................................................................. 3
G.P. FORUM P & WEEKLY SCIENTIFIC PROGRAMME .................... 4
HON. SECRETARY’ DESK .................................................................. 5
ANNOUNCEMENTS ............................................................................. 6
GUEST EDITORIAL .............................................................................. 7
REPORTS .............................................................................................. 8
BAJE MURALIA ...................................................................................13
SYMPOSIUM ON HIV / AIDS ...............................................................14
PALLIATIVE CARE IN CANCER.........................................................15
CANCER SCREENING ......................................................................19
BREAST MRI – A NEW FRONTIER ...................................................23
ACHIEVEMENT ...................................................................................25
TARGETING CANCER TO CURE .....................................................26
STEM CELL TRANSPLANT PART- 3 ..................................................28
APPEAL FOR MEDICAL EDUCATION SCHOLARSHIPSIMA – Mumbai West Awards Scholarships of Rs. 25,000/- each, every year to third M.B.B.S.Students, selected by certain fixed criteria. Donations for these scholarships are receivedfrom members in two forms.a) An amount of Rs. 3 lacs (in memory of their loved ones). This amount forms a corpus
for a scholarship. Theses scholarships are awarded as - “(NAME OF THE DONOR ortheir loved ones) – IMA – MUMBAI WEST SCHOLARSHIP”.
b) An amount of Rs. 25,000/-. This amount is awarded as scholarship for the particularyear. It is awarded as “IMA – MUMBAI WEST SCHOLARSHIP”.
The number of these scholarships will increase or decrease depending on the number ofRs. 25,000/- donations received in any particular year.Members desirous of contributing to these scholarships can do so whenever they desire.Members may contact IMA office for the same. Donations given qualify for Income Taxdeduction under section 80(G)
Please get your IMA Mumbai West IDENTITY CARD. Identity Card shall be mandatory for future events
DISCLAIMER :Unless otherwisestated, the opinionsexpressed by anywriters are theirpersonal opinions.The appearance ofadvertisements in"Medical Image” isnot guarantee orendorsement of theproduct or theclaims made by themanufacturer /advertiser.
Published by : IMA MUMBAI WEST
Contact for write-ups, articles, interviewsand advertisements :
IMA Bldg, Behind Chandan Cinema, J.R.MhatreMarg, J.V.P.D. Scheme, Juhu, Mumbai - 400 049.Office : 2625 4368 / 6523 5579 Fax : 2620 6517
E-mail : [email protected] : www.imamumbaiwest.com
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EDITORIAL BOARD
Editor
DR. S. K. JOSHIBoard
DR.JAYESH LELEDR.DEEPAK JUMANI
DR.PRABHAKAR RAODR.PARTHIV SANGHVI
DR.RASHMIKANT SANGHVIDR. VANI KULHALLI
FOR PRIVATE CIRCULATION ONLY
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INDIAN MEDICAL ASSOCIATION - MUMBAI WESTI.M.A. Bldg., Behind Chandan Cinema, J. R. Mhatre Marg, J.V.P.D. Scheme, Juhu, Mumbai - 400 049.Office : 2625 4368 / 6523 5579 FAX 2620 6517E-mail : [email protected] � Website : www.imamumbaiwest.com
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Hon. Secretary : Dr. Joshi S. K. 2670 1418 2671 2254 99205 76506
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MUMBAI - WEST SUB FACULTY OF IMA - CGP
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Asst. Secretary : Dr. Shah Ronak 2883 5658 2883 5297 9323271274
MUMBAI - WEST CHAPTER OF IMA - AMS
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ear Friends,
At the outset let me thank personally allthe members of medical fraternity for givingtheir full support to IMA led nation widestrike of “ALL DOCTORS” observed on25th June 2012 against the NHRCH Bill,Clinical Establishment Act & resolution ofMCI imposed by the government.
It was very heartening to see doctors ofvarious “pathies” in large number for a commoncause, i.e. for the betterment of our medicalfraternity against the various rules thegovernment is imposing on us. This is just abeginning of a long battle to be fought forourselves and our future generation of doctors.By closing our clinics & hospitals for one dayto observe token strike all over India, we haveshown our solidarity to the govt. & public. Ifwe surrender to assaults on our professiontoday, the government will come with manymore suppressive moves to demean andharass the medical profession. So, if we don’tact now with our full might to dispel thesemoves of the Govt., our future generation willnever excuse us for their predicaments due toour undoings today. This affects every single
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medical professional, so kindly co-operate asand when required.
It is high time, we doctor members shouldinvolve in active politics to safeguard our nobleprofession. It is unfortunate that we are notaggressive in fighting against the Govt. uptothe expected level, but at least we should showour unity and solidarity amongst ourselves byprotesting strongly against them.
Doctor’s Day was celebrated in a grand manneron 1st July 2012. On this day, we pay our tributeto Late Bharat Ratna - Dr. B. C. Roy, a greatperson who lived upto the upliftmet of poor &downtrodden people by his selfless service inMedical Profession, Political arena & SocialActivities. Being a doctor is the most rewardingjourney on this day. We recognize andacknowledge the contributions made by theeminent doctors. “Let Doctor’s day be astimulant to do service”
I am very happy to note that many of our state& local branches celebrate Doctor’s Day. It isa function wherein doctors have to be honouredcheered, thanked & recognized on this specialday for their dedicated services to the society.We felicitated eminent dignitaries from our ownfraternity for their valuable contributions to usand the society
We suggest our members not to panic aboutFood & Drug Administration rules regardingdispensing, storing and prescribing drugs. Wehave invited FDA commissioner GreaterMumbai, Mr. Sanjay Kale to guide our membersregarding this matter during one of the weeklyCME programme.
Do send your feedback.
Long live IMA !!
DR. (MRS.) ALKA B. [email protected]
From
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Lectures on Every Thursdayat 02.00 p.m. sharp
WEEKLY SCIENTIFIC PROGRAMME
Venue : Lupin CME Auditorium, IMA Building,J.R.Mhatre Marg, Behind Chandan Cinema,J.V.P.D. Scheme, Juhu, Mumbai - 400 049.
DR. (MRS. ) ALKA B. MEHTA DR. S. K. JOSHI DR. RASHMIKANT SANGHVI DR. RONAK SHAHPresident Hon. Secretary Asst. Director of Studies Asst. Secretary
IMA - Mumbai West C.G.P. Sub Faculty
••••• WORKING LUNCH WILL BE SERVED FROM 01.00 PM TO 02.00 PM BEFORE EACH CME.• CGP, AMS & IMA Members who have paid Annual Fees : (CGP : Rs. 650/- & IMA :
Rs. 1300/-) Free.• CGP, AMS & IMA Members : Rs. 100/- (Not Paid Annual Fees) (Weekly Lectures).• Eligible Non Members : Rs. 350/- per lecture.• MMC ACCREDITATION HAS BEEN APPLIED FOR.• CHARGES FOR MMC CREDIT HOURS (FOR THE ACCREDITED CMES) Rs. 50/-. APPLICABLE TO ALL IMA MEMBERS DESIROUS OF CREDIT HOURS.
DATE TOPIC SPEAKER
02.08.2012 HOLIDAY ON ACCOUNT OF RAKSHABANDHAN09.08.2012 HOLIDAY ON ACCOUNT OF JANMASTAMI16.08.2012 VIOLENCE AGAINST WOMEN
Legal & Forensic Role of Health Care Professionalsin Cases of DV & Sexual Assault Dr. Jagdeesh ReddyEffectiveness of Health Facility based Dr. Seema MalikResponse to VAW :International & National EvidenceUnderstanding Violence against women Ms. Padma Deosthalias a health care
23.08.2012 CARDIAC UPDATE 2012How to read a Lipid Report & advise on the basis ofthe report in General Practice Dr. Tilak SuvarnaThe Breathless Patient in General Practice Dr. Shekhar AmbardekarManaging Hypertension - The Practical Issues(in Quiz form) Dr. Akshay Mehta
30.08.2012 Cancer Emergencies Dr. Avinash Deo
DATE TOPIC SPEAKER07.08.2012 Nutrition in Pediatrics Dr. Jagruti Sanghvi & Team14.08.2012 Ophthalmic Update Dr. S. Natrajan21.08.2012 ONCOLOGY UPDATE
Toxicity Management of Chemotherapy Dr. Bhavana ParikhPalliative Care Myths & Facts Dr. Prince JohnCase Presentation Dr. Ronak Shah
28.08.2012 Anemia Update Dr. Mukesh Desai & Team
Venue : Lupin CME Auditorium, IMA Building,J.R.Mhatre Marg, Behind Chandan Cinema,J.V.P.D. Scheme, Juhu, Mumbai - 400 049.
Every Tuesdayat 02.00 p.m. sharp
G. P. FORUM PROGRAMME
C.M.E. PROGRAMME FOR GENERAL PRACTITIONERS
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impractical. This raises few questions which aredifficult to answer i) If these doctors don’t go tovillages and prefer to carry out practice in slumsof cities then what? ii) If they make any mistakein prescribing allopathic medicines in criticalsituation whom to blame ? iii) Will any of Govt.official / politician prefer to be treated by suchdoctor in case he / she suffers for any healthproblem or will they prefer reputed qualifiedMBBS doctor or consultant for their treatment?Govt. accuses that very few allopathic doctorsgo to villages but I urge govt. to offer good salary,to improve infrastructure of rural health care, toequip “Primary Health Centres” with at leastproper and sufficient emergency medicines then,I am sure more allopathic doctors would opt forrural practice. Besides good and propertreatment, qualified doctors can be of great helpby spreading awareness about Malaria,Tuberculosis, HIV Cancers etc by offering goodhealth education and by organizing detectionprogrammes for Diabetes, Hypertension, CardiacDisease etc. This along with good impact ofaudiovisual media of TV, internet etc. will go longway in bringing lot of awareness & improvementof health status of rural population.FDA on the other had directs chemists not tohonour allopathic prescriptions of Unani /Ayurvedic / Homeopathic doctors. This is in totalcontradiction to the above proposal.We are in constant touch with IMA MaharashtraState & will wholeheartedly support and strongthe stand taken by IMA Maharashtra State.I am very pleased to know about good responseto movie club project and I am sure membersare really enjoying viewing movie in company offamily and friends.Again we will try our best to present good“Teacher’s Day Programme” on Sunday, 09th
September 2012. This will also include IMAMedical Scholarship Awarding Programme andIMA Medical Text Book Donation Programme.Please attend in large numbers.My hearty festival greetings on account ofRakhee, Janmashtami & Ramzaan Id Festivalsto our members & their families. I look forwardfor your valuable suggestions.
With best regards.
DR. S. K. JOSHIHon. Secretary99205 76506, [email protected](20-7-2012)
I sincerely complement & congratulate each &every member of our branch who observedBANDH on Monday, 25th June making one daytoken medical strike highly successful.We alsoarranged interesting programme in afternoon onthat day & response to that too was tremendousand overwhelming. Dr. Lalit Kapoor, Dr. SuhasPingle & Dr. Jayesh Lele addressed on variousissues in that programme. The print as well aselectronic media also responded well givingexcellent coverage of the event.This was followed by highly successfulprogramme of Doctor’s Day on Sunday, 1st July2012, CME programme, choice of felicitees,entertainment programme & grand dinner wereappreciated by one & all.It appears that medical profession is passingthrough a very critical phase at the moment. Asif Clinical Establishment Act, NHRCH Bill, BRMSCourse & other controversial issues were notenough, Govt. of Maharashtra came out with thebill to regularize & to legalize allopathic practiceby Homeopathic / Ayurvedic / Unani doctors byoffering them one year course in Pharmacology.Govt. assumes that these “non allopathic” doctorsafter this one year course will prefer to go to ruralareas and will serve rural population and willimprove overall rural health care. Govt. furtherbelieves by doing this doctor / patient ratio whichis worst in villages will improve. WHO states idealratio as 1 doctor par 1000 population. In ourcountry it is 1 doctor per 1600 population (in cities/ slums) & 1 doctor per 2000 population(in villages). Govt’s belief is absurd and
From
Hon
. Sec
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Dear Friends,
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MAHARASHTRA STATE CGP CONFERENCE 2012Maharashtra State IMA CGP Faculty announces its Annual CGP Conference on SUNDAY,14TH OCTOBER 2012 from 09.00 am – 05.00 pm at IMA – Mumbai West Branch premises.
Please keep that day free to meet your old and new friends, to exchange thoughts and toupdate the latest in medical field. Speakers and Topics will be announced in due course.Excellent food, useful gifts and MMC credit hours as per norms will be added attractions.
Date upto IMA Member Souses / Kids (No KIT) Non IMA Member
30th June Rs. 1500/- Rs. 1000/- Rs. 2000/-
30th Nov Rs. 2000/- Rs. 1500/- Rs. 2500/-
25th Dec Rs. 2500/- Rs. 2000/- Rs. 3000/-
Spot (No Kit) Rs. 3000/- Rs. 2500/- Rs. 3500/-
Reception Committee Member : Rs. 5,000/- (For online registration add Rs.100/- more)Conference Secretariat : Annammal Hospital Campus, Kuzhithurai - 629 163Kanyakumari Dist., Tamil Nadu. Mob.: 94431 60026, Ph. 04651 - 260264, 97888 60023Website : www.imacon2012.come-Mail : [email protected] / [email protected]
THOSE MEMBERS WHO ARE INTERESTED TO ATTEND IMACON 2012 SHOULDCONTACT : IMA – MUMBAI WEST BRANCH OFFICE : 2620 6517 / 2625 4368
MASTACON - 2012IMA - Mumbai West Branch proudly announces the
IMA - Maharashtra State Annual Conference “MASTACON 2012”on 24th & 25th November 2012 at Hotel J. W. Marriot, Juhu, Mumbai.
IMA Maharashtra State Executive / Council Meetings will be heldon 23rd November 2012 at IMA House, Haji Ali, Mumbai.
• Thought provoking excellent topics, elegant speakers, star venue & beautiful conference gifts.• Banquet on 24th November 2012 for all registered conference delegates.• Limited seats as delegates will be coming from all over Maharashtra state.• Book early to avoid disappointment.• Credit hours applicable as per MMC norms.Delegate Charges : Rs. 1,500/- upto 15th October 2012
Rs. 2,500/- after 15th October 2012Rs. 1,000/- accompanying person for Banquet
DR. MILIND NAIK DR. JAYESH LELE DR. (MRS.) ALKA B. MEHTA DR. S. K. JOSHIPresident Hon. State Secretary President Hon. Secretary
IMA - Maharashtra State IMA - Mumbai West
ANNOUNCEMENTS
INDIAN MEDICAL ASSOCIATION, HEAD QUARTERS, NEW DELHIinvites you to IMACON - 2012
87th Annual National Conference on Thursday, 27th & Friday, 28th December 2012at Hotel Singaar International, Kanyakumari, Tamil Nadu.
REGISTRATION TARIFF
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ear Friends,
It gives an immense pleasure in releasing thisspecial issue in Oncology to you.
In recent years, there has been lot ofimprovement in the treatment strategies,advanced surgical and radio therapeutictechniques, newer chemotherapy drugs andtargeted therapy has given good impacton overall survival. In this issue we havehighlighted some important issues like palliativecare, cancer screening, MRI mammographyand newer drugs in chemotherapy.
In advanced cancer, palliative care plays a veryimportant role. Palliative Care means to makethe patient as comfortable as possible, free ofpain and all distressing symptoms. There is adesperate need to broaden awareness aboutpalliative care and extend its reach. Dr. L. J.Desouza, a senior oncosurgeon, who is apioneer of starting palliative care in India, has
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nicely shared his views in his article ‘palliativecare’. Globally cancer incidence is increasing.We need to detect cancer early to increasecure rates. The goal of cancer screening is toreduce the number of people who develop anddie from cancer. In my article, I have highlightedscreening techniques and guidelines in differentcancers which will be really useful in practice.
MRI mammography is a new development inimaging of breast cancer. It is being used inhigh risk individuals for screening and alsohelps in screening after breast conservativesurgery, monitoring response after neoadjuvantchemotherapy etc. Dr. Sona Pungavkar, in herarticle has given good overview regarding theimportance of MRI in breast cancer. Cancerchemotherapy has given a very good impactin cancer treatment. It is responsible for cureand improving survival of a large number ofcancers. Addition of targeted therapy tochemotherapy has given really encouragingresults. Dr Avinash Deo has very wellelaborated the advantages of targeted therapyin his article ‘Targeting Cancer to Cure’.
I am sure you will find these articles veryinteresting and informative in the field ofoncology. I would like to thank all authors fortheir valuable contribution in releasing thisspecial issue in oncology.
DR. SANJAY DUDHATM.S.Head Dept of OncosurgeryDr. Balabhai Nanavati Hospital
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FORTH COMING EVENTS
1) Additional General Body Meeting & IMA – Maharashtra State Elections onSunday, 12th December 2012.
2) Flag Hoisting Ceremony on Wednesday, 15th August 2012.
3) Teacher’s Day Programme on Sunday, 09th September 2012.
4) Interesting Cultural program of SALSA DANCE.
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REPORT OF INVESTIGATIONS IN CARDIOLOGY PROGRAMME
IMA CGP Sub Faculty of our branch had organized an excellent CME programme of“INVESTIGATIONS IN CARDIOLOGY” on SUNDAY, 17TH JUNE 2012 from 09.30 amonwards at our branch premises.
The programme covered various modalities of investigations of cardiac case & was addressedby leading interventional cardiologists & other leading consultants / specialists of Mumbai.
Dr. Sanjay Arora gave an excellent presentation on the Lab Diagnosis in Cardiology.Dr. Sandeep Kide explained in detail about stress test & its interpretation in his lecture.Dr. Nitin Burkule gave an excellent lecture on 2-D Echo & Stress Echo. Dr. Saurin Pateldwelt upon Nuclear Scan & its implications in cardiology in his presentation. Dr. Varun Chawlaaddressed in an excellent presentation about 24 hours Ambulatory B.P.measurement.Dr. Ameya Udyawar discussed in detail about Holter Studies & its interpretation. Dr. RameshRajani explained in details about CT Coronary Angiography. Dr. Vivek Mehan gave an excellentpresentation on conventional coronary Angiography & its clinical interpretation. Dr. YashLokhandwala discussed the basics of electro physiological studies in cardiology & its clinicalapplications.
The programme was well attended and appreciated by more than 200 delegates.
The above programme was well co-ordinated by Dr. Varun Chawla. We also acknowledge hiscontribution in planning & organising this programme as well.
We appreciate, acknowledge & thank M/s. Seven Hills Hospitals for its kind gesture of supportingthis programme through “Educational Grant”.
DR. RASHMIKANT SANGHVI DR. RONAK SHAH DR. S. K. JOSHIAsst. Director of Studies, IMA CGP Asst. Secretary-IMA CGP Hon. Secretary
REPORT OF DHARNA
We herewith express our highest appreciation & sincerest thanks to our Ex President, Ex.Trustee & veteran leader of our branch – Dr. Bakulesh S. Mehta for representative of our branchat Dharna organised by IMA – HQ on Monday, 18th June 2012 at Jantar Mantar, New Delhi. ThisDharna was highly successful and was attended by nearly 1200 representatives from all ourcountry. It was a great show unity and solidarity of medical fraternity. This Dharna was organisedto protest for the following issues for which 1 day token strike was subsequently called for.
i) Restoration of autonomous and autocratic MCI.ii) To oppose proposed NCHRH Bill.iii) To oppose Clinical Establishment Act.iv) To oppose BRHC / BRMS Course.v) To demand resignation of Honourable Union Health Minister – Govt. of India – Mr. Ghala
Nabi Azad.
DR. S. K. JOSHIHon. Secretary
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REPORT OF TOKEN MEDICAL STRIKEOur branch had taken a major lead & initiative in forming strategy & planning of one day tokenmedical strike on Monday, 25th June 2012. The call for this strike was from IMA Head Quarters andwe whole heatedly supported it. We had excellent support from most of the Local Medical Associations& other IMA local branches from Bandra to Virar. The Presidents & Secretaries of Various MedicalAssociations honoured our invitation and attended many preparatory meeting organised at ourbranch prior to 25.06.2012. The response of members to this strike was very satisfactory.Many general practitioners had kept their clinics closed. Many consultants too did not attend theirconsulting. Many consultants had also instructed hospitals like Nanavati Hospital, Lilavati Hospitalabout their non attending of OPD and other elective services. However emergency services wereattended.In the afternoon our branch had organised programme to discuss issues for which this strike wascalled for. We invited eminent speakers who addressed on this occasion. Leading Medico LegalExpert & General Surgeon – Dr. Lalit Kapoor spoke excellently about Clinical Establishment Act & itsintricacies. Our Ex. President & MMC Member – Dr. Suhas Pingle addressed the members on theissue of proposed NCHRH (National Commission for Human Resources in Health) Bill of 2011.Our Ex President & Hon. State Secretary – IMA MS – Dr. Jayesh Lele presents an account of proposalBRHC (Bachelor of Rural Health & Care) & BRMS (Bachelor of Rural Medicine & Science) courseswhich will be shortly introduced by Govt. of India to prepare “Health Care Givers” to rural population.The programme was well announced in advance. Print media & electronic media were propertycontacted for adequate coverage of our protest strike.It was agreed to submit memorandum of our demands to local Govt. & Health Authorities. Accordinglyour branch had submitted memorandum to collector – Mumbai Suburban District, Honorable HealthMinister, Government of Maharashtra – Mr. Suresh Shetty, local MPs, MLAs & MLCs & other concernedauthorities.We look forward for positive & favourbale outcome of our strike from State & Central governmentauthorities.
DR. (MRS.) ALKA B. MEHTA DR. S. K. JOSHIPresident Hon. Secretary
REPORT OF DENTAL UPDATEIMA CGP Sub Faculty of our branch had organised unique & innovative programme of “DentalUpdate” on Sunday, 08th July 2012 from 09.00 am – 01.30 pm at our branch premises.Leading Dental Super Specialities addressed the audience on this occasion.Dr. Vijay Kadam introduced the audience about current dental practice & also gave an excellentpresentation on “Edendulous Support Society for Senior Citizens” & convinced everybody how itchanges their lives dramatically.Dr. (Mrs.) Shubhangi Mhaske gave an excellent account on recent updates in the field of Ortho-dentistry & braces.Dr. Vijay Tamhane elaborated in detailed about the basic concepts of Dental Implantation & advancesin this field in an excellent manner.Dr. Amit Benjamin presented an excellent account on stem cells in dentistry & informed the audienceabout the new source of retrieving stem cells for the dental pulp.The whole programme was well co-ordinated by Dr. Vijay Kadam. We also appreciate & thank himfor his invaluable help in organizing this seminar.The programme was well attended by more than 80 delegates & was highly informative & interesting.We sincerely thank the distinguished speakers of the seminar and all the delegates for making theprogramme grand success.
Dr. Rashmikant Sanghvi Dr. Ronak Shah Dr. S. K. JoshiAsst. Director of Studies, Asst. Secretary Hon. Secretary
IMA - CGP IMA CGP
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REPORT OF DOCTOR’S DAY PROGRAMMEThis year our branch celebrated Doctor’s Day Programme as per our branch’s tradition in anexcellent Manner. This programme was held at our branch premises on Sunday, 01/07/2012from 4.00 pm onwards. The whole celebration consisted of 3 distinct programmes 1) CMEprogramme 2) Felicitation 3) Entertainment Programme.
1) CME Programme - Hon. Secretary Dr. S. K. Joshi welcomed the delegates & invitedAssist. Director of studies IMA CGP - Dr. R. C. Sanghvi to conduct the programme.
Leading Interventional Cardiologist, Dr. Ajit Menon gave an excellent lecture on CardiologyUpdate 2012. Leading Medical Oncologist, Dr. Adwaita Gore presented an interestingaccount on Metastatic Renal Cell Carcinoma. This was followed by an extremely importantaddress by Honourable Jt. Commissioner FDA - Mr. Dilip Shrirao on the issue of Drugs &Cosmetic Act with lot of practical Do’s & Don’ts. Leading Diabetologist & Endocrinologistof country Dr. Shashank Joshi addressed on what is in & what is out in Diabetes & comeout with many practical tips on the various aspects of management of Diabetes.
2) Felicitation - This programme started around 7.00 pm. Hon. Secretary Dr. S. K. Joshiwelcomed delegates & their families, invitees & felicities. President (Mrs.) Dr. Alka Mehtadelivered her presidential address.
Following dignitaries were introduced to the audience & felicitated by offering them shawl,shreefal, memento & flowers by President, Dr. (Mrs.) Alka Mehta.
1) Dr. Anita Borges 2) Dr. Suhas Pingle 3) Dr. Tatyarao Lahane4) Dr. Shailendra C. Mehtalia 5) Dr. Shashank Joshi
We felt sorry because Dr. Vithal Kamat who was also to be felicitated at this grand functioncould not join the programme as he had to leave abroad to attend urgent meeting duringthat period.
3) Entertainment Programme :- Chairperson, Cultural Sub Committee - Dr. (Mrs.) RohiniBadwe & our Hon. Jt. Secretary Dr. Mehul Bhatt presented an interesting Audio Visual &Musical Programme of “Bhule Bisare Geet” “Yegues efyemejs ieerle” following felicitation Programme.The programme reminded audience of many old popular Melodies of Hindi Cinema andwas highly appreciated.
The programme was well attended by audience of over 200 persons comprising of members &their families. CME programme, choice of celebrities & musical programme were enjoyed byone and all. The programme was followed by Gala Dinner.
We Sincerely thank....• All Distinguished Speakers of CME Programme.• All Felicitees, Invitees & Dignitaries who honoured our Invitation & attended programme.• MSD - Cardio, Intas GSK-onco Standard Chartered Bank and Shaman Cars Pvt. Ltd for
supporting the event by providing Educational Grant.• Dr. Deepak Jumani Chairman Library Sub Committee for excellent Audio Visual Arrangements.• All the members & their families for attending the function & making it a grand success.• Amantran Caterers for Offering Excellent Decoration & Food on This Occasion.• Our Office Staff for their hard work & co-operation.• Building Sub Committee Chairman & Hon. Secretary IMA - MS, Dr. Jayesh Lele, Sr. Vice
President, IMA MS, Dr. Akil Contractor, many senior members and veterans for their invaluablecontribution in planning & organizing this programme
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REPORT OF ACCP(AMERICAN COLLEGE OF CHEST PHYSICIANS)
IMA POST GRADUATE WORKSHOP ON AIRWAYS DISEASE
Medical Education Sub Committee of our branch had jointly organized an excellent workshopon “AIRWAYS DISEASE” with ACCP (American College Of Chest Physicians) on SATURDAY,07.07.2012 at our branch premises from 8.00 am – 5.00 pm.
Hon. Secretary, Dr. S.K.Joshi welcomed the delegates & distinguished speakers & then invitedthe - Leading Chest Physician of Mumbai - Dr. Sanjeev Mehta to co-ordinate the whole workshop.
Leading Chest Physicians & other Specialists of Mumbai as well as different parts of countryaddressed the delegates.
Dr. Kumar Doshi gave an excellent presentation on Pulmonary Function Tests with itsbasic concepts & wave from Dr. Anuradha Shah dealt with in detail Chest Advances in PulmonaryFunction Tests Dr. Sanjeev Mehta discussed in detail about the Pathobiology of Asthma.Dr. D. Behera gave an interesting lecture on Diagnosis of Asthma. Dr. (Mrs) Jyotsana Joshidelivered an excellent account on Management of Stable Asthma. Dr. G. C. Khilnani enlightenedabout Acute Severe Asthma & its Management in an excellent manner Dr. Sanjeev Mehta,Dr. Amita Athavale discussed in detail on Asthma Phenotypes.
Dr. Roshan Shetty presented an excellent account on Imaging Modalities in AirwaysDisease & its implications. Dr. (Mrs.) Jyotsana Joshi dealt with in detail the Diagnosis ofCOPD. Dr. D. Behera discussed at length the Pharmacotherapy of COPD. Dr. G. C. Khilnaniaddressed on exacerbations of COPD & its present management. Dr. Sanjeev Mehta gave aninteresting account on Small Airways Disease. Dr. S. Raju discussed in detail about COPDas a Systemic disease. Dr. Agam Vora gave an interesting insight into the nearly emergingfield of Pulmonary Rehabilitation with excellent demonstration.
Dr. (Ms.) P. Shah & other residential doctors doing post graduation in Medicine / Chest Medicinefrom the audience presented interesting cases & gave many many useful & practical carryhome messages.
We also thank Dr. Mello, Dr. I Lobo, Dr. N. T. Awad, Dr. Rajeev Kacker, Dr. Girija Nair,Dr. P. Singhal, Dr. N. Ramraje, Dr. Jai Lakshmi & other learned chest physicians for chairinglectures of distinguished faculties during the workshop.
The whole workshop was very very informative & interesting. The workshop was well attendedby over 120 delegates & was highly appreciated
This workshop was brainchild of Dr. Sanjeev Mehta. We highly appreciate & acknowledge &thank in for his keen interest & excellent contribution in organizing this workshop. We alsothank him for excellently conducting the whole workshop.
We also highly acknowledge the invaluable contribution received from Dr. Akil Contractor inorganizing this workshop.
We sincerely thank all the resident post graduate doctors for attending workshop in largemembers & making it a grand success.
We convey our sincerest thanks to M/s. Lupin Pvt. Ltd for their kind gesture supporting thewhole workshop through educational grant.
DR. S. K. JOSHI DR. SANJAY DUDHAT
Ho. Secretary Chairman Medical Education Sub Committee
12
� In this year, 1st programme for Post Graduate Residents Education was held on SATURDAY,14th JULY 2012 at Nanavati Hospital at 06.30 pm. Dr. Shobhana Bhatia, Dr. Rahul Tambeand Dr. Nikhil Datar were speakers for this programme. I was the Convenor for the sameprogramme.
DR. SHOBHNA BHATIA, HOD Gastroenterolgy Dept. KEM, has delivered excellent lectureon “COMMUNICATION SKILLS”. Then DR. RAHUL TAMBE, nicely explained aboutpractical aspects of “MANAGEMENT OF VENOUS THRMBO-EMBOLISM”. DR. NIKHILDATAR given good practical tips in his lecture “ERRORS IN MEDICAL PRACTICE”. ThirtyFive residents attended this programme and were very happy about the content
� It gives us great pleasure in informing our members that IMA MUMBAI WEST MEDICALTEXT BOOK DONATION PROJECT started last year. We donated medical text booksto 20 deserving students of First year MBBS soon after getting admission to MBBScourse. It is further heartening to report that all the 20 students who were selected &given text books by our branch did well in FIRST MBBS exam & all passed with goodmarks. We congratulate them & wish them good academic career ahead.
Dr. Sanjay Dudhat Dr. S. K. JoshiChairman, Hon. Secretary
Medical Education Sub Committee
REPORT OF MEDICAL EDUCATION SUB COMMITTEE
WELCOME NEW MEMBERS
Bandra Dr. Dhoke Anil Dr. Dhoke Alka Anil
Borivali Dr. Doshi Himanshu P.
Kandivali Dr. Ambekar Aniruddh Prakash Dr. Ambekar Shilpa AniruddhDr. Patil Shrikant PrakashDr. Shome Debraj Debabrata Dr. Kapoor Rinky Shashi
Vile Parle Dr. Gundiyal Sandhya K.
XX Sub Dr. Pacharkar Rajesh Dharma Dr. Pawar Rajesh Balaram
DR. (MRS.) ALKA B. MEHTA DR. S. K. JOSHIPresident Hon. Secretary
13
CULTURAL SUB-COMMITTEE OF INDIAN MEDICAL ASSOCIATION- MUMBAI WEST has organised an interesting Cultural Programme of Music,Dance & Devotion on the occasion of Jasmashtami. The programme isdevoted to Lord Shrikrishna in Hindi by presenting him melodious Bhajans& Cultural Dances. DR. ROHINI BADWE, DR. MEGHNA JOSHI, DR.MITESH PAREKH, DR. SUNIL PARANJPE & Guest Art is DR. MADHURABARDE & MS. ARCHNA will participate & perform at this programme.
We invites all the members with their families & friends to attend this programme.
Registration : FREE, but compulsory
Day & Date : Wednesday, 08th August 2012Time : 02.30 pm to 05.00 pm
Venue : IMA Hall, IMA Building, J.R. Mhatre Marg, JVPD Scheme,Juhu, Mumbai - 400 049.
DR. (MRS. ALKA B. MEHTA DR. S. K. JOSHI DR. ROHINI BADWEPresident Hon. Secretary Chairperson,
Cultural Sub Committee(93210 24708)
yeepes cegjueer³ee
INVITATION
All are cordially invited for the
FLAG HOISTING CEREMONYOn the occasion of
INDEPENDENCE DAYon
WEDNESDAY, 15TH AUGUST 2012
At 09.00 am sharp at our branch premisesPlease join us in time
DR. (MRS.) ALKA B. MEHTA DR. S. K. JOSHIPresident Hon. Secretary
AIR CONDITIONED CONSULTING ROOMS AVAILABLEOn Hourly Basis Between 8.00 am - 10.00 am & 1.00 pm - 7.00 pm
at the Prime Location, at the Junction of Link Road & M. G. Road, Goregaon (West).
CONTACT : 2872 5703 / 98692 00822
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TIME TOPIC SPEAKER
IMA - CGP MUMBAI WEST SUB FACULTY ofINDIAN MEDICAL ASSOCIATION - MUMBAI WEST BRANCH
Presents “SYMPOSIUM ON HIV / AIDS”Day & Date : SUNDAY, 05TH AUGUST 2012
Time : 09.00 a.m. onwards. Venue : IMA HALL, I.M.A. Building, J. R. Mhatre Marg, Behind Chandan Cinema,
J.V.P.D. Scheme, Juhu, Mumbai - 400 049.
PROGRAMME
09.00 am to 09.30 am Registration & Breakfast
09.31 am to 09.35 am Welcome Dr. Alka MehtaDr. S. K. Joshi
09.35 am to 09.55 am Today’s HIV Scenario Epidemiology &Role of MDACS Dr. S. S. Kudalkar
09.56 am to 10.15 am Psychological Impact of HIV on PatientPre & Post test Counselling Dr. Harish Shetty
10.16 am to 10.35 am Investigations in HIV Diagnostic, Prognostic Dr. R. D. Kharkar
10.36 am to 11.00 am Tea Break
11.01 am to 11.30 am Today’s Scenario - HIV & TB Dr. Ashok Mahashur
11.31 am to 12.00 noon Other Opportunistic Infections in HIV Dr. J. K. Maniar
12.01 pm to 12.20 pm Universal Precautions - Surgical FitnessICU Care, Role of Endoscopies& Care of Equipments Dr. Vasant Nagvekar
12.21 pm to 12.50 pm Antiretroviral Therapy in HIV Prevention ofMother to Child Transmission (MTCT) Dr. D. G. Saple
12.51 pm to 01.05 pm Dermatological Manifestations in HIV Dr. Prakash Bora
01.06 pm to 01.20 pm Post Exposure Prophylaxis (PEP) Dr. R. M. Shah
01.21 pm to 01.30 pm Vote of Thanks Dr. Rashmikant SanghviDr. Ronak Shah
01.30 pm onwards Lunch
PROGRAMME CO-ORDINATOR : DR. RASHMIKANT SANGHVIPROGRAMME Convenor : DR. R. D. KHARKAR
REGISTRATION FEES :• CGP, AMS and IMA Members who have paid ANNUAL Fees = Free. (Only if Registered in Advance)• IMA Members : Rs. 100/- • Eligible Non Members : Rs. 350/-• MMC ACCREDITATION HAS BEEN APPLIED FOR.• CHARGES FOR MMC CREDIT HOURS (FOR THE ACCREDITED CMES) Rs. 50/-
APPLICABLE TO ALL IMA MEMBERS DESIROUS OF CREDIT HOURS.FOR REGISTRATION CONTACT : MS. APARNA / MS. SEEMA / MS. SUNITA
IMA - OFFICE TEL. NO. 2620 6517 / 2625 4368DR. (MRS.) ALKA B. MEHTA DR. S. K. JOSHI
President Hon. Secretary
DR. RASHMIKANT SANGHVI DR. RONAK SHAHAsst. Director of Studies Asst. Secretary
IMA - Mumbai West C.G.P. Sub Faculty
15
25 years ago very little was said, written, or donefor palliative care in Cancer. It never formed a partof the medical curriculum. It was never mentionedin journals and never featured in any conference.In fact the patients suffering from the ravages ofcancer, both during its treatment & in the terminalstages, were forced to bear their pain anddistressing symptoms as best as possible withoutmuch support from the medical profession. Thedoctors were intensely keen on treating thecancer and controlling it as far as possible. butthey did not give enough consideration to theagony and suffering of the patient. Then came thebirth of India’s first hospice,the Shanti AvednaSadan, in November 1986 in Mumbai to care forthe terminally ill cancer patients. This was a smalllight in the darkness of suffering. 25 years laterwe now have three branches of the Sadan inMumbai Delhi and Goa,(Fig) where we havelooked after over 20 thousand terminally ill cancerpatients irrespective of community caste and creedand totally free of cost. More than this, themessage of palliative care has spread throughoutthe country so that today we have more than 12hospices in India and over a hundred palliativecare centers. Every conference on cancer nowhas a session on palliative care. Students in themedical college are also taught about it,and thereare now diplomas and degrees available in palliativecare. Further we have the Indian Association ofPalliative Care (IAPC) which brings together allthose involved in palliative care from the variousmodalities of treatment. We have therefore comea long way since we started 25 years ago, butlots needs to be done before this care reachesevery person that needs it. After over 40 years inthe active treatment of cancer and after over 25years in palliative care I feel obliged to share withthe medical profession the experience that wehave gained in this field & answer some questions.
1. What is Palliative Care?
Palliative Care is directed to make the patientas comfortable as possible, free of pain and alldistressing symptoms. Every patient is a bio-psycho-social individual. and is comprised ofbody, mind and soul. To give total palliative caretherefore to the patient, we must concentrate onall these three factors. The most important isthe body, to relieve it of pain and all distressingsymptoms as far as possible. Once this iscontrolled, the patient becomes a differentpersonality and it is then possible to attend tothe mind and the soul. The final goal is to havethe patient entirely at peace at the end, to himself,his family and his friends. In terminal palliativecare the main aim is “not to add days to life butrather add life to days”. In other words we do nottry to extend the life of the patient in any waybut instead make the patient as comfortable aspossible for the days that are remaining.
2. What are the types of Palliative Care?
Almost 75% of our cancer patients are diagnosedin stage III or IV of the disease. Infact our statisticsat the Shanti Avedna Sadan show that 1/3rd of thepatients admitted for terminal palliative care havenever received any sort of treatment for theirdisease as it has been diagnosed in the veryadvanced stages. I would like to propose thereforethat there are two types of palliative care :
1. Indirect Palliative Care; whereby palliationis given to the patient by treating the diseasewith the various modalities of treatment availableand thereby relieving their pain and distressingsymptoms.
DIRECT PALLIATIVE CARE : is when thedisease is not treated anymore because notreatment will benefit the patient further, but careis given directly to relieve each distressingsymptom of the patient.
PALLIATIVE CARE IN CANCER
DR. L.J. DE SOUZA, M.S., F.R.C.S., F.R.C.S.E.,Consultant Surgical OncologistPD Hinduja Hospital, Breach Candy Hospital, & St. Elizabeth HospitalFounder/ Managing Trustee & Hon. Medical Director-Shanti Avedna Sadan
16
PALLIATIVECARE
DIAGNOSIS DEATH
DIRECT PALLIATION
INDIRECT
PALLIATION
1. When does one change from indirect todirect palliative care?
We can keep on treatment the cancer rightup till the last moments of the patient.Unfortunately this doesn’t help the patientvery much but rather makes him moremiserable at a tremendous cost to thefamily. The point of change from indirect todirect palliative care comes when activetreatment of the disease does not help tocontrol the disease and benefit the patientin any way, but rather makes him moremiserable at a great cost. It is at this stagethat we should shift to direct palliative carewhen we no longer treat the disease butrather treat the patient directly for hisdistressing symptoms to keep[ himcomfortable right u p to the end. It is oftennot easy to decide when to do this, and itmay be necessary for a joint consultationbetween the various disciplines treating thedisease to come to a consensus that nofurther active treatment is going to help thepatient. At this stage it is important toconcentrate on direct palliative care only.
2. How is Palliative Care given?
To give good palliative care it is veryimportant to accurately determine what isdistressing the patient. For this an accurateassessment of the disease and the
Both the types of care, indirect and direct are needed. At the initial diagnosis of the disease moreefforts are given for indirect palliative care i.e., to treat the disease. As the disease progresses andapproaches the end, this care diminishes. On the other hand direct palliative care is minimum atthe beginning only to supplement the treatment of the patient and increases inversely right up tothe end whilst the indirect care decreases (Fig)
symptoms is necessary by carefulexamination and most of all by attentivelistening to the complaints of the patient.Each symptom has to be individuallyassessed and medicated accordingly. Thefirst aim is to relieve the patient of pain. Thisis done by adequate medication startingwith milder analgesics for mild and moderatepain to the use of morphine and the opiatesin severe pain. The secret of success is ingiving the dugs at the right time, by the rightroute and in the right dose. Further the painhas to be initially assessed properly andthen periodically reassessed and thedosage increased as necessary. Wenormally follow the WHO three step ladderfor pain control using NSAIDS for mild pain,weak opiods like codeine for moderate painand morphine and other stronger opiods forsevere pain. The basic principle is to startearlier rather than later so that the patientis benefited from pain medication withouthaving to suffer the pain. In our experiencewe have found that three simple principlesof keeping the patients most comfortableare to make them pain free, keep the bowelsclear and give good sleep at night .
3. Who should give Palliative Care?
It is a duty of every physician to know howto give palliative care and keep the patient
INDIRECT Vs DIRECT PALLIATIVE CARE
17
comfortable throughout the disease andmore so in the terminal stages of cancerwhen the patient is in acute pain andsuffering. In the end stages the patient hasmany problems. They have, pain and otherdistressing symptoms, mental problemsand psychological p[problems withadvanced disease and approaching death,family problems, & even financial problemsas they have spent all their resources forthe treatment of the disease. It is thereforenecessary for teamwork to give the bestpalliative care which consists of doctors,nurses, psychologists, physiotherapists,family members, volunteers and spiritualguides. Who is the most important of allthese? It depends on what is the acute needof the patient at any particular time. Idealpalliative care is therefore a team effort andis best given by a well trained andcoordinated team basically consisting ofdoctor, nurse and social worker with otherteam members as needed. However it is theduty of every family physician and specialistto be aware of palliative care and give it tothe patient form the retime of diagnosis rightup till death.
4. Where is palliative care best given?
The best place for the patient to be at theend is in his own bed in his own home. Andso if adequate palliative care is possible athome with proper facilities and finances tokeep the patient comfortable, then thiswould be the very bet place for terminalpalliative care. However, very often this is
not possible because of lack of facilities,accommodation and finances specially togive the patient morphine and othernecessary treatment for relief of distressingsymptoms. An active treatment hospital isnot the right place because active treatmentis given to control the disease and whenthis is not possible not much attention isgiven to palliative care. Also a terminally illpatient should never ever be put in anintensive care unit which is the last placethey should be in for the end. An ICU ismeant to see that the patient comes out ofthe acute stages so that he may areasonably comfortable life thereafter andthis is not possible in the terminal stagesof disease. There is absolutely no point inblocking a bed in the ICU where the patientis kept alive with all supportive measureswhich are going to be without any benefit. Itis much better that they are surrounded withthere own family in their own bed at homeor in a hospice. The hospice is a suitablealternative for terminally ill cancer patientsas optimal palliative care is given by atrained team of care givers. This can beextended to home care in the home wherepossible and the family physician plays avery important role to maintain thisrelationship between the hospice and thehome as needed.
In the end we must realize that there is alimit to CURE but there is no limit to CARE!That is the essence of Palliative Care inCancer
MUMBAI SADAN DELHI SADAN GOA SADANTel. : 2642 7464, 2645 4590 2619 5092 [email protected] [email protected] [email protected]
18
DR. BALABHAI NANAVATI HOSPITALPEDIATRICS UPDATE 2012
19th August 2012, SUNDAYDear Doctor,
Dr. Balabhai Nanavati Hospital cordially invites you for a CME on “PEDIATRICSUPDATE 2012” on SUNDAY 19TH AUGUST 2012. Accreditation has beenapplied to Maharashtra Medical Council for a credit point.
Following topics will be discussed: -
Topic Speaker Time
Introduction Dr. Tushar Maniar 6:30 pm - 6:45 pm
Welcome Address Dr. Ashok Hatolkar 6.45 pm - 7.00 pm
Approach to a child with Fever Dr. Hiren Doshi 7.00 pm - 7.30 pm
Approach to a child with Short Stature Dr. Aspi Irani 7.30 pm - 8.00 pm
Rational Antibiotic Prescription Dr. Ira Shah 8.00 pm - 8.30 pm
Vaccine Strategy in Pediatrics Dr. Snehal Jhaveri 8.30 pm - 9.00 pm
Question and Answer session 9.00 pm - 9.30 pm
DATE : SUNDAY 19th August 2012
VENUE: KARL’S RESIDENCY, LALLUBHAI PARK, ANDHERI (WEST)
Time: 6:30 pm to 9:30 pm followed by Cocktails & Dinner
Registration is free but compulsory, first 100 Registrations will be considered.
For Registration, please contact:
Dr. Ami (9820782699) or Dr. Ankita (9833167176)
CONVENER PROGRAMME CO-ORDINATOR
DR. TUSHAR MANIAR ( 9820804262), DR. SANJAY DUDHATHead of Dept, Pediatrics Head of Dept. Oncosurgery
19
CANCER SCREENING
DR .SANJAY DUDHAT, M.SHead of Dept. OncosurgeryDr. Balabhai Nanavati Hospital
What is Screening?Screening is the public health interventionused on a population at risk, or targetpopulation. Screening is not undertaken todiagnose a disease, but to identify individualswith a high probability of having or of developinga disease. Universal screening means or massscreening involves screening every one, usuallywithin a specific age group. Selective screeningidentifies people who are known to be at higherrisk of developing cancer, such as people withfamily history of cancer.
There are several criteria for a good screeningtest should have high sensitivity & specificity,simple and low cost, high positive predictivevalue and safe as well as acceptable topatients and clinicians. Examples of goodscreening tests include: mammography forbreast cancer screening and Pap smears forcervical cancer screening.
Screening can lead to false positive or falsenegative results. Hence screening test mustbe effective safe and with acceptably low ratesof false positive and false negative results.
Breast CancerThe main purpose of breast cancer screeningis to detect early disease before it is clinicallyevident/palpable in an effort to reduce thechance of distant metastasis and ideally todecrease the morbidity of the disease. Thereare numerous modalities that have been usedfor breast cancer screening, such as,mammography, MRI mammography, clinicalbreast exam (CBE) by a clinician, breast selfexam (BSE).
Mammography is the most common modalityused. Approximately 40% of lesions are pickedup on mammogram alone and about ½ of
these are invasive cancers <1 cm. At least 8randomized trials have shown a reduction inmortality with the use of mammographicscreening. With 14 years of follow-up, patientsaged 50-69 have a 22% reduction in mortalityfrom breast cancer compared to the controlpopulation. A 15% reduction in mortality wasseen with patients aged 40-49.
In terms of older women, there may be abenefit to continued screening of women overthe age of 70. Most trials included only a smallnumber of women from this population;therefore, the exact benefit is unknown.However, screening is recommended if theindividual is in good health,
American cáncer society recommendationsfor the early detection of breast cáncer arefollowing.
• Yearly mammograms are recommendedstarting at age 40
• Clinical breast exam (CBE) about every3 years for women in their 20s and 30sand every year for women 40 and over
• Breast self-exam (BSE) is an option forwomen starting in their 20s.
• Some women – because of their familyhistory, a genetic tendency, or certainother factors – should be screened withMRI in addition to mammograms.
Cervical CancerCervical cancer represents a clinical entitywhere screening has been very effective.Screening tools include cytological screeningwith PAP smear (introduced by Papanicolaouin 1930 ) and examination with bimanual pelvicexam. Case control studies indicate that thePAP smear decreases the incidence of invasive
20
cervical cancer by 60-90%. PAP smears andpelvic exams have led to a decrease in themortality rate of cervical cancer by more than70% between 1940 and 1970.A positive PAPtest can indicate a high probability of invasivedisease, but a diagnosis of invasive cancercannot be made based on this test.
American cáncer society recommendationsfor the early detection of breast cáncer arefollowing.
• Cervical cancer screening (testing)should begin at age 21. Women underage 21 should not be tested.
• Women between ages 21 and 29 shouldhave a Pap test every 3 years. Now thereis also a test called the HPV test. HPVtesting should not be used in this agegroup unless it is needed after anabnormal Pap test result.
• Women between the ages of 30 and 65should have a Pap test plus an HPV test(called “co-testing”) every 5 years. This isthe preferred approach, but it is also OK tohave a Pap test alone every 3 years.
• Women over age 65 who have hadregular cervical cancer testing with normalresults should not be tested for cervicalcancer. Once testing is stopped, it shouldnot be started again. Women with ahistory of a serious cervical pre-cancershould continue to be tested for at least20 years after that diagnosis, even iftesting continues past age 65.
• A woman who has had her uterusremoved (and also her cervix) forreasons not related to cervical cancer andwho has no history of cervical cancer orserious pre-cancer should not be tested.
• A woman who has been vaccinatedagainst HPV should still follow thescreening recommendations for her agegroup.
Endometrial (Uterine) CancerThe American Cancer Society recommendsthat at the time of menopause, all womenshould be told about the risks and symptomsof endometrial cancer. Women should report
any unexpected bleeding or spotting to theirdoctors. Some women – because of theirhistory – may need to consider having a yearlyendometrial biopsy. Please talk with yourdoctor about your history.
Prostate CancerProstate cancer often grows so slowly thatmost men die of other causes before thedisease becomes clinically advanced. Theseindividuals would therefore not benefit fromscreening. However, those with aggressivelocalized disease may benefit from earlytreatment and thus, a screening program thatcould identify asymptomatic men withaggressive localized tumors might be expectedto reduce morbidity and mortality.
PSA testing has revolutionized prostate cancerscreening. Although it was originally introducedas a tumor marker to detect cancer recurrenceor progression it became adopted for screeningin the early 1990’s. Although it led to adramatic increase in incidence of prostatecancer, there is no evidence that screening insymptomatic men leads to decreasedmortality. 2 Large studies published in 2009compared men who had regular screening vs.men who did not. The European study foundthat screening reduced prostate cancer deathby 20% but the US Study did not detect anydecrease in mortal i ty with screening.Nevertheless, most physicians advocate forscreening with PSA.
Methods of screening include:
PSA (prostate specific antigen)
• sensitivity 80-90% ; specificity 50%
• elevated in benign disease also i.e. BPH
• the reference range depends on age of thepatient i.e. <or = 49, the normal range is0-2.5 but patients <or = 79 have a normalrange of 0-6.
• PSA can be elevated with TRUS or TURP,infection or prostatic massage
DRE (digital rectal exam)
• sensitivity 70% ; specificity 50%• due to the cost effectiveness of this
procedure, it would be useful to include it inthe annual exam in men over 40-50.
21
Colorectal cancer :
Although screening has been shown to reducemortality from colorectal cancer ,screeningrates are low. This is likely due to severalfactors such as, embarrassment on the part ofthe patient, discomfort of the colonoscopy andlimited accessibility of the equipment andspecialists. It is important to look at risk factorswhen deciding on who is a good candidate fortesting. Some of these risk factors include:family history of colorectal cancer or polyps,personal history of inflammatory bowel diseasepersonal history of polyps. Screening guidelineare as follows :
Beginning at age 50, both men and womenshould follow one of these testing schedules:
Methods - Digital rectal examination
- Rigid/Flexible Sigmoidoscopy
- Fecal Occult Blood test
For High risk - Fecal Occult blood test yearly
- Flexible sigmoidoscopy every
5 years
- Colonoscopy every 10 years
- In Ulcerative Coli t is,Colonoscopy & mult iplebiopsies of suspicious lesionsevery 2 years
Oral Cancer : Direct inspection andpalpation of the oral cavity is the mostcommonly recommended method of screeningfor oral cancer, although there are little dataon the sensitivity and specificity of thismethod. Screening techniques other thaninspection and palpation are being evaluatedbut are still experimental.
Take control of your health, and reduceyour cancer risk.
• Stay away from tobacco.• Stay at a healthy weight.• Get moving with regular physical activity.• Eat healthy with plenty of fruits and
vegetables.• Limit how much alcohol you drink (if you
drink at all).• Protect your skin.• Know yourself, your family history, and
your risks.• Have regular check-ups and cancer
screening tests.
9 TIPS FOR BEING MORE TRUTHFUL
• Make a commitment to tell the truth and honor it.
• Tell someone about your commitment and progress.
• Think before you give a dishonest answer, explanation or reason.
• Be careful not to twist the truth or leave out part of it.
• Don’t indulge in little white lies; don’t get caught in cover-ups.
• Watch out for silent lies. When you k now about a lie and keep quiet, the lielives on.
• When you catch yourself lying, throw your mouth into reverse and tell the truth.
• Talk to yourself quietly and ask what is the best thing to do.
• Express your real feelings without anger, without blaming others, withoutexaggerating and without hurting the feelings of someone else.
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FORTHCOMING PROGRAMMES
3rd August 2012 - FRIDAY� Menopouse & Osteoporosis ................................... Dr. Jay Sheth� Breast Imaging & Intervention ................................ Dr. Sameer Shah� Diagnosis & Management of Breast Cancer ........ Dr. Ganesh Nagarajan
Venue : SUNRISE CLINIC, 3rd floor, The Mall Shopping Centre, Station Road, Malad (West), Mumbai. Free parking in the Mall (-3 level)
8th August 2012 - Wednesday
� Oncology Update ....................................... Dr. Ashish Joshi� Vaccination in GP Clinic ............................ Dr. Shweta Chawla
Venue : MMA Hall, 4th floor, Samruddhi commercial complex, Mindspace,Chincholi Bunder road extension, Off. Link road, Malad (West)
24th August 2012 - Friday�� Cardiology update � Diabetology update
Venue : MMA Hall, 4th floor, Samruddhi commercial complex, Mindspace,Chincholi Bunder Road extension, Off. Link Road, Malad (West)
Lunch : 1.30 to 2.30 p.m. for all CMESRegistration Charges : Rs. 50/- per CME
MMC Accredation Charges : Rs. 50/- per CME
Applied for MMC credit hours for all CMEs � REGISTRATION BY SMS COMPULSORY
TO REGISTER SMS YOUR NAME, MMC NO. & DATE OF PROGRAMME TOSCIENTIFIC CHAIRPERSON DR.JESAL SANGHAVI 98204 51481
All the programmes are strictly for Members. Eligibility : MBBS Family Physicians only.
Life Membership Rs. 2,000/- (Individual) & Rs. 3,500/- (Couple)FOR MEMBERSHIP CONTACT : DR.MEHUL BHATT - 93204 07074
Presents
ASSOCIATION OF ALLOPATHIC FAMILY PHYSICIANS
MONSOON PICNIC (Overnight)
DATE : 11th & 12TH AUGUST 2012Venue : SEAROCK VILLA, DAMAN (Walkable distance from Devka Beach)
Charges : Rs. 2,800/- Per person on twin sharing basis (limited seats on first come basis)
Extra person/child in same room Rs.2,200/- Child < 5 years-free (No separate seat in bus)
INCLUSIONS :1. A/C Delux Room 2. Transportation by A/C bus 3. Two breakfast,two lunches,onedinner & one high tea 4. Saturday night entertainment programme 5. Local sightseeing
For further details contact DR. JAYANT SHAH - 98191 43454
DR. MEHUL BHATT DR. RONAK SHAHPresident Hon.Gen.Secretary
23
BREAST MRI – A NEW FRONTIER
DR. SONA PUNGAVKAR, DNB, DMRDConsultant Radiologist.Dr Balabhai Nanavati Hospital
INTRODUCTION :For many decades, the imaging modalitiesavailable to assess the breast included filmmammogram and ultrasound. Although, alongwith cl inical breast examination, thesemodalities provide adequate information,another modality lacking radiation was neededto provide cross-sectional imaging. Magneticresonance imaging ( MRI ) is a non-invasivetechnique, without ionizing radiation, capableof producing 2D and 3D sections of thebreasts. Both breasts can be assessedsimultaneously. It is almost always performedwith contrast injection, except when used forassessing integrity of breast implants, I whichcase a non-contrast study suffices.
Clinically useful imaging protocols for breastMRI are recently available due to the advancesin hardware and software in the field of MR.Both morphology and assessment of contrastkinetics are essential for providing an accuratediagnosis. The normal glandular tissue as wellas lesions enhance on the contrast study.Tumor cells secrete substances which causeformation of new and abnormal vessels withinthe lesion. This term is termed asneoangiogenesis. The contrast is taken upfaster by the lesion and also leaks out rapidlyfrom the lesion. As opposed to this, the normalglandular tissue and benign lesions show slowuptake of contrast and no washout. Thisdifference in the rate of passage of contrastthrough a lesion is used to differentiatebetween benign and malignant lesions. Rapid3D acquisition during the injection of thecontrast is performed to assess the contrastkinetics and is called as dynamic contrast-enhanced examination
(DCE-MRI ).
Another important requirement for a good breastMR study is fat suppression. The fat in thebreast obscures the enhancing lesion. Hence,fat suppression allows increased conspicuityof a lesion.
Technique : After acquiring access to anintravenous line, the patient is place into themagnet in a prone position. A special coil isused to assess both breasts simultaneously.Multiplanar imaging, before during and aftercontrast injection is performed using a gamutof sequences. Post-processing is performedon a workstation. The image dataset obtainedbefore contrast is subtracted from the oneobtained after injection to detect an enhancinglesion. The morphology of the lesion isassessed on the subtracted images. Kineticcurves through the lesion are plotted. Themorphological as well as the kinetic informationis used to characterize the lesion and is usedin the ACR BI-RADS MRI lexicon, which is astandard reporting system.
Indications of MRI : Breast MRI is used asan adjunct to film and sonomammography &is not a replacement for these modalities.Guidelines for current best practice for the useof breast MRI are outlined by the EuropeanSociety of Breast Imaging (EUSOBI).
The indications for breast MRI include
1. Inconclusive findings in conventionalimagingBreast MRI has a very high sensitivity forthe detection of cancer. At times, findingsconventional imaging can be used as aproblem-solving modality. MRI has a highnegative predictive value and hence majorityof the times, allows reliable exclusion ofmalignancy except in case ofmicrocalcifcations.
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2. Preoperative staging
MRI has a few distinct advantage overconventional imaging. The accuracy of thetumor size assessment is higher on MRI,compared to film and sonomammography.Also, additional foci are detected in thesame breast in 10 to 30 % cases. Theintraductal component is more reliably canbe better evaluated with MRI It is evident asa dendritic extension from the tumor margin.It also detects synchronous cancer.However, whether the high sensitivity leadsto increased survival is debatable.
3. Unknown primaryIn patients with nodal metastases from anunknown primary, MRI is used to detectprimary lesions in the breast due to its highsensitivity.
4. Screening in high-risk patients.
American Cancer Society (ACS) has issuedguidelines which include annual screening forBRCA gene mutation carriers and their firstdegree relatives and in women with lifetimerisk of 20–25%. Patients who have receivedradiation to the chest (e.g. for lymphoma) andpatients with inherited syndromes, such asLiFraumeni syndrome, and their first-degreerelatives can also be advised to undergoscreening with breast MRI.
5. Screening after breast conservationtherapy.
Breast MRI can reliably differentiate betweena scar and recurrence. The recurrentneoplasm exhibits morphology and contrastuptake pattern as a primary neoplasm, withspeculations and early washout. A scar. hassmooth margins and enhances very mildlyand persistently.
Other indications include
6. Monitoring response to neo-adjuvantchemotherapy
7. Assessment of integrity of breastimplants
Evaluating patients with nipple discharge
At our centre, we have reliably assessed of aseries patients with nipple discharge followedby ductoscopy & histopathologicalexamiantion. Ductal dilatation can be detectedwithout injection of a dye, due to thecharacteristic signal result ing from theintraductal fluid / hemorrhage. Intraductalenhancement or enhancing focal intraducallesions are detected on MRI. Enhancing lesionscould be papillomas. Linear intraductalenhancement may represent ductal carcinoma-in –situ and /or invasive carcinoma. Lack ofintraductal enhancement rules out these twoabnormalities. However, the technique toperform the study for this indication is different.
Limitations of Breast MRIMRI does not detect microcalcifications, whichare the hallmark of early cancers. The overlapof findings in benign and malignant diseaseprocesses limits the accuracy.
Also, MR detects additional abnormalities dueto the high sensitivity, which in turn increasesthe number of investigations.
MRI guided high intensity focusedultrasound
MRI is used as a guiding technique to monitorthe occurrence of necrosis following ablationwith ultrasound. Temperature monitoring canalso be achieved with MR.
Conclusion : MRI has created a niche placein the armamentarium of breast imaging. It isan easy, non-invasive and non-ionizingtechnique which can be used as an adjunct tofilm and sonomammography.
Fig 1 Late subtraction images – 3D SPGR acquition. Ipsilateral multicentric andsynchronous contralateral neoplasms – Intraductal carcinoma
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Fig 2 Fig 3 Fig 4
Fig 2 Intraductal component extending from the anterior margin of the tumor seen as a linearenhancing dendritic extension.
Fig 3 Enhancing lesion beneath a scar in the skin suggestive of recurrent neoplasm.
Fig 4 Intracapsular rupture of a single-lumen saline implant.
Fig 5 Enhancing non-mass-lesion on the subtractedimages in a high risk patient with normal conventionalimaging. Altered echoexture on second-look ultrasound.Inraductal carcinoma on excision following wirelocalization. Curve 5 is from the lesion ad correspondsto moderately rapid initial uptake followed by a plateau.Curve 4 ia control from the heart. Curves 6 and 7 arecontrols from ipsilateral and contralateral glandular tissue.
ACHIEVEMENT• Heartiest congratulations to our beloved Ex. President & Ex.Trustee
DR. ANIL SUCHAK for being conferred prestigious – LIFE TIME ACHIVEMENTAWARD by ASSOCIATION OF MEDICAL CONSULTANTS (AMC) at DOCTOR’SDAY PROGRAMME held on SUNDAY, 01.07.2012 for his selfless contribution tonumerous Medical, Social, Educational & Spiritual Organization for more than threedecades & for leading active & highly meaningful life and emerging as winner againstfighting all odds ( 2 Cardiac arrests & end stage Liver failure with subsequent LiverTransplant). Sir, you really represent rare iconic figure of inspiration for many manyfuture generation to follow. We are all highly proud of you.
• Heartiest congratulations to our Past President, DR. BALKRISHNA M. INAMDARfor being prestigiously installed as DISTRICT GOVERNOR OF ROTARY DIST 3140FOR THE YEAR 2012-2013. This district has revenue Districts of Mumbai, NaviMumbai & Thane and it will cover more than 125 Clubs & 7000 Rotarians. Weare very proud of him and wish him all the best during his tenure.
• DR. (MS.) SHALMALI B. INAMDAR our life member & daughter of Ex.PresidentDR. BALKRISHNA M. INAMDAR & DR. (MRS.) NILIMA B. INAMDAR, PassedDNB (GENERAL MEDICINE) EXAMINATION of JUNE 2012 at 1ST ATTEMPT. We conveyour Heartiest Congratulations & wish her the best professional carrier.
DR. (MRS.) ALKA B. MEHTA DR. S. K. JOSHIPresident Hon. Secretary
26
TARGETING CANCER TO CURE
DR. AVINASH DEO, M.DConsultant Medical Oncologist,Dr. Balabhai Nanavati Hospital
Chemotherapy is responsible for cure andimproving survival of a large number of cancers.Disseminated cancers like testicular cancersand advanced stage lymphomas are cured bychemotherapy. The most common cancers inthe world are lung, breast, bowel, stomach andprostate. Chemotherapy has had a largeimpacton the outcome of these cancers.Unfortunately chemotherapy is feared andmisunderstood because of it’s side effects.Side effects occur because of chemotherapydoes not kill cancers cell by any specificmechanism. It just kills cells that are rapidlygrowing. Cancer cells being fast growing areki l led. Hair fol l icles, bone marrow,gastrointestinal mucosa cells are also fastgrowing and are also killed causing side effectslike hair loss, lung cancer, ovarian cancer,mucosit is, diarrhoea leucopenia andthrombocytopenia. It became apparent thatanti-cancer drug therapy could only evolve ifthe cancer cells were targeted better.
Cancer is an acquired genetic disease it wasthe study of chromosomes that gave the firsttarget for development of anticancer drugs. Tworesearch groups discovered the f irstchromosomal abnormality in a cancer inpatients with chronic myeloid leukaemia. Asboth the groups were from the city ofPhiladelphia the chromosome was named asPhiladelphia (Ph1) chromosome. Ph1 shown tobe associated having a DNA defect BCR-ABL.BCR-ABL produced an enzyme that wasresponsible for transformation of normal cellsto chronic myeloid leukaemia. In BCR-ABL thecause of at least one cancer was found.Imatinib was synthesized as a drug actingagainst BCR-ABL and it converted a uniformlyfatal disease to a chronic disease with a 85%
survival at five years. Some patients who get avery good response following imatinib appearedto be cured. Two drugs dasatinib and nilotinibare available for those in whom imatinib fails.Imatanib was so effective that it holds therecord as the drug with the fastest approvaland is probably the only drug that has made itto the cover of the Time magazine.
Imatinib has been a runaway success, veryeffective, almost free of adverse effects. Itproved that targeting cancer specif icmechanisms was possible. Cancer targets arefound all over the cancer cell. They are evenfound outside the cancer cell. Two commontargets are gene mutations driving cancer andproteins on cell surface. All tumours need bloodsupply and drugs that can prevent new vesselformation have been used as effectiveanticancer drugs.
The largest set of drugs specifically targetingcancer cells have been drugs that act againstmutations driving cancer. Geftinib and erlotinibinhibit the epithelial growth factor receptor thatdrives certain adenocarcinomas of the lungs.These carcinomas are more common inwomen, non-smokers and in persons of EastAsian ancestor. Patients having the mutationsin EGFR respond better to these drugs thanto chemotherapy. The side effects are mild andinclude a skin rash. The up side is that thosewho have skin rash appear to show a betterresponse. A small proportion of patients withlung cancer have mutations in the ALK kinase.A drug called crizotinib inhibits 90% of thesecancers with side effects less common thanchemotherapy.
About one-fifth of the breast cancers have theC-erbB2 (HER2/neu) gene amplified. This gives
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the cancers an additional growth stimulus andthe outcome of patients with this genetic defectis poor. C-erbB2 is the gene for a receptor ofepithelial growth factor and blocking thisreceptor by a monoclonal antibody(trastuzumab) or an inhibitor of the receptor(lapitinib) have improved the outcome of c-erbB2 positive breast cancer. Trastuzumab iseffective and recommended both in patientswhose tumour has been completely removed(adjuvant therapy) and those with metastaticdisease whereas lapitinib is recommended onlyin patients with metastatic disease.
Two antibodies have changed the outcome ofcolorectal cancer. The first is bevacizumab thatprevents new vessel formation and the secondis cetuximab. Renal cell carcinoma showed
virtually no response to chemotherapy. Twodrugs sunitinib and sorefinib have made controlof these cancers possible.
Virtal ly all patinets of common type oflymphoma benefit from addition of a monoclonalantibody, rituximab, to chemotherapy. R-CVP,R-CHOP or bedamustine-rituximab are thestandards therapy for lymphomas.
The move of cancer therapy from chemotherapyto better targeting has not only reduced theadverse effects but has improved cure. As moretargets are recognized and drugs developedagainst these targets, more cancer will becures. The pathologists will have to incorporateDNA analysis in their diagnostic tools and theclinicians will need to understand these.
CONGRATULATIONS !Our hearty congratulations to following Office Bearers / Managing CommitteeMembers / Members of our branch who got elected for various prestigious postsat GPA - Greater Bombay for the year 2012 - 2013.
Name Post
1) DR. SUBODH KEDIA President
2) DR. MAHMOOD A. MERCHANT Vice President & Conference –Reception Committee Chairman
3) DR. SUBHASH L. SHAH Vice President
4) DR. (MRS.) PRITI BHARGAVA Hon. Joint Secretary & Conference -Scientific Convenor
5) DR. DEEPAK JUMAN Hon. Joint Secretary
6) DR. RAMESH RAJANI Cultural Sub Committee Chairman
7) DR. ASHOK BALSEKAR Managing Committee Member
8) DR. AKIL CONTRACTOR Managing Committee Member
9) DR. (MRS.) LEENA BHAGAT Managing Committee Member
We are very proud of them !
We wish them all the best.
DR. (MRS.) ALKA B. MEHTA DR. S. K. JOSHIPresident Hon. Secretary
28
STEM CELL TRANSPLANT PART- 3
Welcome to third part of a series on STEM CELLTRANSPLANT, for Diseases of Blood – Benignand Malignant.
Question :Dr. Chiragbhai, we are glad to know that youhave now started visiting Mumbai on FirstSaturday of every month, at Apollo Clinic,Andheri. We discussed briefly last time aboutrole of SCT in Thalassemia. Can you elaboratemore?
Answer :
Sure. Common questions are related to donorselection and donor safety; success rate, safety;options for children without a matched sibling,apart from what we discussed last time.
Donor is generally a real brother or sister (sibling).Donor testing is mainly done to ensure that theydo not pass on a disease to recipient, such asHIV, hepatitis or another genetic disorder.Thalassemia minor person can be a stem celldonor.
Donor safety is very good. Young child, up toeven one year age, can be a stem cell donor.Many parents are concerned about thisquestion, and worried about risks to a healthychild. Any person who donates stem cells, eitherchild or adult, does not have any reduction incapacity of body functions of any type. Stemcells are in very large numbers in body, and adonor gives a small fraction only. Also, they arereplaced by forming new stem cells within fewweeks. This is very different from kidney or liverdonation, and parents must be reassured thatthere is no permanent loss of stem cells.
The collection process is also very safe, donoris discharged from hospital in one day, and arefunctioning normally in 1-2 days.
In fact, the donor safety is so good that thereare about 2 crore volunteer donors worldwide.Yes, two crore, who are willing to give their stemcells for even an unrelated person, voluntary,without charge. Such registries are welldeveloped in USA and Europe. Indian registrieshave recently started. Fee charged by theseregistries is for processing and maintainingrecords, not given to donor.
Que :
That solved some important concerns andcleared misconceptions about being a stem celldonor. It is also good to know that Indianregistries have started.
Ans :
Yes, one of the major registries is based inMumbai i.e. MDR India, under main guidanceof senior hematologist Dr. Sunil Parekh. Theother major Indian registry is DATRI, run by adynamic non medical person Mr. Raghu. If moreIndians join one of these registries as volunteerdonors, there is a better chance of finding a stemcell match for our patients, similar to patients inUSA or Europe.
Que :
Thank you for this important new information.Now what is the success rate of Thalassemiatransplant?
Ans :
Thalassemia transplant results published fromItaly, Prof Lucarelli group (IME), has successrates up to 94%. Results depend on aprognostic stage i.e. Pesaro class. Class 1patients have over 90% success and class 3have about 80% success.
Results in Indian patients are lower, in the rangeof 60-80%. This may be due to various factors.However, this is likely to improve with morededicated transplant teams and blood banksfocusing on better thalassemia care now comingup in India. Post transplant care for one year ormore has to be very stringent as well.
Pre transplant care is also important in improvingthe results. Children with better transfusionpractices i.e. use of leukocyte filter, keeping goodpre transfusion Hb, and good regular ironchelation are important determinants of transplantsuccess.
Dr. Chirag A. ShahM.D. Oncology/Hematology (USA),
098988 31496
Diplomate American Board of Oncology andHematology. [email protected]
