an official journal of ima college of general...

AN OFFICIAL JOURNAL OF IMA COLLEGE OF GENERAL PRACTITIONERS

IMA COLLEGE OFGENERAL PRACTIONER -

HQRS, CHENNAI

Although every care has been taken in the publication of this The Family Practitioners of India, the author, thepublishers and the printers shall not be responsible for any loss or damage caused to any person on account of errorsor omissions which might have crept it. The publishers shall be obliged if mistakes are brought to their notice forcarrying out corrections in the next issue. - Editor

EDITED BY:

Dr. T.N. RAVISANKARImm. Past Secretary, IMA CGP HQIMA TN State Hqrs Building,Doctors Colony, Via-Bharathi NagarFirst Main Road, Off.Mudichur Road,Tamaram WestChennai – 600 045.Tamilnadu. INDIA.Ph: 044- 29 000 325 / 8015263117Cell: 94440 47724Email : [email protected]

EDITORIAL BOARD:

Dr. Anil S. Pachnekar, MumbaiDr. Shaila Milton Philip, ChhattisgarhDr.T. Kumaraguru, TamilnaduDr. S. Eswaramoorthy, TamilnaduDr. Punitha Rebecca, TamilnaduDr. K. Surya Rao, A.P.Dr. Satish Chugh, HaryanaDr. S. Abbas Ali, U.P.

PUBLISHED BY:

Dr. A. RAJARAJESHWAR2/2, Poes Road, 3rd StreetmTeynampet, Chennai – 600 018Tamilnadu. INDIA.

PRINTED BY:

S. THEESMASLilly Soosai Offset12/1, Mohamed Hussain LaneRoyapettai, Chennai – 600 014.Tamilnadu. INDIA.

THE FAMILY PRACTITIONER OF INDIAVOLUME - 2 ISSUE - 02 April - 2013

PatronDr. S. ARULRHAJ

National President, IMADr. K. VIJAYAKUMAR

Hony. Secretary General, IMADr. NARENDRA SAINI

Hony. Finance Secretary, IMADr. AJAY GAMBHIR

Dean, IMA CGPDr. P. PULLA RAO

Hony. Secretary, IMA CGPDr. K.M. ABUL HASAN

IMA CGP Joint SecretariesDr. A. RAJA RAJESHWAR

Dr. R. ANBURAJAN

IMA CGP Governing Council Members

Dr. AKHILESH VERMADr. AVDHESH KUMAR GUPTA

Dr. HARIVANSH KUMAR ARORADr. NEERAJ KUMAR GUPTA

Dr. P. RADHA KRISHNA MURTHYDr. AMRIT PAL SINGH

Dr. AMUTHA KARUNANIDHIDr. KIRANSHANKAR WASUDEO DEORAS

Dr. PIYUSH KANTI ROYDr. SATISH CHANDRA PANDEY

INDIAN MEDICAL ASSOCIATIONCOLLEGE OF GENERAL PRACTITIONERS HQ.

IMA TN State Hqrs Building, Doctors ColonyVia Bharathi Nagar First Main Road,

Off. Mudichur Road, Tambaram, Chennai - 600 045.Tel: 044 - 29000325 Email: [email protected] Web: www.imacgpindia.com

Chief Patron Dean, IMA CGP National Secretary, IMA CGPDr. S. ARULRHAJ Dr. P. PULLA RAO Dr. K.M. ABUL HASAN

03THE April 2013FAMILY PRACTITIONER OF INDIA

Dear Colleague, Greetings from IMA CGP Hqrs!

I am glad to inform you that the much awaited IPPC(International Postgraduate Paediatric Certificate Course hasbegun. The contact classes will be held both in Chennai &Hyderabad initially & later extended to other centers. I inviteyou to the inaugural function of the IPPC Courses at Hyderabadon 28.04.13 at 10 AM and at Chennai on the same day evening5PM. Soon we will launch other two new courses ie, FellowshipCourse on Cancer Palliative Medicine and PG Diploma inHospital Management (PGDHM) in collaboration with Vinayaka Mission University.

There were two important meetings happened recently. One was the office bearersmeet at Delhi where I had presented the proposed activities by IMA CGP for this year.It was well received & appreciated by our leaders. The Second meeting we had withCGP office bearers of TN State where we had very fruitful discussions particularlyabout membership growth, new courses and All India Young Medics Convention. I amalso very happy to note that Mega CGP Events also were held at Kanpur, Baroda andMany other places congratulations to them.

I also happily announce that we have instituted awards like Best State Chapter,Best State CGP Faculty & some more awards which will be given in the National CGPConference every year & I am sure that this would motivate our members to scale upCGP activities.

We are close to settling the Itinerary & fee structure of the long awaited US StudyTour, the final settlement will reach you soon, perhaps in this same issue itself.

Long Live IMA

Dr. K.M. Abul HasanNational Secretary, IMA CGP Hqrs


D.D of lesionsin the

Oral Cavity

ORAL MUCOSA-ERYTHEMATOUS LEISONS

Allergy

Erythroplakia

Candidiasis

Geographic Tongue

Stomatitis areata migrans

Plasma cell Gingivitis

Pemphigus vulgaris

ORAL MUCOSA –PIGMENTED LEISONS

Racial pigmentationOral Melonotic maculaePeutz-Jeghers syndromeNeurofibromatosisAlbright’s SyndromeAddison’s DiseaseChloasmaSmokers melanosisDrug reaction – Chlorpromazine,Minocycline,Busulfan,QuinacrineNeviMelanoma

ORAL MUCOSAPUNCTATEEROSIVE LEISONS

Viral – Herpessimplex, Zooster,Coxsackie

Aphthous Stomatitis

Behcet’s syndrome

Reiter’s syndrome

Neutropenia

Acute Necrotizingulcerativegingivostomatitis

Drug reaction

Inflammatory boweldiseaseContact allergy


WHITE LEISONS IN ORAL MUCOSALeukoplakia

White hairy Leukoplakia

Squamous cell carcinoma

Licen planus

Stomatitis nicotinicia

White spongy nevusLeucoedema

Candidiasis

Allergy

Systemic lupus erythematosis

ACUTE ORAL ULCERTrauma (termal)

Aphthous Stomatitis

Syphilis

Herpes simplex infection

Herpes zoster

6) ORAL VESICLES AND ULCERAphthous Stomatitis

Herpes simplex infection

Vincent’s stomatitis

Syphilis

Coxsackie virus

Behcet’s syndrome

SLE

Reiter’s syndrome Crohn’s disease

Erythema multiforme


CIPRFLOXACINAntacids decreases absorption

Calcium decreases absorption

Ferrouse sulphate decreases absorption

Sucralfate decreases absorption

Theophylline is increased in concentration

Warfarin concentration is increased

COMMON DRUGINTERACTIONIN PRACTICE

NSAIDWith ACE and Diuretic has increased risk ofnephrotoxicity and blunted effect ofantihypertensive activity.

Increase the Lithium and Methotrexateconcentration.

With WARFARIN can increase the risk of bleeding.

A 50 years old man with history of exertional angina for many yearspresented to the clinic for evaluation. He has been evaluated twicebefore for the same problem. The two previous evaluations, both of

which included coronary angiograms, were reported as normal. He was onsymptomatic medical management with nitrates and beta-blockers. The ECGtaken at that time is shown below.

ECG

to

ECH

O

Does this patient have ischemic heart disease? If yes, what is the mechanism ofhis angina, given that his coronary arteries were normal on two differentoccasions? If no, what is the alternative diagnosis?

This ECG shows typical features of LVH with diffuse T wave inversions. Thishas been present in the patient’s ECG recordings for many years now. Eventhough this can suggest coronary artery disease, given the situation of his twoprevious coronary angiograms being normal, an alternative diagnosis must alsobe entertained. A very important point to remember is the abnormal QRScomplexes, ST-T changes and conduction abnormalities are typical featuresof cardiomyopathy. Therefore in this case due to the presence of diffuse Twave inversions, a diagnosis of cardiomyopathy must be kept in mind. Althoughthe patient was evaluated twice for angina, an echocardiogram was never doneon this patient; therefore the diagnosis was missed. The echocardiogram in thispatient revealed hypertrophic cardiomyopathy. It is also well known thathypertrophic cardiomyopathy can present with demand ischemia and anginasymptoms. This explains his angina despite normal coronary arteries.

Lessons to Learn

Diffuse abnormal ST-T changes and bizarre QRS complexes are characteristicfeatures of cardiomyopathy. Hypertrophic cardiomyopathy can present withangina with normal coronary arteries due to demand ischemia. Any patientwith abnormal ST-T changes must have an echocardiogram done to rule outcardiomyopathy, ast the diagnosis can otherwise be missed.



In allergic rhinitis allergen avoidance isimportant both to decrease the need formedication and as a protective measure sincethe offspring have a greater than 30% chanceof being atopic. The risk /benefit ratio of anydrug therapy must be carefully consideredsince none of the medications used have beendefinitively proven to lack foetal effect.Some antihistamines may increase the riskof Spontaneous abortion or congenital malformation, but topical corticosteroids have shownno evidence of harmful effects. There has been no danger associated with sodiumcromoglycate during pregnancy.

The rhinitis of pregnancy, which is thought to be similar with that associated with oralContraceptive and hormone replacement therapy, can be quite distressing especially atnight when sleep is difficult. The sparing use of topical vasoconstrictors has been suggested:however, a recent report suggests that this could be a risk factor for abdominal malformation.The use of nasal douching or a nasal saline spray may be effective. Reassurance that this isa self - limiting condition maybe the only therapy necessary.

Rhinitis in Pregnancy

In a prospective trial, 51 patients with a mean ageof 60 years, Who had ulcers >2cm associated withchronic venous insufficiency, were recruited. They wererandomly assigned to compression therapy along with300mg of aspirin or placebo.

Ulcer healing and recurrence were assessedweekly. Healing occurred in a mean of 12 Weeks inthose given aspirin and in 22 weeks in those givenplacebo, a 46% reduction in healing time .The mainprognostic variable for ulcer healing was the initial sizeof the ulcer. Aspirin therapy could cut ulcer healingtime by half (Ann.vasc Surg 2012 :26:620-9).

Aspirin forVenous Ulcers


DEFINITION

A disorder of purine MetabolismCharacterised by hyperuricaemia andrecurrent attacks of synovitis due tourate crystal deposition.

Epidemiology

Male preponderance (male : femaleratio 8:1): rare in pre –menopausalwomen.

Acute gout

Sudden severe joint pain lasts for oneto two weeks if untreated.

Most Commonly affects the firstmetatarsophalangeal joint, ankle andfinger joint, although other joint mayalso be involved.

Affected joint are inflamed andexquisitely tender.

Triggers include alcohol, thiazidediuretics, trauma and surgery .

Chronic gout

Soft tissue deposits of urate (tophi) inthe pinna , tendons and bursae ,leadingto joint disruption and progressivedisability.

Investigations

ESR, CRP and uric acid may beraised.

Synovial fluid microscopy revealsnegatively birefringent crystals underpolarized light.

X-ray show peri –articular punched –out cysts ‘in chronic gout.

Mangement

Acute episodes should be treated with acombination of rest and high –dose NSAIDs.

Systemic Cortico steroid and colchicines aresuitable alternatives.

Allopurinol can be used for prophylaxis in thosewith recurrent attacks, but never for treatmentof acute exacerbation.

Differential diagnosis

Septic arthritis is an important differentialdiagnosis. If in doubt, admit for furtherinvestigations.

Myeloproliferative disorders and renal failureboth result in hyperuricaemia.Gout maybe apresenting feature of these conditions.

The Whole Patient and not Part of Himor Her in Clinical Examination

INTRODUCTION

In the practice of medicine, examining thepatient fully and not in part is rewarding – asmany a senior (experienced) physician willcorroborate.

After symptom elicitation with probingquestions like a lawyer, a physician should othrough the exercise of symptom analysis andlater perform a complete physical examination.

Relevant investigations should e asked for.The author realizes that all this is known to

every physician, but we also know that this doesnot happen in many consultations for variousreasons.

The author is giving hereunder a fewexamples of transgressing the basic principle –examine the whole patient and not part of himhowever trivial the complaint.

A Cauda Equina tumor that remainedundetected for 10 years

A middle-aged male who had difficulty inmicturition saw an urologist initially withoutconsulting a family physician. The urologistconcentrated on the urinary tract and acolleague of his in the United Kingdomsuggested sectioning the urethral sphincter.

A routine clinical examination – includingthe nervous system – because he also haddifficulty in bowel evacuation – revealed a caudaEquina lesion.

The lesson in this case is that one shouldtake cognizance of seemingly irrelevantsymptoms. The bowel problem whichpresented along with wasted gastrocnemius,absent ankle jerks and saddle anesthesia helpedto detect the tumor which remained undetected

Dr. K.V. ThiruvengadamRetd. Professor of Medicine, MMC, Chennai

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○


for 10 years and the urologist clinician barking up thewrong tree.Hazard of a cursory examination of a fully-dressedpatient

A middle-aged muslim lady in burka was seen by apractitioner. Not wanting to embarrass her, he did acursory chest examination for her cough and asked fora chest X-ray.

The X-ray showed a localized shadow in one lungfield. This was taken as TB and antituberculosistreatment (ATT) was advised. After 3 , months, a repeatchest X-ray showed that the lesion was unchanged. Thepractitioner had the clothes removed by persuasion andwhat was found – shocked him.

It was a lipoma on the chest wall that casts theshadow in the X-ray – interpreted as patient (PT).

Unilateral exophthalmos of thyrotoxicosis in ayoung boy- misjudged by faulty interpretation ofCT of the orbit in the early days of CT

A boy with exophthalmos in one eye was straightaway referred to a neurosurgeon and he proposedsurgery since the CT of the orbit was interpreted asshowing a tumor of the medical rectus. Properexamination of the patient revealed thyrotoxicosis andthe eye problem regressed with appropriate treatment.

The lesson: Examine the whole patient and not partof him.A nodule in the scrotum – key to diagnosis ofcerebral cysticercosis

A patient with recurrent seizures was examined byan examination going bright PG student.

He went through the examination in the conventionalmanner – including examination of the genitalia.

A subcutaneous nodule in the scrotum wasdiscovered by him. The patient being a pork eater, thecandidate suggested cysticercosis as possibility for hisseizures. Biopsy of the nodule and CT of the brainconfirmed the suggested diagnosis.Familiarity breeds contempt

A surgeon in a teaching hospital demonstrated aclinical problem to a group of medical students in theirclinical years.

A young boy with an abdominallump: the surgeon asked the boys toexamine the abdomen and suggest theprobable diagnosis. Boy after boy gavevarious diagnoses – rolled upomentum, omental cyst, etc.

The first girl student, who examinedthe patient, pulled the trousers of thepatient, examined the genitalia anddiscovered an undescended testis –and suggested a tumor in the abdomenarising from an undescended testis.

The surgeon, a wit, looked at theboys and said “familiarity breedscontempt”. Apparently because theboys did not examine the genitalia inabdominal examination.

The author has given someinstances in clinical practice, where thebasic principle of examining the wholepatient and not part of him, will standthe clinician in good stead. The rewardwill be wholesome.


I am now seeing a new type of patient—the e-patient. Many of these highly informed, high-tech patients come to my referral clinic fromPune and Bangalore—the Silicon Valley ofIndia.Initially, e-patients referred to those patients whoused email and the Web. Today, thee-patient has become much more sophisticated.E-patients are engaged—with their medicalprofessionals, with their health, and with theirhealthcare system. They do not just readcontent—sometimes they even create it.“User-generated content” is a very powerfulconcept, because patients provide first-handhealth-related information to other patients,in the form of:

blogs—their own, and comments on others’blogs.online health-related support groups.Wikipedia updates.comments on Web sites—doctor reviewsites and general or niche healthcare sites.social mediaand a number of other outlets.

Information sharingE-patients tend to be empowered, knowledge-able, and articulate. They have opinions andare happy to express them. E-patients are oftenexperts about their own conditions or illnesses—and they are happy to share their expertise withothers.They are equipped. They understand how touse the Web and related technology to helpthemselves and to help others. They often willlead and participate in online support groups andare able to discuss highly technical clinicalmedical matters intelligently with their doctors.They do not underestimate their owncompetence or intelligence and understand thatthey have the most at stake when it comes tomatters relating to their health.E-patients are enabled. They have access totechnology and use it intelligently.

Aniruddha Malpani

What yWhat yWhat yWhat yWhat you needou needou needou needou needttttto knoo knoo knoo knoo know aboutw aboutw aboutw aboutw aboutthe new breedthe new breedthe new breedthe new breedthe new breedof ‘e-patients’of ‘e-patients’of ‘e-patients’of ‘e-patients’of ‘e-patients’— high-t— high-t— high-t— high-t— high-tececececech,h,h,h,h,informed,informed,informed,informed,informed,and engagedand engagedand engagedand engagedand engaged


Leveraging thevalue of your e-patientsE-patients are often exceptional patients. Theyare even the kind of patients who can heal asick healthcare system. They are the icons of anew kind of medicine, called participatorymedicine.It might seem easy to be intimidated by an e-patient, but e-patients can be of great help toyou—both in the success of their own care andin sparking communication with other patientsand potential patients. You may want to see ifany of your e-patients are open to:

Sharing their thoughts with you about what

patients with their condition or illness wantto know.Providing sources of online information thatthey find to be useful so that you can vetthem to possibly share with other patients.Sharing their positive experiences at yourmedical clinic with others through onlineoutlets such as doctor review sites andblogs.Leading support groups of your patients thatyou facilitate—either in person or online.

Good doctors appreciate and treasuree-patients—and form partnerships with them,because we can learn a lot from each other.

Zinc reduces treatmentfailure in childrenexperiencing seriousbacterial infections

Adapted from mdCurrent- Of the more than 1 million infantdeaths that occur each year in India, more than 25% areassociated with serious bacterial infections, including pneumonia,sepsis, and meningitis. Zinc deficiency has been linked to higherrates of infection and is a common problem for Indian children,particularly during their first 5 years of life.

In a new randomized, double-blind, placebo-controlled trial conducted at 3 hospitals inNew Delhi, India, investigators randomly assigned 700 infants between 7 days and 120 daysand suffering from a probable serious bacterial infection to receive 10 mg of zinc or placeboorally every day in addition to standard antibiotic treatment.

The study results, which were published in The Lancet, suggested that zinc could in factreduce the risk of treatment failure (ie, the need to change antibiotics in the first week, therequirement for intensive care, or death within 3 weeks) by 40% compared with placebo.While not the primary aim of the study and not reaching statistical significance, the study alsosuggested that zinc might reduce the fatality rate of these infants. Markers of improvement,including time to recovery, weight gain, or oral feeding, were not affected by zincsupplementation.

The authors stated in their paper that: “Zinc syrup or dispersible tablets are alreadyavailable in the public and private health-care systems for treatment of acute diarrhea inmany countries of low and middle income and the incremental costs to make this interventionavailable for young infants with probable serious bacterial infection would be small.”



as antipyretic properties, and was quicklyintroduced into medical practice under the nameof Antifebrin by A. Cahn and P. Hepp in 1886.But its unacceptable toxic effects, the mostalarming being cyanosis due to methemoglobinemia, prompted the search for less toxicaniline derivatives. Harmon Northrop Morsehad already synthesized paracetamol at JohnsHopkins University via the reduction ofp-nitrophenol with tin in glacial acetic acid in1877, but it was not until 1887 that clinicalpharmacologist Joseph von Mering triedparacetamol on patients.

In 1893, von Mering published a paperreporting on the clinical results of paracetamolwith phenacetin, another aniline derivative VonMering claimed that, unlike phenacetin,paracetamol had a slight tendency to producemethemoglobinemia. Paracetamol was thenquickly discarded in favor of phenacetin.

The sales of phenacetin established Bayeras a leading pharmaceutical company.Overshadowed in part by aspirin, introduced intomedicine by Heinrich Dreser in 1899, phenacetinwas popular for many decades, particularly inwidely advertised over-the-counter “headachemixtures”, usually containing phenacetin, anaminopyrine derivative of aspirin, caffeine, andsometimes a barbiturate. Von Mering’s claimsremained essentially unchallenged for half acentury, until two teams of researchers fromthe United States analyzed the metabolism ofacetanilide and paracetamol.

In 1947 David Lester and Leon Greenbergfound strong evidence that paracetamol was amajor metabolite of acetanilide in human blood,and in a subsequent study they reported thatlarge doses of paracetamol given to albino ratsdid not cause methemoglobinemia.

In three papers published in the September1948 issue of the Journal of Pharmacology andExperimental Therapeutics, Bernard Brodie,Julius Axelrod and Frederick Flinn confirmedusing more specific methods that paracetamolwas the major metabolite of acetanilide in human

blood, and established that it was just asefficacious an analgesic as its precursor. Theyalso suggested that methemoglobinemia isproduced in humans mainly by anothermetabolite, phenylhydroxylamine.

A follow-up paper by Brodie and Axelrodin 1949 established that phenacetin was alsometabolized to paracetamol. This led to a“rediscovery” of paracetamol. It has beensuggested that contamination of paracetamolwith 4-aminophenol, the substance von Meringsynthesized it from, may be the cause for hisspurious findings.

Paracetamol was first marketed in theUnited States in 1953 by Sterling-Winthrop Co.,which promoted it as preferable to aspirin sinceit was safe to take for children and people withulcers. The best known brand today forparacetamol in the United States, Tylenol, wasestablished in 1955 when McNeil Laboratoriesstarted selling paracetamol as a pain and feverreliever for children, under the brand nameTylenol Children’s Elixir—the word “tylenol”was a contraction of para-acetylaminophenol.

In 1956, 500 mg tablets of paracetamol wenton sale in the United Kingdom under the tradename Panadol, produced by Frederick Stearns& Co, a subsidiary of Sterling Drug Inc. Panadolwas originally available only by prescription, forthe relief of pain and fever, and was advertisedas being “gentle to the stomach,” since otheranalgesic agents of the time contained aspirin,a known stomach irritant.

In 1963, paracetamol was added to theBritish Pharmacopoeia, and has gainedpopularity since then as an analgesic agent withfew side-effects and little interaction with otherpharmaceutical agents. Concerns aboutparacetamol’s safety delayed its widespreadacceptance until the 1970s, but in the 1980sparacetamol sales exceeded those of aspirin inmany countries, including the United Kingdom.This was accompanied by the commercialdemise of phenacetin, blamed as the cause ofanalgesic nephropathy and hematologicaltoxicity.

Acetanilide was thefirst aniline derivativeserendipitously found topossess analgesic as well

CODE OF MEDICAL ETHIS ANDETTIQUITE

5.2 Public and Community Health: Physicians, especially those engaged inpublic health work, should enlighten thepublic concerning quarantine regulationsand measures for the prevention ofepidemic and communicable diseases. Atall times the physician should notify theconstituted public health authorities of everycase of communicable disease under hiscare, in accordance with the laws, rules andregulations of the health authorities. Whenan epidemic occurs a physician should notabandon his duty for fear of contracting thedisease himself.

INDIAN PENAL CODE inrelation to the ETHICSSECTION 269 Negligent actlikely to Spread infection ofdisease dangerous to lifeWhoever unlawfully or negligently does anyact which is, and which he knows or has

KNOW YOURETHICS

AND LAW

disease dangerous to life shall be punished withimprisonment of either description for a term whichmay extent to six months ,or with fine ,or with both.

Procedure

The offence under section 269 is congnizable,Bailable, Non-Compoundable and triable by anyMagistrate.

Section 270 .Malignant act likely to Spreadinfection of disease dangerous to life.

Whoever maglignently does any act which is, andwhich he knows or has reason to believe to be,likely to spread the infection of any diseasedangerous to life, shall be punished withimprisonment of either description for a term whichmay extend to two years ,or with fine ,or with both

Procedure

The offence under section 270 is cognizadle,bailable, non-Compoundable and triable by anymajistrate.

Section 271. Disobedience toquarantine rule.Whoever knowingly disobeys any rule made andpromulgated by the government for putting anyvessel into a State of quarantine ,or fore regulatingthe intercourse of vessels in a state of quarantine

With the shore or with other vessels, or forregulating the intercourse between places wherean Infectious disease prevails and other places,shall be punished with imprisonment of eitherdescription for a term which may extend to sixmonths , or with fine, or with both.

Procedure

The offence under section 271 is Non- cognizadle,bailable, non-Compoundable and triable by anymajistrate.

reason to believe to be, likelyto Spread the infection of any



IMA COLLEGE OF GENERALIMA COLLEGE OF GENERALIMA COLLEGE OF GENERALIMA COLLEGE OF GENERALIMA COLLEGE OF GENERALPRACTIONER - HQRS, CHENNAIPRACTIONER - HQRS, CHENNAIPRACTIONER - HQRS, CHENNAIPRACTIONER - HQRS, CHENNAIPRACTIONER - HQRS, CHENNAI

Diploma in Child Healthknown also as

International PostgraduatePaediatric Certificate

January – March 2013

The Quadrangle, University of Sydney

Sydney Children’s Hospital Randwick The Children’s Hospital at Westmead

The vision of the DCH / IPPC education environment is to provide affordable accessto an international standard of current best practice in treating children and youngpeople for doctors and suitably qualified nurses worldwide. January 2012.

Website:www.magga.org.auEnquiries to: [email protected]

Our v

ision

SalientFeatures of

IPPC

Conducted byIMA CGP

&Sydney

University

1) Course Starts Immediately2) Application open now, closes on April 31st

3) Course fee Rs. 1 Lakh – two installments4) Course duration – 1 year, exams Dec 20135) 2 Contact classes per month or 8 hrs per month6) Course will have totally 110 lectures, online lectures,

local tutor contact classes, written exams, wardrounds OSCE Model Viva

7) Minimum 10 candidates per center8) Two faculty per 10 candidates9) Centers – Chennai, Madurai, Hyderabad & New Delhi10) Faculties from Sydney would visit three times a

year11) Dr. K.M. Abul Hasan, Dr. Ganesh will be the local

tutor to start with.

QuizOphthalPicture

Dr. T. Nirmal FredrickNirmals Eye Hospitals

Chennai. - South India.

Answer to the above quiz may be sent bye.mail only to [email protected]

From 22-04-2013 to 28-04-2013The first correct entry will receive a gift.

1. What is the male equivalent of Menarche?A) Spermalacia B) Azospermia C) Spermarche


Quiz for March issues 2013. Answer to the Quiz of March 2013Q) Who did the first human heart transplant?

Answer: B) Christian Barnard

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