Journal 1pages FINAL 34- - National Board Of Examination

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education and research. A familydoctor provides primary and continuingcare to the entire family within thecommunities; addresses physical,psychological and social problems; andcoordinates comprehensive health careservices with other specialists, asneeded. The practitioners in familymedicine can play an important role inproviding healthcare services to thesuffering humanity. The Generalpractitioner’s responsibility in Medicareincludes management of emergencies,treatment of problems relating tovarious medical and surgical specialties,care of entire family in its environment,appropriate referrals and follow up. Heis the first level contact for the patientsand his family. In a country with largepopulation spread over to rural sector,the need for adequately trained,properly qualified, competent generalpractitioners is acutely felt. NBE is keento encourage Family Medicine as aspecialty programme since it servesthe need of the society by providingcomprehensive and continuing care ofthe patients in their own family settings.Objectives of DNB (FamilyMedicine) Programme1) The present undergraduate medicalcurriculum and the internship periodare inadequate to turn out well trained,safe and competent medicalprofessionals to serve the CommunityNeeds.2) Preventive, Promotive andRehabilitative aspects which form anintegral part of healthy living has lostits focus with most of the medicalpractitioners.3) More than 80 percent of ourpopulation are either urban poor or Ruralbased. They are unable to get accessto medical care facilities from existinghospitals.4) To practice holistic medicine thetreating physician should understandthe social, cultural and economicconditions of the family.5) Family physician needs to makeoptimal use of funds and Judiciousselection of Investigations.6) Family Physicians form thebackbone of any health delivery system.Management of emergencies andappropriate two way referral to thespecialist and back for follow up willfacilitate patient care.Which are the Institutionseligible to apply?1) All hospitals attached toGovernment and Private MedicalColleges2) All Government hospitals includingGeneral Hospitals, District hospitals,ESI, Defence, Railways, etc3) Multispeciality hospitals alreadyaccredited by the NBE (Single specialityHospitals not eligible)4) Public Sector Hospitals,Corporation, Port Trust & Missionhospitals and multi speciality privateHospitalsInspection FeeNo Inspection fee for above categories1, 2 & 3.For category 4, Inspection fee isRs.10,000/- only.What are the minimumrequirements for eligibility1. The hospital should have full timeconsultants with Postgraduatequalifications MD/MS or DNB orequivalent in the speciality of InternalMedicine, General Surgery, Obst &Gyn. and Pediatrics.Full time or part time or visitingconsultants can provide training in otherspecialities.2. The hospital should have aminimum number of 50 beds (for 2candidates) and 100 beds (for 4candidates)3. The hospital should have causality/emergency medicine department with24 hours service including availabilityof Anesthetists and Blood transfusionservices.4. The hospital should haveRadiological, Imaging and LaboratoryInvestigation facilities viz Biochemistry,Microbiology, Pathology, etc.5. Facilities for teaching in smallgroups, seminars and bed side clinics.6. Library with standard text books andjournals and access to internet.Eligibility criteria for theCandidates1. Any Medical Graduate with MBBSqualification, who has completedInternship and registered with MCI/StateMedical Council (age limit upto 50years).2. Any medical graduate holding P.G.diploma qualification from Indianuniversities and Foreign Medicalgraduates who have passed screeningtest conducted by the NBE andRegistered with MCI/State MedicalCouncil.3. In service candidates from Defence/Central/State Govt. or Railways andPublic sector institutions.How to apply1. The Institutions which are keen onstarting the programme shall fill in theforms available at NBE Office ordownloaded from NBE Website –Complete details should be providedabout the Faculty members andavailability of ancillary services.2. The accredited institutions shallsend the information about thecandidates selected for Registrationwith NBE.Evaluation1. There will be no entrance test tojoin for the course. The Institution shallselect suitable candidates with aptitudefor general practice, their concern andcompassion to live within thecommunity to ensure healthy living.2. The candidate will be evaluated forvarious technical skills, medical ethicsand communication skill at the end of12-18 months.3. The candidate shall maintain a LogBook recording learning schedulemanagement of emergencies,complications and also submit a thesison common subject relevant to generalmedical practice.4. The candidate will be awardedcredit hours for attending variousacademic programmes/seminars/professional conferences conducted byIMA/Professional bodies and others.Journal of Postgraduate Medical Education, Training & ResearchVol. I, No. I & II59
14ReviewArticleKey Issues Related to the Management ofPregnant Mother with Common Disease ofThyroid & Related Recent AdvancesRaksha Arora & Sadhna SharmaDepartment of OBG, Maulana AzadMedical College, New DelhiIntroductionThyroid disease is relativelycommon in women ofreproductive age group andtherefore commonly in pregnancy.Disorders of thyroid hormoneproduction and their treatment can affectfertility, maternal well being, fetal growthand development.Fetal and neonatal thyroid disease mayoccur as a consequence of maternalthyroid dysfunction or independently, butin both cases the diagnosis andmanagement can be challenging. Asregards with thyroid hormone levels inpregnancy – the pregnancy is a state ofthyroid hyperstimulation, therefore ofchanges of thyroid hormone values.Pregnancy has an effect on thyroideconomy with significant changes iniodine metabolism, serum thyroid bindingproteins and the development ofmaternal goiter especially in iodinedeficient areas. Pregnancy is alsoaccompanied by immunologic changes,mainly characterized by a shift from a Thelper-1 lymphocyte to a Th2 lymphocytestate 1 Fetal brain development dependson T transport into the fetus which inturn depends on sufficient maternal iodinesupply.Common Thyroid disease duringpregnancy are Hypothyroidism andHyperthyroidism and PostpartumThyroiditis.Hypothyroidism in pregnancyHypothyroidism was reported to occurin 0.05% of pregnancies 2 , however,population-screening studies havesuggested a higher incidence. In a U.S.study, 49 of 2000 women who had theirserum TSH levels checked between 15and 18 weeks of gestation had levelsthat were elevated to 6 mU/L or greater.Of these 49 women, 58% had positivethyroid antibodies compared with an 11%rate in the group that was euthyroid 3 .In a more recent study that examinedmid trimester TSH levels in pregnantwomen, only 75 of the 25, 215 women(0.30%) had elevated TSH levels 4 . Whencombined with sub clinicalhypothyroidism much higher incidence(2.5%) has been reported by recent study. 1The urge to determine the true incidenceof hypothyroidism in pregnancy is drivenby the knowledge that these women haveincreased rates of miscarriage,preeclampsia, placental abortion, growthrestriction, prematurity and stillbirths andtheir fetuses are at risk for impairedneurologic development.Causes of HypothyroidismThe most common cause ofhypothyroidism is iodine deficiency. Oneto 1.5 billion people are at risk; 500million live in areas of overt iodinedeficiency. Because the transplacentalpassage of maternal T 4 is necessary forfetal brain development early in the firsttrimester before the development of thefetal thyroid gland, lack of iodine duringthis time may lead to impaired neurologicdevelopment. Moreover, even when thefetal thyroid gland has developed, if thereis no iodine substrate for the gland touse, then the fetus is unable to synthesize11s own thyroid hormones. The resultof severe iodine deficiency (intake of20-25 µg/dg) is endemic cretinism. Theseinfants are characterized by severe mentalretardation, deafness, muteness, andpyramidal or extrapyramidal syndromes;the most common cause of mentalretardation worldwide is iodine deficiency.Other common causes ofhypothyroidism are primary thyroid failure(autoimmune), iatrogenic and congenitalhypothyroidism. Diagnosis of primarythyroid failure is made by elevated TSHand low FT4 and FT3 concentrations.In two studies 3, 4 sub clinicalhypothyroidism was found in over 2%of pregnancies, with apparently twothirdsof these resolving spontaneouslywithin 10 weeks of diagnosis. 6 There isa suggestion that screening for thyroidfunction in early pregnancy andlevothyroxin intervention therapy formaternal subclinical hypothyroidismshould be considered but evidence is stillawaited. 1Treatment of HypothyroidismTreatment is with thyroxine replacementand should be initiated as soon asdiagnosis is made. The starting dose ofthyroxinsis 0.1 mg/d to 1.15 mg/d. thedosage is adjusted every 4 weeks to keepTSH at the lower end of the normalwomen who are enthyroid or onthyroxine at the beginning of pregnancyshould have their TSH and free T 4 levelschecked every 8 weeks. T 4 requirementsmost likely will increase as the pregnancyprogresses 7 . This increase in requirementcan be secondary to the increaseddemand for T4 during pregnancy as wellas its inadequate intestinal absorption thatis caused by ferrous sulfate. Thereforeferrous sulfate and thyroxine dosagesshould be spaced at 4 hours apart. Somehave found that thyroxine requirementsin the first trimester of pregnancy increaseby 50-1 00%. 8, 9 . This increasedthyroxine requirement is usually sustained60Journal of Postgraduate Medical Education, Training & ResearchVol. I, No. I & II
Page 1 and 2: 9ReviewArticleThyroid Function Test
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Journal 1pages FINAL 34- - National Board Of Examination

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