Monday, 23 October 2017

WMA policy statement on participation of doctors in executions should be implemented

WMA policy statement on participation of doctors in executions should be implemented

Dr KK Aggarwal

Should doctors participate in state executions or capital punishments? This is a very controversial issue in medical ethics.

Doctors are required to monitor vital signs during the process of execution (hanging in case of India) and look for signs of life and then pronounce death. This is against medical ethics.

Opposing the participation of doctors, the World Medical Association (WMA) came out with a “Resolution on physician participation in capital punishment” in 1981 and amended in 2008. The resolution states as follows

“RESOLVED, that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions.

The World Medical Association

REQUESTS firmly its constituent members to advise all physicians that any participation in capital punishment as stated above is unethical.

URGES its constituent members to lobby actively national governments and legislators against any participation of physicians in capital punishment”

In its general assembly in 2012, the WMA again passed a resolution reaffirming its prohibition of physician participation in capital punishment.

“There is universal agreement that physicians must not participate in executions because such participation is incompatible with the physician’s role as healer. The use of a physician’s knowledge and clinical skill for purposes other than promoting health, wellbeing and welfare undermines a basic ethical foundation of medicine—first, do no harm.

As citizens, physicians have the right to form views about capital punishment based on their individual moral beliefs. As members of the medical profession, they must uphold the prohibition against participation in capital punishment.

Therefore, be it RESOLVED that:

· Physicians will not facilitate the importation or prescription of drugs for execution.

· The WMA reaffirms: “that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions”, and

· The WMA reaffirms: that physicians “will maintain the utmost respect for human life and will not use [my] medical knowledge to violate human rights and civil liberties, even under threat.”

The WMA Declaration of Geneva or the “Modern Hippocratic Oath”, first adopted in 1948 was recently amended in October 2017 at the annual general assembly in Chicago, USA. The revised version also states: “As a member of the medical profession:

· The health and well-being of my patient will be my first consideration;

· I will maintain the utmost respect for human life

· I will not use my medical knowledge to violate human rights and civil liberties, even under threat”

This final version of the Declaration of Geneva has been accepted by all member national medical associations including the Indian Medical Association (IMA).

No doctor should be present during the process of execution. This is violation of medical ethics and is a professional misconduct.

The World Medical Association today has a membership of 112 national medical associations. IMA is a founder member of this world body. This makes India a signatory to all policies and resolutions adopted by the WMA. Hence, the WMA Resolution on Physician Participation in Capital Punishment should also be implemented in our country.

Disclaimer: The views expressed in this write up are entirely my own.

Prolonged neck and back pain should not be ignored

Prolonged neck and back pain should not be ignored

Incorrect posture and sedentary lifestyle are two major causes of back problems today

New Delhi, 22 October 2017: Recent research indicates that about 20% of youngsters today suffer from some form of back and spine problems, with a majority of such people falling the age group of 16 to 34 years. The prevalence of these disorders has been found to be more pronounced in the cities of New Delhi, Mumbai, Bengaluru, and Pune. The IMA indicates that it is not prudent to ignore back and neck problems. With timely treatment, the pain can be resolved by understanding the root cause of the problem.

Stress and lack of exercise are factors that can make the spine vulnerable to injury. This is exacerbated by driving on poor and potholed roads in cities. The spine is most important for accomplishing simple, daily activities such as sitting, standing, bending, and lying down. It is therefore, important to protect it and keep it healthy.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Spine is one of the most marvelous parts of the human anatomy. A string of 33 bony blocks are held together by ligaments and tendons and supported by large muscles. The spine protects our spinal cord and the nerve roots to safely relay messages to and from the brain to various parts of the body. The spine is so designed that it helps in flexibility, strength, and mobility; and helps a person with his/her daily life. Two most important reasons for spine problems are prolonged working hours and lack of exercise. The roads in the cities are also not too kind to this part of the body, with constant jerks from potholes affecting the spine in a major way. It is imperative to keep the spine healthy as it is the backbone of a healthy body.”

Some symptoms of back and spine problems include weight loss, elevated body temperature (fever), inflammation (swelling) on the back, pain down the legs and below the knees, urinary incontinence, difficulty in urinating, fecal incontinence,and numbness around the genitals.

Adding further, Dr Aggarwal, said, “Keeping the right amount of curvature in the back takes pressure off the nerves and will reduce back pain. If you experience fatigue or pain when you wake up in the morning or after you’ve been sitting at your desk for a couple of hours, it may be an indication that your posture is not right.”

The following tips can help in preventing back and spine problems.

Get moving Physical activity helps in keeping the joints fluid. A person who is not physically active is more susceptible to back problems.
Eat healthy If you maintain good eating habits, you not only will maintain a healthy weight, but you also will not put unnecessary stress on your body.
Sleep sideways The best position for sleeping is on your side. If you are sleeping on your stomach, put a pillow under your lower abdomen to help take stress off your back.
Correct your posture and avoid stress The importance of good posture cannot be overlooked in preventing back problems. Additionally, stress can you to tense your muscles, and constant tension of this kind can cause back pain. Thus, it is important to find ways to reduce stress.

Sunday, 22 October 2017

Fungal infections rebound with reckless use of topical steroid creams

Fungal infections rebound with reckless use of topical steroid creams

• People trust quacks and end up buying the medication they prescribe
• Over-the-counter sale of such medicines exacerbates the situation
New Delhi, 21 October 2017: As per the most recent data available, India consumes about Rs1,400 crore worth of topical steroid creams. This is a segment with an annual growth of 16%. This figure, however, excludes the over-the-counter sales.[1] Sale of topical steroids accounts for 82% topical dermatology market. What is alarming is that the top-selling combinations in these topical creams do not have any scientific rationale or logic behind them.

Even the strongest antifungal creams are unable to treat many fungal infections today. This is majorly due to topical steroid creams, which have turned these infections resilient. Topical steroid creams sell fast and are available anywhere over-the-counter. However, whether they are effective or not is still a question that remains unanswered.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Many fungal infections today tend to relapse as soon as the drug dosage is over. Resistance is a microbiological term based on lab data. However, these fungal infections are recalcitrant and are relapsing. Many topical creams are prescribed by quacks and other so-called medical practitioners. People trust them and buy these in order to get rid of the infections quickly. One major reason for this is also perhaps the fact that Indians are not very kind to those with any skin problems. Such use of creams without knowing their side effects can lead to a weakened immune response bringing back the infection when the dosage finishes. Fungal infections are also more pronounced today as many people prefer wearing tight -fitting clothes.”

Long-term use topical steroids can cause side effects, the most common being skin atrophy. This can become worse due to factors such as higher potency steroids, occlusion, thinner skin, and older patient age.

Adding further, Dr Aggarwal, said, “The fact that such drugs can be prescribed by anyone brings us to a serious issue facing the medical profession today – that of quackery. Unqualified people are masquerading as doctors. In the absence of doctors, people have no choice but to visit such quacks for treatment. The need of the hour is to create awareness among the masses about such people and the fact that one should not take medication unless prescribed by a registered medical practitioner. A stringent anti-quackery law also needs to be put in place.”

Here are some tips to prevent fungal infections.
Wear cotton underwear Fungi thrive in a damp environment. Cotton clothes absorb moisture and perspiration better.
Maintain good personal hygiene This one is a no-brainer. Whether it is your skin or the genital area, make sure you maintain hygiene and keep these areas clean.
Avoid tight-fitting clothes Tight-fitting clothes do not allow the skin to breathe and should be avoided.
Avoid too many perfumed products These can ay affect the delicate balance of yeast and bacteria and cause infections.
Destress Research indicates that skin infections can flare up in stress. This is because stress lowers the body’s immune system.
Take natural yogurt with live cultures Antibiotics destroy good bacteria in the body. Make sure you replenish the good bacteria by taking natural yogurt which contains friendly bacteria.

Justice delayed is justice done

Justice delayed is justice done

Dr KK Aggarwal

We are all familiar with saying “Justice delayed is justice denied”. But this by no means is a rule.

Most recently, the parents of the murdered 14-year-old Aarushi Talwar, both dentists, were acquitted of the murder of their daughter after 4 years of imprisonment since 2008 by the Allahabad High Court.

Earlier, Dera Chief Ram Rahim was convicted after 15 long years and sentenced to 20 years imprisonment.

Wrong has been done in both circumstances. While, the parents of Aarushi Talwar suffered imprisonment despite being innocent, in the other case, the Dera Chief was free for last so many years and enjoyed a free life in spite of doing wrong and probably kept on doing wrong.

The irony of the situation is that had these been cases of medical negligence, there would have been a public outrage against the doctor concerned. He/she might well have been arrested without the allegations being substantiated.

Both the above stories with two extreme judgements, became national headlines, exemplify justice delayed but justice done.

This then further raises a question, can the judges be made answerable? One who judged the parents of Aarushi guilty and other, who allowed the Dera chief to lead a free life.

If not, then why action against doctors?

In medical negligence cases, the benefit of doubt should always be given to the doctor unless mens rea can be established or the principle of res ipsa loquitur ‘things speak for themselves’ can be applied.

Justice should be imparted without any delay. It is wrong to delay justice.

Disclaimer: The views expressed in this write up are entirely my own

Saturday, 21 October 2017

Iodine essential for growth and brain development in infants

Iodine essential for growth and brain development in infants

Women planning to conceive should get adequate sources of iodine in their diet

New Delhi, 20 October 2017: As per a study, about 42 million Indians have abnormal thyroid hormone levels. It also indicated that India accounts for 21% of the global population with thyroid disorders. The prevalence of thyroid disorders was more in women than men with about 26% women diagnosed with abnormal TSH levels compared to 24% men. Thyroid disorders are a major outcome of iodine deficiency.

On World Iodine Deficiency Day, there is a need to create awareness on the fact that Iodine is an essential micronutrient required for human growth and development. The average daily requirement of iodine for a normal person is 150 micrograms a day. The requirement of iodine is more in pregnant women than normal women, because the effects of iodine deficiency are most severe in pregnant women and for their babies.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Iodine is stored in the thyroid gland and is important for the production of thyroid hormones thyroxine (T3) and triiodothyronine (T4). Thyroid hormones are needed for the proper development of cells. They have a major role in increasing the metabolic rate of the body and in metabolism of protein. They regulate the growth of long bones and are essential for brain development. Thyroid hormones are also closely linked to fat and carbohydrate metabolism in cells. Iodine deficiency can cause goitre (enlargement of thyroid), hypothyroidism and mental retardation in infants and children whose mother was iodine deficient during pregnancy.”

When the thyroid produces too much hormone it causes hyperthyroidism and when it produces less than what is needed, the condition is called hypothyroidism. Other common disorders of the thyroid are Hashimoto’s disease, Graves’ disease, goiter, and thyroid nodules.

Adding further, Dr Aggarwal, said, “Women planning to conceive should make sure that they get adequate amounts of iodine in their diet to build up good stores before getting pregnant. Pregnancy and lactation increase the demand for iodine to make adequate thyroid hormones, which play a crucial role in the baby’s brain development. Eating a healthy and varied diet is essential to meet one’s iodine needs.”

The following are some good sources of iodine.
Cheese Most dairy products are iodine enriched. Two varieties of cheese that are rich in this mineral include Cheddar and Mozzarella.
Seaweed Iodine is found in both this and seafood. One of the richest sources is a seaweed called kelp.
Eggs Eggyolk is one of the safest and simplest sources of iodine.
Milk Studies indicate that every 250ml of milk has about 150 micrograms of iodine.
Yoghurt A single cup of yoghurt can meet half of the daily iodine requirement giving close to 70 micrograms of iodine. It is also good for the stomach and rich in calcium and protein.
Apart from the above food items, some others that are good sources of iodine include fruits like bananas, strawberries; vegetables such as green leafy vegetables, onions, and sweet potatoes; and grains, nuts and legumes like peanuts, barley, etc.

Paradigm shift in medical ethics

Paradigm shift in medical ethics

Dr KK Aggarwal

There has been a paradigm shift in the thinking of the public. There has been a corresponding paradigm shift in the dynamics of doctor-patient relationship; from paternalism to patient-centric. Today, patients want to be equal partners in decisions about their treatment with the doctor acting as a guide and facilitate decision making. Patient autonomy is also now at the forefront of the principles of medical ethics, along with non-maleficence (do no harm) and beneficence (do good).

From Vedic point of view, the public perception has rapidly shown a shift from Karma Marg to Bhakti Marg and to Gyan Marg. In Karma Marg, people surrender to the doctor-patient relationship. In the phase of Bhakti Marg, they show faith and Gyan Marg, is marked by suspicion and hunger to know why.

There are four types of patients today based on four levels of awareness i.e. their ability to retain knowledge or information that is given to them by the doctor pertaining to their disease. These four levels of awareness are “ignorant, informed, empowered and enlightened”.

• Ignorant patients do not participate in decision making and depend on the doctor to make their decisions, with no questions asked.

• Informed patients have questions for the doctor, but only few. These patients then usually agree to the line of treatment adopted by the doctor.

• Empowered patients have many more questions, they cross check facts and are an equal partner in decision making regarding their treatment.

• Enlightened patients seek the opinions of many are only then convinced about the proposed line of treatment. Convincing these patients involves several counseling sessions.

There can also be three types of doctors.

• Doctors who expect patients to accept what they say.

• Doctors give choices to patients and ask them to choose.

• Doctors who give choices to their patients, but help them to choose the best option.

Miscommunication is at the root of many doctor-patient disputes. This occurs when the level of awareness of doctor and the patient do not match.

There are also four types of students as per Rabbi Dovid Rosenfeld according to the ability to retain the knowledge taught to them: Sponge, a funnel, a strainer and a sifter.

• The sponge retains everything, but is unable to distinguish between correct and incorrect points. He lacks Viveka, the power of discrimination. The funnel is the one for whom information goes in one ear and out the other. With no focus, his hearing and the mind are in different directions.

• The strainer discards the wine (significant material) and retains the lees (incorrect or insignificant points). He remembers all sorts of trivial or useless details of the material he studied.

• The sieve retains the fine flour (significant material) and discards the dust (inconsequential details). He understands the lecture by its main points and remembers them in the form of sutras.

The principle of “suno – samjho – jano – karo” exemplifies this. This is also the gist of Vedic science and has also been clearly defined in Bhagavad Gita by Lord Krishna. We should hear, listen, understand and convert it into wisdom. Hearing means that you hear anything but listening means that you should learn its meaning. Understanding means you should understand its value in your context and wisdom means you should practice it, re-practice it and learn intricacies of its implications. Once knowledge has been converted into wisdom it is of no use unless it is made use of in day-to-day practice.

Similarly, there has also been a paradigm shift in the accountability for doctors. There was an era when self-regulation in the form of an oath was sufficient (Hippocratic and Medical Council of India [MCI] Oath). As this was considered insufficient, the Code of Medical Ethics Regulations came into force from 2002, which was rapidly followed by Consumer Protection Act (CPA), civil liabilities and now criminalization of medical practice including 304 A.

The Code of Ethics Regulations, 2002 is not simply an Ethics code; it is also about conduct and etiquettes. Unfortunately, ethics, conduct and etiquettes are not taught in the medical curriculum. It is also important to differentiate between unethical acts and professional deficiency.

Therefore, today one is not only required to be scientifically correct, but also morally, ethically and legally correct.

Individual ethics (dharma) or code of conduct (ethics in society) change according to society. Dharma (to hold people together) changes as per the collective consciousness of the people. As people are empowered, ethics will also change.

Disclaimer: The views expressed in this write up are entirely my own.

Friday, 20 October 2017

IMA is change maker: Medical voice is heard

Dr KK Aggarwal

As clinicians, doctors prescribe treatments for patients so that they get better. Making the right diagnosis and then prescribing the right treatment is the primary responsibility of doctors. This is what they have been trained for. But, a doctor however plays multifaceted roles. A doctor is not simply a medical expert; he/she is also a communicator, collaborator, manager, health advocate, scholar, professional, community leader. Doctors therefore are also change agents in the community.

The words of a doctor carry weight and they can bring about change that is appropriate to the need. This requires them to be aware of the needs of the community they practice in, the resources available to their patients and any problems regarding these.

Drug shortage, due to multitude of reasons, is one such crisis that rears up time and again. Recently, there was a shortage of two drugs in the market, d-penicillamine (DPEN) and penicillin G potassium (Pentid-Abbott).

D-penicillamine is used to treat patients with Wilson’s disease (copper overload) with liver, neurological and psychiatric manifestations. And, patients have to be on this drug lifelong.

Indian Medical Association (IMA) raised the issue of shortage of the two drugs in its digital platform. The medical voice was heard and consequent to this, earlier DPEN (D-penicillamine) was made available in no time and now, Pentid is also freely available again.
Doctors should use their voice to influence positive change in health care. However, any complaint regarding any health issues and concerns prevailing in the community should not only be proper and in a constructive manner, it should also be voiced at an appropriate platform such as IMA.
It is important to voice concerns and needs of the patients and the community in time before they become too big to handle. Medical voice works…

Disclaimer: The views expressed in this write up are entirely my own.

Thursday, 19 October 2017

WMA TB & HIV-AIDS Resolutions revised in coordination with IMA

WMA TB & HIV-AIDS Resolutions revised in coordination with IMA

Dr KK Aggarwal

In the recently concluded Annual General Assembly in Chicago held from October 11-14, 2017, the World Medical Association (WMA) passed two resolutions on Tuberculosis (TB) and HIV-AIDS, after undergoing major revisions.

Indian Medical Association (IMA) volunteered to be the coordinating national medical association for these resolutions. This was only the right thing to do given the high prevalence of the two diseases in the country and hence, of great public health concern to us.

India accounts for one-fourth of the global TB burden, including MDR TB, as reported in Global TB Report 2016. And, India is among the top three countries with the highest number of people living with HIV. The total number of people living with HIV in India is estimated at 21.17 lakhs (17.11 lakhs–26.49 lakhs) (India HIV Estimation 2015 report). Of these, only 14 lakh are diagnosed.

As the coordinating national medical association for both these resolutions, suggestions from all member national medical associations were sent to IMA, who compiled and finalized the resolutions, which were then passed by the recent Assembly at Chicago.

Both these Resolutions on TB and HIV-AIDS were first adopted in October 2006 by the WMA Annual General Assembly in South Africa.

WMA Assembly also passed a Revised Declaration of Geneva incorporating various changes and additions. IMA was a part of the workgroup that worked on the amendments to ‘The Physician’s Pledge’.

IMA is also coordinating revisions to another WMA document on Reproduction Rights.

Some salient points of the two resolutions are as below:

WMA Resolution on TB

• “Screening of high risk groups including PLHIV (people living with HIV) and vulnerable populations including migrants, prisoners, and the homeless should be considered within each national epidemiological context as a component of tuberculosis prevention.

• Rapid diagnosis with molecular tests and supervised daily treatment started early should help arrest the spread of disease.

• The WMA supports the WHO “End TB Strategy” and its visions, goals and milestones.

• The WMA calls on National Medical Associations to support their National TB Programmes by generating awareness among healthcare professionals about TB management and early reporting of cases in the community.”

WMA Resolution on HIV-AIDS

• “In addition to representing a staggering public health crisis, HIV/AIDS is also fundamentally a human rights issue.

• Discrimination against HIV / AIDS patients by physicians is unacceptable and must be eliminated completely from the practice of medicine.

• Patients with HIV/AIDS must be provided with competent and appropriate medical care at all stages of the disease.

• Physicians must ensure that patients have accurate information regarding the treatment options available to them.”

Better be safe than sorry during the festival of lights

Better be safe than sorry during the festival of lights

Those with cardiac and respiratory ailments should be particularly careful

Eating and drinking should be healthy and in moderation, with adequate physical activity

New Delhi, 18 October 2017: Diwali, the festival of lights and harbinger of prosperity and cheer, is characterized not just by this. It is also that time of the year when health risks escalate. From the ghee-laden sweets to the pollution-inducing crackers, there is a lot to think about in terms of one’s health. According to statistics, the annual carbon dioxide emissions from fireworks is 60,000 tonnes. The IMA says that this is not only to the environment but also to the health. Add to this the sweets and savories and alcohol binge, and one’s weight is sure to catapult.

Diwali is that time of the year when people lose track of their eating, drinking, and fitness habits. Apart from this, noxious gases such as carbon monoxide from crackers can be detrimental for those with asthma or heart ailments.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “There is a sudden change in both eating and sleeping patterns during Diwali. Late night parties binge-eating, alcohol, and lack of exercise affect health in many ways. People also do not drink enough water to keep themselves hydrated. White sugar in sweets can lead to uncontrolled diabetes and gain weight in individuals. Adulterated khoya can cause GI upset. Artificial coloring in sweets can cause cancer in long run. Those with COPD (adult asthma) need to be careful as the smoke from crackers can worsen respiratory illnesses. Excessive noise pollution during Diwali can cause hearing loss, high blood pressure, and mental irritation. It can also exacerbate heart ailments in people sometimes leading to a cardiac arrest as well. One should also be careful of candle pollution as petroleum is a known human carcinogen and can cause indoor pollution.”

Diwali fire hazards are also not uncommon and can result in burns and loss of life. Particlesof crackers can cause eye burn and irritation. People also indulge in excessive consumption of alcohol which is injurious to health.

Adding further, Dr Aggarwal, said, “The best item for Diwali is fruits and dry fruits. Avoid ‘chhena’ and ‘khoya’ sweets, along with sweets and milk products from roadside shops. One should not drive after consuming more than 30 ml in one hour. While gambling one should not argue with others as someone under the influence of alcohol may cause harm. Those with COPD should use wet clothes whenever they are exposed to smoke. It is imperative to remember that health is above all and no festival or occasion should be an excuse to compromise on health.”

Here are certain things one can observe to stay away from harm and ensure good health during Diwali.
Limit the use of firecrackers and avoid loud explosives. Those with asthma should wear face masks to prevent inhaling the poisonous mix of gases. Those with cardiac problems and hypertension should wear ear plugs to prevent the impact of the cracker explosions.
Check the manufacturing and expiry dates of sweets and snacks before buying them. Avoid buying anything from roadside shops.
Replace oily snacks with a combination of fresh fruits, curd dips, raw salads, roasted food items and nuts like almonds and pistachios. Replace carbohydrates and proteins with fibre and vitamins in your diet. Ensure that you stay hydrated by drinking lots of water through the day.
In case of burns, the affected part should be put in running water till the burning sensation disappears. Blisters should not be punctured, as they work like a natural dressing.

Wednesday, 18 October 2017

Trauma-related deaths can be prevented by timely action

Trauma-related deaths can be prevented by timely action

Need for more trauma centres across cities that are up-to-date and organized

New Delhi, 17 October 2017:In India, one person dies of a road accident every minute, indicate statistics. Road accidents account for about 1,50,000 deaths every year. Injuries and the resultant trauma rank fourth in the causes of death across all age groups children, adolescents, and young adults. These are also reasons for more premature deaths than cancer, heart disease or other such diseases.[1]On World Trauma Day, there is a need to raise awareness on the fact that majority of these trauma-related deaths can be prevented through timey action and medical care.

Many deaths occur either within minutes of the injury, at the scene of accident or injury, before the victim is taken to the medical facility, or immediately upon arrival at the hospital. Some of the reasons for death include massive hemorrhage or severe neurological injury.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “There is still a long way to go in terms of immediate trauma care in India. There are many issues in offering critical care to injury victims. India lacks significant pre-hospital care in most cities with the golden hour concept still an ambiguity for many. This is further exacerbated by poor ambulances services and the lack of a centralized agency to monitor them. Hospitals need to ensure availability of casualty medical officers who can do more than just resuscitation. Add to this the fact that there are no dedicated trauma surgeons in India, which often causes delays in clinical decision making. This is because various aspects are handled by various departments and not a single entity. Last but not the least, there is no central trauma registry in any institute.”

In a survey, it was found that the risk of deaths in injured people can be reduced by about 25% if a trauma victim is treated at a dedicated trauma centre.[2]Trauma centres are classified into four levels based on the available resources and the number of patients admitted.

Adding further, Dr Aggarwal, said, “There is a need to have dedicated trauma centres in cities throughout the country that can provide the best emergency services and have up-to-date trauma systems. This means that such a hospital should have high-quality intensive care ward and an operating theatre, learned and dedicated personnel, and updated and latest equipment. Apart from this, it is imperative to make efforts to prevent injury or reduce the severity of injuries, as this will help in preventing many cases of immediate death.”

Prevention is always better than cure. Trauma can be prevented by staying alert at an individual level.

Some do’s and don’ts to consider with regard to accidents and injuries are as follows.

Follow the road safety rules and be aware of warning signs and traffic signals.
Do not forget to wear a helmet and take a break if you are driving for a long distance.
Do not use the mobile phone while driving or listen to loud music.
Keep a first-aid kit ready at home and in your vehicle.
Do not drive if you are sleepy, tired, or have had drinks.
If you notice a person with head or spinal injury, move the person from the site only with professional help to avoid serious back or neck injuries.
Do not give fluids to any unconscious or semi-conscious traumatized person.
Learn basic life support techniques and help the injured.

Global issues discussed during the WMA General Assembly

Global issues discussed during the WMA General Assembly

Dr KK Aggarwal

The World Medical Association (WMA) concluded its annual General Assembly in Chicago held from October 11-14. More than 50 national medical associations attended the annual General Assembly and discussed various global issues.

Dr Yoshitake Yokokura, President of the Japan Medical Association, was installed as President of the WMA for 2017-18. Dr Leonid Eidelman, President of the Israel Medical Association, was elected President elect. He will take office in a year’s time to serve as President in 2018-19.

Hunger strikes: The Assembly agreed that the WMA would support any physician who faces political pressure to take part in forced feeding of hunger strikers against their ethical advice. In a revision of its policy on hunger strikers, the WMA says that national medical associations ‘have a responsibility to make efforts to prevent unethical practices, to take a position against ethical violations, and to investigate them properly’. Delegates agreed that where physicians are pressured to take part in torture, the WMA would protest internationally and publicize information about the case.

Bullying: A policy of zero tolerance towards bullying and harassment in the medical profession was supported by the meeting. Delegates agreed a statement condemning bullying under any circumstances and encouraging all national medical associations members, medical schools, employers, and medical colleges to establish and implement anti-bullying and harassment policies.
WMA President, Dr. Yoshitake Yokokura said: ‘Bullying in the health workplace is entirely unprofessional and destructive, and should not be tolerated. It is time the profession took steps to prevent, confront, report and eliminate such behaviour at any level’.

Armed conflict: Against a background of armed conflicts in many parts of the world, the Assembly issued a strongly worded statement reminding governments of the human consequence of warfare. It says that armed conflict should always be a last resort and physicians should encourage politicians, governments, and others in positions of power to be more aware of the consequence of their decisions to start or continue armed conflict. Efforts to avoid conflicts are often insufficient and inadequate and country leaders may not seek all alternatives. Delegates stressed that avoiding war and seeking constructive alternatives is always desirable.

Access to health care: A call for ethical codes for recruiting health professionals was agreed in a bid to reduce inappropriate recruitment activities by states. The Assembly approved a new policy to combat the problems of a global maldistribution of health care workers. It declared that the global movement of workers, especially from less developed to better developed countries, is leading to continuing shortages. It said that ethical recruitment codes were needed for both governments and commercial recruitment agencies to ensure that countries did not actively recruit from other states.

Alcohol: A worldwide drink drive limit of no more than 50 milligrams per 100 millilitres of blood was called for by the Assembly in a new drive to reduce excessive alcohol consumption. In a statement, the WMA says that key deterrents should be implemented for driving while intoxicated, including a strictly enforced legal maximum blood alcohol concentration for drivers of no more than 50mg/100ml, supported by social marketing campaigns and the power of authorities to impose immediate sanctions. WMA President Dr. Yoshitake Yokokura said: ‘The human cost of drunk driving across the world is appalling. The daily tragedy of death and injury caused by drivers who drink while over the limit is unforgivable. I hope that governments will act to reduce the drink drive limit’.

Child abuse: Guidance to physicians on dealing with child abuse were agreed. In a new policy document, the WMA says that child abuse in all its forms, including exploitation of children in the labour market, is a world health problem and that physicians have a unique and special role in identifying and helping abused children and their families. All physicians should be educated about the overriding importance of the welfare of children. They should act in the best interests of children in all of their contacts with children, young people, families, policy-makers and other professionals.

Fair trade: The Assembly condemned the abuses of labour standards, evidence of modern slavery and unethical working conditions that have been uncovered in the manufacture of many medical products around the world. In a new Declaration, the WMA calls for a fair and ethical purchasing policy for medical goods. It urges all its national medical association members to advocate for human rights to be protected throughout the global supply chains of products used in their healthcare systems.

New members: Five new members were admitted – the Czech Medical Chamber, the Belarusian Association of Physicians, the Pakistan Medical Association, the National Medical Chamber of Russia and the Belize Medical and Dental Association. This increases the total number of medical associations and constituent members in the WMA to 114.

All the policies adopted by the Assembly can be found on the website of the WMA.

(Source: WMA, October 16, 2017)

Tuesday, 17 October 2017

AHA guidance on improving employee health and engagement

AHA guidance on improving employee health and engagement

Dr KK Aggarwal

The American Heart Association (AHA) has released an evidence review report titled “Resilience in the Workplace: An Evidence Review and Implications for Practice”, with practical actionable guidance for employers looking to implement resilience training programs. According to the report, resilience is an emerging, innovative strategy to improve employee health and productivity, and organizational performance.

The CEO Roundtable is the AHA’s leadership collaborative with 30-plus member CEOs who represent some of the nation’s largest employers who are committed to applying evidence-based approaches to improve their employees’ overall health.

Studies suggest resilience training may be a useful primary prevention strategy for employers to improve employee health and engagement. Although there is no consensus on how to define resilience, the report says that “resilience can be considered, in general, the ability to withstand, recover and grow in the face of stressors and changing demands”.

Resilience training aims to develop or strengthen a person’s ability to withstand, recover and bounce back from adversity and may improve the ability to cope with, and recover from negative workplace stressors.

In an online employee of 1,001 working adults within the US, which has also been included in the report, 73% said that their participation in resilience training programs improved their health a great deal or fair amount; specifically, they reported having more energy (51%), exercising regularly (45%), and improved quality of life (41%).

(Source: AHA News Release, October 11, 2017)

IMA stands in solidarity with junior doctors on strike in Poland

IMA stands in solidarity with junior doctors on strike in Poland

New Delhi 16 October2017: Junior doctors in Poland are on hunger strike protesting the poor pay and conditions including poor healthcare funding. Supporting their protest, the World Medical Association (WMA) delegates passed an emergency resolution on October 13, 2017 expressing serious concern about the dispute at the annual assembly of the Association in Chicago. The resolution also urged the Prime Minister of Poland to intervene and negotiate an acceptable solution and further said, ‘It is essential that a resolution is found before these physicians suffer irreversible harm, or die, as they seek to improve working conditions for their colleagues and a better financial basis for health care provision for the population’.

According to the Polish Chamber of Physicians and Dentists, they made several appeals, unsuccessfully, to the Government to take action on all the above issues; hence, the hunger strike. The current level of expenditure did not cover the justified needs of the population and was insufficient to ensure proper working conditions for health care professionals.

Commenting on this, Padma Shri Awardee Dr KK Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon Honorary Secretary General IMA in a joint statement, said, “As part of WMA, the IMA supports the Junior doctors in Poland. Our demands are also similar. Health care spending in India too needs attention as India continues to be among the countries with the lowest relative public expenditure on healthcare. This is very evident from the Union budget for the year 2017-18, which has allocated only 1.3% of the GDP for healthcare. The National Health Policy 2017 has proposed increasing public health expenditure to 2.5% of the GDP. But this is just not enough. Every citizen of this country has a right to receive affordable or free preventive and emergency health care and the best of treatment. The health budget should be 5% of the GDP for universal health coverage. No to adhocism, pay parity and uniform service conditions for service doctors all across India is another of our major demand. ”

Indian Medical Association (IMA) is the only representative, national voluntary organization of doctors of modern scientific system of medicine, which looks after the interest of doctors as well as the well-being of the community at large. IMA represents the collective consciousness of over 3 lakh doctors of modern medicine, spread across 1,700 local branches and 31 State and Territorial branches.

Adding further Dr KK Aggarwal said, “In addition to these, there are several important issues and concerns of doctors that need to be addressed urgently. Criminal prosecution of doctors, increasing violence against doctors, uncapped compensation in negligence cases, unrealistic laws like CEA and PCPNDT, to name a few. Doctors are feeling insecure and live in fear of criminal prosecution or violence. IMA has been fighting for a solution to these problems and had organized the “Dilli Chalo” movement on 6th June this year followed by a Dawn to Dusk fast on 2nd October to bring to the attention of the nation the many problems faced by the doctors today. We had also published an open letter to the Prime Minister prior to the fast seeking his immediate intervention in resolving these issues to better protect the health of the public, which we still await. We also hope that the WMA also passes a resolution supporting our demands.”

Monday, 16 October 2017

WMA approves Modern Physicians Pledge

WMA approves Modern Physicians Pledge

Dr KK Aggarwal

A modern successor to the Hippocratic Oath for physicians around the world has been approved by the World Medical Association.
Physician leaders, meeting at the WMA’s annual General Assembly in Chicago approved revisions to the Declaration of Geneva, which was adopted by the Association in 1948.
The revised Declaration, to be called a pledge, refocuses the text to reflect changes over the decades in the relationship between physicians and their patients and between physicians themselves. As a result, the new pledge makes specific reference for the first time to respecting the autonomy of the patient, which is not included in the current text. It also includes a new obligation for respect between teachers, colleagues and students.
The present Declaration says students must respect their teachers, but there is no reciprocity. There is a new obligation on physicians to share medical knowledge for the benefit of their patients and the advancement of healthcare.
Also added is a requirement for physicians to attend to their own health, well-being and abilities in order to provide care of the highest standard.
The current Declaration of Geneva is used across the world by physicians. In many countries it is actually part of the medical professional code and in some it is legally binding. However, in other countries it is either not used at all or is adapted in some way.
The WMA is now expecting that the revised pledge, agreed following a two-year revision process, including a period for public consultation, will become a global ethical code for all physicians.
WMA President Dr. Yoshitake Yokokura said: ‘The new wording respects the unique character and significance of this Declaration, but focuses more on important ethical principles not in the current version and not expressed explicitly.
‘The life of physicians today is completely different to what it was in 1948 when the original Declaration of Geneva was adopted. Since then, the Declaration has become a core document of medical ethics and a modern version of the 2,500-year old Hippocratic Oath.
‘We hope that the Declaration approved today will be used by all physicians around the world to strengthen the profession’s determination to maintain the highest standard of health care for patients’
(Source: WMA News Release, October 14, 2017)

India still lags behind in child nutrition with a child-wasting prevalence of 21%

India still lags behind in child nutrition with a child-wasting prevalence of 21%

A healthy diet including all food groups is key to preventing this condition

New Delhi, 15 October 2017: Twenty-one percent of children under 5 years of age in India suffer from wasting, according to a report. India has not seen any significant strides in checking the prevalence of this indicator since the last 25 years. Djibouti, Sri Lanka, and South Sudan are the only remaining countries in the Global Hunger Index (GHI) 2017 with a child-wasting prevalence over 20%. Child wasting is one of the four indicators in the GHI.

Statistics indicate that the prevalence of child wasting in India has increased from 17.1% in 1998-2002 to 21% in 2012-16. This is way above the global prevalence. Wasting or thinness in a child is the result of acute and inadequate nutrition along with frequent infections leading to rapid weight loss or failure to gain weight normally.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Wasting is also called as acute malnutrition and as low weight-for-height. A healthy child is normally expected to gain 2 to 3 kg of body weight every year. Wasting occurs when the weight-for-height measurement in a child is less than two standard deviations from the globally accepted reference cut-off point. Severe wasting happens when a child’s weight-for-height measurement is less than three standard deviations from the globally accepted norm. Wasting and stunting are often two separate forms of malnutrition requiring different interventions for prevention and/or treatment. However, they are closely related and often occur together in the same populations and often in the same children.”

Some signs and symptoms of malnutrition include loss of fat, breathing difficulties, abnormally low body temperature, weakened immunity, higher susceptibility to feeling cold, longer healing time for wounds, reduced muscle mass, tiredness and fatigue, and irritability.

Adding further, Dr Aggarwal, said, “Children with severe malnutrition experience slow behavioral and intellectual development, leading to intellectual disabilities later in life. Even when they are treated, under nutrition can have long-term effects in children including impairments in mental function and digestive problems, which can last for their whole life.”

Prevention of malnutrition entails eating a healthy balanced diet. There are four major food groups that should form a part of a child’s diet plan. These include:
Bread, rice, potatoes, and other starchy foods. This forms the largest portion of the diet and provides calories for energy and carbohydrates that are converted to sugars which provide energy.
Milk and dairy foods – Vital sources of fats and simple sugars like lactose as well as minerals like Calcium
Fruit and vegetables – Vital sources of vitamins and minerals as well as fiber and roughage for better digestive health
Meat, poultry, fish, eggs, beans and other non-dairy sources of protein – These form the building blocks of the body and help in numerous body and enzyme functions.
Other factors to be considered include adequate nutrition of the mother during pregnancy and promoting the practice of exclusive breastfeeding.

Sunday, 15 October 2017

Spirituality is friendly to Wellbeing

Spirituality is friendly to Wellbeing

Dr KK Aggarwal

What you believe in may impact health and longevity. Spirituality and religion have been shown to have a positive association with well-being and better health outcomes.

Spirituality and the practice of religion have been associated with a slower progression of Alzheimer’s disease. Positive thinking results in almost 30% decrease in pain perception. People who regularly attend organized religious activities may live longer than those who do not participate. Regular participation in such activities reduces mortality rate by about 12% a year. Satsang is one way of acquiring spiritual well–being. Many scientific studies have shown that when mediation or chanting is done in groups it has more benefits than when done individually.

Spirituality can influence function of the immune system, which can be measured, like an increase in white blood cells.
Patients who undergo cardiac rehabilitation feel more confident and perceive greater improvements in their physical abilities if they keep strong faith. Increased levels of spirituality and religious faith may help substance abusers kick their habit.

Spirituality stimulates the relaxation response. It shifts one from sympathetic to parasympathetic mode, which is the relaxed state. It is healing and allows one to make better and correct, consciousness-based choices. People who are very religious or deeply spiritual have lower cortisol responses. Cortisol is a hormone released in the body in response to stress. When the body is relaxed, the heart rate, blood pressure and breathing rate all go down, which decrease the body’s stress response. This is also why most of our temples are located in distant places. The silence of the spiritual atmosphere reduces the internal noise and helps us onward in our inner journey.

The Mantra to acquire spiritual health is to think positive and differently. It is very difficult to remove negative thoughts but it is very easy to cultivate positive thoughts. Persistent negative thoughts creates sympathetic over activity and leads to lifestyle disorders like blood pressure, acidity, depression, diabetes and heart blockages.

Spirituality is what brings you peace and safety. It can be achieved through God or Goddess, nature, a beautiful sunset, a meditation, Pranayama, religious meeting, chanting, mind body relaxation, etc. Spirituality is something that can help all the way from promoting wellness to helping with recovery.

(Disclaimer: The views expressed in this write up are entirely my own).

Preterm babies are more likely to develop cognitive and other difficulties later

Preterm babies are more likely to develop cognitive and other difficulties later

Such children also more likely to develop ADHD

New Delhi, 14 October 2017: As per a new large-scale study conducted among more than 60,000 children, it has been found that preterm babies are at a higher risk of developing cognitive, motor, and behavioral difficulties in later childhood, affecting even their later school performance. Preterm children are also twice as likely to be diagnosed with attention deficit hyperactivity disorder (ADHD).

The World Health Organization (WHO) estimates that every year, about 15 million babies are born prematurely around the world amounting to more than one in 10 babies born globally. The rate of preterm birth across 184 countries ranges from 5% to 18% of babies born. In India, the figure stands at 3.5 million babies out of the 27 million babies born every year.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “A premature birth is one that happens before 37 weeks of pregnancy. A normal pregnancy usually lasts about 40 weeks.
A baby born prematurely has less time to develop in the womb and often has complicated medical problems. Many preterm babies who survive suffer from various disabilities like cerebral palsy, sensory deficits, learning disabilities and respiratory illnesses. The morbidity often extends to later life, causing physical, psychological, and economic stress to the individual and the family.”

Preterm babies are small in size, sharper looking and have a disproportionately large head, less rounded features than a full-term baby, fine hair covering much of the body and low body temperature. Labored breathing or respiratory distress and lack of reflexes for sucking and swallowing are further signs of a preterm birth.

Adding further, Dr Aggarwal, said, “While preterm births cannot be attributed to one particular reason, the predisposing risk factors include age at pregnancy; previous preterm birth; multiple pregnancies; infections and chronic conditions such as diabetes and high blood pressure; stress; genetic factors and nutritional disorders. Lifestyle is increasingly becoming an important factor for preterm births. Identification of risk factors and educating the pregnant woman about the signs and symptoms of preterm labor during antenatal care can prevent preterm births.”

Here are some measures women can take to avert the risk of preterm delivery.

Do not miss antenatal care This is the best way to avert any preterm labor and identify signs. The doctor should be able to advice on how to eat right, what is the ideal weight, and what can be harmful for the baby.

Understand your risks Some women are at more at risk of delivering early. This is truer for those who have had a prior preterm delivery; who smoke or drink; have pre-existing health problems, etc. Understanding these can help you cope better.

Watch your weight Find out how much weight gain is apt for your body type and the baby. Too much weight gain can also cause complications like gestational diabetes and preeclampsia. Talk to your doctor about the recommended weight and eat accordingly. Ask your doctor about a healthy exercise plan.

Eat right Consume a nutritious diet as it is vital to the development of the fetus. Whole-wheat carbs, healthy sources of protein and dairy, and an abundance of fruits and vegetables is key. Avoid tobacco, alcohol & other non-prescribed drugs.

Saturday, 14 October 2017

AHA survey finds only 25% survivors feel confident in preventing another stroke

AHA survey finds only 25% survivors feel confident in preventing another stroke

Dr KK Aggarwal

Results from a new survey conducted by the American Heart Association/American Stroke Association (AHA/ASA) show that stroke survivors have low confidence in their ability to prevent another stroke.

The survey, which included 1,129 adult participants (survivors, caregivers and healthcare professionals) nationwide, was conducted as part of the American Stroke Association’s Together to End Stroke® second stroke awareness campaign. The specific goals of the campaign include:

• Reducing stroke reoccurrence
• Reducing 30-day hospital readmission
• Increasing stroke patient knowledge of risk factors
• Educating about healthy lifestyle changes and medication adherence
• Educating about rehabilitation options and benefits

Exercising regularly was reported as the biggest challenge by Survivors (23%). The most common changes that survivors made to their lifestyle since their stroke are taking recommended medication (83%) and taking aspirin daily (63%). Only half of Survivors and Caregivers (49%) were aware of FAST. Both Survivors and Caregivers view high blood pressure as the most important factor putting someone at risk for a second stroke (58% and 59%, respectively).

Most strokes, including recurrent stroke are preventable. Physical activity, healthy eating, adherence to prescribed medications along with stroke rehabilitation can prevent another stroke. Educating patients about the risk factors and the necessary lifestyle changes enables patients to take control of their health. The need for regular check-ups and necessity of compliance to the prescribed treatment must also be explained to them. A doctor has to encourage his/her patient at every step and support them in their struggle to cope with the illness and not be judgement or critical of occasional slip ups.
This gives confidence to not only to the patient but also the caregivers so that they are better equipped to prevent a second stroke.

(Source: AHA News Release, October 12, 2017)

People living with lupus are prone to depression

People living with lupus are prone to depression

New Delhi, 13 October 2017: Statistics place the prevalence of Systemic Lupus Erythematosus (SLE) in India at 30 per million people. Women are affected more frequently than men (10:1). SLE is a frequently overlooked disease, primarily due to lack of awareness, with the average diagnostic delay standing at almost 4 years.

A chronic disease, SLE is an autoimmune disease with phases of active disease when the symptoms worsen and phases of remission when the disease is quiet or has minimal symptoms. It is the most common form of lupus. The disease also involves the heart, lungs, kidneys, and brain and can be life threatening. People living with lupus are prone to depression.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “SLE is an autoimmune disease. The immune system is designed to fight off infectious agents, bacteria, and foreign microbes. One of the ways that the immune system fights infections is by producing antibodies that bind to the microbes. People with lupus produce abnormal antibodies called ‘autoantibodies’ in their blood, which attack the body’s own healthy tissues and organs rather than foreign infectious agents. While the exact reason for abnormal autoimmunity is unknown, it could be a mix of genes and environmental factors. Sunlight, infections and certain medications such as anti-seizure drugs are known to trigger SLE.”
The symptoms of lupus can vary over time but the common symptoms include fatigue, joint pain and swelling, headaches, a butterfly-shaped rash over the cheeks and nose, skin rashes, hair loss, anemia, increased tendency to form blood clots and poor circulation in fingers and toes, which turn white or blue when cold, known as Raynaud’s phenomenon.

Adding further, Dr Aggarwal, said, “There is no cure for SLE. However, treatment can help ease or control the symptoms and can vary depending on the severity. The common treatment options include nonsteroidal anti-inflammatory medications (NSAIDs) for joint pain and stiffness, corticosteroid creams for rashes, antimalarial drugs for skin and joint problems, oral corticosteroids and immunosuppressant drugs to minimize immune response.”

Some tips to combat SLE symptoms include the following.
Maintain a good doctor-patient relationship. It is also important to get adequate family support.
Take all medications as advised. Visit your physician regularly and get involved in your care.
Stay active as this will help in keeping the joints flexible and prevent cardiovascular complications.
Avoid excessive sun exposure as the ultraviolet rays can cause the skin rash to flare up.
Avoid smoking and try to minimize stress and fatigue.
Maintain normal body weight and bone density.
Young women with lupus should time pregnancies for periods when lupus activity is low. Pregnancies must be carefully monitored and certain medications should be avoided.

Friday, 13 October 2017

Explaining cardiac interventions: Using analogies to improve communication

Explaining cardiac interventions: Using analogies to improve communication

Dr KK Aggarwal

The doctor-patient relationship is the foundation of practice of medicine. And, communication is the key factor that decides the interaction between the doctor and his/her patient and influences outcomes.

Doctors are bound, both ethically and legally, to provide adequate information to the patient so that the patient can participate in the decision making process and are in a position to take an ‘informed’ decision.

Any information given to the patient should be in a language, using words or using terms he/she can understand.

But do patients really comprehend the information that is given to them during the process of informed consent? The science of medicine is abound with complex concepts. Medical terminology uses technical words and jargon that are unfamiliar to the patient and difficult to understand. This may hinder the effectiveness of communication.

One way to improve communication and enhance understanding of medical information is by using analogies. The dictionary meaning of an analogy is a ‘resemblance between two situations, people or objects that are otherwise unlike, especially when used as a basis for explanation’.

Analogies are situations that are familiar to the patient and so easily understood. The information is also better retained. Hence, using analogies to explain complex medical terms or concepts can improve doctor-patient communication.

This is how I explain cardiac interventions to my patients. I take the example of traffic management, a situation familiar to all.

For any traffic management, following are the options:

• Placing traffic signals can be equated to dos and don’ts of lifestyle management.
• Posting a traffic inspector on the crossing. This can be equated with a clinical cardiologist.
• Diverting the traffic from main road to side roads. This can be equated to opening collaterals by drugs and/or exercise.
• Hiring an architect to make maps. This can be equated to an angiographer (cardiologist) doing angiography.
• Looking for the possibility of widening the roads. This can be equated to balloon angioplasty.
• To prevent encroachment of widened roads to place railings around the widened roads can be equated to placement of metallic stent.
• To prevent mishandling of railing, safety grills are put. This can be equated to drug-eluting stents.
• When the roads cannot be widened, flyovers are made, which can be equated to bypass surgery.
• Flyovers can be made by stopping the traffic. This can be equated to open heart bypass surgery.
• Flyovers can be made without disturbing the traffic, this can be equated to heart bypass surgery.
(Disclaimer: The views expressed in this write up are entirely my own)

Every arthritis is different with different treatment methods

Every arthritis is different with different treatment methods

A combination of diet, medication, and exercise can help in reducing inflammation and pain

New Delhi, 12th October 2017: As per statistics, arthritis affects about 15% of the Indian population, which is over 180 million people in the country.[1] Women are more prone to develop arthritis than men as evident in a recent survey, which showed high erythrocyte sedimentation rate (52.07%) and Rheumatoid Factor (13.08%) in women as compared to men.[2]

Arthritis is an inflammation of the joint and can affect one or multiple joints. While arthritis is most commonly seen in adults over the age of 65, it can also develop in children, teens, and younger adults. There are several different types of arthritis, each with different causes and treatment methods. Osteoarthritis (OA) and rheumatoid arthritis (RA) are the two most common types of arthritis.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “OA is caused by the normal wear and tear of bones. This natural breakdown of cartilage tissue can be further exacerbated by an infection or injury to the joints. RA, on the other hand, is an autoimmune disorder, which occurs when the body’s immune system attacks the body tissues. RA invades and destroys a joint and can eventually lead to the destruction of both bone and cartilage inside it. OA can be compared to rusting of a door joint and RA can be likened to termites affecting the joint. While OA, also called as green arthritis, may require only painkillers and rehabilitation exercises, the red inflammation arthritis called RA, if not treated early and aggressively, can end up causing serious deforming complications.”

The most common symptoms of arthritis are joint pain, stiffness, and swelling. Arthritis also decreases the range of motion and a person can also experience redness of the skin around the joint. Pain is worse in the morning in people with OA.

Adding further, Dr Aggarwal, said, “Treatment of arthritis revolves around reducing the amount of pain and preventing additional damage to the joints. Some people find relief with heating pads and ice packs while others can use mobility assistance devices such as canes or walkers, which can help in taking pressure off the sore joints. Doctors usually suggest a combination of treatment methods for best results, including medication and physical therapy.”

Here are some other things one should consider.
The best exercises for osteoarthritis are brisk walking, aerobics, cycling, and swimming.
One should not give painkillers in osteoarthritis for more than three months. It is always better to try methods which can omit painkillers. It is a myth that glucosamine helps. In acute arthritis, one can try cold fomentation and in chronic cases, hot fomentation.
Weight loss and maintaining a healthy weight can help reduce the risk of developing OA and reduce existing symptoms.
It is important to consume a healthy diet for weight loss. A diet rich in lots of antioxidants, such as fresh fruits, vegetables, and herbs, can help reduce inflammation. One must also avoid fried and processed items, dairy products, and high intake of meat.
________________________________________
(1) http://www.arthritis-india.com/
(2) As per survey conducted by a leading diagnostic chain

Thursday, 12 October 2017

Meaning of Birthday

Meaning of Birthday

Dr KK Aggarwal

A birthday is the day when we should file our Vedic returns of all that we have done, good and bad, in the last one year.

All of us are born with both Sanchit Karma and Prarabdha Karmas. Prarabdha Karma are the part of sanchit karma, a collection of past karmas, which are ready to be experienced through the present body in this lifetime. We have to bear the fruits of Prarabdha Karmas, while Sanchit Karmas can be negated with our positive Karmas, both present and future.

On this day, we must also make a balance sheet of our three debts and pay them if not paid by this time. There are three types of rins (debts): Dev Rin, Pitra Rin and Rishi Rin. God or the devtas gave us the consciousness, parents gave us our body and teachers gave us the knowledge or intellect.

I file my Vedic returns at 6 pm, the time of my birth, every year on my birthday.

Do good karmas to keep the balance in the positive. Do good karmas for a good life!

Disclaimer: The views expressed in this write up are entirely my own.

Bipolar disorder symptoms can be effectively managed with certain lifestyle changes

Bipolar disorder symptoms can be effectively managed with certain lifestyle changes

About 10 to 20 million people in India are affected by this condition

New Delhi, 11 October 2017: As per a recently published study, patients with bipolar depression treated with adjunctive bright white light showed a significantly higher remission rate as compared with the placebo light group. This corresponds to 68.2% vs 22.2%, respectively, at weeks 4 to 6 and significantly lower depression scores at the end of the study period. In India, about 10 to 20 million people suffer from mental disorders, one of them being bipolar disorders.

Bipolar disorder is a condition associated with episodes of mood swings ranging from depressive lows to manic highs. The cycles of mood swings can often last for days, weeks, or months, with the changes being so intense that they interfere with a person’s ability to function properly. The condition not only affects daily activities of life, but also the person’s relationship with others.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “A depressed person feels sad or hopeless and loses interest or pleasure in most activities. When this mood shifts to mania or hypomania, the person can be euphoric, full of energy, unusually irritable or aggressive. These mood swings can affect the person overall in terms of their sleep, energy, activity, judgment, behavior, and the ability to think clearly. Such mood swings may occur rarely or multiple times a year. While most people experience some emotional symptoms between episodes, some may not experience any at all. While the exact cause of bipolar disorder is not known, it could be due to a combination of genetic and environmental factors and altered brain structure and chemistry.”

A person with bipolar disorder may also experience at least three of the following: grandiose ideas or pumped-up self-esteem; far less need for sleep than normal; an urgent desire to talk; racing thoughts and distractibility; increased activity that may be directed to accomplishing a goal or expressed as agitation; and a pleasure-seeking urge that might get funneled into sexual sprees, overspending, or a variety of schemes, often with disastrous consequences.

Adding further, Dr Aggarwal, said, “Bipolar disorder can become worse, if left untreated. However, a good treatment plan including psychotherapy, medications, a healthy lifestyle, a regular schedule, and early identification of symptoms can help people live well even with this condition. There are also certain complementary health approaches like aerobic exercises and meditation, which can support treatment in such people.”

Here are some tips for self-management of symptoms in those with bipolar disorder.
Avoid stress as this is a major trigger. Relieve stress through techniques like yoga and meditation. Talk to your family or friends, if this can help relieve stress.
Stick to a regular schedule as this can help control mood swings to a great extent. People with bipolar disorder are usually affected by too many changes. Have meals, do errands, exercise, and go to bed about the same time every day.
Studies show that regular exercise can help improve mood. Start slowly with walking and get physical activity every day in some form or the other.
Avoid caffeine, alcohol, and drugs. Caffeine is a stimulant and can exacerbate manic episodes by keeping you awake. Alcohol and drugs can affect how your medications work.
Keep a journal in which you make a note of the triggers and schedule. This will help you establish a pattern and prepare yourself accordingly. It will also help your doctor evolve a treatment plan suited to your needs.

Wednesday, 11 October 2017

A Unique Permanent Registration Number for all registered doctors

A Unique Permanent Registration Number for all registered doctors

Dr KK Aggarwal

Under its Digital Mission Mode Project, the Medical Council of India (MCI) is implementing a new Indian Medical Register (IMR) through UPRN (Unique Permanent Registration Number) generation for each registered doctor in India. The UPRN number will be generated for the existing records in IMR, which is approximately 10 lakh.

On implementation of the system, the existing registration numbers of the doctors shall be migrated to a standard system of UPRN. Doctors shall also apply online for additional qualification registration in IMR like post-graduation, super specialty etc. The system can be used to make online applications for services like issue of certificates etc.

Here is how every registered doctor can covert IMR to UPRN.

• Register by Visiting www.mciindia.org and click on “Doctor Login”. Enter basic information like Name and Contact details including email address. A User id and Password will be sent on the email address.
• Doctors need to use this user id & Password to login and enter all the requested details including Personal Details, Contact Details, Aadhar number, and Professional details and upload the latest qualification documents.
• Pay the fees to MCI Online/offline and select Date and time when the Doctor will visit the State Medical Council for verification of the documents.
• Once the Documents are physically verified at State Medical Council (SMC) then the respective SMC will process the record in the system. The system will perform the following tasks automatically
o Aadhar Details will be verified.
o UPRN number will be generated.
o IMR database will be updated with the new UPRN number and will update the latest details of the Doctor
o Email notification will go to Doctor, MCI and SMC

Timely detection of amblyopia in children increases chances of successful treatment

Timely detection of amblyopia in children increases chances of successful treatment

Eye health in both children and adults should not be ignored

New Delhi, 10th October 2017: The prevalence of amblyopia or lazy eye is about 2% to 12% in various parts of India, according to statistics. Studies also indicate that amblyopia is one of the leading causes of visual impairment in children globally.[1]

Amblyopia, also known as lazy eye, is a condition that begins during infancy and early childhood. While it affects only one eye in most of the cases, both eyes can be affected, in some cases. It is a vision development disorder in which one eye fails to achieve normal visual acuity, even with prescription eyeglasses or contact lenses. The brain favors one eye and ignores the image from the affected eye, due to poor vision, which becomes weaker in due course of time, leading to amblyopia.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Amblyopia starts with one eye having better focus than the other. Sometimes, one eye may have significant farsightedness or astigmatism, but the other doesn’t. When a child’s brain receives both a blurry image as well as a clear one, the brain starts ignoring the blurry one. If this is not detected in time and goes on for some months or years in a young child, the vision in the blurry eye worsens. Sometimes a child’s eyes do not align with each other, the eyes may turn in or out while looking at an object. This is called strabismus, and it can lead to amblyopia eventually. Children with this condition cannot focus their eyes together on an image and often see double. It is important that all children be screened for amblyopia before they get to the school age.”

Some symptoms of this condition include blurred and/or double vision, poor depth perception (of vision), eyes not appearing to work together, and an eye turn (upward, downward, outward, or inward).

Some complications of this condition, if left undetected, included blindness, eye turn, and central vision.

Adding further, Dr Aggarwal, said, “The younger the child, the more effective is the treatment for this condition. The likelihood of vision improvement reduces once the child crosses the age of 8. Two approaches to treating lazy eye include treating an underlying eye problem and getting the affected eye to work so that normal vision can develop.”

Here are some general tips for good eye health that one can follow:
Get examined for diabetes and high blood pressure. If left undetected, these diseases can lead to eye problems such as diabetic retinopathy, macular degeneration, and eye strokes (blockage in the blood vessels in the retina).
Look for any changes in your vision. If you notice any warning signs, contact your doctor immediately.
Get plenty of physical activity. If your work involves a lot of screen time, make sure to take breaks frequently and do some eye exercises. It is also a good idea to wash your eyes with some cold water.
Eat a healthy and balanced diet. Antioxidants in fruits and dark green leafy vegetables can possibly reduce the risk of cataracts. Omega-3-fatty acids are also beneficial for eyes.
Get your eyes checked at least every two years. A comprehensive eye exam, including dilating your pupils, can determine your risk for major eye diseases such as diabetic retinopathy, which has no early warning signs or symptoms.
Quit smoking. The many dangers of smoking have been well documented. When it comes to eye health, people who smoke are at greater risk of developing age-related macular degeneration, cataracts, uveitis and other eye problems.

Tuesday, 10 October 2017

High-sugar diet increases risk of heart disease in healthy people

High-sugar diet increases risk of heart disease in healthy people

Dr KK Aggarwal

A study from the UK has shown that healthy people who eat high amounts of sugar are at an increased risk of developing heart disease due to alteration in their fat metabolism.

The study reported October 4, 2017 in the journal Clinical Science examined two groups of men with either high or low levels of liver fat, and fed them a high (650 calories daily) or low sugar (≤140 calories daily) diet to find out if the amount of liver fat influences the impact of sugar on their cardiovascular health.

Men who had high levels of liver fat (non-alcoholic fatty liver disease [NAFLD]) had changes in their fat metabolism that are associated with an increased risk of cardiovascular disease, heart attacks and strokes after 12 weeks on the high sugar diet.

What is important to note in this study is that when the group of healthy men with a low level of liver fat consumed high amounts of sugar, their liver fat increased and their fat metabolism became similar to that of men with NAFLD putting them at risk of heart disease.

With the festive season coming up, we all should take care to not eat too many sweets. Diwali sweets have very high content of white sugar and cause metabolic syndrome, insulin resistance and consequent increase in blood pressure, blood sugar and body weight. Some sweets may be made in trans fats (vanaspati), which lower the good cholesterol and increase bad cholesterol.

The findings of the study are especially relevant for the young who regularly consume foods and drinks high in added sugars. Lifestyle disorders like diabetes, obesity, hypertension, heart disease, stroke, NAFLD are escalating in our country mainly due to an unhealthy lifestyle. What is of more concern is that these diseases are now affecting people at a younger age.

(Source: University of Surrey Press Release, October 4, 2017)

Vitamin D supplements can help cut the risk of asthma attacks

Vitamin D supplements can help cut the risk of asthma attacks

· Over 20 million people in India suffer from asthma

· Airway sensitivity both rural and urban areas has gone up due to many factors

New Delhi, 09 October 2017: As per a recent study, taking oral vitamin D supplements in addition to standard asthma medication causes a 30% reduction in asthma attacks requiring treatment with steroid tablets or injections, in those with mild-to-moderate asthma. As per the findings, there was a 50% reduction in the risk of people experiencing at least one asthma attack requiring hospitalization or visit to emergency Dept with vitamin D supplementation. Vitamin D is thought to protect against attacks triggered by viral upper respiratory infections by boosting immune responses and dampening down harmful airway inflammation.

A chronic lung disease that inflames and narrows the airways, asthma causes recurring episodes of wheezing, chest tightness, shortness of breath and coughing. The coughing often occurs at night or early in the morning. About 15 to 20 million people in India have asthma, and some studies even put this number at 30 million.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “It is important to understand the working of airways to understand asthma. The airways are tubes that carry air into and out of the lungs. In people with asthma, these airways are inflamed, which makes them swollen and very sensitive. Due to this, the airways react strongly to certain inhaled substances, which causes the muscles around them to tighten. As a result, the airways become narrow causing less air to flow into the lungs. The cells in the airways might make more mucus than usual. All these can result in asthma symptoms, which can occur each time the airways are inflamed. Asthma attacks are also known as flare ups or exacerbations.”

Adding further, Dr Aggarwal, said, “Airway sensitivity is going up among people in both rural and urban areas due to sustained exposure to a combination of triggers. Asthma requires continuous medical care and those with moderate-to-severe asthma must take long-term medicines such as anti-inflammatory drugs. These should be taken every day to prevent symptoms and attacks. Short-term medicines such as inhaled short-acting beta2-agonists are also used for quick relief of asthma symptoms.”

Here are some tips to prevent asthma.

Follow your care plan diligently. Asthma needs regular monitoring and following your prescribed medication schedule can help you manage symptoms to a great extent.
Identify what triggers an attack. It could be anything from outdoor allergens and irritants to household dust and mites.
Monitoring your breathing and identifying a possible attack can also help you in taking medications and precautions in a timely manner, thus avoiding flare ups.
Getting vaccination for influenza and pneumonia can prevent asthma flare ups.

Monday, 9 October 2017

One in four people leave work a year after a heart attack

One in four people leave work a year after a heart attack


Dr KK Aggarwal

Most people leave their job within a year of returning to work after having a heart attack, says a study reported in the Journal of the American Heart Association. Patients aged between 30 and 39 years and those between 60 and 65 years reported the highest rate of work dropout after return to work.

About 91% of the 22,394 heart attack patients who were employed before hospitalization for a first-time heart attack, returned to work within a year of the episode. But, within a year of resuming work, 24.2% of them left their jobs and were supported by social benefits.

Comorbid heart failure, arrhythmia, and depression, diabetes were found to be the clinical risk factors for unemployment. Patients with high income and high education level were more likely to remain employed, compared with those with lower educational and income levels.

Several factors – medical, economic, psychosocial – influence return to work following a heart attack. As doctors we take care of the medical factors, drug therapy, managing complications and secondary prevention. But, being part of the multidisciplinary cardiac rehabilitation team, it is equally important to take care of psychosocial factors that may affect recovery of a patient.

This study brings into focus the rehabilitation of post-MI patients and shows that return to work may not be a valid measure of successful recovery of working capacity.

Besides improving functional capacity, cardiac rehabilitation also supports a patient in returning to work following a heart attack. Hence, the rehabilitation of each patient should take into consideration the individual physical, psychological and social challenges of the patient. Post-MI patients, particularly the young patients and those with comorbidities and poorer socioeconomic status should receive increased focus on cardiac rehabilitation so that they continue with their jobs even after a heart attack.

(Source: AHA News Release, October 4, 2017)

The 24th HCFI MTNL Perfect Health Mela concludes with stellar performances and successful mass health awareness initiatives

The 24th HCFI MTNL Perfect Health Mela concludes with stellar performances and successful mass health awareness initiatives
New Delhi,08 October 2017: Heart Care Foundation of India (HCFI), a leading national non-profit organization committed to making India a healthier and disease-free nation concluded its annual flagship event – the 24th MTNL Perfect Health Mela today.The five-day event was organized jointly with the Health and Family Welfare Dept. NCT Delhi, MTNL, NDMC, and other central and Delhi state government departments. The IMA was the knowledge partner for the event. The theme for this year’s event was ‘Digital Health’, a concept which talks about how technology can help in preventive health and creating mass health awareness. Experts at the Mela deliberated and debated on strategies for preventive health and health management.
The Health Mela is a confluence of tradition and modernity and has successfully since the past two and a half decades been working towards creating mass awareness on all aspects of health; using a consumer-driven model as the medium. It began with much fanfare and a grand inauguration by the Hon’ble Chief Minister of Delhi, Shri Arvind Kejriwal on the 4th of October 2017
Speaking at the valedictory, Padma Shri Awardee Dr KK Aggarwal, President HCFI & National President IMA, said, “I am extremely happy at the successful conclusion of the event and the huge participation. It is time to focus on preventing lifestyle diseases by making certain changes to our diet and lifestyles. I also urge everyone to have a healthy Diwali and take necessary precautions to protect oneself and others from injury and harm. Avoid bursting crackers as they can contribute to increasing pollution levels in the city and thereby hamper health.”
The five-day event served as a podium for over 40 on-the-spot competitions in which over 8200 children from various schools and colleges took part with great enthusiasm. Among the competitions were Indian and western dance, fashion show, rock band, Mehendi art, collage making, painting, and slogan writing.There were also special performances by the Punjabi Academy, the Urdu Academy, and the National School of Drama, which added value to the event. The purpose behind these competitions and performances was to use infotainment as a way of imparting health education to the masses.
With lifestyle diseases on the rise, the Mela focused on various aspects of preventive health.The message conveyed was that a healthy diet, physical activity, and stress-free life can go a long way in preventing many lifestyle conditions.Experts also shortlisted some people with heart diseases for support and treatment under the Sameer Malik Heart Care Foundation Fund.Adding further, Dr R N TandonHonorary Secretary General IMA, said, “This is another one of IMA’s efforts in sensitizing the masses on health and connected issues. The IMA has always worked towards preventive health and creating awareness and this year was no different. I am happy to see the youth participate in large numbers and takeaway some valuable lessons from this Mela.”
A one-of-its-kind All Religious Conference titled Asto Ma JyotirGamaya and an All Pathy Conference with the theme Rog EkIlajAnek were also organized on the last day of the Mela. In both the conferences, the panels constituted eminent medical practitioners and Dharma gurus, respectively. They shared valuable insights and enlightened the audience with their rich experience and knowledge. A performance by the Rajasthan Academy added fun and fervor to the last day of the Mela.Speaking at the valedictory,Dr P K Sharma, Medical Health Officer, NDMC and; the civic partner of the year’s Perfect Health Mela, said "We all thank everyone who came and attended the 24th Perfect Health Melaand made it such a success. We are happy to be supporting this event every year and will ensure to extend the same support in the years to come.”
Among other things, the Mela focused on generating oxygen through indoor plants, promoting fast food (easy to eat and quick items like fruits and vegetables) as opposed to traditional fried fast food items, learning to create noise and pollution free environments, importance of doctor-patient relationship, eliminating refined carbs, and misuse of antibiotics. The 24th edition of the Mela being held this year will be a precursor leading up to its silver jubilee celebrations starting the next year.x