Friday 31 March 2017

Learning to be good doctors from the dead

Learning to be good doctors from the dead Dissection of the human cadaver is a fundamental part of training of doctors. All specialities of medicine require a knowledge of the human anatomy. Dissection allows a student to directly see and touch the intricate structure of the human body, the various organs, muscles, bones, etc., or its various anomalies, which no digital technology can simulate, however advanced it may be. This visual imprint on the mind perhaps stays on for life. Medicine is not all science; it is not just about being able to interpret lab reports, or read an x-ray or CT scans etc. or prescribing medicines. Doctors have been regarded as next to God since Vedic times and no other profession has been accorded the same exalted status as that of the medical doctor. This places a responsibility on the doctors to nurture the doctor-patient relationship, based on trust and mutual respect. Doctors should be compassionate, empathetic, courteous and respect the dignity of the patients, their privacy and confidentiality. These are qualities that can be inculcated in doctors, right from the first day, they enter a medical college to begin their education. When a medical student enters a dissection hall for the first time, he/she may experience a mix of different emotions... anxiety, stress or even excitement in taking that first step towards being a real doctor. It is important to cultivate in them respect for the cadaver or the dead human body. While they teach us the anatomy of the human body, they can also teach us ‘humane’ qualities, which will make a medical student, a good doctor later on. These cadavers were once living persons, just like us. Disrespecting them means disrespecting the dead person. Many cadavers would have been voluntarily donated during a person’s lifetime. This is a gesture that is truly selfless and altruistic, made for research for advancement of medicine or training of medical students, the future doctors. Or, the body may have been donated after death by the family or legal heirs to teaching institutions. It is therefore important to respect the family that has suffered an irreversible loss. Disrespecting the cadaver would mean disrespecting the family of the dead person. After they have been used, the cadavers are usually buried, without any rituals. There should be a funeral service for the used cadavers with all rituals as an act of respect. Students should take a ‘Cadaveric oath’ on their first day in the dissection hall before starting the dissection. An example of such a cadaveric oath can be as below: “I … do solemnly pledge that I will always respect the cadaver. I will always treat the cadaver with dignity. I will be compassionate towards the cadaver. I will respect the privacy and confidentiality of the cadaver. I will be grateful to the cadaver and/or their family or legal heir/s for the gift of knowledge. I will be altruistic and use my knowledge for the service of society.” The way we treat the dead body will shape our interactions with a living person. A dissection hall is a good place to learn to be caring and compassionate doctors. Dr KK Aggarwal National President IMA & HCFI

Individuals with existing morbidities should adopt healthy fasting practices this Navratri

Individuals with existing morbidities should adopt healthy fasting practices this Navratri Patients with existing chronic diseases like cardiovascular issues, diabetes, and blood pressure should take extra precautions when fasting. Skipping meals or eating an inappropriate diet can affect your health adversely if you are on continuous medications. Diabetic patients should decrease their insulin intake up to 40 percent if they are fasting and consume only one meal a day. New Delhi, 30th March 2017: There is a lot of hustle bustle around, as the festive season is setting up. And we all know that Navratri marks the festive season, which is an auspicious 9-day period for Hindu devotees. Fasting, worshipping and playing dandiyaare a few important things that matter the most during this period. From kids to elders, you see almost everyone indulging in the 9-day fast schedule that is observed during the festival. But sometimes, people end up ignoring their health because they believe in adhering to the strict fasting norms like eating once a day, staying without water till the last mean, consuming salt once a day and only consuming potato-based meals. The strict fasting practices do not suit individuals who are suffering from long-term chronic diseases like heart ailments, diabetes and blood pressure or for that matter pregnancy. They can all cause life-threatening complications for such patients and must be observed with caution and post-consultation with the treating doctor. 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, “Fasting has many positive impacts on one's health if an optimum level of nutritional intake are maintained. For patients who have heart issues, we recommend that they don’t eat fried foods like potato pakoras, fried potatoes and processed potato chips. Diabetics must immediately end their fast if the body’s blood sugar level falls below 60 mg. They must also drink ample amounts of fluid given that dehydration can lead to paralysis and heart attacks. The risks associated with fasting are low in patients with Type 2 diabetes. However, patients suffering from Type 1 diabetes should not fast. Fasting in chronic patients must be done in strict consultation with the doctors since the dosage of regular medicines may need to be reduced by 40-50% during fasts.” A few healthy fasting tips during the Navratri include • Lauki Raita can be consumed instead of plain curd • One can eat almonds (badam) in between as snacks • Stuffed kuttu (buckwheat) roti with pumpkin (kaddu) vegetable should be consumed • Ample fruits should be consumed at regular intervals to maintain nutrient levels • Both chestnut flour and buckwheat flours can be combined as a healthy option • Singhara is not a cereal but a fruit and hence a good substitute for a Navratri fast where cereals are not to be eaten • A gluten free product, chestnut flour is an ideal food option for people with celiac disease or other gluten intolerances or allergies

Thursday 30 March 2017

IMA congratulates all winners of Dr BC Roy National Awards The Dr BC Roy National Awards for the years 2014, 2015 and 2016 were presented by the President of India on Tuesday. IMA congratulates and extends its best wishes to all the winners. Here is a list of the winners under various categories: 2014 • Eminent Medical Person: Dr Arvind Kumar, Prof (Dr) Randeep Guleria • Eminent Medical Teacher: Dr Ravi Kant, Dr Ashwani Kumar, Dr Rajesh Malhotra, Dr Rakesh Yadav, Dr PVLN Murthy • Best talents in encouraging the development of specialities in different branches in Medicine: Dr Janak Desai, Dr Rajesh Upadhyay, Dr Binay Karak, Dr Ashok Rajgopal, Dr DS Rana • Outstanding services in the field of Sociomedical Relief: Dr Rama Reddy Karri, Dr Jitender B Patel, Dr Sudipto Roy 2015 • Eminent Medical Person: Dr C Palanivelu, Dr Ashok Seth • Eminent Medical Teacher: Dr N Sanjeeva Reddy, Dr CS Yadav, Dr AK Bisoi, Dr DJ Borah, Dr Arun Thakur • Best talents in encouraging the development of specialities in different branches in Medicine: Dr HP Bhalodiya, Dr Parimal M Desai, Dr Anand Khakhar, Dr Ambrish Mittal, Dr Amlesh Seth • Outstanding services in the field of Sociomedical Relief: Dr A Marthanda Pillai, Dr John Ebnezar, Dr A Arulvisagan • Aid or Assistance to Research Project: Dr JB Sharma 2016 • Eminent Medical Person: Dr Vipul R Patel • Eminent Person Literature: Dr Anil Kumar Chaturvedi • Eminent Medical Teacher: Dr Daljit Singh, Prof Dr Premnath Dogra, Dr M Unnikrishna, Dr GS Umamaheshwari Rao, Dr Ved Prakash Mishra • Best talents in encouraging the development of specialities in different branches in Medicine: Dr Sanjay Balwant Kulkarni, Dr OP Yadava, Dr Pawanindra Lal, Dr D Raghunadha Rao, Prof Pradeep Tandon • Outstanding services in the field of Sociomedical Relief: Dr T Rajgopal, Dr Satchit Balsari, Prof (Dr) S Geethalakshmi, Dr Devraj Rai, Dr P Raghu Ram • Aid or Assistance to Research Project: Prof (Dr) Punit Gupta (Source: Press Information Bureau, President's Secretariat, March 28, 2017) Dr KK Aggarwal National President IMA & HCFI IMA congratulates all winners of Dr BC Roy National Awards The Dr BC Roy National Awards for the years 2014, 2015 and 2016 were presented by the President of India on Tuesday. IMA congratulates and extends its best wishes to all the winners. Here is a list of the winners under various categories: 2014 • Eminent Medical Person: Dr Arvind Kumar, Prof (Dr) Randeep Guleria • Eminent Medical Teacher: Dr Ravi Kant, Dr Ashwani Kumar, Dr Rajesh Malhotra, Dr Rakesh Yadav, Dr PVLN Murthy • Best talents in encouraging the development of specialities in different branches in Medicine: Dr Janak Desai, Dr Rajesh Upadhyay, Dr Binay Karak, Dr Ashok Rajgopal, Dr DS Rana • Outstanding services in the field of Sociomedical Relief: Dr Rama Reddy Karri, Dr Jitender B Patel, Dr Sudipto Roy 2015 • Eminent Medical Person: Dr C Palanivelu, Dr Ashok Seth • Eminent Medical Teacher: Dr N Sanjeeva Reddy, Dr CS Yadav, Dr AK Bisoi, Dr DJ Borah, Dr Arun Thakur • Best talents in encouraging the development of specialities in different branches in Medicine: Dr HP Bhalodiya, Dr Parimal M Desai, Dr Anand Khakhar, Dr Ambrish Mittal, Dr Amlesh Seth • Outstanding services in the field of Sociomedical Relief: Dr A Marthanda Pillai, Dr John Ebnezar, Dr A Arulvisagan • Aid or Assistance to Research Project: Dr JB Sharma 2016 • Eminent Medical Person: Dr Vipul R Patel • Eminent Person Literature: Dr Anil Kumar Chaturvedi • Eminent Medical Teacher: Dr Daljit Singh, Prof Dr Premnath Dogra, Dr M Unnikrishna, Dr GS Umamaheshwari Rao, Dr Ved Prakash Mishra • Best talents in encouraging the development of specialities in different branches in Medicine: Dr Sanjay Balwant Kulkarni, Dr OP Yadava, Dr Pawanindra Lal, Dr D Raghunadha Rao, Prof Pradeep Tandon • Outstanding services in the field of Sociomedical Relief: Dr T Rajgopal, Dr Satchit Balsari, Prof (Dr) S Geethalakshmi, Dr Devraj Rai, Dr P Raghu Ram • Aid or Assistance to Research Project: Prof (Dr) Punit Gupta (Source: Press Information Bureau, President's Secretariat, March 28, 2017) Dr KK Aggarwal National President IMA & HCFI

People who fast during Navratri are at an increased risk of food poisoning and diarrhea

People who fast during Navratri are at an increased risk of food poisoning and diarrhea Eating leftover and oily food can make you sick...Keep a check on your liquid intake to celebrate the festival of Navratri with all the enthusiasm Starving and not eating for too long can make you feel weak. It is advised that you consume mini meals after an interval of every 2-3 hours New Delhi, 29th March 2017: Have you ever wondered what is the reason behind the 9-day fast during Navratri? In addition to the religious reasons, fasts also help in the purification of the body by relaxing its metabolism. The consumption of low calorie and less spicy food items helps relieve the body of the extra work it has to do on a regular basis. However, this purpose gets defeated when people indulge in starchy and oily foods like potatoes and kuttu pakoras. 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, “During Navratris, people have fewer food options, which are mostly restricted to kuttu and singhara flours. We advise that the people who are on a fast consume ample amounts of liquids to maintain energy levels and prevent dehydration. It is also strongly recommended that the kuttu or singhara flour left over from the previous year should not be used as they may be contaminated and result in diarrhea. Eat lot of fruits. Eating too much of very oily and high sugar food items like burfi, ladoo and potato fries may also cause diarrhea.” Keep the following in mind in order to avoid the chances of food poisoning and diarrhea and help in maintaining a healthy fasting routine: • Use singhara flour, it is not a cereal but a fruit as it is made from dried ground water chestnuts and hence a good substitute for a Navratri fast, where cereals cannot be consumed. It is an excellent source of energy and provides 115 kcal per 100g. • Singhara plants bear ornately shaped fruits containing a single very large starchy seed. These seeds or nuts are boiled and eaten as a snack and can be eaten raw as well • The Singhara is made from dried ground water chestnuts. These nuts are boiled peeled and dried before grinding. In such a case, there are no chances of impurities. • Chestnuts are relatively low in net carbs (total carbohydrate minus dietary fiber). It is included in many low carb diets. They do not contain the fat that regular nuts have. They also contain less carbohydrate than white flour. • Avoid eating deep fried chestnut flour pooris or parathas. • Buy only branded best quality flour as leftover flour from last year can lead to food poisoning. • One should not use high trans fat vegetable oils to cook chestnut flour bread. • You should consume as many fruits as you can, fruits are the best alternatives for the individuals who are on a fast. • To keep your body hydrated, you should drink as much liquid as you can like in the form of water and juices.

Wednesday 29 March 2017

IMA highlights deficiencies in the new Mental Health Bill 2016 passed by the Parliament

IMA highlights deficiencies in the new Mental Health Bill 2016 passed by the Parliament The Lower House of the Parliament passed the new Mental Healthcare Bill 2016 on Monday. The Upper House had already passed the Bill in August last year. · It clearly spells out clearly government’s responsibility. · It decriminalizes attempt to suicide. · It has made the mentally ill eligible for insurance cover etc The Bill has some very good provisions (as above) and it has been enacted by the Parliament, it suffers from some fundamental inconsistencies and poor drafting. Submissions have been made in detail to the Hon’ble Health Minister by the Indian Psychiatric Society. Some of the fundamental problems with the Bill are as mentioned below 1. Definition of mental illness: Mental illness is defined as “substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behavior, capacity to recognize reality and ability to meet ordinary demands of life” · This definition is at variance with that of National Mental Health Policy. · As per the definition, even serious mental illnesses like Depression and Delusional Disorder cannot be considered as mental illnesses. Common mental illnesses like Panic Disorder, Obsessive compulsive disorder also cannot be considered as mental illnesses, whereas these illnesses can be very disabling. Hence, the provisions of the act can benefit only a small portion of people with mental illnesses (PMI). · The act states that all PMI should be admitted as “Independent” as per Section 65(2). How can this be possible? A person who suffers from grossly impaired judgement and not able to meet ordinary demands of life will be in no position to seek voluntary admission. 2. Mental Health Establishment Section 2(1) (P): As per the definition, even a general hospital psychiatric unit (GHPU) will be deemed to be a Mental Health Establishment and therefore needs to be registered as such. · Singling out mentally ill in this fashion goes against the vision of National Mental Health Policy, which envisages full integration of psychiatric services in mainstream medicine. · As per the definition, practically all hospitals will be deemed to be Mental Health Establishments because mental illnesses and physical illnesses frequently coexist. For example, a person who gets into a hospital for Diabetes may have Depression and will need psychiatric treatment. · It will not be possible for the State mental health authority to regularly monitor all hospitals and other establishments 3. Mental Health Nurse Section 2(1)(q): As per the definition even a nurse with diploma in general nursing is mental Health Nurse and can be registered as a mental health professional (Section 55). A mental Health professional can admit patients and send them on leave. A Psychiatrist who had undergone rigorous training for 10 years is sought to be equated with person with 3 years training in nursing! Giving responsibilities to people who have no adequate knowledge and skill will create havoc in mental health care service. 4. Advance Directive (Section 5): It is almost impossible for a common man (Future Psychiatric Patient) to determine what treatment he should have or should not. Psychiatric knowledge is limited even in medical graduates. 5. Nominated Representative (Section 14): In our country, family members take the major responsibility of caring for mentally ill. Bringing a third party into the decision making process is against the culture of our country. Even the WHO Mental Health Act and Convention on the Rights of Persons with Disabilities (CRPD) advocate culturally consistent laws for member states. 6. Section 18(1) (3) Not Consistent with section 2(1)(s). 18(1)(3) section states that every person should have access to mental health care, whereas section 2(1)(s) even excludes people suffering from common mental illnesses and even some serious mental illnesses. 7. State Mental Health Authority: In our country, we have one psychiatrist for more than 3 lakh people. This small number of psychiatrists is shouldering enormous responsibilities. Psychiatrists who are experts in the field are not adequately represented in the State Mental Health Boards. At least 4 psychiatrists including 2 private psychiatrists should be included as members. 8. Central Mental Health Authority: At least 4 psychiatrists as above should be included as members. 9. Electro Convulsive Therapy (Section 94(3)): This is a treatment NOT a punishment as depicted in films. It is lifesaving in certain psychiatric conditions. High voltage current is directly applied to the chest without anesthesia in cardiac emergencies. Surgeons routinely apply electric current to burn tissues during operation to stop bleeding. Why special restrictions are placed on psychiatrists? It would be in the best interests of patients if treatment decisions are left to specialists. 10. Community Care: The bill deals with institutional care. Provisions for Community care are not there in it at all. DRAFTING ERRORS The Bill is studded with errors. For example: · In the index at the beginning of the Bill “Mental Health Commission” is mentioned. There is NO Mental Health Commission in the Bill. · Section 103 quoted as emergency treatment whereas it is section 94, which actually deals with emergency treatment. · There are many more such errors Conclusion This bill is a Legal cum Professional document. Enormous difficulties will arise in implementing the present bill. People particularly in the vast rural areas of country will be at a disadvantage in getting access to mental health care. The Indian Psychiatric Society, the premier body of Psychiatrists in our country, is prepared to sit with concerned officials to sort out the lacunae in the bill. Summary The Mental Health Care (MHC) Bill may end up ruining the mental health sector in the country. The MHC Bill proposes to bring the General Hospital Psychiatry Units (GHPUs) under its purview. The general hospitals mostly treat people with depression, anxiety, phobias, sexual dysfunctions, adjustment and stress disorders, etc, before any disability sets in. “If we are trying to put these everyday life events into legal framework, people will not seek treatment and some of them may even commit suicide, ultimately leaving the Bill a disaster.” GHPU attached to teaching hospitals, general hospitals, and to some major private hospitals was the biggest revolution in psychiatry in the last 50 years. It has de-stigmatized psychiatric treatment by bringing mental health care from the confines of the mental hospitals to the doorsteps of the common man. Moreover, the MHC Bill is modelled on certain Western Bills. Various clauses in the Bill like ‘nominated representatives’ and ‘advance directives’ are completely alien to the Indian family ethos. Dr KK Aggarwal National President IMA & HCFI With contributions from: Dr (Prof) Roy Abraham Kallivayalil, National Vice-President, IMA and Dr RN Tandon Hony Secy Gen IMA With detailed inputs from: Dr Prof Brig MSVK Raju, President, Indian Psychiatric Society

The health benefits of eating KuttuKaAata or Buckwheat Flour during the Navratri season

The health benefits of eating KuttuKaAata or Buckwheat Flour during the Navratri season New Delhi, 28th March 2017: Navratri is the detoxification of a person’s body, mind and soul. During this time wheat flour is omitted from a person’s diet and replaced with buckwheat flour or kuttukaaata to help cleanse one’s body. Buckwheat is not a cereal grain butis derived from fruits and hence is a good substitute for cereals.
Explaining the health benefits of buckwheat flour Padma Shri Awardee Dr KK Aggarwal, National President, Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) said, “KuttuKaAata or buckwhear flour is extremely high in protein and is a wonderful substitute for those who are allergic to gluten (found in wheat).It is rich in magnesium, vitamin B, iron, calcium, folate, zinc, copper, manganese and phosphorus. It also contains phytonutrient rutin, which lowers cholesterol and blood pressure. It is also recommended to patients suffering from celiac disease.”
As the buckwheat hulls are hard to chew, traditionally they are soaked for about six hours and then cooked to make them softer and easily digestible.As the flour is gluten-free, a potato is used to bind the flour together. It is important to remember that we should not make pooris with hydrogenated oils or vanaspati as doing so will take away all the medical benefits of consuming buckwheat flour.Pooris made from buckwheats flour are crunchier than the normal wheat flour pooris. Instead of poori or pakodas (fried items) made from kuttuatta (buckwheat flour), eat kuttuki roti.One can also prepare idli from the kuttuatta (buckwheat flour) and dosa from the samak rice
Some health benefits of consuming buckwheat flour include:
1. Kuttu is 75% of complex carbohydrates and 25% of high quality protein, which makes it an ideal food for weight loss. 2. It also contains alpha linolenic acid, which enhances HDL cholesterol ("good" cholesterol) and controls LDL cholesterol ("bad" cholesterol). 3. It is a good source of insoluble fiber and prevents occurrences of gallbladder stones. According to the American Journal of Gastroenterology, a 5 % increase in the insoluble fiber intake results in a 10% reduced risk of gall-bladder stones. 4. Being high in fiber and with low glycemic index it is good substitute for diabetic patients. The glycemic Index for buckwheat is 47 (Low GI foods have a GI value less than 55; medium GI foods have a GI value between 55 and 69 and high GI foods have GI value greater than 70). 5. The chiro-inositol present in the buckwheat has been identified as the diabetes-preventing component. Buckwheat flour however is subjected to adulteration and it is important to purchase form a credible source. Leftover flour must also not be used from the previous year as it may lead to food poisoning.

Tuesday 28 March 2017

Patients with family history of high cholesterol should be screened early

Patients with family history of high cholesterol should be screened early New Delhi, 27thMarch 2017: A person is said to be suffering from pre-mature heart disease when he is diagnosedwith the condition before the age of 55 years in men 65 years in women. The prevalence of dyslipidemia in these patients is usually found to be as high as in the range of 75-85%, said 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. Dyslipidemia is high levels of cholesterol and/or triglycerides in the blood. About 54% of all patients with premature heart disease and 70% of those with a lipid abnormality have a familial disorder. Hence, it is recommended that the first-degree relatives of patients who have had a heart attack, especially if premature, should be screened for lipid abnormalities. First-degree relatives of a person include brothers, sisters, father, mother or children; second-degree relatives are aunts, uncles, grandparents, grandchildren, nieces, or nephews and third-degree relatives refer to first cousins, or siblings of grandparents. “Screening should begin with a routine lipid profile and if the results of this are normal, then further testing should be done for lipoprotein (a) and apolipoproteins B and A-I. About 25% patients with premature heart disease and a normal standard lipid profile may have abnormal Lp(a) or apo B profile. High apo B levels and reduced apo A-I levels are associated with increased risk of heart disease. Similarly, a high Lp(a) level increases the risk of developing heart disease”, added Dr KK Aggarwal. Familial hypercholesterolemia (FH) is a genetic disorder, which runs in families and is characterized by high cholesterol levels, in particular, very high levels of LDL or the bad cholesterol and premature heart disease. Patients with FH are at an increased risk of developing premature heart disease at an earlier age of 30 to 40 years. Heterozygous FH is a common genetic disorder, occurring in 1:500 people in most countries. Homozygous FH is much rarer, occurring in 1 in a million births. Heterozygous FH is normally treated with drugs. Homozygous FH often does not respond to medical therapy and may require apheresis or liver transplant. Heterozygous FH is when the FH gene is inherited only from one parent. If both parents have FH and the FH gene is inherited from both of them, this is homozygous FH. Universal screening at the age of 16 years should be done to detect familial high cholesterol levels. In patients with heterozygous FH, the cholesterol levels are between 350 to 500 mg/dL, and in homozygous, the levels are between 700 to 1,200 mg/dL.

Global warming implicated in the rising diabetes prevalence

Global warming implicated in the rising diabetes prevalence Global warming may be contributing to the worldwide epidemic of diabetes, suggests a new study from The Netherlands published online in the journal BMJ Open Diabetes Research & Care. In the year 2015, 415 million adults globally had diabetes and this number is estimated to rise up to 642 million cases by 2040, an increase of almost by 55%. Researchers from the Leiden University Medical Center attempted to investigate if global increases in temperature were contributing to the current rise in the prevalence of type 2 diabetes by negatively affecting the glucose metabolism via a reduction in brown adipose tissue activity. Data on diabetes incidence amongst adults in 50 states of the USA and three territories (Guam, Puerto Rico and Virgin Islands) for the years 1996 to 2009 from the National Diabetes Surveillance System of the Centers for Disease Control and Prevention (CDC) was used in the study. On average, with every 1°C rise in temperature, age-adjusted incidence of diabetes was found to increase by 0.314 per 1,000 in the US. The global prevalence of glucose intolerance also increased by 0.17% per 1°C rise in temperature in mean annual temperature. Overall, warmer countries tended to have a higher prevalence of glucose intolerance. This effect of warmer temperatures on glucose metabolism has been linked to brown adipose tissue. It has been shown earlier that colder temperatures can activate brown fat and improve insulin action and sensitivity. Therefore, it was hypothesized that warmer temperatures could have the opposite effect; decrease in activity of the brown adipose tissue could reduce insulin sensitivity and an increase in the prevalence of type 2 diabetes. Although this study did not establish a cause and effect relationship between global warming and type 2 diabetes, the fact remains that climate change is real and is a major challenge of the 21st century, which needs to be tackled urgently. The impact of climate change are global and not limited to a particular region of the world. Climate change affects the environment and consequentially human health both directly and indirectly. Climate change directly affects five components of the environment: water, air, weather, oceans, and ecosystems. Through changes in the environment in the form of extreme heat and cold waves, floods and droughts, typhoons, hurricanes, worsening air quality and other natural disasters, it indirectly affects human health. Many vector-borne diseases such as dengue, Chikungunya are showing a resurgence making them more difficult and challenging to control. Moreover, they are being redistributed across the world to areas that are currently not endemic for these diseases. Not only infectious diseases, non communicable diseases (NCDs) such as heart disease, stroke, respiratory diseases, type 2 diabetes have also been linked to climate change. (Source: BMJ Open Diabetes Research & Care. 2017, Volume 5, Issue 1)

Monday 27 March 2017

The dead too deserve to be treated with respect and dignity

The dead too deserve to be treated with respect and dignity Dr KK Aggarwal National President IMA “Be respectful” This is what we have been taught since childhood… our traditions and culture also teach us to always be respectful towards every living being, and not just towards another human being. The Right to Life is recognized in Article 3 of the 1948 Universal Declaration of Human Rights and Article 6 of the 1966 International Covenant on Civil and Political Rights. The ‘Right to life’ is enshrined in our constitution in Article 21, which says “No person shall be deprived of his life or personal liberty except according to procedure established by law.” The scope of Article 21 has been expanded over the years in various judgements of the Supreme Court by adding the dimensions of right to health and medical care among other things that are essential to life such as adequate nutrition, education, etc. The Right to life also means the ‘Right to live with human dignity’. In its judgement in Francis Coralie Mullin vs The Administrator, Union Territory of Delhi & Ors dated 13th January, 1981, the Apex Court held: “The right to life includes the right to live with human dignity and all that goes along with it, namely, the bare necessaries of life such as adequate nutrition, clothing and shelter and facilities for reading, writing and expressing oneself in diverse forms, freely moving about and mixing and commingling with fellow human beings… Every act which offends against or impairs human dignity would constitute deprivation pro tanto of this right to live and it would have to be in accordance with reasonable, fair and just procedure established by law which stands the test of other fundamental rights…” It’s not just the living, who deserve our respect … the dead too deserve dignity just as the living do. A dead person has the right to be treated with dignity as exemplified by the right to a decent burial or cremation. A dead person has the right to remain undisturbed and unharmed. Section 297 of the Indian Penal Code ‘Trespassing on burial places, etc.’ has recognized it as a punishable offence and says, “Whoever, with the inten¬tion of wounding the feelings of any person, or of insulting the religion of any person, or with the knowledge that the feelings of any person are likely to be wounded, or that the religion of any person is likely to be insulted thereby, commits any trespass in any place of worship or on any place of sepulchre, or any place set apart from the performance of funeral rites or as a depository for the remains of the dead, or offers any indignity to any human corpse, or causes disturbance to any persons assembled for the performance of funeral ceremonies, shall be punished with imprisonment of either description for a term which may extend to one year, or with fine, or with both.” Also, organs or tissues of a dead person can be harvested as defined under the Transplantation of Human Organs and Tissues Rules, 2014. For most organs and tissues, the time between death and donation is 12 to 36 hours. The approximate maximum time span between recovering organs/tissues and transplantation for the following organs/tissues is: Lung (4-6 hours); Heart (4-6 hours); Liver (24 hours); Pancreas (24 hours); Kidney (72 hours); Corneas (14 days); Bone (5 years); Skin (5 years); Heart valves (10 years). A dead body is living as long as organs can be harvested and the dead body deserve to be treated with respect and dignity… Vedic texts describe five different movement forces in the body: apana vayu expulses urine, stool, baby and menses; samana vayu controls the intestinal movements; vyana vayu controls the circulatory system; udana vayu controls the neurological impulses and the connection between soul and spirit and prana vayu controls the brain stem reflexes. The Soul or consciousness is linked to udana vayu and prana vayu. According to the Chandokya Upanishad, at the time of death, the Prana Vayu (life force and respiration) merges with Udana Vayu (brain stem reflexes) and leaves the body. But this does not happen immediately after clinical death, which is defined as stoppage of heart and respiration. Except for cornea many organs can be harvested for donation after a person has been declared as brain dead. The vital organs of the body such as the heart, lungs, liver, intestine, kidneys can be kept viable for some time, if a brain-dead person is kept on a ventilator to maintain oxygenation of organs, so that organs remain viable till they are harvested. This is because the body has normal Prana Vavy, Samana Vayu and Apana vavy. The patient will maintain blood pressure, GI functions, urinary functions and reproductive functions. The life force resides in each one of us… This vital force is the soul, Atman or consciousness. To summarise, a living person has a right to live with dignity so does a dead body with retrievable organs and tissues (as it is considered still a living body) and finally the fully dead body, including the mummified body or the cadaver, also needs to be treated with dignity

Effective management of summer induced heart problems

Effective management of summer induced heart problems
With the onset of summer, heart patients are at increased risk of heart failure due to excessive dehydration and heat exhaustion New Delhi, March 26, 2017: With the onset of summer, more and more cases of heat-induced disorders are being reported in tropical countries like India. The commonest forms of these disorders are: dehydration, heat cramps, heat exhaustion and heat stroke. Given that excessive dehydration and exhaustion can trigger atrial fibrillation and can also precipitate stroke and heart failure in individuals with pre-existing cardiac disorders, raising mass awareness about precautionary measures is crucial. A healthy body temperature is maintained by the nervous system. As the outside temperature increases, the body tries to maintain its normal temperature by transferring heat. Sweating and blood flow to the skin help us keep our bodies cool. Most healthy people tolerate these changes without missing a beat. However, people with damaged or weakened hearts, or older people whose bodies don’t respond as readily to stress as they once did, have a much harder time, and may succumb to heat stroke. 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 that, “Seasonal changes can hamper our health if adequate precautions are not taken particularly by high-risk individuals. People living with high blood pressure, diabetes, cardiac arrhythmias, and elderly patients are more likely to experience problems due to excessive heat during the summer months. Various medications like beta-blockers, ACE-inhibitors, calcium channel blockers that are prescribed to heart patients can also amplify the body’s response to excessive heat. Patients must consult their doctors if they exhibit common symptoms of a heat stroke including altered consciousness, high grade fever, and dry armpit and not passing urine once in 8 hours. One must never stop medicines on their own, as discontinuation of the same can significantly increase the risk of cardiac problems.” “Excessive heat can lead to dehydration, which makes the blood thick and can precipitate a heart attack in patients with uncontrolled blood pressure or diabetes. Exhausting summers can result in the deficiency of body fluid (up to 6 to 8 litters) and sodium or salt. Hence, to combat excessive heat it is advised to drink plenty of water, consume fruits and eat light meals that are easy on your stomach,” added Dr K K Aggarwal. Some tips to prevent summer induced health problems: • Drink plenty of water, fluids and consume fruits • Try to stay away from direct sunlight for long time • Wear light coloured and light weighted clothes as it may trap less heat against the body • Intense and outdoor exercises must be avoided • Avoid consumption of alcoholic and caffeinated beverages as they increases the risk of dehydration due to their diuretic property’ • Elderly people and those taking anti-allergic medicaments must stay away from heat

Sunday 26 March 2017

Rivers declared as living beings…Shouldn’t air be accorded a similar status?

Rivers declared as living beings…Shouldn’t air be accorded a similar status?

In the first of its kind unique decision, the New Zealand parliament passed a bill on March 15 granting a river the same legal rights as a person recognizing it as a living entity. The Whanganui River has been regarded as “an indivisible and living whole” and recognized in their traditions and customs by the local Maori tribe ‘Iwi’, who had struggled to get recognition of the river as an ancestor for more than a century. Two representatives of the river, one from the Maori community and one from the govt, have also been appointed. This decision acknowledged the spiritual connection between the Whanganui Iwi (tribe) and its ancestral river. Just few days later, the Uttarakhand High Court also declared the rivers Ganga and Yamuna as living entities, citing the reference of the case in New Zealand, and accorded them same constitutional and legal rights as a human being, including the right to life. The High Court said that both the rivers have been regarded sacred for centuries. Our ancestors have worshipped nature in all its forms as is evident from the history of India. The five elements of nature - Prithvi (Earth), Jal (Water), Agni (Fire), Vayu (Air) and Aakash (void) – have been depicted as celestial beings or deities in our mythology and ancient scriptures including the Rigveda. The Rivers Ganga and Yamuna have been held sacred since ancient times. They have not only provided physically as source of water but have also provided spiritual sustenance. But, these rivers are now on the verge of losing their existence because of pollution. Human waste, agricultural waste, industrial waste are being dumped into the river without proper treatment. Air pollution too has been making headlines recently. The quality of air has deteriorated over the years, often to dangerous toxic levels that are hazardous to health. Vehicular emissions, fuel wood or biomass burning, crop burning, industrial emissions, construction activities, burning of waste etc. are some of the important sources of air pollution all of which are man-made sources. That there is a need for controlling the air pollution cannot be more emphasized. Recognizing these rivers as a human being means that polluting the rivers would legally amount to harming a human being. And, a case can now be filed against those polluting the rivers. This judgement of the Uttarakhand High Court has paved the way for further such judgements. Shouldn't there be a similar judgement recognizing air as a living entity and give it a legal voice?

IMA Antimicrobial Resistance Initiative

IMA Antimicrobial Resistance Initiative Spurious use of antibiotics has lead to the emergence of pathogens resistant to multiple antimicrobial drugs. New Delhi, March 25, 2017: Use of antibiotics needs to be carefully monitored to curb unnecessary prescription, as we are currently witnessing rising antimicrobial resistance on a global scale. Antibiotics work by targeting specific mechanisms within the microorganisms essential for growth and survival, however, bacteria have certain defense systems that gradually evade these effects, and become resistant. Spurious use of antibiotics can speed up this defense system much faster than we can counteract them. Hence, it is necessary that awareness be raised about global antibiotic resistance and encourage best practices of usage amongst doctors and patients. 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 when the doctor or the patient at fault is when antibiotic usage is concerned. From the physician’s side, over prescription needs to be controlled. Sometimes, these drugs are given as a preventive measure rather than a cure. Moreover, in the interest of being careful, physicians deem it best to prescribe a low dose antibiotic even when the said drug is not clinically required. From the patient’s side, self medication is worrisome. Several of clinically precious antibiotics are available over the counter, and are often taken without a guided instruction about dosage and proper regimen.” “Antibiotic resistance is a global concern. No new class of antibiotics have been discovered or invented during last three decades. We stand at the edge of an imminent ‘post-antibiotic’ era where resistant bacteria can render precious lifesaving drugs obsolete. Medical science is heavily dependent on antibiotics, from treating simple tetanus wounds to complex surgical procedures. If this overusage continues, even simple infections will have the potential to be fatal. It is important that both medical and patient community become more aware about the judicious and just use of these precious drugs”, add Dr K K Aggarwal. Following are some key points: • Refrain from prescribing antibiotics when no bacterial infection exists. • Wrong dose and unnecessarily long treatment schedules can give pathogens multiple chances to develop resistance. • Use National Treatment Guidelines for use of Antibiotics for judicious usage of antimicrobial agents. • No need to use antibiotics in simple cough and colds, mild diarrhea. • Do not indicate strong antibiotics, when a less strong would be as effective. • Patients should not stop antibiotics as soon as their symptoms start improving. Strengthen Infection prevention and control by adopting hand hygiene and hand shake free culture.

Saturday 25 March 2017

8 golden rules to preventing kidney diseases

8 golden rules to preventing kidney diseases Chronic kidney disease, especially end stage or third stage kidney disorders are on the rise in India. New Delhi, March 24, 2017: Chronic kidney disease can strike any one. 17% of urban Indians suffer from kidney disease, as per latest estimates. Diabetes and high blood pressure are the two leading causes which today account for 40–60% cases of CKD in India.
Chronic kidney disease can strike any one. Diabetes and high blood pressure are the two leading causes. Other risk factors for kidney disease include heart disease and a family history of kidney failure—a severe form of kidney disease.
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, “If you have these risk factors, it is important to be screened for kidney disease. That usually involves simple laboratory tests: a urine test to look for kidney damage, and a blood test to measure how well the kidneys are working. The urine test checks for a protein called albumin, which is not routinely detected when your kidneys are healthy. The blood test checks your GFR—glomerular filtration rate. GFR is an estimate of filtering ability of your kidney. A GFR below 60 is a sign of chronic kidney disease. A GFR below 15 is described as kidney failure.”
“Without treatment, kidney disease often gets worse. If your GFR drops below 15, you may feel tired and weak, with nausea, vomiting and itching. By that point, you may need a kidney transplant or dialysis. Optimal hydration is the key to maintaining good kidney health. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body, which in turn, results in a “significantly lower risk” of developing chronic kidney disease. CKD is also associated with metabolic disorders and bone disease and is an important risk factor for peripheral vascular diseases, cardiovascular disease and stroke”, adds Dr K K Aggarwal.
The 8 Golden Rules to avoid or delay reaching the point of kidney failure:
1. Keep fit and active, it helps reduce your blood pressure and on the move for kidney health. 2. Keep regular control of your blood sugar level as about half of people who have diabetes develop kidney damage. 3. Monitor your blood pressure: It is also the most common cause of kidney damage. The normal blood pressure level is 120/80. Between this level and 129/89, you are considered pre-hypertensive and should adopt lifestyle and dietary changes. At 140/90 and above, you should discuss the risks with your doctor and monitor your blood pressure level regularly. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and cardiovascular diseases. 4. Eat healthy and keep your weight in check as this can help prevent diabetes, heart disease and other conditions associated with chronic kidney disease (CKD). Reduce your salt intake. The recommended sodium intake is 5-6 grams of salt per day (around a teaspoon). In order to reduce your salt intake, try and limit the amount of processed and restaurant food and do not add salt to food. It will be easier to control your intake if you prepare the food yourself with fresh ingredients. 5. Maintain a healthy fluid intake: Traditional wisdom has long suggested drinking 1.5 to 2 litres (3 to 4 pints) of water per day. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing chronic kidney disease. But do not advocate “aggressive fluid loading”, which can cause side effects. 6. Do not smoke as it slows the flow of blood to the kidneys. Smoking also increases the risk of kidney cancer by about 50 percent. 7. Do not take over-the-counter pills on a regular basis: drugs like ibuprofen are known to cause kidney damage and disease if taken regularly. 8. Get the kidney function checked if you have one or more of the ‘high risk’ factors.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446915/

Vedic Prescriptions

Vedic Prescriptions Chapter 2: Lessons from Vaidya Sushena A medical doctor is accorded a status next to God as he or she has a duty to heal the sick irrespective of their caste, creed, race or financial status. The classical description of the duty of a doctor was depicted in the Hindi movie ‘Achanak’ starring Vinod Khanna made by Gulzar in 1973. In the movie, Vinod Khanna enacted the character of an army man who loves his wife intensely. He returns home after the 1971 war to find his wife, actress Lily Chakravarti, involved with his close friend. In a fit of emotion, he kills them both. He is sentenced to death but is wounded in an attempt to escape the police. At the hospital, he is looked after by a team of doctors (Om Shivpuri, Asrani) and a nurse (Farida Jalal). They work hard day in and day out to save him from the lethal injury only to hand him over to the police chief (Iftekhar) for the due capital punishment. The story ends with the message that the duty of a doctor is to save the dying man and the duty of a policeman is to award the due deserved capital punishment. Historically, the first known example of medical ethics comes from the epic Ramayana (5000-7500 BC). During the war between Lord Rama and Ravana, Meghnath (brother of Ravana) shot a Brahmastra shakti baan (arrow) that hit Laxmana (brother of Rama) and he became unconscious. Vibhishana informed Sri Rama about the physician, Sushena, who lived in Lanka. Hanumana was asked to bring him. He brought Vaidya Sushena, together with his house. Vaidya Sushena, well aware that he was a physician attached to the kingdom of Ravana, and that treating Lakshmana could end up annoying Ravana, took a conscious ethical decision of treating the wounded Lakshmana. He said that only the ‘Sanjivani Booti’ (an herb found only on Sumeru Hill) could save Laxmana. But that herb grew on Himalayas at a great height and needed to be brought before day break. Then Jambavanta reminded Hanumana that only he could bring back the ‘booti’ before sunrise. He said, “Fly across the ocean to Himalaya Mountains and bring back herbs Mritha Sanjivani, Vishalya karani, Savamakarani and Sandhanakarani.” Hanuman went to Sumeru Hill, which was far, far away from the battlefield. There he found several herbs that looked similar to the ‘Sanjivani Booti’. Confused, Hanumana immediately lifted the Sumeru Hill in his right hand and flew back to the battlefield in Lanka. Thus, Laxmana was saved by Vaidya Sushena who waited by Lakshaman’s side till Hanuman returned with the remedy. Both the above depictions relate to the true message later described in the classical Hippocratic Oath, traditionally taken by physicians pertaining to the ethical practice of medicine. But today many doctors in many countries are ruining the image of the medical profession. They indulge in indiscriminate sex determination, carry out illegal abortions, illegal organ trade etc. We should take lessons from the movie ‘Achanak’ and from Vaidya Sushena who stood by his professional duty and act according to what was right and ethical. Dr KK Aggarwal National President IMA & HCFI

Friday 24 March 2017

World TB Day: Some key messages on TB

World TB Day: Some key messages on TB • India has the highest TB burden country in the world in terms of the absolute numbers of incidence cases each year. Mortality due to TB is the third leading cause of years of life lost (YLLs) lost, in the country. • TB is caused by bacilli spread through droplet nuclei (less than 5 microns) infection. Droplet nuclei can remain suspended in the air for extended periods, and thus are a source of exposure to susceptible individuals. • Split AC is not the right atmosphere for sputum-positive cases. Natural windows and fans are better alternatives. • TB does not spread through handshakes, using public toilets, sharing food and utensils, blood transfusion and casual contact. • TB can be of lungs (pulmonary), or outside the lungs (extra pulmonary). In 85% of cases, lungs are involved. • TB infection and TB disease are not the same; 90% of those infected may not develop TB in their life time. • Although TB is an infectious disease, all cases of TB are not infectious. Only sputum–positive TB patients are infectious to others. • Extra-pulmonary TB is not infectious. • All open TB patients need to immediately identified and treated till they become sputum negative and non-infective. • Most TB-positive patients do not disclose their TB status due to the fear of social stigma and so keep spreading the disease to others. • The public needs to be informed that every open case of TB will cause 15 new cases of TB, if not treated in time. • TB is a curable disease. Full and adequate treatment is important for complete recovery. • About 2-3% of TB cases have primary MDR TB. Whenever MDR TB is suspected, refer the patient to TB specialist • Do not ignore a cough of more than two weeks. • Every cough with or without sputum is not TB. • Any person with symptoms and signs suggestive of TB including cough >2 weeks, fever >2 weeks, significant weight loss, blood in sputum etc. and any abnormality in chest X-ray must be evaluated for TB. • Children with persistent fever and/or cough >2 weeks, loss of weight / no weight gain, and/or contact with pulmonary TB cases must be evaluated for TB. • If the first sputum is positive, a second sample should also be tested; if both are positive, this indicates heavy infection load. • Sputum should always be collected early in the morning as the first sample. Rinse the mouth with water and cough out the sputum. Do not use mouthwash. Move away from people, when collecting the sputum sample. • Patients with TB should dispose their sputum by burning, burying it in the soil or disinfecting them with a disinfectant. • All patient with cough should be provided with simple mask at the reception of a hospital. Doctors should wear N 95 mask for TB prevention • 10% of HIV–positive patients will develop TB every year. • If an elderly develops TB, rule out diabetes and if an elderly develops diabetes, rule out TB. • Rule out TB in every case of uncontrolled diabetes. • A minimum six months of treatment is required for a patient with TB. • In TB meningitis, treatment duration of 9 months is required • Bone TB requires treatment for 9 months. • Diagnosis and treatment for both, drug sensitive and drug resistant TB, under RNTCP, is free of cost. • The first-line drugs used for new TB cases under RNTCP are a combination of rifampicin, isoniazid, ethambutol and pyrazinamide, administered as standardized treatment regimen. Injection Streptomycin is an additional drug given to re-treatment cases. • The main second-line anti-TB drugs for treatment of MDR-TB are kanamycin, levofloxacin, ethionamide, pyrazinamide, ethambutol and cycloserine. • TB drugs are often taken as single dose. Divided doses are not recommended. • It takes up to 15 days for a sputum-positive case to make non-infectious case. The first 15 days before a person becomes non-infectious are most dangerous to the family members as the bacilli is most infectious during this period. • A sputum-positive case, if not treated, remains infective for the coming 2 to 3 years. • If untreated, two-thirds of people with full blown TB will die. • It is very important to trace or track every contact of TB. • If the patient stops treatment within one month, restart the treatment & complete it. • If the patient stops the treatment for more than one month, he/she should be treated as re-treatment case. Cases where the gap in treatment is more than one month should be referred to and treated by TB Specialists. • Treatment of sputum-negative TB is similar to that of a new sputum-positive case. • Treatment of extra pulmonary TB is similar to that of a new sputum-positive case. • Presumptive TB patients without microbiological confirmation (smear microscopy, culture and molecular diagnosis), but with strong clinical and other evidence (e.g. X-ray, Fine Needle Aspiration Cytology (FNAC, histopathology) may be diagnosed as “Probable TB” and should be treated. • In children, anti-TB drugs are to be given as per weight for each child. • Vide letter number Z-28015/2/2012-TB, the Government of India, Ministry of Health and Family Welfare on 7th May 2012 declared TB as a notifiable disease. • Not notifying TB is a violation of MCI Act (5.2, 7.14), Municipal Corporation Act and Sections 269 & 270 of the Indian Penal Code. • In adults starting ATT only on the basis of X-day or tuberculin test may amount to deficiency in service under CPA. • Compliance of treatment should be counseled. Not counseling a patient about compliance may amount to violation of Indian Penal Code under Clauses 269 and 270. • Maintenance of written records in TB care is very important. • Government of India has released Standards for TB Care in India (STCI), an initiative to introduce uniform standards for TB care in all sectors. • Serological tests for TB are banned in the country. • In 2016, Bedaquiline, a new anti-TB drug for treatment of MDR TB was launched as part of the RNTCP. It is being introduced at six identified tertiary care centres across India. • Cartridge Based Nucleic Acid Amplification Test (CBNAAT) was also introduced in the program in 2016. CBNAAT is a rapid molecular test which detects Mycobacterium tuberculosis and rifampicin drug resistance, simultaneously. • IMA plans to open IMA Surveillance Cell, IMA Single Window Disease Surveillance and Adverse Events Reporting Cell under one roof for Notifiable diseases such as TB and other communicable diseases. • IMA is committed to the SDG target (3.3) of ending the epidemic of TB by 2030. Dr KK Aggarwal National President IMA & HCFI

World Tuberculosis Day: prevention, management and treatment of TB

World Tuberculosis Day: prevention, management and treatment of TB
IMA is determined to spread awareness and educate Indians about causes, prevention and management of Tuberculosis New Delhi, March 23, 2017: Every year March 24, is marked as World Tuberculosis Day, to spread awareness and educate people about the prevention and management of tuberculosis (TB). The Day also highlights the success and progress achieved till date in curbing TB. India has the highest TB burden in the world. According to WHO statistics (2014), globally 9 million people are diagnosed with TB out of which 2.2 million cases are reported from India. Around 40% of the Indian population is infected with TB bacteria, and among these TB patients cases of latent TB are significantly higher than active TB cases. Each year 12 lakh Indians are newly diagnosed with TB out of which at least 2.7 lakh Indians die. TB can affect any age, caste or race but poor people and mostly men are at increased risk of TB. Slum dwellers, tribal populations, prisoners and individuals with compromised immune systems are more likely to develop TB, compared to general population. The economic and social burden associated with TB is extremely high in India. It was observed that between 2006 and 2014, TB cost the Indian economy a massive loss of USD 340 billion. 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 that, “Because of lack of awareness, large number of TB cases either go undiagnosed, or if diagnosed, are not treated properly, or treated but not registered to Revised National Tuberculosis Control Program (RNTCP). Tuberculosis is a notifiable disease. IMA is determined to educate its 2.5 lakh members as well as the Indian population about the importance of timely diagnosis, prevention, management and rehabilitation of TB. IMA is determined to bring each and everyone together to help raise a common voice against the growing incidence of TB in our country and hope that we will fulfil the aim of Swachh, Swasth and TB Mukt Bharat.” “Tuberculosis is an extremely contagious disease that is transmitted from one person to another through droplet nuclei, which are less than 5 microns in size. These droplet nuclei can remain suspended in the air for long periods, and thus are a source of exposure to susceptible individuals from the throat and lungs of patients with active respiratory disease. The causative agent of TB is Mycobacterium tuberculosis, which most commonly affects the lungs. The common symptoms of active TB of the lung includes: cough, blood in sputum, chest pain, weakness, weight loss, fever and night sweats. Tuberculosis is a curable disease,” added Dr K K Aggarwal. Some points of importance about TB • Cough of more than 2 weeks, must not be ignored. • Diagnosis and management of TB cases should be done as per the IMA Standards for TB Care in India. • Serological tests for diagnosis of TB are banned in India. • MDR or multidrug drug resistant TB should be treated for at least 24 months. • Proper counseling of all TB patients on cough hygiene, nutrition & treatment adherence must be done.

Thursday 23 March 2017

Vedic Prescriptions

Vedic Prescriptions Chapter 1 - Know your dharma [Dharma the foundation of bioethics] Dharma is the path of righteousness and living one’s life as per the codes of conduct described in Vedas. Its western equivalents might include morality, ethics, virtue, righteousness and purity. The term dharma can best be explained as the “law of being” without which things cannot exist. The word dharma is derived from dhri, which means “to hold”. It literally means “that which holds” the people of this world and the whole creation. The same is described in the Vedic Text, in Atharva Veda as: Prithivim dharmana dhritam, that is, “this world is upheld by dharma”. In Hinduism Dharma is the very foundation of life. Tulsidas the author of Ramcharitmanas, defined the root of dharma as compassion. Buddha also used this principle in his book Dhammapada. According to Hindu philosophy, it’s the GOD which holds us through “Truth” and or “LOVE”. “Dharma prevails” or “truth prevails” is the essence of Hinduism. To achieve good karma, Vedas teaches us that one should live according to dharma (the right action). This involves doing what is right for the individual, the family, the class or caste and for the universe. As per Bhagavat Purana, righteous living or life on a dharmic path has four pillars: Truthfulness (satya), austerity (tap), purity (shauch) and compassion (daya). It further adds that the adharmic or unrighteous life has three vices: Pride (ahankar), contact (sangh), and intoxication (madya). Manusmriti, prescribes ten essential rules for the observance of dharma: Patience (dhriti), forgiveness (kshama), piety or self control (dama), honesty (asteya), sanctity (shauch), control of senses (indraiya-nigrah), reason (dhi), knowledge or learning (vidya), truthfulness (satya) and absence of anger (krodha). Manu further writes, “Non-violence, truth, non-coveting, purity of body and mind, control of senses are the essence of dharma”. In Bhagavad Gita Lord Krishna says that in the society dharma is likely to fall from time to time and to bring dharma back; a GOD representative is born from time to time. The shlokas (parithraanaaya saadhoonaam vinaasaaya cha dhushkr.thaam|dharma-samsthaapanaarthaaya sambhavaami yuge’ yuge’ (Chapter IV - 8) says that “For the protection of the virtuous, for the destruction of evil-doers, and for establishing the rule of righteousness (Dharma), I am born from age to age [in every age]”. Another Shloka “ yada yada hi dharmasya glanir bhavati bharata abhyutthanam adharmasya tadatmanam srjamy aham” means that “Whenever and wherever there is a decline in religious practice, O descendant of Bharata, and a predominant rise of irreligion - at that time I descend Myself”. Deepak Chopra in his book Seven Spiritual Laws of Success talks about the “Law of “Dharma” or Purpose in Life’”. According to Dr Chopra everybody should discover his or her divinity, find the unique talent and serve humanity with it. With this one can generate all the wealth that one wants. According to him when your creative expressions match the needs of your fellow humans, then wealth will spontaneously flow from the un-manifest into the manifest, from the realm of spirit to the world of form. In spiritual terms this is an attempt to find out whether his life is progressing as per the Laws of Dharma (Dharma in Sanskrit means ‘purpose in life’) which, according to the scriptures, is said to be the sole purpose for a human being to manifest in this physical form. To achieve one’ DHARMA Dr Chopra suggests the following exercises: 1. Today I will lovingly nurture the god or goddess in embryo that lies deep within my soul. I will pay attention to the spirit within me that animates both my body and my mind. I will awaken myself to this deep stillness within my heart. I will carry this consciousness of timeless, eternal being in the midst of time-bound experience. 2. I will make a list of my unique talents. Then I will list all of the things I love to do while expressing my unique talents. When I express my unique talents and use them in the service of humanity, I lose track of time and create abundance in my life as well as in the lives of others. 3. I will ask myself daily, “How can I serve?” and “How can I help?” The answers to these questions will allow me to help and serve my fellow human beings with love. Karma, dharma and samsara are three fundamental aspects of the Hinduism. Buddhism, Jainism and Hinduism are all built on this. Dharma is one’s appropriate role or attributes. Karma, measures of how well one performs one’s dharma, explains why one is born where he or she is, why there is suffering and seeming injustices. Samsara, is the continuous round of birth, death and rebirth, and the context for all experience. Dharma sutras from Dharma Shãstras are the basic texts which talks about the morality of individuals and he society. Most India laws are made from these Shãstras. In Jainism, also the wheel of Dharma (Chakra) with 24 spokes represents the religion preached by the 24 Tirthankaras consisting of nonviolence (Ahimsa) and other virtues. The very first word of the Gita is “Dharma”. The Gita concludes with the word “Mama”. The whole of Bhagavad Gita is contained in the two words Mama and Dharma. When you join these two last words it becomes mamadharma, meaning your true Dharma. This is what the Gita teaches. What is your Dharma? How to achieve your dharma 1. Do unto others what you do unto yourself. Satisfy your conscience. That is your Dharma. 2. The word Living Dharma signifies the right action in every moment of the life. 3. Do not follow the dictates of body and do not indiscriminately follow the mind, for the mind is like a mad monkey. Follow the conscience. 4. Practice Random acts of kindness to inculcate the spirit of Dharma. 5. According to many Saints, to do dharma, includes eight-fold path and these are 1. Nonviolence; Control over the Senses; Compassion or daya; Forbearance or Khsma; Peace; Meditation; Penance or Tapas and Truth. 6. The Bhagavad Gita also starts with the phrase, “Dharmakshetre Kuruksetra” which means the battle of dharma and adharma. 7. In Mahabharata, when Duryodhana went to Gandhari, his mother, on the eve of the war, for her benediction. She blessed Duryodhana saying, “Victory will be there, where dharma is.”

Tackling obesity in children

Tackling obesity in children More than 30% people of the society including children have potbelly abdominal obesity. India reportedly witnesses 10 million cases of childhood obesity annually. New Delhi, March 22, 2017: India is witnessing an epidemic of metabolic syndrome, which is characterized by abdominal obesity, high triglyceride, low good cholesterol, high blood pressure and high sugar. Abdominal girth of more than 90 cm in men and 80 cm in women indicates that the person is vulnerable to future heart attack. Normal weight obesity is the new epidemic. A person could be obese even if his body weight was within the normal range. Children with BMI equal to or exceeding the age-gender-specific 95th percentile are defined obese. An extra inch of fat around the abdomen increases the chances of heart disease by 1.5 times. 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 that, “Normally once the height stops growing, most of the organs will also stop growing. The weight of the heart, liver of kidney cannot increase after that. Only muscles can build up to some extent. The only thing, after that stage, which can increase the weight of the body, is deposition of fat. Therefore any weight gain after puberty is invariably due to fat. Though the overall weight can be in the acceptable normal range but any weight gain within that range will be abnormal for that person. One should not gain weight of more than 5 kg after the age of 20 years in males and 18 years in females. After the age of 50, the weight should reduce and not increase.” “Potbelly obesity is linked to eating refined carbohydrates and not animal fats. General obesity is linked to eating animal fats. Refined carbohydrate includes white rice, white maida and white sugar. Brown sugar is better than white sugar. Refined carbohydrates are called bad carbohydrates and animal fat is called bad fat. Trans fat or vanaspati is bad for health. It increases the levels of bad cholesterol and reduces good cholesterol in the body. Reduction in weight can reduce snoring, pain of arthritis, blood pressure and control uncontrolled diabetes”, add Dr K K Aggarwal. Childhood Obesity can further lead to diabetes, high blood pressure and high cholesterol. 70 percent of obese youth had at least one risk factor for cardiovascular disease. Children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as social stigma and poor self-esteem. Following are some key points for tackling obesity in children: 1. Skip carbohydrates once in a week. 2. Combine a sweet food with bitter food (prefer aloomethi over aloomatar). 3. Walk, walk and walk… 4. Consume green bitter items in foods such as karela, methi, palak, bhindi etc. 5. Do not eat trans fats (vanaspati). 6. Do not consume more than 80 ml of soft drink in a day. 7. Do not consume sweets with more than 30% sugar. 8. Avoid maida, rice and white sugar. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859125/

Wednesday 22 March 2017

Obesity in Indian setting

Obesity in Indian setting New Delhi, March 21, 2017: Obesity is considered as a major health problem of the current era. Obesity never comes alone, but always comes associated with bunch of other diseases like diabetes, cardiac and kidney problems, altered liver function, and many others. Obesity, both generalized and abdominal greatly affects Indian populations, but the recent data published online in the Indian Journal of Medical Research, suggests that the abdominal obesity predominates the generalized one. 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 that, “More than 80 % of people living in Delhi-NCR are obese and majority of them don’t realize that they are actually overweight and hence are at increased risk of developing obesity-induced disorders. Thus, it is imperative to increase awareness about causes and ill-effects of obesity so as to reduce the burden of diseases associated with it. “Many people, especially Indians have a misconception that obesity is associated with high standard livelihood (i.e. people from “khate peete khandan se”), due to which the prevalence of obesity increases both in adults as well as in children. Also, it is observed that Indian urban population is comparatively more obese than rural population. Further, it is easy to lose extra body weight but very difficult to maintain it. Hence, self-control, physical activity, healthy food choices, and removal of all kind of misconceptions regarding obesity will improve the quality of life and reduce the obesity-induced mortality rate of Indians” added Dr K K Aggarwal. Causes of obesity: • Unhealthy food choices at work and school • Consumption of calorie-dense less nutritious food items • Sedentary life-style • Genetics: many genes are responsible for causing obesity • Poor socioeconomic status of parents increases the chances of obesity in their children • Sleep apnea or deprivation Some tips to prevent obesity • Overeating must be avoided • Consumption of healthy and highly nutritious food • Intake of large amount of water • Avoidance of western diet • Increased physical activity or exercise is recommended as it burns extra calories • Regular weight monitoring will safeguard from becoming overweight • Proper sleep • Thyroid check: untreated thyroid condition can also lead to obesity

Coffee shops & ATMs may be ideal locations for lifesaving AEDs

Coffee shops & ATMs may be ideal locations for lifesaving AEDs Community coffee shops and automated teller machines (ATMs), might be ideal locations for public access to automated external defibrillators (AEDs), says a new study reported in the American Heart Association’s journal Circulation. Use of publicly accessible AEDs can help to reduce the time to defibrillation in out of hospital cardiac arrests. Public access to defibrillation (PAD) means making AEDs available in public and/or private places where large numbers of people gather or in areas where high risk population lives. PAD programs are a major goal of the AHA to ensure that AEDs and trained lay rescuers are available in public areas where sudden cardiac arrest is likely to occur. This study also attempted to identify areas in the community where AEDs could be placed. In this new study, researchers from Canada evaluated different businesses and municipal locations in Toronto, Canada to find out the best to place AEDs in the community. These were ranked based on the number of cardiac arrests that had occurred within 100 meters of the locations, and when they were open. They found 2,654 publicly located, non-traumatic out-of-hospital cardiac arrests in Toronto from January 2007 to December 2015. Coffee shops from three major chains and ATMs from the five largest Canadian banks occupied eight of the top 10 spots for out-of-hospital cardiac arrest in Toronto and its Downtown area. And, the rankings remained stable over time. Giving cardiopulmonary resuscitation (CPR) and using an AED can greatly increase the chance of survival of a victim of cardiac arrest. Guidelines related to the use of AEDs have maintained early defibrillation as a high priority goal and have called for healthcare providers with a duty to perform CPR to be trained, equipped and authorized to perform defibrillation. In its latest update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care published October 14, 2015 in the journal Circulation the AHA has said, “To reduce the time to defibrillation for cardiac arrest victims, the use of an AED should not be limited to trained individuals only (although training is still recommended). A combination of self-instruction and instructor-led teaching with hands-on training can be considered as an alternative to traditional instructor-led courses for lay providers.” Easy and quick access to AEDs can make a difference of life and death for the victim, who has suffered a sudden cardiac arrest. This has been aptly demonstrated by this study, a sentiment also expressed by Timothy CY Chan, PhD, study author and Canada Research Chair in Novel Optimization and Analytics in Health, University of Toronto in Canada who said, “Health organizations, foundations and policymakers aiming to develop public access defibrillator programs could use our rankings to identify promising businesses to develop partnerships with for AED deployment. Ultimately, we want to get AEDs in the right locations, so they are accessible when needed most.” (Source: AHA Press Release, March 20, 2017)

Tuesday 21 March 2017

Recurrent kidney stones: IMA guidelines

Recurrent kidney stones: IMA guidelines
About half of people who develop a kidney stone will find it recurring at least once at some stage. New Delhi, March 20, 2017: Lifetime prevalence of kidney stones is approximately 13% in men and 7% in women. Without treatment, approximately 35% to 50% of those with kidney stones will experience recurrence within 5 years from the first stone. Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA) in a joint statement said, “A stone may cause no problems but often it causes pain. Most kidney stones are small and pass out with the urine. Some stones become stuck in a kidney or in the tube draining urine from the kidney (the ureter). They can then cause persistent symptoms or problems. There are various treatment options to remove a stuck stone. About half of people who have a kidney stone develop another one at a later time in their life. Drinking plenty of water each day may prevent this from happening again (a recurrence).”
“Some stones become stuck in a kidney or in one of the tubes draining urine from a kidney (the ureter) and cause persistent symptoms or problems. In these cases, the pain usually becomes severe and you may need to be admitted to hospital. Sometimes a large stone can completely block the passage of urine down one of the tubes draining urine from the kidney (the ureter). This may lead to infection or damage to the kidney. This is usually avoided, as X-rays or scans will detect a blockage and large stones can be removed.”, adds Dr K K Aggarwal.
Following are some guidelines: • Increase fluid intake to achieve at least 2 L of urine per day. “Increased fluid intake spread throughout the day can decrease stone recurrence by at least half with virtually no side effects. However, people who already drink the recommended amount of liquids, or when increased fluid intake is contraindicated, should not increase their fluid intake. • Available evidence shows no difference between intake of tap water or intake of a specific brand of mineral water in preventing kidney stones. • If drinking increased amounts of water is ineffective in preventing kidney stones, one may try pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol. These three types of drugs effectively reduced recurrence of composite calcium stones in patients who had a history of two or more stones. Combination therapy is no more effective than monotherapy. All these drugs were associated with adverse events. For thiazides, these were orthostasis, gastrointestinal upset, erectile dysfunction, fatigue, and muscle symptoms. Citrates are associated with gastrointestinal symptoms and allopurinol with rash, acute gout, and leukopenia. • Patients should reduce intake of colas and other soft drinks acidified with phosphoric acid, as lower consumption is linked to lower risk for stone recurrence. • Fruit-flavored soft drinks can be taken as they are often acidified with citric acid. • Patients should reduce consumption of dietary oxalate, typically found in chocolate, beets, nuts, rhubarb, spinach, strawberries, tea, and wheat bran. • Patients should eat less dietary animal protein and purines. • Patients should maintain normal dietary calcium.

Avoid weight gain at younger age to stay healthy in your old age

Avoid weight gain at younger age to stay healthy in your old age
Results of the Chicago Healthy Aging study presented at the recent American Heart Association's (AHA) Epidemiology and Prevention | Lifestyle and Cardiometabolic Health 2017 Scientific Sessions in Portland, Oregon show that significant weight gain over time as well as obesity and overweight in younger age result in poor physical performance in older age.
Researchers from Northwestern University in Chicago, Illinois evaluated 1,325 men and women who were initially examined in 1967-73 and then re-examined in 2007-10 in the Chicago Healthy Aging study. The mean age at baseline was 33 years and at follow-up was 71 years, when muscle strength (hand grip) and performance (4m gait speed and Short Physical Performance Battery [SPPB]) were measured.
The short physical performance battery (SPPB) measures static balance, gait speed, and getting in and out of a chair and has been used to monitor function in older people. The scores range from 0 (worst performance) to 12 (best performance).
At follow-up, subjects who were initially overweight and had gained the most weight (> 20lbs) were more likely to have a low SPPB score, slow walking speed (gait speed <0.8 m/s), or sex-specific handgrip strength (ORs: 4.55, 4.58, and 1.86, respectively) vs those study participants who had normal weight at baseline with minimal weight change (-10lbs to 20lbs), independent of other risk factors for cardiovascular disease.
Results of this study highlights the fact that prevention is better than cure. And preventive efforts of lifestyle diseases such as heart disease, obesity, type 2 diabetes and osteoporosis should start at a young age.
Normal weight obesity is the new epidemic of the society. A person can be obese even if the body weight is within the normal range. An extra inch of fat around the abdomen can increase the chances of heart disease by 1.5 times. A waist circumference of more than 90 cm in men and 80 cm in women increases the risk of future heart attacks. Normal weight obesity is also associated with the same health risks as does somebody who is overweight and obese.
Any weight gain after puberty is invariably due to fat. Though the overall weight can be in the acceptable normal range but any weight gain within that range will be abnormal for that person. Therefore, any individual who gains weight of more than 5 kg after the age of 18 years in girls and 20 years in boys is obese and overweight. Any weight gain at this age should be avoided. After the age of 50, the weight should reduce and not increase.
To live more than 80 years without lifestyle diseases, keep your abdominal circumference, lower blood pressure, LDL (bad) cholesterol, pulse rate and fasting sugar all lower than 80. Dr KK Aggarwal National President IMA and HCFI

Monday 20 March 2017

Painkillers may increase risk of cardiac arrest

Painkillers may increase risk of cardiac arrest Pain is one of the most common presenting complaints of patients. And, painkillers are the most widely used drugs, whether taken OTC or prescribed. But, they have side-effects and their adverse effects on GIT, kidney, heart and liver have been well-documented. Now a new research published in the March 2017 issue of European Heart Journal - Cardiovascular Pharmacotherapy has shown an association of non-steroidal anti-inflammatory drugs (NSAIDs), especialy diclofenac and ibuprofen, to increased risk of out-of-hospital cardiac arrest. All patients who had an out-of-hospital cardiac arrest in Denmark between 2001 and 2010 were identified from the nationwide Danish Cardiac Arrest Registry. Data was collected on all redeemed prescriptions for NSAIDs from Danish pharmacies since 1995. These included the non-selective NSAIDs (diclofenac, naproxen, ibuprofen), and COX-2 selective inhibitors (rofecoxib, celecoxib). A total of 28,947 patients had an out-of-hospital cardiac arrest in Denmark during the 10-year period. Of these, 3,376 were treated with an NSAID up to 30 days before the event. Ibuprofen and diclofenac were the most commonly used NSAIDs, making up 51% and 22% of total NSAID use, respectively. Use of any NSAID was associated with a 31% increased risk of cardiac arrest. Diclofenac and ibuprofen were associated with a 50% and 31% increased risk, respectively. Naproxen, celecoxib and rofecoxib were not associated with the occurrence of cardiac arrest, probably due to a low number of events. It is a common perception amongst the public that OTC drugs are safe because they are available over the counter. However, this study further highlights the fact that though available without a doctor’s prescription, OTC drug does not mean that it can be taken without a doctor’s advice. If not taken as directed, painkillers can cause side effects, at times potentially dangerous. (Source: ESC Press release, March 15, 2017)

Have a healthy breakfast to reduce the risk of diabetes

Have a healthy breakfast to reduce the risk of diabetes

Eating a healthy breakfast decreases the risk of developing type 2 diabetes


New Delhi, March 19, 2017:  American Diabetes Association repeatedly emphasizes on the importance of starting the day with a healthy breakfast to help prevent the onset of type 2 diabetes and effectively manage all types of diabetes to avoid complications.


Diabetes is a huge and growing burden: while 382 million people were living with diabetes in 2016 that number is expected to balloon to almost 600 million people by 2035. Diabetes is fast gaining the status of a potential epidemic in India with more than 62 million diabetic individuals currently diagnosed with the disease.

Up to 11% of total healthcare expenditure in every country across the globe could be saved by tackling the preventable risk factors for type 2 diabetes and over 70% of type 2 diabetes cases can be prevented or delayed by adopting healthier lifestyles.


*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,
“On average, breakfast skippers snack more often, eat more sugary, high-fat snacks, drink more soda, are more likely to overeat at night, and are more often overweight or obese than breakfast eaters. Either way, breakfast is
especially important for people with diabetes. For someone on insulin, if there's no food on board, that person runs the risk of hypoglycemia or lowblood sugar.”

 “A healthy diet containing leafy vegetables, fresh fruit, whole grains,lean meat, fish and nuts can help reduce a person’s risk of type 2 diabetes and avoid complications in people with diabetes. A healthy diet is, more
expensive than an unhealthy one. The wide availability of cheap energydense low-nutrient food is contributing to the global epidemic of type 2 diabetes. Foods which reduce the risk of type 2 diabetes such as
vegetables, fresh fruit, whole grains and unsaturated fats need to be moreaffordable and more widely available”, adds *Dr K K Aggarwal.*

The best breakfasts are low in carbohydrates and fat, and high in protein and fiber. Ideally, you should get between 7 and 10 grams of fiber at breakfast, which will fill you up. Breakfast that has protein added in it
is what creates that satiety and prevents snacking later on.

Following are some healthy breakfast options for those with diabetes or those looking to prevent it:

   - Missi Roti: Rich in dietary fiber and a chromium reserve which helps    in diabetes control.
   - Barley Soup: It is rich in fiber and has more essential nutrient than    refined grains.
   - Vegetable omelet: High satiety index and low on glycemic index
   - Ragi Uttapam: Rich in calcium and essential nutrients.
   - Brown Bread and Brown Rice: Have low glycemic index than white rice,    also a good source of dietary fiber
   - Go for natural sweeteners like jiggery, anjeer or salvia. The sugar in    these products is fiber bound and hence healthy.

Sunday 19 March 2017

Write drug names in capital letters to avoid prescription errors

Write drug names in capital letters to avoid prescription errors Doctors are known to have poor handwriting and they also use abbreviations in their prescriptions. As a result, quite often, prescriptions may be unreadable and it is often said that only chemists could decipher a doctor’s prescription. This is an area that needs to be addressed by doctors as illegible prescriptions may be misread and wrongly dispensed, often with disastrous consequences. A report ‘Preventing Medication Errors’ from the Institute of Medicine (IOM) published in 2006 said, “In hospitals, errors are common during every step of the medication process—procuring the drug, prescribing it, dispensing it, administering it, and monitoring its impact—but they occur most frequently during the prescribing and administering stages.” Beneficence and nonmaleficence along with patient autonomy and justice constitute the four guiding tenets of medical ethics. Patients come to us when they are sick and as clinicians, we are trained to use our skills and knowledge to diagnose and treat them. This is the principle of beneficence ‘do good’ complemented by that of 'non-maleficence' i.e. to do no harm. The fiduciary nature of the doctor-patient relationship places an ethical obligation on the doctor to always put the interests of the patient first. To reduce prescription errors, the Medical Council of India (MCI) has issued guidelines that require doctors to write in capital letters to that the writing is legible. In September 2016, MCI revised its code of ethics notified as Indian Medical Council (Professional Conduct, Etiquette and Ethics) (Amendment) Regulations, 2016 – Part – I. this revision required doctors to write the generic names of drugs and in capital letters so that the drugs prescribed could be easily read and dispensed. The notification read as follows: In Chapter 1-B-Duties and responsibilities of the Physician in general, Clause – 1.5 under the heading – Use of Generic names of drugs, the following shall be substituted: “Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs.” IMA welcomes the new MCI gazette notification asking doctors to prescribe generic medicine in capital letters but clarifies it further. “Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs”. Here are some examples of common prescription errors and how to avoid them. • Always spell the drug: Always spell the drug if you are giving telephonic instructions. Sound-alike drugs can cause confusion. o E.g. the patient received Isoprin IV in place of Isoptin and nearly died. o E.g. Amlopress AT/80mg; a hypertensive called up his family physician who asked him to take amlopress AT but the patient took amlopress 80 mg. After sometime he developed dizziness, flushing, palpitation, nausea, abdominal pain. • Never write ‘U’ to abbreviate the word ‘units’: Do not write ‘U’ for units when writing prescription. Always write the complete word ‘units’. It may be mistaken as zero. E.g. never write 4U insulin. The patient may be given 40 units of insulin when the doctor meant 4 U (4 units). • Never write the numeric after a decimal point: The use of a trailing zero after a decimal point when writing prescription may lead to medication errors. E.g. do not write 3.0 mg. There are chances that the patient may get 50 mg; 5.0 mistaken as 50 mg if the decimal point is not seen. • Always write the numeric 0 before the decimal point: Always add a leading zero when writing dose of a drug, which is less than one. Lack of a leading zero may lead to a decimal point being missed. For example, never write .25 mg; instead write 0.25 mg. Otherwise there are chances the patient may take 25 mg in the first instance itself. • 8-2-8 mistake: The time interval should be written more clearly as 8am 2pm 8pm. Or, the patient may consider it to be the number of tablets to be taken 8 in the morning, 2 in the afternoon and again 8 at night