Gut microbiome may hold the key to predicting PTSD

Gut microbiome may hold the key to predicting PTSD

PTSD is one of the many serious mental health conditions affecting the Indian population

New Delhi, 30 October 2017: A recent study has indicated that gut bacteria can help predict the risk of developing post-traumatic stress disorder (PTSD) after experiencing a life-threatening trauma. Microbes in the gut microbiome have an important role to play inmetabolizing food and medicine, as also fighting infections. Studies have now found that the gut microbiome also influences the brain and brain function. This is possible by the production of neurotransmitters/hormones, immune-regulating molecules and bacterial toxins.[1]

Statistics indicate that about 13.7% of India's general population suffers from a variety of mental illnesses, one of which is PTSD. Of these, 10.6%need immediate medical intervention.[2]PTSD is a mental health condition triggered by a terrifying event — either experiencing it or witnessing it.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “The symptoms of PTSD may start within a month of some traumatic event. However, many a time, these may not be evident until after a year. PTSD can impact a person’s social, personal, and professional life alike. It can also interfere with their ability to do normal daily tasks. Although PTSD has been traditionally regarded as a psychological disorder, studies now indicate that it should be considered a systemic disorder and not just a psychological disorder. This is because, this condition is associated with several comorbidities independent of exposure to trauma. Most people going through traumatic events may have temporary difficulty adjusting and coping. However, with time and good self-care, they usually get better.”

The symptoms of this condition are generally grouped into four categories: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. These can vary with time and from person to person.

Adding further, Dr Aggarwal, said, “If left untreated, PTSD can put a person at the risk for developing other health problems such as depression, eating disorders, drug or alcohol abuse, suicidal thoughts, and cardiovascular diseases. If diagnosed in time, this condition and its symptoms can be managed well with a combination of psychotherapy and medication. It is also important to reach out to people or join support groups which can offer counselling and therapy.”

Some tips for those with PTSD to help manage the condition and symptoms include the following.

• Stay connected with family, friends or someone with whom you can share how you feel. Spending time with loved ones can bring solace and help in healing.
• If you feel you cannot talk to family or friends, it is a good idea to approach a psychologist who can understand your problem and give some coping tips.
• Some form of physical activity everyday can help in distracting you from disturbing emotions and increase feelings of being in control again.
• In addition to physical activity, make sure you consume a balanced diet, read, listen to music, take up a new hobby, or indulge in an activity that is of your interest.
• Ensure that you do not self-medicate. Alcohol or drugs can make the problem worse. It is also a good idea to avoid caffeine and nicotine, which can worsen anxiety.
• Turn to techniques such as yoga and meditation which will help you cope with stress. 

IPC Sections 88 and 92 protect doctors against any professional liability for acts done in good faith

IPC Sections 88 and 92 protect doctors against any professional liability for acts done in good faith

The Indian Penal Code (IPC) has provisions for defenses for doctors under sections 88 and 92, which protect doctors from allegations of negligence, for instance, when treatment given in an emergency or a cardiopulmonary resuscitation (CPR) done is not successful.

Section 88 IPC provides for exemption for acts not intended to cause death, done by consent in good faith for person’s benefit: “Nothing which is not intended to cause death, is an offence by reason of any harm which it may cause, or be intended by the doer to cause, or be known by the doer to be likely to cause, to any person for whose benefit it is done in good faith, and who has given a consent, whether express or implied, to suffer that harm, or to take the risk of that harm”.

The illustration accompanying this section explains it further: “A, a surgeon, knowing that a particular operation is likely to cause the death of Z, who suffers under a painful complaint, but not intending to cause Z’s death and intending in good faith, Z’s benefit performs that operation on Z, with Z’s consent. A has committed no offence”.

Section 92 provides for acts done in good faith for benefit of a person without con­sent but with provisos: “Nothing is an offence by reason of any harm which it may cause to a person for whose benefit it is done in good faith, even without that person’s consent, if the circumstances are such that it is impossible for that person to signify consent, or if that person is incapable of giving consent, and has no guardian or other person in lawful charge of him from whom it is possible to obtain consent in time for the thing to be done with benefit: Provided—

·         (First) That this exception shall not extend to the intentional causing of death, or the attempting to cause death;

·         (Secondly) That this exception shall not extend to the doing of anything which the person doing it knows to be likely to cause death, for any purpose other than the preventing of death or grievous hurt, or the curing of any grievous disease or infirmi¬ty;

·         (Thirdly) That this exception shall not extend to the voluntary causing of hurt, or to the attempting to cause hurt, for any purpose other than the preventing of death or hurt;

·         (Fourthly) That this exception shall not extend to the abetment of any offence, to the committing of which offence it would not extend”.

Illustration ‘c’ of this section is important for doctors. “A, a surgeon, sees a child suffer an accident which is likely to prove fatal unless an operation be immediately performed. There is no time to apply to the child’s guardian. A performs the operation in spite of the entreaties of the child, intending, in good faith, the child’s benefit. A has committed no offence”.

In Kusum Sharma & Ors vs Batra Hospital &Med Research on 10 February, 2010, the Hon’ble Supreme Court also observed as follows:

“The Indian Penal Code has taken care to ensure that people who act in good faith should not be punished. Sections 88, 92 and 370 of the Indian Penal Code give adequate protection to the professional and particularly medical professionals… It is our bounden duty and obligation of the civil society to ensure that the medical professionals are not unnecessary harassed or humiliated so that they can perform their professional duties without fear and apprehension. The medical practitioners at times also have to be saved from such a class of complainants who use criminal process as a tool for pressurizing the medical professionals/hospitals particularly private hospitals or clinics for extracting uncalled for compensation. Such malicious proceedings deserve to be discarded against the medical practitioners… The medical professionals are entitled to get protection so long as they perform their duties with reasonable skill and competence and in the interest of the patients. The interest and welfare of the patients have to be paramount for the medical professionals”.

Both Sections 88 and 92 protect the doctor against any professional liability or allegations of medical negligence, in situations when acts done for the benefit of the patient, with or without his consent, do not have the desired outcome. These sections provide that any act done in good faith is not negligence. Doctors should be aware of these sections as a defense against cases of negligence filed against them.

New ADA Recommendations on language for diabetes care and education

New ADA Recommendations on language for diabetes care and education 

Dr KK Aggarwal

The importance of communication can never be emphasized enough, especially for a doctor. Communication, rather lack of it, or miscommunication is often the root cause of disputes, including those involving doctors and patients.

Avoid the 3 Cs of violent communication: Condemn, criticize and complaint. A positive communication approach is more productive and improves adherence to treatment and patient satisfaction with better therapeutic outcomes. This is very important in cases of chronic diseases such as diabetes. Lifestyle modifications are an integral part of management of type 2 diabetes, which is a lifestyle disorder. Patients have to become accustomed to living with a disease. Therefore, they not only need treatment from their doctor, they also look to them for empathy and support in adjusting to a new lifestyle.

The language that doctors and other healthcare professionals involved in treatment use to discuss the disease may impact both self-perception and treatment outcomes for people living with diabetes.

The American Diabetes Association (ADA) and the American Association of Diabetes Educators (AADE) have published a Consensus Report to help guide the language used by healthcare providers to be positive, respectful, inclusive, person-centered and strengths-based, acknowledging the paradigm shift in diabetes care toward a collaborative approach that includes people with diabetes as the primary member of their care team.

The task force made five key recommendations for discussing diabetes:

1. Use language that is neutral, nonjudgmental, and based on facts, actions, or physiology/biology
2. Use language that is free from stigma
3. Use language that is strengths-based, respectful, inclusive and imparts hope 
4. Use language that fosters collaboration between patients and providers
5. Use language that is person-centered

The Consensus Report titled “The Use of Language in Diabetes Care and Education” is published online October 17, 2017 in the journal Diabetes Care.

(Source: ADA News Release, October 17, 2017)

Adequate intake of Vitamin D can prevent the risk of Type 1 diabetes in children

Adequate intake of Vitamin D can prevent the risk of Type 1 diabetes in children

It can also lower the risk of developing islet autoimmunity

New Delhi, 29 October 2017: A recent research indicates that children receiving higher levels of Vitamin D during infancy and childhood have significantly lower risk of developing islet autoimmunity as well as Type 1 diabetes. The incidence of Type 1 diabetes is increasing by about 3% to 5% annually worldwide. Statistics indicate that over 80% of people in India are deficient in Vitamin D. Vitamin D represents a candidate protective factor for Type 1 diabetes as it regulates the immune system and autoimmunity.

Islet autoimmunity is detected by antibodies that appear when the immune system attacks the islet cells in the pancreas that produce insulin. This is a precursor to Type 1 diabetes. Type 1 diabetes in children requires consistent care. However, advances in blood sugar monitoring and insulin delivery have improved the daily management of the condition.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Although the exact cause of Type 1 diabetes is unknown, in most people the body's immune system mistakenly destroys insulin-producing (islet) cells in the pancreas. Genetics and environmental factors have a role to play in this process. Insulin has a critical role – that of moving glucose from the bloodstream to the body's cells. When food is digested, glucose enters the bloodstream. Once the islet cells are destroyed, very little or no insulin is produced. This causes glucose to build up in the bloodstream, where it can cause life-threatening complications. Type 1 diabetes develops gradually, but the symptoms may seem to come on suddenly.”

One of the early signs of diabetes in children is increased urination and thirst. Some other warning signs include fatigue, changes in vision, fruity smelling breath, extreme hunger and unexplained weight loss, and unusual behavior such as being more moody or restless than normal.

Adding further, Dr Aggarwal, said, “While it may not be possible to prevent this condition entirely, it is possible to reduce complications by helping your child maintain good blood sugar control as much as possible; teaching them the importance of eating a healthy diet and participating in regular physical activity; and scheduling a yearly eye exam beginning no more than five years after the initial diabetes diagnosis. This condition requires lifelong treatment and includes blood sugar monitoring, insulin therapy, healthy eating, and regular exercise.”

In Type 1 diabetes, tight control of blood sugar can prevent diabetes complications. Some other preventive tips for those with Type 1 diabetes include the following.

• Choose healthy foods to share.
• Take a brisk walk together every day.
• Talk with your family about your health and your family’s risk of diabetes and heart disease.
• If you smoke, seek help to quit.
• Make changes to reduce your risk for diabetes and its complications — for yourself, your families and for future generations.

Follow the principle of ‘Sarvodaya’ to live on for generations into the future

Follow the principle of ‘Sarvodaya’ to live on for generations into the future

Dr KK Aggarwal

The four Purusharth (Dharma, Artha, Kama and Moksha) are the basic purposes of life. Purushartha in Vedic text denote positive effort or action. Purushartha stands for actions (self-effort) - righteous action (dharma) and righteous earning (artha) - based on morality, ethics and religious obligations with the ultimate goal being to attain Moksha or inner happiness.

How long do you want to live after death?

How long you are remembered after death depends on how long will your actions last for.

Will it last for just this one generation? Will it last for three generations (one lifetime), will it last for seven generations (around 170 years, if we consider one generation to be 25 years), or will it last for more than seven generations?

What can you do so that people remember you even after your death?

Prakriti is when a person lives for himself or when his actions are centered towards oneself. Sanskriti is when one lives for the sake of others and vikriti is nothing but distortion in one’s living. Greed is a type of vikriti, which can make a ‘nar’ a ‘narbhakshi’ and later ‘nar rakshas. On the other hand, if a person works towards sanskriti, it can convert him or her ‘nar’ to ‘narottam’ and from ‘narottam’ to ‘Narain’.

The basic fundamental principle of Vedas is also based on Sarvodaya. The aim in life, therefore, should be to work not for oneself but for the welfare of the others. These people gradually start working for themselves often for the family, society, nation and universe respectively.

Lord Buddha also said that any action done should follow the rule that it is directed for the welfare of all. Sarvodaya is also at the core of the Gandhian Philosophy as propagated by Mahatma Gandhi.

Making a discovery or invention, postage stamp, winning National awards, heading a national body, become the prime minister of your country – these also put your name in history, which is passed on from generation to generation.

This is also how vidya or knowledge is passed on from generation to generation.

Every action has a reaction. This is the law of karma. Hence, every action of ours must be done taking into consideration its impact on the generations to come.

The soul never dies and so do your Sanskars and good work done. The aim of life should be that one should live even after the death of his or her physical body. It is your good Karmas, which keep your memories alive even after your physical death. Work for the welfare of all, it will last.

The Isha Upanishad has shown the path towards this. The first shloka of Isha Upanishad says:

“Om Isha vāsyam idam sarvam yat kiñ ca jagatyam jagat ||

tena tyaktena bhuñjitha ma grdhah kasyasvid dhanam.”

“Om. All this, whatever moves on the earth, should be covered by the (innermost) Self. Protect your Self through that detachment. Do not covet anybody’s wealth. Or – Do not covet, for whose is wealth?”

The second shloka of Isha Upanishad says:

“Kurvanneveha karmani jijivisecchatam samah ||

evam tvayi nanyatheto’sti na karma lipyate nare.”

“By doing karma, indeed, one should desire to live for a hundred years. For a man, such as you (who wants to live thus), there is no way other from this, whereby karma may not cling to you.”

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

About 1.8 million Indians suffer from stroke every year

About 1.8 million Indians suffer from stroke every year

On World Stroke Day, it is important to create awareness on the fact that timely detection and treatment can prevent permanent disability

New Delhi, 28 October 2017: The second most common cause of death globally, next to coronary artery disease, stroke is also the most prevalent cause of chronic adult disability, reveal statistics. India accounts for more than four-fifths of all strokes with about 1.8 million Indians suffering from this condition every year. The IMA opines that stroke is not just limited to the elderly and increasingly, young Indians below 40 years of age are becoming susceptible to this condition primarily due to lifestyle factors.

A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. It is imperative to detect a stroke early, as with every second that the disease goes untreated, about 32,000 brain cells are damaged.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, ‘Time is brain’. A patient with suspected stroke or ‘brain attack’ should therefore be shifted to hospital at the earliest and given a clot dissolving therapy. A stroke may result from a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). In others, there could be a temporary disruption of blood flow to the brain (transient ischemic attack, or TIA).About 85% of strokes are ischemic in nature. Some common risk factors for stroke in the country include hypertension, diabetes, smoking, and dyslipidemia. These are further insufficiently controlled due to low awareness levels about the disease. Another major challenge in this direction is that treatment for stroke is still evolving in our country.”

The acronym FAST can be used to recognize the warning signs of stroke: face drooping, arm weakness, speech difficulty, and time to emergency. The disabilities caused due to a stroke can be temporary or permanent, depending on how long the brain lacks blood flow and which part is affected.
Adding further, Dr Aggarwal, said, “Stroke is an emergency and getting timely help and treatment is extremely important. Hence, it is very important to act fast to identify these patients. Early treatment improves the chances of recovery. While one cannot control factors such as race, gender, and genetic predisposition, it is possible to make certain lifestyle changes which will go a long way in reducing a person’s chances of getting a stroke at a young age.”

Some tips to prevent a stroke include the following.
Lower your blood pressure levels as a high BP is one of the leading causes for a stroke.
Losing weight can help prevent other associated complications.
Indulge in about 30 minutes of physical activity every day.
Quit smoking and drink in moderation if you must.
Keep your blood sugar levels under control.
Reduce stress through activities such as meditation and yoga. 

Wealth management: Filing Vedic returns (Part 3)

Wealth management: Filing Vedic returns (Part 3)

Dr KK Aggarwal

Every year all of us file our returns for the previous financial year. This is mandatory. Some of us also pay off instalments or EMIs (equated monthly instalment) on loans etc.

It is also important to file our Vedic returns on the total wealth accumulated by us. To reiterate, money alone is not wealth. The eight forms of Goddess Lakshmi or “Ashta Lakshmi” describe our total wealth, as I discussed few days back. All these forms of wealth are also taken into consideration, when one is writing their will.

Evaluation of wealth or value of a company (or your own), also includes evaluation of the people as a resource and the business plan of the company (or your own growth plan). A company’s worth is not just assessed by its assets as they stand today. Five or 10 years down the line will also decide the assets of a company. Here lies the importance of a business plan (or your retirement plan).

If you try to earn without planning, several hardships will come your way. Doing it with meticulous planning gives you ‘effortless earning’ as also described by Dr Deepak Chopra as ‘Law of least effort’ in his book ‘The Seven Spiritual Laws of Success’. He writes “If you observe nature at work, you will see that least effort is expended… And it is human nature to make our dreams manifest into physical form, easily and effortlessly. In Vedic Science, the age-old philosophy of India, this principle is known as the principle of economy of effort, or “do less and accomplish more”.

As per Yoga Sutras of Patanjali, any wealth acquired more than one needs will not allow one to sleep properly.

In a dialogue with King Dhritrashtra in Vidura Niti, Vidura has also included money as a cause of insomnia or sleeplessness. He said, “Sleeplessness overtakes a thief (one has stolen somebody’s money), a lustful person, him that has lost all his wealth, him that has failed to achieve success, and him also that is weak and has been attacked by a strong person”.

Lord Krishna in Bhagavad Gītā said that whatever elders do, others follow the same. If one acquired money out of unfair means, it is likely that the next generation will follow the same

Chanakya in his neeti wrote that the cycle of corruption does not last for more than eight years. According to Chanakya, non-righteously earned money will not last for more than eight years and those who have acquired money by unethical means will have to pay back to the society within eight years.

Ethical earning is a part of ethical medicine. Accepting rebates and commission from diagnostic centers/laboratories and hospitals or fee splitting without involving any service for the referring, recommending or procuring of any patient is unethical. And, any income generated out of such practices is unethical earning

Dharma, Artha, Kama, Moksha are the four basic purposes of life. It means earning righteously with a desire to fulfil the inner happiness. The word ‘Artha’ relates to righteous earning. Any unrighteous earning can put one into danger.

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 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).

File your Vedic returns once a week, once a month or yearly to see if the balance is in the negative or positive. You can choose your birthday to do so, or at Diwali or Chaitra navratri.

Also make a balance sheet of our three debts or rins (Dev Rin, Pitra Rin and Rishi Rin) on the day you choose and pay them if not paid by this time. God or the devtas gave us the consciousness, parents gave us our body and teachers gave us the knowledge or intellect

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

Antibiotic resistance making it difficult to treat diseases

Antibiotic resistance making it difficult to treat diseases

Bacteria causing infections such as gonorrhea are becoming particularly resistant

New Delhi, 27 October 2017: As per recent reports, antibiotic resistance is making gonorrhea ‘much harder and sometimes impossible’ to treat. The report cites data from around 77 countries, one of which is India. About 11.4 million in the southeast Asian Region, including India, are infected with the disease every year. The bacteria that cause gonorrhea are becoming particularly resistant. Every time, a new class of antibiotics is used to treat the infection, the bacteria evolve to resist them.

Gonorrhoea is a sexually transmitted infection also known as the ‘clap’ or ‘drip’. It is caused by the bacterium Neisseria gonorrhoeae, which grows and multiplies easily in the mucous membranes of the body. It can grow in the warm, moist areas of the reproductive tract as also in the mouth, throat, and anus.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Antibiotic resistance is a growing concern and its impact on patients and communities is known to all. This is a public health problem, one which is rapidly spreading across the globe, with not enough resources to control it. Antibiotic resistance has made it harder for us to treat many infections such as typhoid, pneumonia, tuberculosis, and now gonorrhea. Antibiotic resistance prolongs hospitalization, and increases the cost of treatment and the risk of death. Several studies have also corroborated the adverse impact of antibiotic resistance on health. Doctors as well as patients should be aware about and advocate judicious use of antibiotics. Over prescription and self- prescription, both, need to be checked. Taking cognizance of the impact of antibiotic-resistant infections, IMA has proposed several initiatives to tackle this public health threat – “Jaroorat Bhi Hai Kya”, “3A Avoid Antibiotic Abuse campaign”, “Use Wisely not Widely”, “Think Before you Ink”.

The treatment recommendations for gonorrhea have changed substantially during the last few years. Due to a high rate of antimicrobial resistance, fluoroquinolones are no longer recommended to treat gonorrhea.

Adding further, Dr Aggarwal, said, “Improving and adhering to diagnostic tests for various diseases will help curb the inappropriate use of antibiotics, which compromises measures to control antimicrobial resistance. The imminent need of the hour is to address this issue. A coordinated intervention designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the most appropriate antimicrobial drug regimen, dose, duration of therapy, and route of administration.”

The following tips can help in preventing gonorrhea.

Talk with your partner about sexually transmitted infections before starting a sexual relationship. Assess your risks and remember that it is quite possible to be infected with an STI without knowing it.
Avoid sexual contact with anyone who has symptoms of an STI or who may have been exposed to an STI.
Avoid having multiple partners as this can increase your chances of contracting such infections.
Use adequate protection such as condoms to reduce the chances of infections.
Ensure that you take adequate care of hygiene and cleanliness before and after sexual contact.

Wealth management: The Nine Nidhis (Part 2)

Wealth management: The Nine Nidhis (Part 2)
 

Dr KK Aggarwal
 

Our mythology has described nine types of Nidhis (nawanidhi) or treasures or valuable things, which belong to Kubera, the God of wealth. These nine types of treasures or nidhis are: Mahapadma (great lotus flower), Padma (lotus flower), Shankha (conch), Makara (crocodile), Kachchhapa (tortoise), Kumud (a particular precious stone), Kunda (jasmine), Nila (sapphire) and Kharva (dwarf).

Our total wealth is our treasure. Here, wealth does not represent only material wealth, but also other forms of wealth such as knowledge, children, strength, achievements, awards as denoted by the eight forms of Goddess Lakshmi. Each form of wealth can be further classified and subclassified.

Firstly, according to the duration of the wealth 'how long will your wealth last for'. This can be further subclassified into three:

• Will your total wealth be enough for just one generation?
• Will your total wealth last for your seven generations to come?
• Will your total wealth sustain forever 'amar'?

Then there are four negatives attached to wealth or the pursuit of wealth.

• Worry (chinta): One is constantly thinking and worrying about wealth; how to keep your money safe
• Dwarf: Here, dwarf means "hold back normal growth". One is handicapped because of the money e.g. not using it for fear of being caught or using it for negative purposes.
• Miser (kanjoos): One who spends his wealth reluctantly and hoards wealth akin to the 'food hoarding behavior of a rat'.
• Extremely miser (mahakanjoos): One who fears losing his wealth and therefore neither enjoys his wealth himself nor allows anybody to use his wealth.

Each form of wealth also has two positives to it. Ask yourselves: 

• Is your wealth growing sustainably and profitably?
• Is it allowing me to grow and in turn everybody to grow?

A well-thought out investment plan will help your total wealth to grow itself 'auto growth'.

Taken together, all these nine aspects of wealth or the pursuit of wealth constitute the nine nidhis, or nine ways by which total wealth can be viewed as.

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

A more proactive approach needed to combat dengue

A more proactive approach needed to combat dengue

• This is true for other mosquito-borne illnesses as well
• Collective failure needs to be turned into success through community participation

New Delhi, 26 October 2017: As per recent reports, there have been 650 fresh cases of dengue in the capital city of Delhi in the past one week. This has taken the confirmed cases of dengue this year to 5,870. Estimates also indicate that the death toll due to this condition today stands at three. The IMA indicates that dengue is spreading alarmingly in Kerala, West Bengal, and Karnataka; and has taken the form of a mysterious illness in Indore with arthritis. Collectively, we have failed in controlling the mosquito menace.

It has taken over a decade for doctors to understand that dengue 1 and 3 strains are not dangerous and cause only platelet deficiency with thinning of blood. Dengue 2 and 4 strains are dangerous as they lead to platelet destruction along with thickening of blood due to capillary leakage and rise in haematocrit. It is time to convert this biggest failure to success.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Any mosquito container index above 5% requires a community integrated cluster approach for mosquito density reduction together with effective anti-larval measures. Mosquito repellent impregnated mosquito nets are not available to patients. Anti-larval measures; temephos, an organophosphate larvicideteme; and mosquito fish or Gambusia, a freshwater fish also are not available to the common man. There is a need to bring about a paradigm shift in our thinking. We need to over report and act in time. There is no point acting when the cases have started. Often, the civic bodies publicly act in monsoon season. They may be planning ahead but public awareness and public involvement must start much ahead of time. Even the recent CAG report mentions that under reporting of dengue is disastrous to the society. We need to act on all the mosquitos (aedes, culex, and anopheles) and not just on aedesalone.”

All campaigns thus far have focused on a day biter; wearing long sleeved shirts and pants during the day; and that there is no need to use night mosquito nets. However, precautions need to be taken throughout the day as the mosquito only recognizes the light and not the day or night.

Adding further, Dr Aggarwal, said, “It is true that disease spreading mosquitos do not make noise but noise producing nuisance mosquitos unless addressed to will not create a public movement. One must report all the suspected cases and not wait for confirmation of the diagnosis. We have failed because the government has been insisting to notify only ELISA confirmed cases. An SMS should be sent to all doctors practicing in specific areas with a case so that they can become a part of the public health action chain.”

Few other points to be considered include the following.
• Machine reading of platelet count can be defective. There can be an error of 20%. A platelet count of 10,000 by machine reading can mean it is actually 50,000.
• A community approach means that 100% of the society talks about dengue. Every premise must indicate that it is mosquito free. When you are invited to someone’s house, you should ask “I hope your premises are mosquito free”. When you invite, write, “welcome to my house, it is mosquito free”.
• One of the five greatest vows of Jainism is Non-attachment/Non-possession or Aparigraha. It talks about not storing unwanted things. However, in today’s era, our roofs and verandahs are full of left over tyres, utensils, plastic utensils, etc. We buy a new car tyre and keep the old one on our roof top. We need to change this habit.
• We have forgotten to plant Tulsi and Peepal in our premises and stopped the daily Yagna, all which have anti mosquito properties.
• Also, the idea of checking your house once a week needs a change. One needs to be alert every day. It should be a part of your routine. You do not clean your premises once a week. Make it a habit to look for the breeding places.

Wealth management: Eight types of wealth (Part 1)

Wealth management: Eight types of wealth (Part 1)

  Dr KK Aggarwal

Generally speaking, wealth means all assets owned by an individual. Money is commonly used to define or measure wealth, but all wealth is not money. Besides money, knowledge, good health, strength, children, strength among others are also our wealth.

Our wealth or assets can be described by “Ashta Lakshmi”, the eight forms of Goddess Lakshmi, which denote different aspects of wealth.

1.    Dhana Lakshmi: represents wealth in the form of money or riches.

2.    Dhanya Lakshmi: ‘Dhanya’ literally means food grains. This form of Lakshmi represents agricultural income.

3.    Gaja Lakshmi: Represents strength and depicts your ‘sena’ or your team, which helps you to achieve your goals and objectives. They can also be called as ‘gana’, which literally means "flock, troop, multitude, number, tribe, series or class" (Wikipedia).

4.    Santana Lakshmi: Children too are our wealth; they bring us joy and happiness as part of family and represent our future.

5.    Veera or Dhairya Lakshmi: Represents patience, status, courage, character i.e. ‘aura’ of a person - how we tackle the hardships of life. One can sense the positive or negative aura of the person with whom you are talking. Absence of any worries itself creates a healthy aura or a healthy environment around us.

6.    Vijaya Lakshmi: ‘Vijaya’ as we know means victory. This form of Lakshmi represents our achievements and awards other than the material income that we earn.

7.    Vidya Lakshmi: Represents knowledge or ‘vidya’, which is essential for ‘dharma’ - righteous living or the right action. According to the Bhagavat Purana, righteous living or life on a dharmic path has four pillars: truthfulness (satya), austerity (tap), purity (shauch) and compassion (daya).

Manusmriti describes ten essential rules to observe dharma as patience (dhriti), forgiveness (kshama), piety or self-control (dama), honesty (asteya), sanctity (shauch), control of senses (indriya-nigrah), reason (dhi), knowledge or learning (vidya), truthfulness (satya) and absence of anger (krodha).

Maharishi Yagyavalkya, the great Vedic philosopher, had two wives, Maitreyi and Katyayani. In the Brihadaranyaka Upanishad, Maitreyi is described as Yajnavalkya's scholarly wife. Katyayani was a housewife. When Yagnavalkya wanted to divide his assets between his two wives, Maitreyi chose ‘knowledge’, while Katyayani chose material wealth.

8.    Adi or Maha Lakshmi: All the above seven forms of Lakshmi together are called Adi Lakshmi. ‘Adi’ means the beginning or eternity. Adi Lakshmi represents my total wealth so far.

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

Childhood obesity a major public health crisis today

Childhood obesity a major public health crisis today

On World Obesity Day, awareness needs to be created on the fact that small steps at home and school can prevent obesity in children

New Delhi, 25 October 2017: Statistics indicate that India has the second highest number of obese children in the world after China. About 14.4 million children in the country are overweight as per findings. Obesity is the leading cause of many health problems and globally, about 2 billion children and adults suffer from such issues. The rate of increase in obesity among children today is alarmingly high when compared to adults, indicates the IMA.

Childhood obesity can be identified by measuring the Body Mass Index or BMI. Children with a BMI in the range of 85% to 95% are classified as being obese. Overweight and obese children are likely to stay so way into their adulthood. They also stand the chance of developing noncommunicable diseases (NCDs) such as diabetes and cardiovascular diseases at a relatively younger age.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Childhood obesity is increasing worldwide at an alarming pace. India has not been spared either. The prevalence of overweight and obesity in children is steadily increasing. A multifactorial disorder, unhealthy diet – eating foods high in fats, sugar and salt (junk food, processed food) and a sedentary lifestyle contribute significantly to this escalating epidemic. Today, TV, internet, computer and mobile games have taken precedence over outdoor sports. Childhood obesity is well-recognized as a precursor to obesity in adulthood. Most obese children grow up to be obese adults. Overweight and obesity in childhood also predispose children to other lifestyle disorders such as type 2 diabetes, hypertension, dyslipidemia, metabolic syndrome later in life. Hence, there is an urgent need to prevent and control obesity in children.”

Obese children and adolescents are more prone to bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem.

Adding further, Dr Aggarwal, said, “It is important to start inculcating good nutritional habits from the beginning in children. Ensuring enough physical activity right from an early age is an equally important aspect of every child’s growth. Prevention of lifestyle diseases should start early. Schools can help in shaping the lives of students and have a very important role to play in the battle against childhood obesity. Healthy habits in childhood lay a foundation for a healthier adulthood. The IMA’s Aao School Chaleinprogramme aims at this and more.”

Here are some tips that parents can follow at home to tackle obesity and unhealthy habits in children.
• Encourage healthy eating habits right at the onset.
• Try making favorite dishes healthier. Few changes can make even snacks healthier.
• Avoid tempting children with calorie-rich food. It is okay to treat them but in moderation and by limiting high-fat and high-sugar or salty snacks.
• Make kids understand the importance of being physically active.
• Lead by example. Indulge in at least 60 minutes of moderate to intense physical activity every day.
• Reduce sedentary time. While reading is a good option, too much of screen time is not.
• Replace screen time with the outdoors and fun activities to keep children engaged.

Dengue Revisited

Dengue Revisited

Dr KK Aggarwal

Napoleon Hill once said that “Most great people have attained their greatest success just one step beyond their greatest failure.”

It’s time for all of us to convert our biggest failure, to control mosquito menace, into success.

Today dengue is in alarming condition in Kerala, West Bengal, Karnataka and a mysterious illness in Indore (? Zika ? Alpha Virus) with arthritis.

We all must agree that collectively we have failed in controlling the mosquito menace. Any mosquito container index above 5% requires community integrated cluster approach for mosquito density reduction together with effective anti-larval measures. Mosquito repellent impregnated mosquito nets are not available to patients. Anti-larval measures such as temephos (an organophosphate larvicide) and mosquito fish or Gambusia (a freshwater fish) also are not available to a common man.

Then what is the answer? We need a paradigm shift in our thinking.

We need to over report and act in time. There is no point acting when the cases have started. Often the civic bodies publically act during monsoon season. They may be planning ahead but public awareness and public involvement must start much ahead of time. Even the recent CAG report mentions that under reporting of dengue is disastrous to the society.

We need to act on all mosquitos - Aedes, Culex and Anopheles. Acting only on Aedes will not work.

The campaign that “Aedes is a day biter and only breeds in indoor fresh water” will not work. Even if this is true, then by killing Aedes you may end up increasing the density of Culex and malaria causing Anopheles mosquito. But the fact is that Aedes can breed and bite in the evening or night also.

Culex mosquito, which causes filarial and Japanese encephalitis, is already rampant in many states.

Aedes, which causes Chikungunya, West Nile, Zika and Dengue can spread by the bite of infected female Aedes aegypti (indoor) or A. albipecto (outdoor) mosquito. 

It is true that Aedes aegypti are more dangerous because they can fly up to 200 m and only feed on human blood whereas the Aedes albopictus that thrives outdoors can only fly as far as 80 m and feed on animal blood other than human blood. However, the outdoor Aedes cannot be ignored.

  

The entire campaign until now has focused on Aedes being a day biter, wear long sleeved clothing during the day and no need to use night mosquito nets. But precautions need to be taken all through the day. The mosquito only recognizes the light and not day or night.

That the mosquito only breeds in clear water also needs to be re-learnt. Aedes breeds in stagnant water anywhere inside or outside the house. Rain water is the most important source and can collect in any plastic container inside or outside the house. Even collected garbage in open areas can have left over plastic cups or tiny bottle caps with collected rainy water collections providing ideal atmosphere for mosquito breeding.

It is true that disease-spreading mosquitoes do not make noise but noise-producing nuisance mosquitoes unless addressed will not create a public movement.

The law says that dengue and Chikungunya are notifiable diseases, but one can notify within seven days of diagnosis. Aedes mosquito takes up to three meals in a day and by seven days will bite over 21 people in the vicinity. Municipal anti-mosquito and anti-larval actions must occur within hours of its detection. The very purpose of notification is lost if the disease is not notified within hours of even suspected cases.

All suspected cases must be reported without waiting for confirmation of the diagnosis. We have failed because the government has been insisting on notification of only ELISA confirmed cases.

An SMS should be sent to all doctors practicing in that PIN code area with a case so that they can become a part of the public health action chain.

All public health measures should start right when the first case is suspected in a state, colony or house. An SMS should go to the local councillor, MLA, MPs, all practicing doctors, local chemists, NGOs, RWAs, local IMA Branch, State IMA Branch, IMA Headquarters and other Specialty Organizations to join the public health chain efforts.

It has taken over a decade for us doctors to understand that dengue 1 and 3 strains are not dangerous and causes only platelet deficiency with thinning of blood and dengue 2 and 4 strains are dangerous as they lead to platelet destruction along with thickening of blood due to capillary leakage and rise in hematocrit.

Platelet transfusion is not required in absence of active bleeding and thickening of blood. Timely fluid resuscitation is more important and not platelet resuscitation. Remember a raid fall in platelets along with a rapid rise on hematocrit is dangerous and not rapid fall of platelets alone.  

Dengue becomes serious when fever is subsiding. We admit dengue cases with high fever and always are in an urgency to discharge them when fever was subsiding.

Now we know that the machine reading of platelet count can be defective. There can be an error of 20%. A platelet count of 10,000 by machine reading can mean that the platelet count is actually 50,000.

Hospital beds should be reserved only for severe dengue and severe Chikungunya cases. Just because one can claim reimbursement in Mediclaim or PSU, one should not be admitted. If it was the US, Medicare by now would have come out with admission guidelines.

The message has been going that fogging has no answer. But at this stage of container index of > 40, we need not just ground fogging, but also aerial fogging.

When Zika threat came up Brazil, they deployed army to join and made it a public movement. All political parties reach every house during election process then why can’t each one of them reach every house and make the anti-mosquito and anti-larval measures more effective.

Breeding checkers are only with Municipal Corporation and they also have regulatory powers to put fine. We need breeding checkers in private sector also. The Skill development Ministry should start courses so that anyone can hire a breeding checker on weekly basis to check their premises.

Community approach means that 100% of the society talks about dengue. Every premise must write that their premises are mosquito free. When you are invited to someone you should ask “I hope your premises are mosquito free” and when you invite somebody write “Welcome to my house and it is mosquito free”.

Even today most hospitals do not provide mosquito nets to dengue or Chikungunya patients. It is true they may be having anti- larval mesh doors or mesh windows but for secondary prevention of dengue or Chikungunya we need to ensure that medial establishments are certified as mosquito-free.

In flats or apartments, the mosquitoes may be breeding in the roof top belonging to one of the owners and if he is out of station for a holiday, the anti-larval measures may remain deficient. The RWAs may use their powers to check all unoccupied or closed premises including hostels, hotels and construction places in that premises.

One of the five great vows of Jainism is Non-attachment/Non-possession or Aparigraha. It talks about not storing unwanted things. But in today’s era our roofs, verandas and courtyards are full of left over tires, utensils, plastic utensils etc. We buy a new car tire and keep the old one on our roof top. We need to change this habit.

We have forgotten to plant Tulsi and Peepal in our premises and stopped the daily Yagna, all which have anti-mosquito properties.

The new strategy must focus on small collections of water like in bottle caps, finding mosquitoes lower in the room under the table or the bed, to look for them in all three parts of the house roof tops, verandas and inside the rooms, including unused toilets accessories.

Also, the slogan to check your house once a week needs a change. One needs to be alert every day. It should be a part of your daily routine. You do not clean your premises once a week. Make it a habit to look for the breeding places every day.

The innovative approach should be a war against indoor or outdoor mosquitoes; fresh stagnant or dirty water mosquitoes; in small containers like bottle caps or large containers like overhead tankers; made of mud or plastic; throughout the day (early morning fogging when pupa hatch for Aedes, late night for malaria); rub cleaning the utensils

Indian Medical Association (IMA) and Heart Care Foundation of India (HCFI) slogan is “Katwayega to nahi” i.e. whenever you someone ask “I hope your premises are mosquito free”. Also, when you invite somebody at home say, “You are invited at my home and I have checked there are no mosquitos”.

Remember the slogan: “Ghar ke andar or ghar ke bahar; din me or rat me, deewaron ke niche or upar, chote pani or bade pani ke collection me, eggs larve or mosquito, teeno ko maro.”

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