Aging is not bad -- even for blood

Aging is not bad -- even for blood

Dr KK Aggarwal

The view that “when blood transfusions are needed, it may be best to use the freshest blood” is no more true as per McMaster University researchers.

A study of 31,497 patients published in the New England Journal of Medicine of almost 31,500 patients at six hospitals in four countries (Australia, Canada, Israel and the U.S) has shown that having a transfusion with the freshest blood did not reduce the proportion of patients who died in hospital. 

"our study finally puts an end to the question about whether stored blood could be harmful and fresher blood would be better," said Nancy Heddle, lead author and a professor emeritus of medicine for McMaster's Michael G. DeGroote School of Medicine. "Our study provides strong evidence that transfusion of fresh blood does not improve patient outcomes, and this should reassure clinicians that fresher is not better."

Having a supply of stored blood helps to ensure that blood is available when a patient needs it.

The mortality rate was 9.1 per cent with people receiving the freshest blood, and 8.7 per cent among those receiving the oldest blood. 

Advances in blood storage now allow blood to be stored up to 42 days before transfusion and the usual practice is to use up the blood that has been in storage the longest. But, because there are biochemical, structural and functional changes in the blood during storage, there had been concerns about the use of 'older' blood. [source science daily]

Heart Care Foundation of India's (HCFI) annual flagship event, the MTNL Perfect Health Mela, to focus on the global concept of ‘One Health.'

Heart Care Foundation of India's (HCFI) annual flagship event, the MTNL Perfect Health Mela, to focus on the global concept of ‘One Health.' To raise mass health awareness about new age health epidemics like Bird Flu, Swine Flu, Dengue, Zika & Chikungunya The event will be inaugurated tomorrow at the Talkatora Indoor Stadium by none other than Shri Satyendar Jain – Honorable Minister of Health & Family Welfare, Govt. of NCT of Delhi & Dr SY Quraishi – Former Election Commissioner
New Delhi, 24th October 2016 - Heart Care Foundation of India, a leading national non-profit organisation committed to making India a healthier and disease-free nation is all set to roll out its annual flagship event – the 23rd MTNL Perfect Health Mela from Oct 25 – 29 at the Talkatora Indoor Stadium New Delhi.
The global concept of ‘One Health’ recognises that the health of humans is connected to the health of animals and the environment. With this as the event’s theme, a primary focus of the 23rd edition of the Perfect Health Mela is to deliberate, debate and deliver a comprehensive strategy for the National management of new age health epidemics such as bird, flu, chikungunya, zika, malaria, dengue and swine flu.
The Health Mela is a confluence of tradition and modernity and has successfully since the past two and a half decades been working towards creating mass awareness on all aspects of health; using a consumer-driven model as the medium. It is being co-organized in association with the IMA, MTNL, MCD and NDMC, Ministry of Science & Technology and Handicraft, Coca Cola, LIC, AYUSH GOI, DCW, Women & Child Dev., Govt. of Delhi, DTTDC, Johnson & Johnson, Dept. of Environment Delhi Govt., DSACS, DHS, Drugs Control, Family Welfare Delhi Govt. & Delhi AIDS Cancer Society. The five-day event will showcase seminars, on-ground checkups, entertainment programs, lectures, workshops, and competitions all centred around preventive health issues. For the first time ever, the entire Mela will offer a free Wi-Fi zone for all visitors. It will also feature regular webcasts on important preventive health issues. A special webcast on bird flu will be held on Thursday, Oct 27, 2016. A special IMA Godhbharai event will also be organised with a focus on antenatal health. Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President HCFI and President Elect IMA said, "Over the past decade we have seen a drastic rise in diseases closely associated with the environment, humans and animals. For this reason, the focus of this year's MTNL Perfect Health Mela will be ‘One Health'. The most recent scare has been that of Bird Flu, a virus that is rapidly killing birds in the city. While it is a contagious virus that can affect birds and humans alike, there is no need to worry as of yet since this version is a milder one and is unlikely to spread to humans. We thank all our partners and look forward to having large audiences at the event”. Adding to this, Sh Sunil Kumar Director EB & HR, MTNL & Sh N K Joshi ED Delhi, MTNL in a joint statement said, “Mass health awareness programmes such as the Perfect Health Mela are much needed in a country like India where chronic lifestyle diseases and other acquired infections like Swine Flu and Dengue plague the society. Preventive health education is key for a healthy society. We are happy to be associated with the event and will continue to support it in the future as well.” "Initial symptoms of bird flu include high fever, sore throat, abdominal pain, chest pain and diarrhoea. But it can manifest into severe symptoms like respiratory distress and pneumonia leading to death. HCFI & IMA will be coming up with guidelines for health providers and the public on early identification of bird flu cases and ways to avoid the spread of infection through a consensus meeting held at the Perfect Health Mela,” added Dr Aggarwal.
The entry to the MTNL Perfect Health Mela is free for all. To know more about the event, please call on the NGO's helpline number +919958771177.

WMA proposes a comprehensive program to prevent childhood obesity

WMA proposes a comprehensive program to prevent childhood obesity The World Medical Association (WMA) has published a comprehensive program to prevent childhood obesity including consideration of a tax on non-nutritious foods and sugary drinks. WMA has also called on governments to regulate availability of food and beverages of poor nutritional value, particularly in the vicinity of schools by way of regulating price, advertising and labeling of unhealthy foods to combat obesity. According to the WMA, a sedentary lifestyle, unhealthy diets, and lack of exercise are contributing to childhood obesity. In view of this, the WMA Assembly adopted a new statement on ‘Obesity in Children’ at its recent annual Assembly in Taiwan which recommends that schools should incorporate daily physical activity into their daily routine and all children should be encouraged to participate regardless of their economic status. The National Medical Associations should work to raise public awareness about childhood obesity. Physicians should educate parents and children in how to live healthy lives and emphasize the importance of doing so. It’s not only parents and children who need to be educated about childhood obesity, the WMA statement also recognizes that physicians and health professionals should be educated in nutrition assessment, obesity prevention and treatment by strengthening CME activities focused on nutritional medicine. WMA President Dr. Ketan Desai, said: ‘We know there is a link between the extent of advertising and childhood obesity, and so we are recommending that the advertising of non-nutritious products on television be restricted during programmes that appeal to children. Children frequently watch programmes designed for adults, so regulators must ensure that legislation and regulation also limits marketing associated with such programs. ‘We are also urging governments to consider imposing a tax on non-nutritious foods and sugary drinks and to use the additional revenue to fund research into preventing childhood obesity and reducing the resulting disease risk.' IMA Viewpoint • The incidence of metabolic syndrome is rising in urban school children. • This high incidence of metabolic syndrome is contributing to childhood obesity. • Increased consumption of refined carbohydrates – white rice, white sugar, white maida – several times in a day is fuelling the increase in metabolic syndrome. If not checked in time, this will lead to an epidemic of diabetes, hypertension and heart attacks precipitated by obesity. • Avoid replacing saturated fats with refined carbohydrates. • Avoid eating highly refined and processed grains and carbohydrates. • Eat more fresh fruits and vegetables and whole grains. • Stay active.

A proud moment for IMA: Dr Ketan Desai takes over the reins of World Medical Association

A proud moment for IMA: Dr Ketan Desai takes over the reins of World Medical Association

Dr K K Aggarwal and Dr Ved Prakash Mishra

Taipei Taiwan: Indeed a historical moment of which every Indian would feel proud was when Dr Ketan Desai took over the reins of World Medical Association as its President at 10 am on Friday 21^stOctober 2016 at Hotel Grand Hyatt to a thundering applause by the world 

professional fraternity.  

It was a diligent recognition which came way of an illustrious leader who always with passion rendered himself to the cause of medical profession and medical education alike.

His initiatives on several counts got converted into policy frame and have catered to the public interest in a very substantial manner.

Be it National entrance examination test, doctor pharma relationship, enforceable punishment on those who were committing frauds and misrepresentations and rationalizing minimum standards requirements facilitating development of medical schools in the country, he was the torch bearer and the front runner as well.

It was under his initiative that the Government run medical schools in the country were granted a onetime increase in post graduate seats without any onsite verification exclusively based on furnishing of information by increasing the permissible ratio of registered students against a professor post graduate teacher to 1:2. This in one stroke resulted in an increase of well over 2500 post graduate seats in the Government colleges in the country which were and are open and available for meritorious students within their affordable reach.

His stint as President MCI for two terms is known for his steering roles in shaping the face, facet and future of medical education in the country. It was his initiative to put into place competency based post graduate curriculum and also structure out National faculty development program for the full time teaching faculty in medical schools.

It was under his guidance that the National faculty development program resulted in training and orienting full time medical teachers in medical colleges across the country numbering now to well over 30,000 which makes the MCI as the only regulator of medical education to have taken the onus of such a program on its shoulders in an exemplary and emulative manner.

The efforts initiated by him in the Year 2009 to bring transparency in the process of medical admissions ensuring that merit alone turns out to be the sole criteria for admission to the medical courses in the country that the NEET was conceived and structured which ultimately saw the light of the day as an operational reality in the academic year 2016-17 setting to rest all the speculations that came to be raised on the very issue from time to time.

His ascendancy to the highest office of presidency of World Medical Education is neither an accident nor a conjuncture. IMA is an integral part of WMA and is recognized as a valuable member and a partner because of the significant role it has played on wide and varied issues pertaining to medical professionals within and outside the country.

The inputs furnished by IMA on the various issues at the WMA forum have not only been well appreciated but also have resulted in shaping its global perceptive on vital issues pertaining to the medical education, health care delivery systems and practicing of the profession judiciously and ethically.

In his speech Dr Desai rightly evoked the core issue of professional autonomy which in countries like Turkey, UK and India is under threat of subjugation and marginalization as well. This in his opinion was inconsistent with the well set out democratic norms which mandate participative decision making in an accountable manner. Such attempts for whatever reasons and from which ever quarter need to be dealt by an iron hand.

His observations on this count evoked huge cheers from the professional fraternity around the globe present at the installation ceremony.

He equally emphasized the need of making the world terror free. He observed that be it bruised Brussels, traumatized Paris, school children bombarded in Pakistan or deeply injured Uri all are slur in the name of humanity. Terrorism neither has a color, religion, caste or a creed. It is only terrorism alone. There is nothing like good or bad terrorism. In reality it dehumanizes mankind and traumatizes humanity. It has to be abandoned at all costs in the interest of bringing peace and tranquility to this planet in order to make it worthy of living for all times to come.

He strongly brought to fore the ill tendency of resorting to kickbacks for various reasons by the health professionals which on every count is unbecoming on their part. Profession has to be practiced within the tenets of ethicality, morality and judiciousness its sanctity is paramount and needs to be upheld at all costs and independent of consequence.

In the same breath he also emphasized that there is an urgent necessity to protect the health professional from unprovoked assaults and hurts on any and every count.  They need to be accorded required protection and desired insulation.

He categorically stated that those professional who trespass ethical conduct and take recourse to the sex determination resulting in female feticide should be dealt by the penalty of permeant removal of their names from the medical register  and delisting them from practicing the profession for life.

It is such deterrent measures alone which in his opinion could set the otherwise disturbed house in order.

Bringing to fore the importance of Yoga he recorded his appreciation gratitude to Sh Narendra Modi the Honorable Prime Minister of India for bringing Yoga, a parasympathetic lifestyle, on the global platform as a result of which 21^st June has been declared as the World Yoga day by united national organization.

It is only Yogic approach which could be the most cost effective modality for putting into place the preventive and promotive aspects of global health in an affordable and handy manner.

His suggestion to the global partners under the umbrella of WMA  to the effect that time has come where by a serious thought is necessary to structure out a world health keeping force on the lines on which world peace keeping force came to be created.

National Medical Associations across the world that have substantial and huge professional memberships can substantially contribute towards actualization of these perceived realistic needs. This suggestion was very well received by all present there.

World Medical Association President Dr Ketan Desai alarms over political onslaught on medical autonomy

World Medical Association President Dr Ketan Desai alarms over political onslaught on medical autonomy

A strong warning about continued political attempts around the world to marginalise the autonomy and self-governance of the medical profession has been given by the new President of the World Medical Association.

Dr. Ketan Desai, a former President of the Indian Medical Association, was delivering his inaugural speech as President of the WMA at the Association’s annual Assembly in Taiwan.

He told delegates from more than 40 national medical associations: ‘In many countries like Turkey, India, and the United Kingdom, there are continued political attempts to undo or marginalize autonomy and self-governance of the medical profession, including mauling and trampling on the trinity of professional autonomy, clinical independence and self-governance.’

‘Yet professional autonomy is not limited to asking for the privilege to do what we want to do. It is less about physicians and more about patients’ rights. It is the assurance that individual physicians have the freedom to exercise their professional judgment in the care and treatment of their patients without undue influence of any type from any quarter how so powerful and mighty they be’.

‘Regulation of clinical practice, framing evidence-based standard treatment guidelines, defining and checking professional malpractice and medical education all need vital professional independence and a democratic system based on meaningful participative decision making. The WMA has been, is and must continue to be against government attempts to usurp professional independence through bureaucrats and politicians and making the same ‘subservient’, as a part of their calculated nefarious designs.’

He said that in a democratic society, self-governance is an element of horizontal power-sharing and an important pillar of civil society and democracy itself. ‘Doing away with the vital concept of self-governance will not only amount to subverting a valuable element of democracy but end up in devouring the very soul of it.’

Dr. Desai, a urologist and a former President of the Medical Council of India, will serve as President of the WMA for 2016/17.

He emphatically brought out that cross border terrorism anywhere and everywhere needs to be stopped at all costs. Be it the 9/11 terrorist attack in the USA ( twin tower), Mumbai terror attack, traumatized Brussels, victimized Paris, school children massacred in Pakistan, bruised Uri or any other attack Globally disrupts the tranquillity and harmony of the society in an irreparable manner. Terrorism by any name and for any reason is terrorism and terrorism alone.  There is nothing like “good” or “bad” terrorism.  It is a slur on civilization of mankind and hence needs to be dealt with an iron hand and commensurate political will by all the countries in the world.

In his speech, Dr. Desai also called for physicians to receive more protection, whether in war or civil conflict situations. He said physicians were under constant threat throughout the world.

‘They are risking their lives while treating their patients in a committed manner. While on one hand in some parts of the world hospitals are being bombarded, ambulances hijacked, nurses and doctors kidnapped or killed and physicians pressured, threatened and tortured, on the other hand in other parts of the world, especially Asian Countries, doctors are being assaulted and medical establishments attacked and damaged’.

‘The Geneva Convention is practiced more in breach than observance, invariably ending up in flagrant violation of the inviolate human rights’.

‘It is a core commitment of physicians as a part of their basic duty to help patients by their professional knowledge without any distinction or discrimination of any type and magnitude. To a physician, a patient is neither a friend nor an enemy. They legitimately need protection from violence while at work, whether in war or civil conflict situations’.

In a wide-ranging speech, Dr. Desai also warned that professional honesty and integrity were at risk in many countries because physicians were prescribing and referring patients based on pecuniary self-interest or ‘kick backs’. He said the profession should be practices transparently. Physicians should not receive any financial or other consideration for referring patients to laboratories, pharmacies or opticians.

He has emphasised in his speech that perhaps the time has come to seriously think about the need to create a “World Health Keeping Force” on the lines of “World Peace Keeping Force”. By virtue of the fact that National Medical Associations that have substantial membership of Health professionals with them together can jointly go in for creation of such an ‘international health keeping force’ under the aegis of the WMA.

He ended his speech by extolling the virtues of yoga. With the expense of medical care rising and the need for preventive medicine, yoga was a proven way to prevent illness and preserve health. It was totally non-invasive, gentle and soothing and was cost effective. In diligent recognition of the same since last year the United Nations had adopted 21st June as the International Yoga Day.

“IMA National leaders and its 2.7 lakh members congratulate Dr Desai on taking over as the President of the World Medical Association. This is an extremely prestigious post and will allow key issues affecting the Indian healthcare system to be addressed at a global platform”, said Padma Shri Awardee Dr KK Aggarwal – President Elect Indian Medical Association.

All Website Link - http://www.ima-india.org/drdesai/

e-book - http://module.ima-india.org/15102016d/espeech/index.html

Video - http://module.ima-india.org/15102016d/Video.html

Audio - http://module.ima-india.org/15102016d/Audio.html

Photos - http://module.ima-india.org/15102016d/photo/default.htm

Updated clinical practice guidelines for rheumatologic manifestations of Sjögren's syndrome

Updated clinical practice guidelines for rheumatologic manifestations of Sjögren's syndrome

Dr K K Aggarwal The first Clinical Practice Guidelines (CPG) from Sjögren's Syndrome Foundation (SSF) are published online July 7, 2016 in the journal Arthritis Care & Research. Physicians are advised to use nonpharmacologic approaches such as exercise to reduce fatigue in patients with primary Sjögren's syndrome. Pharmacologic therapy should be initiated with the drugs having the lowest potential for adverse effects and then escalated according to clinical response. The guidelines include a decision tree for the use of oral disease-modifying antirheumatic drugs (DMARDs) for inflammatory musculoskeletal pain beginning with hydroxychloroquine (HCQ) and progressing to methotrexate (MTX), then HCQ + MTX, then short-term corticosteroids, then long-term (>1 month) corticosteroids. Use of tumor necrosis factor-α (TNFα) inhibitors for sicca symptoms is strongly discouraged, but they can be considered in patients who also have rheumatoid arthritis (RA) or related conditions. Rituximab can be considered for treating keratoconjunctivitis sicca in primary Sjögren's inadequately controlled by conventional therapies or for xerostomia in patients with primary Sjögren's who have some residual salivary production and significant evidence of oral damage

New consensus statement discourages contralateral prophylactic mastectomy

New consensus statement discourages contralateral prophylactic mastectomy Women diagnosed with breast cancer who are at average risk should be discouraged from undergoing a contralateral prophylactic mastectomy (CPM), because the majority of women will obtain no oncologic benefit, says a new consensus statement from the American Society of Breast Surgeons (ASBrS). The first part of the statement outlines the effect that CPM has on relevant clinical outcomes and which patients might be appropriate candidates for CPM. While, the second part focuses on issues such as how patients feel about CPM. Key recommendations from the position paper are: • Sentinel lymph node surgery on the CPM side should not be routinely performed • CPM is a cost-effective strategy for women with BRCA mutations. At this time, there is insufficient evidence to support the concept of superior cost effectiveness for CPM in women with sporadic breast cancer and the cost effectiveness is highly dependent on the quality of life assumptions. • Women should be counseled on the potential long-term outcomes of CPM on body image and sexuality. • Shared decision making that includes a comprehensive discussion of risks and benefits of CPM is important. • CPM counseling should include discussion of CPM, risks of CPM, rates of CBC, and ensure patients are engaged in the decision making, and making decisions that are concordant with their treatment preferences and personal values The position statements are published online July 28, 2016 in the Annals of Surgical Oncology. (Source: Medscape)

IMA hails PM taking up the cause of medical profession

IMA hails PM taking up the cause of medical profession

Dr K K Aggarwal PM Modi initiates health campaign and asks people to avoid taking antibiotics without the doctor’s prescription In his monthly address to the people of the nation in ‘Mann Ki Baat’, Prime Minister Shri Narendra Modi urged people to not take antibiotics without the prescription of a doctor since resorting to such short cuts to get better soon has been giving rise to new problems. He also asked the citizens to take antibiotics for the entire course prescribed by the doctors and not leave it midway as it can potentially lead to antibiotic resistance. He informed the people that the Government is resolute on stopping the menace of antibiotic resistance and that antibiotic medicine strips are now having a red line to warn the people. He suggested that in order to get well soon, consuming any antibiotic that is available easily, without consulting a doctor, is not a wise choice. While explaining the issue of antibiotic resistance, he stated that random and excessive use of antibiotics makes the causative organisms accustomed to the particular drug, and the drug thus loses its efficacy and utility. This practice of impetuous use of antibiotics thus creates newer problems that require years of research to find out solutions for. Additionally, leaving an antibiotic course, prescribed by a doctor, midway, or continuing it for longer than prescribed, both will harm the patient and help the bacteria. The causative organisms are fast undergoing mutations and rendering the once-effective antibiotics, ineffective now, thus adding to the problem of antibiotic resistance. While antibiotic resistance is a global public health problem, the issue nowhere is it as stark as in India. Resistance to fluoroquinolones among invasive Salmonella Typhi isolates in India was 8% in 2008 that rose to 28% in 2014. And antibiotic use itself is the most significant driving force behind this resistance. In the year 2010, India was the world’s largest consumer of antibiotics for human health, with consumption estimated at 12.9 x 109 units (10.7 units per person). It is high time that we start taking our health seriously and understand that the use of antibiotics without prescription is going to do more harm than good.

Monsoon fever can be deceptive

Monsoon fever can be deceptive

New Delhi, July 31, 2016: Fever during the monsoon season in India can be deceptive as malaria, viruses causing dengue, chikungunya and jaundice, and bacteria causing typhoid can all produce fever in this season, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA.

Following are the Dos and Don’ts to follow if you have fever in the monsoon season:

1. No antibiotic should be started unless a diagnosis of typhoid is confirmed.
2. Cough, eye redness and nasal discharge can also be present in viral disorders.
3.  In dengue, one may have pain with the eye movement.
4.  In chikungunya, patients may have fever, rashes and joint pains. The joint pains will typically increase on compression of the wrist joint.
5. Malaria fever may present with chills and rigors, with no toxemia in between the fever episodes.
6. In jaundice, fever normally disappears by the time jaundice appears clinically.
7. In typhoid, patient looks toxic and the pulse rate may be relatively low compared to the fever.
8. Fever medicines like aspirin should not be given in monsoon season as many fevers may have low platelet counts.
9. Most viral disorders are self–limiting and resolve within a week.
10.  In most monsoon related viral disorders, treatment is adequate hydration.
11. Fever in the setting of chronic medical disease should not be ignored and shown to the doctors at the earliest.

Monsoon season is the time to give our child a de–worming tablet

Monsoon season is the time to give our child a de–worming tablet New Delhi, July 30, 2016: During the monsoons, most of the worms in the soil come up to the surface and infect the vegetables. The associated humidity also leads to more breeding of house flies and mosquitoes.
It is thus important to ensure that all fruits and vegetables, are washed thoroughly with clean water and if needed Potassium Permanganate is added to them during the monsoon season to prevent illnesses, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA.
Round worms are normally present in the soil and good sanitation is required to prevent their fecal contamination, which is often impossible in the monsoon season. Washing hands before meals and drinking boiled water can reduce the risk of round worm infection; but, in the India scenario, the same may not be possible.
The easiest way is to give your child a de–worming tablet 3–4 times in a year.
Treatment of school-going children with single dose of de–worming tablet every 3–4 months has been advocated in many countries. In a study conducted in Zanzibar, a single dose of mebandazole tablet given three times a year reduced round worm infection by 97%.

AAP updates guidelines for fetal alcohol spectrum disorders

AAP updates guidelines for fetal alcohol spectrum disorders The American Academy of Pediatrics (AAP) has updated guidelines to diagnose fetal alcohol spectrum disorders, published online July 27, 2016 in the journal Pediatrics. The new guidelines recommend evaluation of maternal alcohol consumption and that she should be interviewed carefully. Begin with more general questions about the child's health and then narrowing the focus to alcohol during and before pregnancy. The definition of alcohol exposure may include at least 6 drinks per week during at least 2 weeks of pregnancy, or at least 3 drinks per occasion on 2 or more occasions. Facial features should be evaluated. A positive result includes 2 of the following 3 criteria: short palpebral fissures, smooth philtrum, and thin vermilion border of the upper lip. If either facial features or maternal alcohol intake are positive, a neuropsychology evaluation is recommended. The guidelines also include a time line of the emergence of different developmental deficits, giving information on what to look for in infants, toddlers, and school-age children (Source: Medscape)

Obsessively yours: Signs That You May Have OCD New Delhi, July 26, 2016: Obsessive–compulsive disorder (OCD) is a disabling and potentially chronic anxiety disorder and is characterized by anxiety–provoking intrusive thoughts and repetitive behaviors, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Obsessions may consist of aggressive thoughts and impulses, fears of contamination by germs or dirt, or fears of harm befalling someone. Compulsions such as washing, checking, or counting are rituals whose purpose is to neutralize or reverse the fears. OCD occurs in 2 to 3 percent of the population. People with OCD have uncontrolled thoughts that compel them to develop habits or rituals to ease their anxiousness. The Anxiety Disorders Association of America offers this list of potential warning signs of OCD: • Persistent irrational fears or concerns, commonly about being dirty or getting sick. • Obsessing about things being in order or arranged a certain way. • Being afraid that your thoughts or actions will cause harm to you or someone else. • Hoarding objects with no value. • Irrational doubts or fears that you will harm someone else. • Impulsively and repeatedly cleaning your body or your home. • Repeatedly checking something, such as if the doors are locked, appliances are unplugged or the stove is turned off. • Habits such as repeatedly saying a word or a name, or walking in the same place or in the same way. • Constantly re–living conversations, repeating words or counting.

Today is World Head & Neck Cancer Day

Today is World Head & Neck Cancer Day Dear Colleague We are all aware that Head-Neck Cancer is among the most common cancers in the Indian subcontinent. Head and Neck Squamous Cell Carcinoma (HNSCC) with a global incidence of over 500,000 cases and 200,000 deaths annually is the leading cause of mortality and disability in many parts of the world. In India also it accounts for nearly 1.5 lakh cases every year. It mainly affects people in the productive age group, yet most of this mortality and morbidity is preventable. The burden of HNSCC is putting a strain on our national health care systems and impoverishing individuals, families and society. The International Federation of Head & Neck Oncologic Societies (IFHNOS) has declared to observe 27th July as "World Head & Neck Cancer Day (WHNCD)" to draw the world’s attention on effective care and control of HNSCC, for all to work together and also to reduce use of Tobacco- the most prevalent but preventable cause of Head & Neck Cancer. The move is supported by many Head Neck Societies around the globe, numerous Governments, UICC and civil society organizations. IFHNOS is a global organization established through cooperation of national and regional Societies and Organizations in the Specialty of Head and Neck Surgery and Oncology with membership from national and regional multidisciplinary organizations, representing 65 countries. The purpose of the Federation is to provide a common platform for Specialists in the field of Head and Neck Cancer to interact in professional matters of mutual interest. IFHNOS declared 27th July as World Head & Neck Cancer Day on the occasion of its 5th World Congress in New York on 27th July 2014, the largest gathering of Head and Neck Cancer specialists in history. Oral Cancers are often associated with smoking and alcohol use, however, oropharyngeal cancers (cancer of back or base of tongue and tonsils are associated with human papilloma virus and marijuana use as well as smoking and alcohol use. WHNCD targets two areas: • Advocacy for strengthening health care system and introduce community-based approaches for awareness, risks, prevention and early detection of HNSCC. • Enhance expertise of physicians by upgrading their knowledge and skills through CME programs. WHNCD activities can be :- o Educating the physicians on early diagnosis, current treatment paradigms and frontiers in research in Head and Neck Cancer o Awareness programs for the general public. o Free screening for Head and Neck cancers. o Interaction with cancer survivors and their families. o Interaction with government and policy makers. Involvement of newspaper and electronic media, other NGOs and Government representatives in the programs will give wide publicity and spread awareness too. IMA supports this International movement to increase awareness, promote education & training in early diagnosis and treatment of this imminently preventable cancer. (Contributions from Dr Dilip Kumar Acharya, Chairman-IMA National Cancer & Tobacco Control Committee)

Sexual activity in patients with cardiovascular disease

Sexual activity in patients with cardiovascular disease New Delhi, July 23, 2016: “Heart patients and paralysis survivors can resume usual sexual activity as soon as they feel that they are ready and comfortable with the idea”, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. After recovery from a heart attack or stroke, patients may feel depressed, which is normal, and in 85% of cases it goes away within three months. If a person can walk one kilometre or climb two flights of stairs without any discomfort in the chest or breathlessness, he or she can resume normal sexual activity without any cardiac risk. The first-onset of erectile dysfunction after the age of 40 may be an indication of underlying coronary blockages. Penile blockages go hand in hand with blockages in the channels supplying blood to the heart. Viagra-like drugs are a boon for heart patients as they can improve blood circulation to the male penile organ helping men perform better in bed. However, patients on nitrates must not consume any such drug as a combination of Nitrate and Viagra like drugs can drastically lower one’s blood pressure and prove to be fatal. Heart patients who are unstable, have not had a relationship with their partner for years or are not mentally ready should not indulge in sexual activity with their parnet while using Viagra-like drugs without medical supervision. Any unaccustomed exercise, in patients with underlying coronary blockages that may be silent, can precipitate a heart attack and sudden cardiac death.

India is yaws, maternal/ neonatal tetanus/ Polio / Guinea Worm/ Small Pox free.

India is yaws, maternal/ neonatal tetanus/ Polio / Guinea Worm/ Small Pox free.

Dr K K Aggarwal

This is the strength of Modern Medicine. 1. In May 2016 WHO certified India yaws-free. India is the first country under the 2012 WHO neglected tropical diseases (NTD) roadmap to eliminate yaws, a disease known to affect the most underserved population. It is said ‘where the road ends, yaws begins’. 2. Until a few decades ago the country reported 150 000 to 200 000 neonatal tetanus cases annually. After India’s success in MNTE (maternal and neonatal tetanus elimination), Indonesia was validated for the same on 18 May this year. With this the entire WHO South-East Asia Region has achieved elimination of maternal and neonatal tetanus. WHO SEAR is the second WHO region, after European Region, to achieve MNTE. Indonesia and Timor-Leste are now the only remaining countries with yaws transmission in the WHO South-East Asia Region. 3. India is already Polio free 4. Guinea Worm disease free in February 2000 5. Smallpox free

India is yaws, maternal/ neonatal tetanus/ Polio / Guinea Worm/ Small Pox free.

India is yaws, maternal/ neonatal tetanus/ Polio / Guinea Worm/ Small Pox free.

Dr K K Aggarwal

This is the strength of Modern Medicine. 1. In May 2016 WHO certified India yaws-free. India is the first country under the 2012 WHO neglected tropical diseases (NTD) roadmap to eliminate yaws, a disease known to affect the most underserved population. It is said ‘where the road ends, yaws begins’. 2. Until a few decades ago the country reported 150 000 to 200 000 neonatal tetanus cases annually. After India’s success in MNTE (maternal and neonatal tetanus elimination), Indonesia was validated for the same on 18 May this year. With this the entire WHO South-East Asia Region has achieved elimination of maternal and neonatal tetanus. WHO SEAR is the second WHO region, after European Region, to achieve MNTE. Indonesia and Timor-Leste are now the only remaining countries with yaws transmission in the WHO South-East Asia Region. 3. India is already Polio free 4. Guinea Worm disease free in February 2000 5. Smallpox free

Burnout syndrome: A Critical Care Societies Collaborative call-to-action statement

Burnout syndrome: A Critical Care Societies Collaborative call-to-action statement Critical care health care professionals have one of the highest rates of burnout syndrome (BOS), compared with other health care professionals, according to a Critical Care Societies Collaborative call-to-action statement published in the July 2016 issue of the journal Chest. The statement has categorized risk factors by personal characteristics, organizational factors, quality of working relationships and exposure to end-of-life issues and calls for healthy ICU work environments that ultimately improve patients’ quality of care. The Critical Care Societies Collaborative (CCSC) comprises four major US professional and scientific societies: the American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society, and the Society of Critical Care Medicine. The statement reviews the diagnostic criteria, prevalence, causative factors and consequences of BOS along with potential interventions that may be used to prevent and treat BOS. • BOS occurs due to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. • The outcomes include increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. • BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. • Being self-critical, engaging in unhelpful coping strategies, sleep deprivation and a work-life imbalance have been identified as some of the personal traits associated with BOS. • Other personal risk factors associated with BOS are idealism, perfectionism and overcommitment, qualities that are often found in the best and most productive employees. • Critical care health-care professionals and their friends and family should be able to recognize the features of BOS and each critical care health-care professional should be personally responsible for managing their own BOS symptoms and related consequences • ICU teams should improve their ability to function as a group, respect each other, and reduce triggers of BOS. • ICU leaders should implement programs that identify and manage employees with BOS. • Hospitals should provide assistance programs for employees with (or at risk for) BOS and other psychological disorders such as PTSD. • Hospitals or clinical practices should consider limiting the number of consecutive days that a critical care health-care professional works, while promoting healthy sleep habits and the importance of sleep recovery. • Professional societies should educate and inform their members about BOS and other psychological disorders that impair the mental and physical health of their members, reduce the quality of care of their patients, and may deter trainees from entering their specific field.

Traffic noise linked to increased risk of heart attack

Traffic noise linked to increased risk of heart attack Traffic noise has been known to trigger stress reactions. If you live near a highway, you are at a greater risk of heart attack. Results of a case–control study based on secondary data published 17th June, 2016 in the journal Deutsches Arzteblatt International show that the risk of heart attack increases with the amount of exposure to traffic noise. This increase in risk was found to be greatest with road and rail traffic noise and less with aircraft noise. The evaluation was performed on the basis of the continuous 24-hour noise level and the categorized noise level (in 5 decibel classes). The study compared data from 19,632 patients from the Rhine-Main region of Germany who were diagnosed with myocardial infarction in the years 2006–2010 with 834,734 controls. Their exposure to aircraft, road and rail traffic in 2005 was matched to their residences. Analysing data specifically for those who died of heart attack up to 2014-15, a statistically significant risk increase due to road noise (2.8% per 10 dB rise) and railroad noise (2.3% per 10 dB rise) was observed, but not airplane noise. The author suggest that this may be due to the fact that with aircraft noise, unlike road and rail traffic noise, a continuous noise level above 65 dB did not occur; hence, the low risk association with aircraft noise. This study is part of the Europe-wide NORAH (Noise-Related Annoyance, Cognition, and Health) study investigating the health consequences of traffic noise.

Frequent urination at night: look for snoring

Frequent urination at night: look for snoring New Delhi, July 14, 2016: "Frequent urination at night, a condition called nocturia, is common among snorers with obstructive sleep apnea (cessation of respiration during sleep)," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Nocturia is the need to void two or more times each night. In obstructive sleep apnea, soft tissues at the back of the throat temporarily collapse during sleep causing brief moments in which the patient stops breathing. The disorder can cause daytime sleepiness and can be effectively treated with a breathing device called CPAP that pushes air into the throat to prevent the tissues from collapsing. Quoting a Japanese study published in the journal Urology by Dr. Yoji Moriyama, Dr Aggarwal said that nocturia is present in 41% of patients with sleep apnea. The risk of nocturia is directly related to the severity of sleep apnea and the association is particularly strong in patients younger than 50 years of age. Snorers at risk of sudden death Interrupted nighttime breathing because of sleep apnea increases the risk of death. Sleep apnea is a common problem in which one has pauses in breathing or shallow breath during sleep. Studies have linked sleep apnea during snoring to increased risk of death. A study published in the edition of Sleep suggests that the risk is present among all people with obstructive sleep apnea. The study showed a sixfold increase which means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who doesn't have sleep apnea. For the Busselton Health Study, the team collected data on 380 men and women, between 40 and 65 years of age. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow-up, about 33% of those with moderate-to-severe sleep apnea died, compared with 6.5% of those with mild sleep apnea and 7.7% of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly linked to the condition. People who have, or suspect that they have sleep apnea, should consult their physicians about diagnosis and treatment options

Poor hygiene habits may lead to Typhoid fever

Poor hygiene habits may lead to Typhoid fever New Delhi, July 11, 2016: "Typhoid fever is caused by a bacterium called Salmonella typhi and is transmitted via ingestion of food or drink that has been contaminated by the feces or urine of infected people," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Flying insects feeding on feces may occasionally transfer the bacteria through poor public sanitation conditions. Though the cases occur round the year, more cases are seen during summer and rainy seasons. Symptoms usually develop 1–3 weeks after exposure, and may be mild or severe. They include high fever, malaise, headache, constipation or diarrhea and enlarged spleen and liver. A healthy carrier state may follow acute illness. This fever can be treated with antibiotics. However, resistance to common antimicrobials is widespread. Healthy carriers should be excluded from handling food. Sanitation and hygiene are the critical measures that can be taken to prevent typhoid. Few salient facts about Typhoid fever • Typhoid does not affect animals and therefore transmission is only from human to human. • Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water. • Careful food preparation and washing of hands are crucial to preventing typhoid. • Typhoid fever in most cases is not fatal. • Prompt treatment of the disease with antibiotics reduces the fatality rate to approximately 1%. • When untreated, typhoid fever persists for three weeks to a month. • Resistance to common antibiotics is now common • Typhoid that is resistant to common antibiotics is known as multidrug-resistant typhoid (MDR typhoid). • Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia. • Azithromycin is a new drug for drug-resistant typhoid. • Typhoid vaccine taken every three years is the best preventive approach. • All school children should take typhoid vaccine every 3 years. • Typhoid prevention sutra: heat it, boil it, cook it, peel it or forgot it