Treatment gap and social stigma, the biggest barriers for those with epilepsy

Treatment gap and social stigma, the biggest barriers for those with epilepsy 

Need to remove misconceptions and myths associated with the condition

New Delhi, 17^th November 2017: About 80% of those with epilepsy live in low and middle-income countries, as per reports by a global health body(WHO). Over 50 million people around the world suffer from this condition and about three-fourth of these live in low- and middle-income countries. The ‘treatment gap’ and the social stigma associated with the disorder in India further exacerbate conditions for people with epilepsy.

Epilepsy is a chronic disorder of brain characterized by recurrent ‘seizures’ or ‘fits’. The seizures are caused due to sudden, excessive electrical discharges in the neurons (brain cells). The condition can affect people at any age and each age group has unique concerns and problems.

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 International League Against Epilepsy (ILAE) has expanded the definition of epilepsy to incorporate a single unprovoked seizure with a probability of future seizures. The new definition also specifies that epilepsy can be considered ‘resolved’ if a patient has been seizure-free for 10 years, with no seizure medicines for the last 5 years. The previous definition stipulated that a patient needs to have 2 unprovoked seizures more than 24 hours apart. Epilepsy is mostly treatable with medications. The critical thing about epilepsy is that treatment should not be delayed. Start the treatment as soon as it is diagnosed. This prevents further deterioration of the condition.”

Some causative factors for epilepsy include brain damage from prenatal and perinatal injury, congenital abnormalities, brain infections, stroke and brain tumors, head injury/accidents, and prolonged high fever during childhood.

Adding further, Dr Aggarwal, said, “A lot of progress has been made in the country for treating epilepsy and controlling the onset of seizures. Many effective new anti-epileptic drugs are available in the market today. India also many centres that offer treatment facility for this condition. Only mass awareness can dispel the associated myths with epilepsy. It is important to create awareness that those with epilepsy can lead a normal life, get married, have children, and even work. This is not a contagious condition and does not spread through contact.”

One of the major reasons for incomplete control of seizures is non-compliance. Some tips to prevent onset of seizures and the condition from getting worse are as follows:

• Adhere to the prescribed medication
• Following a regular sleep cycle to remain stress-free
• Keep yourself hydrated
• Eat a balanced diet
• Get regular medical checkups done

Findings of DAWN trial may influence treatment of stroke

Findings of DAWN trial may influence treatment of stroke

Results of the DAWN trial published in the New England Journal of Medicine shows that clot removal up to 24 hours after stroke led to significantly reduced disability for properly selected patients.

The international multi-center DAWN trial randomized 206 patients of acute stroke who arrived at the hospital within six to 24 hours to either standard medical therapy alone or to endovascular clot removal therapy plus standard care.

It is currently recommended that clot removal should be done only within 6 hours of stroke onset of stroke.

Patients were selected for the trial based on brain imaging (diffusion-weighted MRI or perfusion CT) to assess the extent of irreversible brain damage plus clinical criteria to help decide if thrombectomy would help the patient even if he/she arrives after 6 hours but within 24 hours, rather than just using the 6-hour window as the cut-off.

Almost 50% of patients with stroke due to occlusion of the intracranial internal carotid artery or proximal middle cerebral artery and who had a mismatch between the severity of the clinical deficit and the infarct volume, who underwent clot removal reported significant decrease in disability at 90 days post- treatment. On the other hand, only 13.1% patients who received medical treatment showed such reduction in disability. Decrease in disability means more independence in activities of daily life. Mortality and other safety end-points were similar between the two groups.  

“Time is brain”. The trial abides by this and re-emphasizes the importance of reaching the hospital as early as possible after the onset of stroke. The findings of the trial though may influence management of some selected patients who present to the hospital late, outside the 6-hour window period. “Patients with a clinical deficit that is disproportionately severe relative to the infarct volume may benefit from late thrombectomy.”

The DAWN trial is published online November 11, 2017 in the New England Journal of Medicine.

Treatment for cerebral palsy currently limited to palliative care in India

Treatment for cerebral palsy currently limited to palliative care in India

Lack of oxygen during labor and pregnancy for the fetus is probably one of the reasons

New Delhi, 11 November 2017: There are about 25 lakh children and adults in India with cerebral palsy (CP). The incidence of this condition around the world is 2 to 2.5 cases per 1000 live births. In most people with CP, the cause is unknown, and the condition has no known cure. As per the IMA, the treatment options for this disorder in India is currently limited to palliative care

CP is an umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development (i.e., up to 5 years). It includes various kinds of disabilities such as difficulty in coordinated and alternate movements, abnormal movements and postures, and difficulty in keeping the body in antigravity postures.

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, “Cerebral palsy may only be mild and cause only a slight disruption to a person’s daily life. It can also be more severe, affecting the whole body and may significantly impact how a person participates in daily activities. There are three predominant types of cerebral palsy and each are characterized by different movement patterns. Movements can be uncontrolled or unpredictable, muscles can be stiff or tight and in some cases people have shaky movements or tremors. Most people with cerebral palsy have a normal life expectancy. The damage to the brain that causes cerebral palsy does not progress (get worse) as the person gets older. This condition is also not contagious.”

Some signs and symptoms of this condition include overdeveloped or underdeveloped muscles; poor coordination and balance; involuntary movements; stiff muscles that contract abnormally; crawling in an unusual way; lying down in awkward positions; favoring one side of the body over the other; and a limited range of movement.

Adding further, Dr Aggarwal, said, “Some newborns may be deprived of oxygen during labor and delivery. Research indicates that fewer than 1 in 10 cases of cerebral palsy stem from oxygen deprivation during birth. In most cases, the damage occurs before birth, probably during the first 6 months of pregnancy. People with cerebral palsy have problems with communication and learning. Cerebrum damage can sometimes affect vision and hearing as well.”

Some preventive measures can help reduce the risk of cerebral palsy in children.  A woman who is planning to become pregnant should ensure that all her vaccinations are up-to-date. Additionally, it is important to:

• Attend all antenatal appointments
• Quit alcohol, tobacco, and drugs as they can hamper the fetus in many ways.
• Indulge in regular exercise in consultation with your doctor
• Eat healthy food such as fruits, vegetables, and whole grains.

Updated guidelines for treatment for patients with ventricular arrhythmias

Updated guidelines for treatment for patients with ventricular arrhythmias

Dr KK Aggarwal

The American College of Cardiology (ACC), American Heart Association (AHA) and the Heart Rhythm Society (HRS) have jointly published new guidelines for the management of adults who have ventricular arrhythmias or who are at risk for sudden cardiac death, including diseases and syndromes associated with a risk of sudden cardiac death from ventricular arrhythmias.

According to the guidelines, patients considering implantation of a new ICD or replacement of an existing one should be informed of their individual risk of sudden cardiac death and nonsudden death from heart failure or noncardiac conditions, and the effectiveness and potential complications of the ICD. In patients nearing the end of life from other illness, clinicians should discuss ICD shock deactivation as they reassess their patients’ goals and preferences.

Emphasizing on the role of shared decision making between patients and their doctors, the guidelines say that treatment decisions should also take into consideration, the health goals, preferences, and values of the patients.

The “2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death” have been published online October 30, 2017 in the Journal of the American College of Cardiology, Circulation and HeartRhythm.

(Source: ACC News Release, October 30, 2017)

Every arthritis is different with different treatment methods

Every arthritis is different with different treatment methods

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

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

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

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

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

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

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

Varicose veins is a highly ignored condition

Varicose veins is a highly ignored condition • Timely treatment is imperative to avoid complications • It is better to avoid tight clothes and high heels New Delhi, 11 August 2017: According to a recent study, varicose veins are a growing concern in Indians with about 7% of India's youth suffering from this condition. Women are four times more likely to suffer from this condition than men. As per the IMA, some of the major reasons for varicose veins include a sedentary lifestyle and wearing tight clothes and high heels. Varicose veins are formed when the valves of the superficial veins of the lower limbs get damaged. As a result, blood flow from the lower limbs to the heart is decreased resulting in retention of blood in the veins. It is most commonly found in legs and feet, particularly calves. 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 legs contain multiple valves that help the blood to flow in the direction of the heart. Varicose ulcer can be found in both legs. Blood starts accumulating in the legs, when these valves get damaged, resulting in swelling, pain, fatigue, skin discoloration, itching, and varicosities. This a slow but progressing condition. Although the symptoms are mild in the beginning, people usually delay in getting themselves tested, which can lead to complications that become difficult to treat. It is imperative to treat this condition on time failing which it can develop a non-healing ulcer on the leg.” Some factors that influence the onset of varicose veins are age, sex, genetics, obesity, and the position of legs for longer periods. Ageing can also result in wear and tear of the veins. Pregnancy, pre-menstruation, and menopause are some factors influencing varicose veins in women. Adding further, Dr Aggarwal, said, “There is a lack of awareness in many people about this condition. What is alarming is that this is an under treated disease. Lack of timely treatment can lead to chronic venous insufficiency, venous ulcers, eczema, cosmetic disfigurement, and systemic hypertension. Provided the patient has no symptoms or discomfort, treatment should be accorded on time. Some patients may also undergo treatment for cosmetic reasons.” Certain self-help tips can help in preventing varicose veins. • Get moving Stimulate blood circulation in your legs by taking regular walks. • Control your weight and diet It is important to lose that excess weight to avoid pressure on the legs. Follow a low-salt diet to prevent swelling caused from water retention. • Wear comfortable clothes and footwear Low-heeled help exercise the calf muscles more and are hence, better for the veins. Avoid wearing clothes that are tight around the waist, legs, or groin. • Elevate your legs Take short breaks between work to elevate your legs above the level of your heart. You can lie down with your legs resting on three or four pillows. • Don’t sit or stand for a long time Change your position frequently to encourage blood flow.

Consent Revisited: Inability to manage complications leads to violence

Consent Revisited: Inability to manage complications leads to violence Consent, as we know, is the authorization or grant of permission by the patient for treatment or any diagnostic, surgical or therapeutic procedure to be carried out by the doctor. A doctor has to take consent from the patient before proceeding with his treatment. It is ethical and in today’s scenario, a legal requirement. Any act done without permission is “battery” or physical assault and is liable for punishment. A valid consent has three components: Disclosure, Capacity and Voluntariness i.e. provision of relevant information by the doctor, capacity of the patient to understand the information given and take a decision based on the adequate information without force or coercion. This is informed consent. Any permission given under any unfair or undue pressure makes the consent invalid. The Hon’ble Supreme Court of India has defined ‘adequate information’ in the landmark case of Samira Kohli vs Dr Prabha Manchanda. This includes “(a) nature and procedure of the treatment and its purpose, benefits and effect (b) alternatives if any available (c) an outline of the substantial risks and (d) adverse consequences of refusing treatment.” No doctor practices medicine without taking informed consent. Yet we read and hear of incidents of violence against doctors from all parts of the country. So, are we going wrong somewhere? Are we doing something wrong somewhere? “Medicine is an art based on science”, said Dr. William Osler. Complications, adverse events or untoward incidents may occur at any time during the treatment. What is important here, how competent, we are, as doctors, or how competent is the hospital or the clinical establishment, in managing these complications or untoward incidents in a non-emergent situation. Not being able to manage complications leads to violence. The patient should be informed of every possible complication that may occur during this treatment, however rare they might be; even a complication rate as low as 0.1% might be 100% for that particular patient. No surgery can be called as a ‘minor’ surgery. Mistakes are made, but we believe that nothing will happen either to us or the patient. As I wrote few days back, it’s the case of "Kya pharak padta hai" to "bahut pharak padta hai". If nothing goes wrong, then "chalta hai". But, if something does go wrong or an unanticipated event occurs, then this becomes unacceptable “chalta nahi hai”. The key word here is ‘anticipation’. Anticipate what all can happen in the course of a treatment and be prepared to handle them or keep your patient informed. For example, you may need to shift the patient in an emergency to a higher care center and your establishment does not have an ambulance. Outsourcing an ambulance will delay patient transportation, and in an emergency situation, the longer the delay, more agitated are the patients or family members and may become violent. Let’s take another example. You might need the services of a specialist, say a urologist, neurosurgeon, or a nephrologist. If your hospital does not have these specialty doctors on its staff, then subsequent delays in procuring their services will increase risk of violence. Should you have these services and other such facilities as standby? Yes, everything must be on standby. The standby fee is 25%, while presence fee is 100%. This may increase the cost of treatment. The time has come when the patient must know that safety comes at a price in bigger hospitals. Inform the patient and the family members beforehand, let the patient choose and accordingly the consent should be taken. Safety of the patient is very important and should be our primary objective. A small set-up may not have all facilities as their bigger and better equipped counterparts. These smaller set-ups should keep the patient and/or family members informed about this lack of facilities and take consent. Good communication can reduce the rapidly increasing problem of violent attacks on doctors and healthcare establishments. ‘Adequate information’ for consent should include not only the competency of the doctor to treat the case, but also include the competency of the doctor and/or the hospital to manage any emergencies or untoward incident in a non-emergent situation. Any breach in this duty is negligence. This, I believe, is an area which we need to work on. It is the inability to manage complications that leads to violence. As doctors we SERVE our patients and the community and provide • Service which we have professionally trained for, which is • Excellent i.e. anticipated • Responsible, give our 100% to the patients and take responsibility • Value – Group; each member of the group knows the duties of another, so no gap in service may result • Enthusiasm: A positive happy atmosphere This is how we can avoid incidents of assault and violent attacks on doctors from happening. Dr KK Aggarwal National President IMA & HCFI Recipient of Padma Shri, Dr BC Roy National Award,Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO) Past Honorary Secretary General IMA Past Senior National Vice President IMA President Heart Care Foundation of India Gold Medallist Nagpur University Limca Book of Record Holder in CPR 10 Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand Editor in Chief IJCP Group of Publications & eMedinewS Member Ethics Committee Medical Council of India (2013-14) Chairman Ethics Committee Delhi Medical Council (2009-15) Elected Member Delhi Medical Council (2004-2009) Chairman IMSA Delhi Chapter (March 10- March 13) Director IMA AKN Sinha Institute (08-09) Finance Secretary IMA (07-08) Chairman IMAAMS (06-07) President Delhi Medical Association (05-06)

Patients who trust their doctors more likely to follow treatment

Patients who trust their doctors more likely to follow treatment • Important to restore confidence and trust for the profession in patients • Stringent action must be taken against quacks who are damaging the nobility of the profession New Delhi, 27 June 2017: According to a study conducted recently this year, patients with high blood pressure who had more trust in the medical profession were more likely to take their medication than those with less trust. People with higher levels of trust took their blood pressure medicine 93% of the time versus 82% of the time for those who had lower levels of trust. Additionally, having trust in the medical profession has been linked to greater resilience (ability to adapt to difficult life circumstances) and better health-related quality of life.
In medical practice, the very foundation of the relationship between a doctor and his patient is trust. It is a fiduciary (derivative of the Latin word for 'confidence' or 'trust') relationship. Both sides need to have mutual trust for positive treatment outcomes. However, in the present scenario, this trust is waning away and the doctor–patient relationship is no longer held sacrosanct as before.
Speaking on this issue, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said "A recent survey conducted by the IMA showed that patients expect their doctors to be courteous; almost 90% of patients want their doctors to introduce themselves to patients, acknowledge the patient, give every patient a patient listening, impart complete information about the diagnosis, investigations, and treatment and revise and review what the patient has understood. Patients who do not trust their doctors will not confide in them nor will they be motivated to adhere to the prescribed treatment plan. Modern medicine is patient-centric and based on partnership, where the patient is an equal partner in the diagnostic and therapeutic process. Patients rely on doctors to take care of their health, so trusting the doctor assumes paramount importance. It is essential that doctors are courteous with their patients and explain the management plan in a language that they are able to understand. This is the concept of informed consent."
Lack of communication is a major cause of disputes between doctors and patients today. This can be tackled by the triad of ‘Plan, Communication, and Documentation’, where ‘Plan’ means observations and treatment decided by the doctor. If the same is ‘Communicated’ to the patient, ‘Documented’, and then implemented, there can never be a dispute. Any disparity between a plan and the outcome leads to a dispute.
Defining the ABC of a doctor, Dr Aggarwal further added, "Three components of a good doctor are: Available, Behavior, and Competency. It is important to remember that an available and a well-behaved doctor is much more important than a doctor who is competent. With medical diseases becoming more complex and lifespan increasing, there has never been a more appropriate time for patients to trust their doctors fully. Doctors must remember their oath and make their patients the center of their work. Additionally, the medical community must also take a stand against quacks in order to restore the nobility and integrity of this profession."
To build a successful doctor-patient relationship: • Do what you say: For example, if you have told your patient that you would be late by one hour, make sure that it is only one hour and not later than that • Document what you speak • Preserve what you document

Lack of awareness impediments treatment of Parkinson's disease

Lack of awareness impediments treatment of Parkinson's disease Disease causes 60% to 80% of dopamine-producing cells to become damaged New Delhi, 25 June 2017: According to a report published in the International Journal Of Nutrition, Pharmacology, Neurological Diseases out of every 1, 00,000 people in India, 70 have Parkinson’s disease. What is alarming is that the brain has already lost more than half of its dopamine-producing cells, by the time the characteristic symptoms develop in patients. The symptoms of this disease are so subtle that it can remain undiagnosed for years. Parkinson's disease is a neurodegenerative disorder that is chronic and progressive. It occurs when the nerve cells in the brain stop producing dopamine, a chemical which helps in controlling movement. Dopamine helps in the smooth transmission of messages to different parts of the brain and regulates body movements in healthy adults. When a person develops this disease, about 60% to 80% of the dopamine-producing cells get 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, "The main impediment to managing Parkinson's is the lack of awareness about this condition. This disease generally affects those who are above the age of 60 and the risk increases with age. The symptoms can vary from person to person. Some early stage symptoms include very slight shaking of hands, difficulty in walking and/or postural imbalance. The four key motor symptoms of Parkinson’s disease include tremors (hands, arms, legs, jaw); stiffness or rigidity (arms, legs, trunk); slowness of movement; and postural imbalance (poor balance and coordination). This is a progressive disorder but not life threatening. However, people with Parkinson’s disease may be unable to perform daily movement related functions and eventually stop working due to progressively disabling symptoms." Diagnosis of Parkinson's can be done through a 99mTc-TRODAT-1 SPECT scan of the brain. Early detection is very important in minimizing dopamine loss in the brain and maintaining muscle function. Adding further, Dr Aggarwal, said, "While there is no cure for Parkinson's disease as yet, treatment can definitely help people live a good quality life, provided the diagnosis is done at the right time. The decision to start taking medicine, and which medicine to take, varies from person to person." Tips for people with Parkinson's disease • Simplify daily tasks and set realistic goals. • Plan activities such as household chores, exercise, and recreation well in time. Distribute them throughout the day. • Take some rest before and after any activity. • Do not plan activities right after a meal. Rest for 20 to 30 minutes after each meal. • Divide your work among friends and family. Do not hesitate to ask for help. • Get proper sleep and elevate your head when sleeping. Avoid extreme physical activity or lift heavy objects.

Timely diagnosis of congenital heart disease imperative for right treatment

Timely diagnosis of congenital heart disease imperative for right treatment About 1.8 lakh babies in India are born with congenital heart disease, which may occur due to genetic factors New Delhi, 24 June 2017: About 8 out of every 1000 children in India are born with a congenital heart disease (CHD) resulting in about 1.8 lakh babies born every year with a CHD. Of these, about 60,000 to 90,000 have critical CHD, which requires an immediate intervention. Children with high-risk CHD can die if not diagnosed in time and this makes early diagnosis extremely important. Some chhildren with uncorrected heart defect may survive into adulthood and require intervention later. Congenital heart disease is a result of a defect in the formation of the heart. Care should be taken to avoid medications or alcohol etc. that are likely to interfere with organ formation in the fetus to lower the risk of CHD. Newborns with critical CHD exhibit symptoms that can be identified soon after birth. However, in some cases diagnosis is not possible till a later time. 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 "Certain medications such as retinoic acid for acne, alcohol or drug abuse during pregnancy, and poorly controlled blood sugar in women who have diabetes during pregnancy increase the risk of CHD in the baby. Although the exact cause is not known, CHD may be genetic and get passed down through families. Although not entirely preventable, it is possible for children with CHD to lead active and productive lives with timely diagnosis and the right treatment. Though there is a good success rate for treatments, it is important to diagnose this condition early enough and reach the hospital on time. However, most of the times babies are diagnosed much later and reach the hospital in a critical stage. This reduces the efficacy of treatments." It is possible to detect any structural abnormalities in the fetus, including in the heart, with the help of a level-II ultrasound in the second trimester. Adding further, Dr Aggarwal, said, "It is imperative to make testing for CHD a standard practice in hospitals before babies are discharged. As a part of the efforts to save lives of children with CHD, the HCFI under its flagship project, the Sameer Malik Heart Care Foundation Fund, has saved over 500 lives in the past two years. This fund was initiated towards ensuring that no one dies of a heart disease just because they cannot afford treatment." Though it is not possible to prevent the likelihood of CHD in babies, there are some precautions that mothers can take during pregnancy. • Get vaccinated against rubella and flu • Avoid drinking alcohol or taking drugs • Taking folic acid supplement during the first trimester relatively lowers the risk of giving birth to a baby with CHD or any other birth defects. • Do not take any over the counter (OTC) medication including herbal remedies without consulting your doctor. • Avoid contact with people who have any infection. • Women with diabetes should try and keep the condition under check. • Avoid exposure to organic solvents, such as those used in dry cleaning, paint thinners, and nail polish remover.

ACP releases new guidelines on the treatment of osteoporosis

ACP releases new guidelines on the treatment of osteoporosis The American College of Physicians (ACP) has released new guidelines on the treatment of osteoporosis, which have been published in the Annals of Internal Medicine. The recommendations for treating osteoporosis were last published in 2008. • Physicians should treat women with osteoporosis with bisphosphonates (alendronate, risedronate, or zoledronic acid) or denosumab, a biologic agent for five years. Continuing treatment after the initial five years may be beneficial for some patients and may be appropriate after reassessing the risks and benefits of continuing therapy. • Bisphosphonates are also recommended in men with osteoporosis to reduce fracture risk. • Bone density monitoring during the five-year treatment period is not recommended due to lack of evidence of the benefit of monitoring. • Use of hormone-replacement therapy (HRT), either estrogen alone or estrogen + progestin or raloxifene for the treatment of osteoporosis in women is not recommended. The serious adverse effects of estrogen treatment such as increased risk for cerebrovascular accidents and venous thromboembolic events outweigh the potential benefits. • The decision to treat osteopenic women 65 years of age or older at a high risk for fracture should be based on fracture risk profile; and the benefits, harms, and costs of medications and patient preference. • Most women with normal bone density measurements do not progress to osteoporosis within 15 years; hence, ACP does not support frequent monitoring of women with normal bone density for osteoporosis At the same time, the ACP does not recommend physicians use, (Source: ACP Press Release, May 9, 2017)

Trust makes patients adhere to prescribed treatment

Trust makes patients adhere to prescribed treatment Study finds lack of communication as a major cause for dispute between doctors and patients New Delhi, 20 April 2017: According to a new study of 101 Hispanics and 100 non-Hispanics from the University of California, patients with high blood pressure who had more trust in the medical profession were more likely to take their high blood pressure medicine than those with less trust. The study was presented at the recent American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2017 in Arlington, Virginia. The doctor–patient relationship is the foundation in the practice of medicine. It is a fiduciary relationship; the word "fiduciary" derives from the Latin word for "confidence" or "trust", which forms the basis of an effective doctor–patient relationship. The study conducted also showed that mutual trust is important for positive treatment outcomes. However, in recent times, it is being seen that this trust is slowly eroding away and a doctor–patient relationship is no longer held sacrosanct as it once was. Speaking on this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "A patient who does not trust his doctor will not confide in him nor will he be motivated to adhere to the prescribed treatment plan. Modern medicine today is patient-centric and based on partnership. The patient is an equal partner in the diagnostic and therapeutic process. Patients rely on doctors to take care of their health, and therefore, it is important that patients trust their doctors. Doctors must be courteous with their patients and explain the management plan in a language that they are able to understand. This is the concept of informed consent. Patients must in turn show respect towards their doctors and trust their judgment." The study also concluded that patients who had higher levels of trust in their doctor, and the treatment plan, took their blood pressure medicine 93% of the time versus 82% of the time for those who had lower levels of trust. Additionally, placing trust in the medical profession was linked to greater resilience (ability to adapt to difficult life circumstances) and better health-related quality of life. It also deduced that trust had an equally protective effect on the health of both groups studied regardless of race or ethnic origin. Dr K K Aggarwal further opined, "Lack of communication is a major cause of disputes between doctors and patients today. This can be tackled by the triad of ‘Plan, Communication, and Documentation’, where ‘Plan’ means observations and treatment decided by the doctor and if the same is ‘Communicated’ to the patient, ‘Documented’ and then implemented, there can never be a dispute. Any disparity between your plan and the outcome leads to a dispute." The following points are key to a successful doctor–patient relationship. • Do what you say. For example, if you have told the patient that you would be late by one hour, make sure that it is only one hour and not later than that. • Document what you speak • Preserve what you document

Intensive medical treatment can reverse type 2 diabetes

Intensive medical treatment can reverse type 2 diabetes Type 2 diabetes can be reversed…Data from a study published in the Journal of Clinical Endocrinology & Metabolism show that a short course of intensive lifestyle and medical treatment using oral medications and/or insulin may lead to drug-free remission of type 2 diabetes, at least in the short term. Patients with type 2 diabetes of up to 3 years in duration were randomized to three groups: Standard diabetes care and intensive metabolic intervention: One group underwent the intensive metabolic intervention for 8 weeks, while the other was treated intensively for 16 weeks. • In the intensive metabolic intervention, the participants were provided with a personalized exercise plan and a suggested meal plan that reduced their daily calorie intake by 500-750 calories a day. Their progress was regularly tracked and they also were given oral medications and insulin at bedtime to tightly manage their blood glucose levels. • The control group received standard blood sugar management advice from their usual doctor along with standard lifestyle advice After the intervention, individuals in both groups stopped taking diabetes medications and were encouraged to continue with lifestyle changes Three months after the intervention was completed, 11 out of 27 individuals in the 16-week intervention group met HbA1c criteria for complete or partial diabetes remission, compared to four out of 28 individuals in the control group. Three months after finishing the 8-week intervention, six out of 28 individuals in that group met the same criteria for complete or partial diabetes remission. Natalia McInnes, MD, MSc, FRCPC, of McMaster University and Hamilton Health Sciences, in Hamilton, Ontario, Canada and the first author of the study said, “These findings support the notion that type 2 diabetes can be reversed, at least in the short term not only with bariatric surgery, but with medical approaches. Type 2 diabetes is a life-long progressive disorder and the findings of this study showing that the condition may be potentially reversible may motivate patients to adhere to the prescribed lifestyle changes and medications. The goal of managing a patient with type 2 diabetes could shift from achieving and maintaining glycemic control to inducing remission and then monitoring the patient for any signs of relapse (Source: Endocrine Society Press Release, March 15, 2017) Dr KK Aggarwal National President IMA & HCFI