Thursday, 31 August 2017

IMA as on today

IMA as on today A meeting of the IMA Action Committee & State Presidents’ & Secretaries’ Annual Review Meeting was held on 27th August, 2017 at New Delhi where following issues were deliberated and passed: • IMA is planning an IMA fast for nonviolence on 2nd October where every doctor will fast from Dusk to Dawn and will continue its efforts in persisting with its demands with the government, the nonviolent way. • IMA is against criminal prosecution of doctors unless mens rea or an intention to harm can be established. • IMA takes strong objection to the application of Section 308 on doctors of Gorakhpur Medical College for administrative lapses. The concerned officers could have been suspended/transferred, as is usually done, so that a fair inquiry can be conducted, but not to charge them with penal provisions until the report of the inquiry. The recent widespread violence in Haryana after Ram Rahim was convicted was also due to a system failure. But, only the DSP was suspended. Also, Section 308 was not applied in this case. • IMA has requested that all health care providers (interns, PG, doctors) to be mandatorily given vaccination by their employers. • All IMA members will conduct school health program under Aao School Chalen programme on the 5th of every month. • All IMA members should either conduct Aao Gaon/Slum Chalen Project for the community or participate in antenatal services camp as the case may be on the 9th of every month. • To build up the professional image of IMA and to raise various issues, IMA is coming out with series of advertisements. IMA brought out 14 half page advertisements in Indian Express during the monsoon parliament session and will bring out 15 full page advertisements in the winter parliament session. IMA also regularly releases advertisements in newspapers regarding public health. • Past is past. IMA does not want to go into the controversy whether or not the practice of “cuts and commissions” is prevalent in the society. IMA has issued a circular to all its member doctors informing them that they are only entitled to charge for consultation, skilled procedure and medical services provided to their patients. • Doctors are brand ambassadors for the society and IMA has decided that over 1 lakh members of IMA will pledge their organ donation on NOTTO website before 2nd October. • IMA has declared MDR TB as a public health emergency and the new IMA campaign, which is the 2nd freedom struggle will be IMA TB Initiative: GTN. G is for diagnosis of TB using GeneXpert test, T is for tracing the contacts and treat them and N stands for Notifying (mandatory) TB patients. • IMA Adverse action reporting has been made mandatory by IMA for all its members at helpline Number 9717776514. • IMA has also appointed Honorary IMA Professors as academic Brand Ambassadors of the profession all over the country. • IMA is also campaigning to check the menace of Antimicrobial Resistance, which is a new epidemic of the society. • IMA has also offered to the Govt. to adopt a few different tribal areas on a PPP Model. • IMA has also written to all its members to promote Digital Payment while dealing with their patients. • IMA has also directed all its State Branches to make use of all public events in their respective states like Melas and Fairs and conduct public health activities in the same. • IMA has also written to the ministry to consider risk hazard allowances for all doctors working in various hospitals starting from their internship. • IMA is against any hospital (Govt. or Private) having more than 85% bed occupancy rate. All patients getting admitted where the occupancy is more than 85% should be referred to the nearest empanelled hospitals and in case of Government, the expenses should be borne by the government. IMA can, in no way, justify or support the Government’s move for not denying any admission and keeping two patient on one bed. To maintain quality and safety, such cases should be referred to the nearest hospitals where facilities are available and the expenses should be borne by the hospitals on predefined terms and conditions. • Residents of the hospitals should not be allowed to work more than 48 hours in a week and the practice of moonlighting should be introduced in Govt./Private Hospitals where doctors from outside can be appointed as an ad hoc locum on hourly basis. • IMA has also decided to promote Khadi, our cultural heritage. During its CWC meeting, all doctors should wear a Khadi Apron and will support the campaign for Swadeshi Khadi as a healthy cloth. • IMA new policy for Blood Donation is to collect blood in multiple bags to facilitate separation of components. • IMA is coming out with sustained campaign on Swachh Bharat. Disclaimer: The views expressed in this write up are entirely my own.

Indian men increasingly suffering premature hair loss

Indian men increasingly suffering premature hair loss Men in 20s and 30s are opting for hair restoration surgery New Delhi, 30 August 2017: According to statistics, there has been an increase in the number of people with premature hair loss in the last few years. Of every 10 people complaining of hair loss, about 8 are men. As per the IMA, a sizeable number of young men in their 20s and 30s are opting for hair restoration surgery. Premature hair loss is a problem that is increasing in incidence among young Indian men due largely to stress and lifestyle factors. It is normal for a person to lose about 50 to 100 strands of hair a day. However, serious hair loss is a sign that something is not right with the body and is called alopecia. The four major factors responsible for premature hair loss include stress, certain habits such as smoking and drinking, pollution, and poor nutrition. 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, “Alopecia is usually genetic. However, thanks to the lifestyle changes and stress today, younger men are becoming prone to this problem. Hair fall can be a reaction to extreme mental or physical stress. The body typically starts shedding hair after a gap of three months. Other than this, certain diseases which cause mal-absorption of nutrients such as food poisoning can also lead to hair loss. With increasingly stressful jobs, consumption of junk food that is devoid of nutrients and fibre, inadequate consumption of water, and habits such as smoking and drinking, premature hair loss is becoming a major cause of concern among young men.” Nutrition is vital for hair growth. No other part of the human body grows at the rate of half an inch per month, except the bone marrow. It is therefore important to feed it right. Adding further, Dr Aggarwal, said, “Unless the problem becomes severe and requires treatment, it is possible to bring about an 80% change through lifestyle changes only. One can bring about some simple lifestyle changes such as getting seven hours of sleep, drinking enough water (strands are made up of minerals, which only water can replenish), and eating protein-rich foods at regular intervals, as these can prevent premature hair loss.” Some tips to prevent premature hair loss include the following. • Massage your scalp with lukewarm oil as this will help in improving blood circulation and stimulate hair follicles. • Try and avoid stress through techniques such as yoga and meditation. The stress hormones, epinephrine and cortisol, interfere with the natural growth of hair. • Eat fresh fruits and vegetables as they help in promoting healthy hair growth. It is good to consume food rich in iron, zinc, proteins, and omega three fatty acids. • Quit smoking and drinking. Not only do these habits result in hair loss but also prevent hair growth.

Wednesday, 30 August 2017

IMA Fast for Non Violence on 2nd October

IMA Fast for Fast on 2nd October Dear Colleague During the recent meeting of IMA National Action Group, it has been decided to observe "IMA Fast for Non Violence", a Dawn to Dusk Fast by every Branch and every member of IMA on the occasion of Gandhi Jayanti, October 2, 2017 from 6.00 am to 6.00 pm, to mark our continuing Satyagraha to the Government to take action on our demands. All Medical Organizations and Associations (FOMA) and all members of IMA are requested through our State & Local Leaders to observe the fast on 2nd October 2017, in support of our pending demands. The broad guidelines for observing the above Fast shall be as follows:- • Pandals to be erected near the District Collectorate in all the Districts of the country. • Prominent leaders of the district to take part in the Fast. • Necessary banners, backdrops and Placards to be prepared and displayed in the Pandal (content will be made available soon on IMA website). • All medical students to be involved in the Fast and they will organize their Fasts in respective Medical Colleges in specially erected dedicated pandals (necessary backdrops, banners to be arranged). • All practicing doctors to observe “Dawn to Dusk Fast” in their Clinics/Medical Institutions while working. • All fasting participants to wear badges (content of badge to be provided by IMA HQs). • Proper reporting to be done to IMA HQs on the proforma (to be provided by IMA HQs.) along with digital copies of photographs of the event. • Special venues for the Fast are: o Rajghat o Sabarmati Ashram, Gujarat o Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha You are requested to kindly take suitable necessary action at your Branch level to ensure utmost success of the event, which will go a long way in acceptance of our demands by the Govt. Dr KK Aggarwal, National President, IMA Dr RN Tandon, Hony. Secretary General, IMA Dr RV Asokan, Chairman, IMA National Action Cell Disclaimer: The views expressed in this write up are entirely my own.

Skewed doctor-patient ratio and quackery major issues in public healthcare today

Skewed doctor-patient ratio and quackery major issues in public healthcare today Rural areas have only 1.1 lakh doctors and many unqualified professionals masquerade as doctors New Delhi, 29 August 2017: As per recent statistics, India has only about 1 million allopathic doctors to treat its population of over 1.3 billion people. Of this, only 1.1 lakh doctors work in the public health sector and therefore, about 900 million people in the rural areas are dependent on this small number of doctors for their healthcare requirements. According to the IMA, in such a situation, patients must share beds and doctors face severe burnout due to the skewed doctor-patient ratio in these areas. India lacks adequate number of hospitals, doctors, nurses, and public health workers. There is a wide gap in the quality of and access to healthcare. This is not just between states but also urban and rural areas. The issue is further compounded by quackery with unqualified people masquerading as doctors. In the absence of doctors, people have no choice but to visit such quacks for treatment. 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 recent infant deaths in UP bring to light, two very pertinent issues in healthcare delivery today: one is the skewed doctor-patient ratio and the other is that of quackery in the profession. It is a sad fact that in rural areas, the sick are first taken to the ‘so-called’ faith healers offering treatment in the garb of doctors, before they are brought in to a hospital for actual treatment. These quacks are at times educated only up to Class 12 and lack any medical qualification whatsoever. What is disturbing further is that there are not enough trained doctors in the country. Many do not wish to opt for entering the public healthcare system and this results in even ward boys proclaiming themselves as doctors in rural areas.” As per surveys, only 1 out of 5 doctors in the rural areas are qualified to practice medicine. The IMA has taken a strong stand against quackery. This was also one of the issues raised by the association in a movement called Dilli Chalo conducted in June this year. Adding further, Dr Aggarwal, said, “There is a need to conduct an updated assessment of quackery at both the state and district levels. Instead of training Ayush practitioners and quacks in prescribing allopathic medicine, there is a need to strengthen the traditional systems of medicine in offering first line of treatment and care.” IMA urges one and all to beware of quacks as they indulge in cuts and commissions, will never refer the patient in time, invariably give steroids in every case, and will over investigate the patient to appear genuine. On the other hand, people should have faith in registered and qualified doctors as they do not indulge in unethical practices, do not take or give commissions, work with the primary aim and dharma of healing and not financial gain, believe in Karma and not Kriya, and will always guide patients with the best of interest.

Tuesday, 29 August 2017

IMA Campaigns to build up the image of the medical profession

IMA Campaigns to build up the image of the medical profession Dr KK Aggarwal National President IMA Dear Colleague To build up a strong image of the medical profession, the Indian Medical Association (IMA) is starting the following campaigns: • MDR TB now a public health emergency as it is now a threat to community as well as health care providers. IMA: 2nd freedom struggle to end TB IMA TB Initiative: GTN, where G stands for sputum GeneXpert test for all suspected cases, T stands for trace and treat all contacts and N stands for notify (mandatory) at Nikshay • Doctors are brand ambassadors for the society and unless they pledge their organs, the society will not follow. All doctors are requested to pledge their organs at: • Charity begins at home. The general public will not follow preventive health advice unless doctors themselves follow the same. All IMA members are requested to get their annual checkup done once a year under the IMA campaign: Physician’s Health first. All doctors should get themselves get fully vaccinated. • To build the community image of the profession all doctors are requested to visit a school assembly on 5th of every month and conduct a 5-minute (or more) school children health education advisory program under “IMA Aao School Chalen” project. • All IMA members are required to report adverse reactions to drugs (serious or non-serious), devices, vaccines, herbs, blood transfusion to IMA PvPI number 9717776514 under IMA PvPI Initiative. • All designated IMA Professors should spread the positive image of medical profession under the IMA campaign “Jiska Koi Nahi Uska IMA”. • Each state or local branch of IMA should adopt slums/ villages / elderly homes and conduct an activity of 9th of every month under IMA Aao Gaon Chalen project • Each state or local branch of IMA should on conduct antenatal awareness and check-up program on the 9th of every month in support of the Pradhan Mantri Surakshit Matritva Yojana. • All state and local branches are directed to file complaints to IMA headquarters against all doctors indulging in female feticide, unethical medical practices or tarnishing the name of IMA in media or social media. • All members should resort to digital transactions with the patients • Past is Past: We do not want to go into controversy whether or not there were cuts and commissions in the medical practice, now onwards medical practice will be 100% ethical and doctors will charge only for consultation, skills and medical services provided. - All IMA CMEs should have the following slide inserted before every lecture - IMA PvPi number 9717776514 - IMA CMEs are tobacco-free, noise and air pollution-friendly, - IMA CME lectures must cover a question each on mental health, bioethics, legal medicine and rational use of antibiotics and investigations - Pledge organs at - Report every TB case at - IMA has zero tolerance for cuts, commissions without service, female sex determination and female feticide. - Do not criticize your colleagues in social media or news media. - Join IMA Fast for Non-Violence on 2nd October. Disclaimer: The views expressed in this write up are entirely my own.

Severe psoriasis may trigger heart attack

Severe psoriasis may trigger heart attack
It is imperative to prevent triggers to avoid the symptoms from becoming worse

New Delhi, 28 August 2017: A study that followed over half a million people for about 5 years has indicated that psoriasis may increase the chances of getting a heart attack. The risk of a heart attack was related to the severity of psoriasis in people. The overactive immune system that triggers psoriasis can cause inflammation which can further infiltrate the arteries of the heart. As per the IMA, patients with one illness may be stricken by another condition which may seem unrelated and sometimes more serious. This is known as a ‘shadow disease’.

Psoriasis is an immune-mediated condition affecting the skin and causes red, flaky, crusty patches of covered with silvery scales. The condition occurs when the immune system mistakes a normal skin cell for a pathogen, and sends out faulty signals that cause overproduction of new skin cells.

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, “Psoriasis is an incurable, long-term (chronic) inflammatory skin condition. The severity of the condition varies --- periodically improving and worsening. At times, the condition may not appear for years and stay in remission. In some people, the symptoms can aggravate in the winter months. The spectrum of this disease ranges from mild with limited involvement of small areas of skin to large, thick plaques to red inflamed skin affecting the entire body surface. There are multiple clinical subtypes of psoriasis. Plaque psoriasis, the most common presentation of psoriasis, most commonly presents with sharply defined erythematous plaques with overlying silvery scale. The scalp, extensor elbows, knees, and back are common locations for plaque psoriasis lesions.”

Psoriatic arthritis occurs in about 30 percent of patients with psoriasis, and precedes the skin manifestations in approximately 15 percent of patients. A diagnosis of psoriasis can be made by history and physical examination in majority of the cases. Occasionally, a skin biopsy is needed to rule out other conditions.

Adding further, Dr Aggarwal, said, “Numerous topical and systemic therapies are available for the treatment of psoriasis. Treatment modalities are chosen on the basis of disease severity, relevant comorbidities, patient preference (including cost and convenience), efficacy, and evaluation of individual patient response.”

Some tips to prevent psoriasis flare up are as follows.
Reduce stress Stress can have a negative impact on people with psoriasis. The body tends to have an inflammatory reaction to stress in turn leading to a flare-up.
Avoid certain medications Some medications can interfere with the body’s autoimmune response and cause inflammation, thus triggering psoriasis.
Prevent skin injuries Injuries to the skin can trigger psoriasis in some people. This is known as the Koebner phenomenon.
Eat a healthy diet Being obese or overweight appears to make psoriasis symptoms worse. Thus, it’s important to manage your weight by exercising and eating a healthful diet.

Monday, 28 August 2017

Communicating with patients may motivate them to adhere to prescribed treatment

Communicating with patients may motivate them to adhere to prescribed treatment Dr KK Aggarwal A new research reports that low-income patients with high blood pressure are less likely to take their medications as directed if their healthcare providers do not use a collaborative communication style or ask them about social issues. The three-month study published in the journal Circulation: Quality and Outcomes examined the impact of patient–provider communication on medication adherence among a sample of primary care providers and their patients who had hypertension. Most of the participants were black, unemployed and reported some college education. The study found that: • Patients were three times less likely to take their high BP medications when their providers did not possess a collaborative communication style such as asking open-ended questions and checking their understanding of instructions. • Patients were also six times less likely to take their medications as prescribed when a healthcare provider did not ask them about social issues such as employment, housing and partner relationships. This study demonstrates the negative impact of poor communication on adherence to treatment and highlights the need for better doctor-patient communication to improve compliance to treatment and achieve desired treatment outcomes. The study says that “such discussions signal to the patient genuine caring and concern by the doctor, which strengthens patient’s ability to cope with their life and illness, along with motivation and confidence related to self-management of their disease”. Listening is very important skill for doctors. The concerns of patients should be addressed without being judgemental. Therefore, in addition to prescribing medicine, doctors should also take note of the social determinants of health when managing their patients, as they have significant role to play in the health and wellbeing of the patient. Patients want support and encouragement to take their prescribed medications, especially in case of chronic illnesses such as hypertension, diabetes, heart disease, etc. They either often forget to take their medication or may not realize the need for adherence to treatment. Low income patients usually may not be well educated. This group of patients must be explained the need of compliance to the treatment prescribed. They have to be educated about the disease and why medication is important. This reassures the patient and he/she is motivated to follow your instructions more willingly. On the other hand, high income patients sometimes may be too busy to remember to take their medications. It may not be a priority for them, at that time. Adherence to medications in such high income patients can be improved by SMS reminders. As Sir William Osler famously said, “The good physician treats the disease; the great physician treats the patient who has the disease.” (Source: AHA News Release, August 22, 2017) Disclaimer: The views expressed in this write up are entirely my own.

Indian males at a risk for developing Metabolic Syndrome due to fault lifestyle

Indian males at a risk for developing Metabolic Syndrome due to fault lifestyle Healthy eating and timely assessment of vital statistics are some preventive measures New Delhi, 27 August 2017: Statistics indicate that people with metabolic syndrome (MS) are at a three times higher risk for heart attack and stroke. They are also at a five-fold risk of developing Type II diabetes. According to the IMA, the urban male is likely to develop MS largely due to faulty lifestyle. Abdominal or central obesity is a common occurrence in India and such individuals have thin limbs but fat around the abdomen. A person is said to have MS when along with Waist Circumference of more than 90 cm (men), 80 cm (women), any two of following five are present:triglycerides of more than 150 mg/dl, HDL Cholesterol less than 40 mg (male) and 50 mg (female), fasting sugar (glucose) of more than 100 mg or presence of Diabetes and Hypertension of more than 130 mm Hg systolic or 85 diastolic. 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, “Increasing inactivity and a diet consisting of processed food are some primary reasons for MS. MS refers to a cluster of conditions namely increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. When these occur together, the chances of heart disease, stroke, and diabetes automatically increase. MS is also linked to insulin resistance. In this condition, the cells don't respond normally to insulin, and glucose can't enter the cells as easily. This makes the glucose levels in blood rise despite the body's attempt to control it by churning out more and more insulin.” Some risk factors for MS include age, race, obesity and weight around the abdomen, diabetes, and other conditions such as cardiovascular disease, nonalcoholic fatty liver disease or polycystic ovary syndrome. Adding further, Dr Aggarwal, said, “The best way to prevent the risk of MS is to make aggressive lifestyle changes such as diet and exercise.If these do not work, the doctor might prescribe medications to help control your blood pressure, cholesterol levels, and blood glucose.Studies have indicated that individuals who consume a vegetarian diet have a lower risk for developing MS than those who do not.” Here are some tips to prevent MS. • Exercise for about 30 to 60 minutes every day. Make a slow start but ensure that your continue physical activity thereafter. • Eat a healthy diet rich in fruits and vegetables, lean protein, whole grains, and low fat dairy. Go easy on saturated fats, trans fat, cholesterol, and salt. • Those who are overweight should lose weight and people with a normal weight should aim at maintaining the same. • Quit smoking right away. • Schedule regular checkups with your doctor to assess your blood pressure, cholesterol, and blood sugar.

Sunday, 27 August 2017

Right to information vis-à-vis right to privacy

Right to information vis-à-vis right to privacy Dr KK Aggarwal Until this week, right to privacy was only inferred from the Article 21 “Protection of Life and Personal Liberty” of our constitution and not recognized as a fundamental right or guaranteed by the constitution. But, the judgement of the Supreme Court of India on August 24 (Thursday) has now granted the right to privacy as a fundamental right. It’s a historic judgement, which may well redefine what information can be accessed and how information can be used. The Right to Information (RTI) Act was enacted in 2005 to make the citizens informed about the activities of the Government. Under the provisions of the Act, any citizen of India may request information "public authority", which is established, constituted, owned, controlled or substantially financed by funds provided directly or indirectly by the Govt (Central/State/UT). RTI mandates timely response to citizen requests for government information. This right to information includes right to obtain information and to disseminate that information. Privacy of information gives a person control over his personal information including health information. He/she has the right to decide if as well as with who this information can be shared with. There is a concern that personal health information of a patient can be accessed via the RTI Act. However, the RTI Act has provided for the protection of patient’s personal information in Section 8(1)(j) and section 11, which relates to third party information. Section 8(1)(j) relates to exemption from disclosure of personal information, which is purely concerned to the person in question and is not of public interest. It secures personal health information and does not automatically grant the right to request any personal information such as medical records, tax returns. Disclosure can be refused unless it is in the larger public interest. “Section 8(1)(j): information which relates to personal information the disclosure of which has not relationship to any public activity or interest, or which would cause unwarranted invasion of the privacy of the individual unless the Central Public Information Officer or the State Public Information Officer or the appellate authority, as the case may be, is satisfied that the larger public interest justifies the disclosure of such information: Provided that the information, which cannot be denied to the Parliament or a State Legislature shall not be denied to any person.” Section 11 relates to disclosure of third party information. Any confidential third party information can be disclosed after informing the third party i.e. who has provided the confidential information. Information can still be disclosed, even if the third party denies permission, if the public interest outweighs any injury to privacy of the said third party. “11. Third party information.— (1) Where a Central Public Information Officer or the State Public Information Officer, as the case may be, intends to disclose any information or record, or part thereof on a request made under this Act, which relates to or has been supplied by a third party and has been treated as confidential by that third party, the Central Public Information Officer or State Public Information Officer, as the case may be, shall, within five days from the receipt of the request, give a written notice to such third party of the request and of the fact that the Central Public Information Officer or State Public Information Officer, as the case may be, intends to disclose the information or record, or part thereof, and invite the third party to make a submission in writing or orally, regarding whether the information should be disclosed, and such submission of the third party shall be kept in view while taking a decision about disclosure of information: Provided that except in the case of trade or commercial secrets protected by law, disclosure may be allowed if the public interest in disclosure outweighs in importance any possible harm or injury to the interests of such third party. (2) Where a notice is served by the Central Public Information Officer or State Public Information Officer, as the case may be, under sub‑section (1) to a third party in respect of any information or record or part thereof, the third party shall, within ten days from the date of receipt of such notice, be given the opportunity to make representation against the proposed disclosure. (3) Notwithstanding anything contained in section 7, the Central Public Information Officer or State Public Information Officer, as the case may be, shall, within forty days after receipt of the request under section 6, if the third party has been given an opportunity to make representation under sub‑section (2), make a decision as to whether or not to disclose the information or record or part thereof and give in writing the notice of his decision to the third party. (4) A notice given under sub‑section (3) shall include a statement that the third party to whom the notice is given is entitled to prefer an appeal under section 19 against the decision.” Doctors have an ethical duty to keep patient’s health information confidential and not disclose it to others without consent as per the MCI Code of Ethics Regulations. But the MCI Ethics Code has also defined conditions when patient information can be disclosed under Regulations 2.2 and 7.14. “2.2 Patience, Delicacy and Secrecy: Patience and delicacy should characterize the physician. Confidences concerning individual or domestic life entrusted by patients to a physician and defects in the disposition or character of patients observed during medical attendance should never be revealed unless their revelation is required by the laws of the State. Sometimes, however, a physician must determine whether his duty to society requires him to employ knowledge, obtained through confidence as a physician, to protect a healthy person against a communicable disease to which he is about to be exposed. In such instance, the physician should act as he would wish another to act toward one of his own family in like circumstances. 7.14 The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except – in a court of law under orders of the Presiding Judge; in circumstances where there is a serious and identified risk to a specific person and / or community; and notifiable diseases. In case of communicable / notifiable diseases, concerned public health authorities should be informed immediately.” Right to information and right to privacy can be considered two sides of the same coin. Like all fundamental rights, right to privacy is fundamental, but not an absolute right. It is subject to reasonable restrictions as imposed by the State. But, will the new fundamental right to privacy impinge upon the RTI Act and limit its scope in some way? This would depend on if the definition of “public interest” is expanded. Disclaimer: The views expressed in this write up are entirely my own.

Stethoscopes can also harbor pathogens and lead to hospital-acquired infections

Stethoscopes can also harbor pathogens and lead to hospital-acquired infections Lack of infection control guidelines and use of outdated technology are some possible reasons New Delhi, 26 August 2017: As per recent statistics, hospital-acquired infections (HAIs) account for about 2 million cases and 80,000 deaths a year around the world. A study conducted has also found that the rate of HAIs and antimicrobial resistance were markedly higher in India. According to the IMA, one of the primary reasons for this is the overcrowding in hospitals in India thanks to the skewed doctor-patient ratio, which further results in lapses in basic hygiene protocols. One of the most important instruments used by doctors, the stethoscope, also harbors pathogens. Some of these include Staphylococcus aureus, Pseudomonas aeruginosa, Clostridium difficile, and vancomycin-resistant enterococci. These are responsible for many diseases such as pneumonia, urinary tract infections (UTIs), and skin infections, some of which can be life threatening. 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, “Some of the common causes of HAIs are lack of compliance with infection control guidelines and use of outdated technology. Most infections become clinically evident after 48 hours of hospitalization.The sad fact, however, is that there is lack of knowledge about HAIs in India. Patients and at times, even hospital staff, fail to follow certain basic hygiene protocols which can go a long way in preventing these infections. This is further exacerbated by the fact that there is no specific documentation of HAI incidence in India, at least in the major cities.” Insufficient hygiene and patient-isolation protocols in operating rooms (OTs) and intensive care units (ICUs), poorly maintained equipment, understaffing and overcrowding are all conditions conducive for breeding of bugs. Patients whose immunity is weak become the easiest target. Apart from this, doctors also use increasingly potent antibiotics on the bugs, and many of these become drug-resistant. Adding further, Dr Aggarwal, said, “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’, and ‘Think Before you Ink’. IMA has also proposed to come out with a book on ‘When Not to Use Antibiotics’.” Some basic precautions which can help prevent HAIs include the following. • Practice hand hygiene. • Use personal protective equipment appropriately according to risk of body fluid exposure. • Reprocess re-useable instruments and equipment as appropriate. • Handle and dispose sharp and potentially infectious material safely. • Handle waste and linen with care. • Put environmental control measures including cleaning and spills management in place. • Make it compulsory to wear disposable gowns, gloves, and eye protection on entry to the patient’s room.

Saturday, 26 August 2017

Bad posture leading to increased spinal problems in Indian youth

Bad posture leading to increased spinal problems in Indian youth Prolonged sitting and standing can put a lot of pressure on joints and muscles New Delhi, 25 August 2017: Recent statistics indicate that every fifth Indian in the age group of 20 to 30 suffers from different kinds of spinal ailments. What is alarming is that the incidence has increased by 60% in the Indian youth. As per IMA, wrong posture and other lifestyle issues are responsible for an increase in spinal problems in youngsters, which until a decade ago were only common among senior citizens. Postural dysfunction or “poor” posture is one where the spine is positioned in unnatural positions. The curves are emphasized which puts stress on the joints, muscles, and vertebrae. This prolonged poor positioning leads to a build-up of pressure on these tissues. Although physiotherapy can help solve this problem, it is important to correct one’s posture at the outset. 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, “Sitting for a long time in the same position can put pressure on the back muscles and spinal discs. Further, slouching can over-stretch the spinal ligaments and strain the spinal discs causing major pain in the back and neck. Prolonged standing also has its own health implications. Keeping the body upright needs a lot of muscular effort. Standing for a long time leads to pooling of blood in the legs and reduces active circulation of blood. This accelerates the onset of fatigue causing pain in the leg, back, and neck muscles.” Sitting continuously for more than four hours in a day is harmful to the spine and back. If not addressed on time, this can further cause permanent damage to the cervical spine causing lifelong pain. Adding further, Dr Aggarwal, said, “Apart from wrong posture at work, prolonged use of mobile phones is another major cause of spinal problems today. Keeping the right amount of curvature in the back takes pressure off the nerves and will reduce back pain. If you experience fatigue or pain when you wake up in the morning or after you’ve been sitting at your desk for a couple of hours, it may be an indication that your posture is not right.” Here are some tips to prevent spinal problems. • Exercise and get moving. Physical activity helps in keeping the joints fluid. A person who is not physically active is more susceptible to back problems. • Eat right. If you maintain good eating habits, you not only will maintain a healthy weight, but you also will not put unnecessary stress on your body. • Sleep sideways. The best position for sleeping is on your side. If you are sleeping on your stomach, put a pillow under your lower abdomen to help take stress off your back. • Maintain correct posture and avoid stress. The importance of good posture cannot be overlooked in preventing back problems. Additionally, stress can you to tense your muscles, and constant tension of this kind can cause back pain. So find ways to reduce stress.

IMA Guidelines for Scrub Typhus Encephalitis

IMA Guidelines for Scrub Typhus Encephalitis Prof Dr Binay Karak, Prof Dr Bhupendra Chaudhary & Dr KK Aggarwal Scrub typhus encephalitis is a mite- borne infectious disease caused by Orientia tsutsugamushi bacteria and transmitted by bite of larval mites (chiggers) is a re-emerging infection with significant morbidity and mortality, limited to region known as 'tsutsugamushi triangle' of south and south-east Asia. Clinical features: Non-specific and includes high grade fever, severe headache, diffuse myalgia, gastrointestinal (vomiting and loose motions) and respiratory tract symptoms (cough and breathlessness), maculopapular rash and lymphadenopathy - all mimicking viral infectious disease. Later altered sensorium, delirium, confusion and seizure develop leading to aseptic meningitis to frank meningoencephalitis. It can cause multiorgan failure. Scrub typhus lasts for 14 to 21 days without treatment. Death may occur as a result of these complications, usually late in the second week of the illness. Rash: Approximately one-half of all patients develop a characteristically nonpruritic, macular or maculopapular rash. The rash typically begins on the abdomen and spreads to the extremities. The face is also often involved. Eschar (pathognomonic or diagnostic clue): Seen in early phase of disease, at the site of chigger bite. It is a painless ulcer up to 1 cm with a black necrotic center (resembling the mark of cigarette burn) with surrounding hyperemia, mostly on exposed body parts like legs, neck, axilla, chest, abdomen and groin. Localized, and subsequent generalized lymphadenopathy, occurs in the majority of patients, and may be accompanied by inflammation of the lymphatic sinuses, splenomegaly, and portal triaditis. In later stages atypical pneumonia, respiratory failure, ARDS and acute renal failure along with myocarditis complicates the disease. Incubation period: Infection commonly presents as an acute febrile illness 7 to 10 days after the bite of an infected larval trombiculid mite (chigger). Lab diagnosis • IgM Elisa / Weil Felix reaction / PCR from eschar and blood. • CSF findings are non-specific. • Eschar biopsy if diagnostic in presence of lymphohistiocytic vasculitis. Differential diagnosis: Malaria, dengue, leptospirosis and other rickettsial diseases Treatment: Doxycycline is DOC (orally or IV) Adults • Doxycycline 200 mg / day in two divided doses for individuals above 45 kg for 7 days (orally or intravenously) or, • Azithromycin 500 mg in a single dose for 5 days (orally or IV), or • Chloramphenicol or Tetracycline 500 mg in 4 divided doses for 7 days (orally or IV) Regimens as short as one day of doxycycline (400 mg given in two divided doses) have been effective in scrub typhus but are associated with an increased risk of relapse. Doxycycline is contraindicated in pregnant women. The preferred agent is azithromycin (DOC) 500 mg in a single dose for 5 days Children • Doxycycline 4.5 mg/kg/day in two divided doses for children below 45 kg, or • Azithromycin in single dose of 10 mg / kg for 5 days, or • Chloramphenicol or Tetracycline 150 mg / kg / day for 5 days If not treated early in the course, case fatality rate is as high as up to 60%. Therapeutic diagnosis Patients treated with appropriate antibiotics typically become afebrile within 48 hours of starting therapy. This response to treatment is useful diagnostically; failure of defervescence within 48 hours is often considered evidence that scrub typhus is not present. Delayed defervescence if present is associated with jaundice and relative bradycardia. Prevention There is no vaccine. Hence, prevention consists of chemoprophylaxis and mite control. • Chemoprophylaxis: In endemic areas, a single dose of doxycycline (200 mg) weekly: started before exposure to 6 weeks after exposure • Mite control: Application of insect repellants and miticide to both skin and clothing such as N, N, Diethyl-3-methyl benzamide (DEET), permethrin or benzyl benzoate, etc. Intensive efforts at rodent control may paradoxically increase the risk of human disease. In this setting, chiggers lose their preferred and normal hosts, thereby becoming more likely to bite humans. • Early case detection, public education, rodent control and habit modification are other important preventive measures.

Friday, 25 August 2017

Privacy a fundamental right, rules Supreme Court of India

Privacy a fundamental right, rules Supreme Court of India In a landmark judgement delivered yesterday, the Supreme Court of India unanimously ruled that privacy is a fundamental right. In its order, the nine-judge constitutional bench headed by Chief Justice of India said “The right to privacy is protected as an intrinsic part of the right to life and personal liberty under Article 21 and as a part of the freedoms guaranteed by Part III of the Constitution”. Article 21 ensures protection of life and personal liberty."No person shall be deprived of his life or personal liberty except according to procedure established by law.” In doing so, the Bench overruled the two earlier judgements, also by the Apex Court, which had ruled against privacy as a fundamental right. Right to privacy will be now find a place along with the other six fundamental rights recognized by the constitution of India. 1. Right to equality 2. Right to freedom 3. Right against exploitation 4. Cultural and educational rights 5. Right to constitutional remedies Privacy and confidentiality are important tenets of ethical medical practice. They are the foundation of the doctor-patient relationship built on trust. The terms, privacy and confidentiality have often been considered as synonyms. But, the two are not the same and it is important to know the difference between the two. Privacy is the right of a person (patient) to keep his health information, including any other personal information, private and undisclosed. Doctors are often privy to private information shared by the patients during the course of history taking and treatment. Confidentiality, on the other hand, is what we, as doctors (or other concerned persons) do with the information that has been entrusted to us. Confidentiality implies the duty of everyone entrusted with any information to keep that information private. Health information is a part of personal information and includes information for example demographic data (name, address, phone no etc.), insurance information, identification data, medical history. Such information along with medical examination, clinical images during consultation and treatment is considered as information private to the patient. Clinical images e.g. photos of a body part/skin lesion/injury, lab reports, x-rays/scan reports, audio/video recordings are also health information. They can be taken and shared only after consent of the patient. Protecting the privacy of patient information is the ethical duty of the doctor as also mandated in the MCI Code of Ethics Regulations. “2.2 Patience, Delicacy and Secrecy: Patience and delicacy should characterize the physician. Confidences concerning individual or domestic life entrusted by patients to a physician and defects in the disposition or character of patients observed during medical attendance should never be revealed unless their revelation is required by the laws of the State. Sometimes, however, a physician must determine whether his duty to society requires him to employ knowledge, obtained through confidence as a physician, to protect a healthy person against a communicable disease to which he is about to be exposed. In such instance, the physician should act as he would wish another to act toward one of his own family in like circumstances. 7.14 The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except – • in a court of law under orders of the Presiding Judge; • in circumstances where there is a serious and identified risk to a specific person and / or community; and • notifiable diseases. In case of communicable / notifiable diseases, concerned public health authorities should be informed immediately. 7.17 A registered medical practitioner shall not publish photographs or case reports of his / her patients without their permission, in any medical or other journal in a manner by which their identity could be made out. If the identity is not to be disclosed, the consent is not needed.” Privacy and confidentiality has been included among the important principles of bioethics (Article 9) defined by UNESCO under its Universal Declaration on Bioethics and Human Rights that should be respected. “The privacy of the persons concerned and the confidentiality of their personal information should be respected. To the greatest extent possible, such information should not be used or disclosed for purposes other than those for which it was collected or consented to, consistent with international law, in particular international human rights law.” Another very important aspect that should be understood and kept in mind is that while hospitals or healthcare establishments own the physical (or electronic) records, they are only “held in trust by them on behalf of the patient”. The information or data in the records are owned by the patient. This information is protected health information. What constitutes protected health information? The Electronic Health Records Standards for India 2016 notified last year have elaborated on this. “Protected Health Information (PHI) would refer to any individually identifiable information whether oral or recorded in any form or medium that (1) is created, or received by a stakeholder; and (2) relates to past, present, or future physical or mental health conditions of an individual; the provision of health care to the individual; or past, present, or future payment for health care to an individual. Electronic Protected Health Information (ePHI) would refer to any protected health information (PHI) that is created, stored, transmitted, or received electronically. Electronic protected health information includes any medium used to store, transmit, or receive PHI electronically. As per the Information Technology Act 2000, Data Privacy Rules, refers to ‘sensitive personal data or information’ (SPI) as the subject of protection, but also refers, with respect to certain obligations, to ‘personal information’ (PI). Sensitive personal information is defined as a subset of personal information. Followings are Sensitive personal information that relates to: 1. Passwords 2. Financial information such as bank account or credit card or debit card or other payment instrument details 3. Physical, psychological and mental health condition 4. Sexual orientation 5. Medical records and history 6. Biometric information 7. Any detail relating to (1) – (6) above received by the body corporate for provision of services 8. Any information relating to (1) – (7) that is received, stored or processed by the body corporate under a lawful contract or otherwise” The patient is the supreme consent giver, and no action pertaining to his/her health information can be taken without consent from the patient. Any protected health information can be shared only after patient consent and that too only with the authorized person. Divulging this information to any unauthorized person without consent of the patient is breach of privacy and confidentiality. This judgement will have huge implications on how information can be used. In light of this judgement, privacy is no longer a common law right. And, it’s not just our ethical duty to respect the right to privacy of a patient simply because it is prescribed by the MCI Ethics Code or any other regulatory bodies. Privacy is now a fundamental ‘inviolable’ right under the Constitution of India. Disclaimer: The views expressed in this write up are entirely my own.

HSV-1 increasingly becoming a cause for genital herpes

HSV-1 increasingly becoming a cause for genital herpes The disease is incurable but can be managed by practicing safe sex and with medications New Delhi, 24 August 2017: As per recent statistics, about two-thirds of the world's population under 50 has the highly infectious herpes virus. More than 3.7 billion people under the age of 50 suffer from the herpes simplex virus type 1 (HSV-1), which they usually contract in childhood. As per the IMA, this virus causes cold sores around the mouth. HSV-1 is increasingly becoming a cause of genital infection too, mainly in rich countries. A genital herpes outbreak or episode can occur when the HSV-1 or HSV-2 virus is reactivated from its dormant stage. This is an incurable disease, and once contracted, a person may experience outbreaks throughout their lifetime. The first outbreak of herpes is often the longest. 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, “Genital herpes is a sexually transmitted disease (STD) which causes herpetic sores. These are painful blisters (fluid-filled bumps) that can break open and ooze fluid. These viruses get into the body through the mucous membranes which are thin layers of tissue lining the openings of the body. These are found in a person’s nose, mouth, and genitals. Once inside the body, these viruses incorporate themselves into your cells. As viruses multiply or adapt to environments very easily, treating viral infections becomes difficult. It is important to inform the doctor if you have genital herpes during pregnancy. This will enable them in taking precautions to prevent the virus from being transmitted to the baby during delivery.” Some general symptoms in both men and women include blisters on the mouth, lips, and elsewhere; itching or tingling in the infected area; ulcer and oozing in the blisters; crust over the sores; swelling in the lymph glands; and headaches, body aches, and fever. Adding further, Dr Aggarwal, said, “It is important to practice safe sex and use condoms during intercourse to prevent genital herpes and other STDs from spreading. Although there is no cure for this condition, medication can help in managing it. The disease tends to stay dormant within the body until something triggers an outbreak such as stress, illness, or tiredness. Discussing it with the doctor can help in arriving at a correct treatment plan.” Here are some tips to prevent genital herpes. Use a condom every time you have sex. A latex condom can give protection from the herpes virus if it covers the infected area. Enquire about your partner’s sexual history A person with many partners is more likely to be infected with the virus. Indulge in safe sex Don't have sex with a partner who has sores on his or her genitals. Get your partner tested If you think your partner is at high risk for genital herpes, you may consider asking him or her to be tested. In that case, you should be tested, too.

Thursday, 24 August 2017

Women smokers can lower their risk of heart disease by quitting the habit

Women smokers can lower their risk of heart disease by quitting the habit Lifestyle changes and strong resolve to quit are key New Delhi, 23 August 2017: As per WHO estimates, 3 million people in industrialized countries will have died due to tobacco use by 2030, and an additional 7 million people in developing countries will meet the same fate. Smoking is still the leading preventable cause of death. Not only does tobacco smoke cause lung cancer, it is also implicated in heart disease, other cancers and respiratory diseases. As per the IMA, women who quit smoking have a 21% lower risk of dying from coronary heart disease within five years of quitting their last cigarette. Women who are current smokers have almost triple their risk of overall death compared with non-smoker women. Current smokers also have a 63% percent increased risk for colon cancer compared with never-smokers, while former smokers have a 23% increased risk. The risks of dying from other conditions also decline after quitting, although the time frame varies depending on the disease. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "It’s never too early to stop, and it’s never too late to stop. Women who started smoking earlier in life are at a higher risk for overall mortality, of dying from respiratory disease and from any smoking–related disease. However, a smoker’s overall risk of dying returns to the level of a never-smoker 20 years after quitting. Women metabolize nicotine more quickly than men and cigarette smoke appears to be more toxic for women. Women's coronary arteries are typically smaller than men's. Smaller blood clots can block the vessels and trigger a heart attack.” Most of the excess risk of dying from coronary heart disease vanishes within five years of quitting. For chronic obstructive pulmonary disease (COPD), the return to normal takes 20 years, although there is an 18% reduction in the risk of death is seen within 5 to 10 years after quitting. And the risk for lung cancer does not return to normal for 30 years after quitting, although there is a 21% reduction in risk within the first five years. Adding further, Dr Aggarwal, said, “Nicotine replacement therapies may not be as effective in women as in men. This is because their menstrual cycle affects tobacco withdrawal symptoms and the results of anti smoking medications can be inconsistent. However, women should not wait until the development of a heart disease to quit this habit. Making certain lifestyle changes along with quitting smoking can help them lead a longer and healthier life.” The following tips can help quit the smoking habit. • Identify the trigger situation, which makes you smoke. Have a plan in place to avoid these or get through them alternatively. • Chew on sugarless gum or hard candy, or munch raw carrots, celery, nuts or sunflower seeds instead of tobacco. • Get physically active. Short bursts of physical activity such as running up and down the stairs a few times can make a tobacco craving go away. • Eat a healthy diet rich in whole grains, fruits and vegetables. • Keep yourself busy.

Triple talaq judgement may relieve stress in women

Triple talaq judgement may relieve stress in women Dr KK Aggarwal Our Vedas tell us that every thought in our mind arises from the silent potential web of energized information or consciousness. This thought from the mind is then analyzed by the intellect and the personalized by the ego. It then leads to an action. Every action leads to a memory, which in turn leads to a desire and with this a cycle of action, memory and desire is set into motion. If the desire is fulfilled, it leads to action again and then desire again. Repeated fulfillment of desires leads to habit formation, addictions and development of a particular personality. Unfulfilled desires, on the other hand, lead to irritability and then to anger. Anger destroys peace of mind. It hampers the powers of discriminating between good and bad. Anger distorts intellect and fosters negative emotions. Loss of intellect leads to animal-like behavior and ultimately self-destruction. Anger can be expressive anger or suppressive anger. Expressive anger or anger outbursts manifest as aggressive behavior, violence, hostility and cynicism. Emotionally stressful events, including anger, may trigger the onset of acute heart attack, asthma, anxiety. Cynical hostility has been recognized as major risk factor for coronary artery disease. While, suppressed anger or chronic anger in due course of time may cause depression, despondency, behavioral changes, anxiety, acidity and diarrhea. However, anger is not always bad. Righteous or spiritual anger is a type of anger with good intentions. The classical example of righteous anger is when you become angry in a situation where you see a person doing something wrong to check that person. Righteous anger can make people stand up for their rights and fight against what is wrong. The story of a young Muslim woman who allegedly committed suicide after her son had been taken away from her, two weeks after being divorced through triple talaq was published earlier this year. Depression was reported to be the factor leading to this extreme step. (April 12, 2017. Many such women in the country are living in a similar chronic stage of fear and apprehension of being discarded by their husbands. They are vulnerable to depression, anxiety, and various psychomotor disorders. The historic verdict of the Supreme Court of India, abolishing the practice of triple talaq, will liberate women from such fears. Empowering them and giving women equal right in marriage will reduce the prevalence of acute and chronic mental disorders in them, most commonly depression. Stressful events such as psychological trauma, etc. may also trigger development of depression. According to the World Health Organization (WHO), depression is now the leading cause of ill health and disability worldwide. More than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. A person with depression is typically depicted as sad, lonely, having no interest in activities that they earlier enjoyed, too much or too little sleep, low self-esteem, hopelessness. But, depression can also present as anger, irritability, addictions, eating too much or not eating enough, persistent aches and pains, memory problems, fatigue, or other behavioral changes. Disclaimer: The views expressed in this write up are entirely my own.

Wednesday, 23 August 2017

Be tuned to the signals of nature

Be tuned to the signals of nature The human body is made up of matter. If you break the matter, it is converted into atoms and then to subatomic particles (protons, electrons and neutrons), photons, quantum and wave in sequence. Matter can therefore be converted into non-matter. Photon is a state where you are both matter and non matter. In quantum mechanics, this is called wave particle duality in which every particle can be described as a particle and also as wave. When two photons particles interact or become ‘entangled’ and then separate, they are connected at a speed much faster than the speed of light and act similar even when separated by huge distances. Einstein called this connection as “spooky action at a distance” as according to him this was impossible. This phenomenon answers many of the mysteries of consciousness. Because at the level of photon, we are connected to everybody in the universe. When we learn to live in the present, there is harmony between our inner rhythm and the rhythms of the nature, a phrase described in Vedic text as “ritam bhara pragya” Ritam (rhythm), Bhara (full of), Pragya (mind) or simply put, a “mind full of rhythm”. This is the extreme parasympathetic state of the body and represents a state of mind where the thought waves are synchronous with the order of the universe. It is the interface between the disturbed and the undisturbed state of consciousness. It can be achieved by deep meditation. People who meditate have been said to acquire many powers like telepathy, reverse telepathy, spontaneous fulfilment of desires, meaningful coincidences, synchrodestiny etc. Our consciousness or the soul is the silent state of mind with infinite powers. These powers are hidden under the smoke of mind, intellect and ego. Ritam bhara pragya is controlling the mind, intellect and ego. Our Vedas say that nature regularly sends us signals that show that you are on the right path or have taken a wrong turn in life. But we are oblivious to them because at that particular moment, we are living either in the past or in the future. The state of Ritam bhara pragya brings us in close contact with nature, enabling us to pick up the signals of the nature. Once the state of ritam bhara pragya is achieved, we start living in the present. Living in the present is sometimes referred to as mindfulness. If we live our lives mindfully, we will get more out of life. Because then the intention becomes powerful, and one starts experiencing spontaneous fulfilment of desires. This is also the level where one experiences Siddhis, or the super normal powers described by Patanjali in the Yoga Sutras. Disclaimer: The views expressed in this write up are entirely my own. Dr KK Aggarwal

Increase intake of fluids to avoid kidney stones

Increase intake of fluids to avoid kidney stones Those with kidney stones have more chances of developing a chronic kidney disease New Delhi, 22 August 2017: Statistics reveal that the lifetime prevalence of kidney stones is approximately 13% in men and 7% in women. Without treatment, approximately 35% to 50% of those with kidney stones will experience recurrence within 5 years from the first stone. As per the IMA, increased fluid intake spread throughout the day can decrease stone recurrence by at least half with virtually no side effects. Kidney stones are formed due to the accumulation of dissolved minerals on the inner lining of the kidneys. There are several types of kidney stones: calcium stones, uric acid stones, struvite stones and cysteine stones. Calcium oxalate stones are the most common. People with kidney stones are at a significantly higher risk of developing chronic kidney disease. 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, “Lack of water in the body is the primary cause of kidney stones. In the absence of enough water to dilute uric acid (a component of urine), the urine becomes more acidic. This acidic environment is conducive for the formation of kidney stones. Kidney stones can grow as large as a golf ball and have a sharp, crystalline structure. Small stones can pass without pain. Larger stones, on the other hand, can obstruct urine flow. This can be very painful.” Some of the common symptoms of kidney stones include severe pain in the groin and/or side and back below the ribs, colicky pain, blood in urine, nausea and vomiting, pain on urination, burning sensation during urination, constant urge to urinate and fever and chills (in case of an infection). Adding further, Dr Aggarwal, said, “Certain medications can increase the risk of developing kidney stones. Long-term use of vitamin D and calcium supplements cause high calcium levels. Family history, dehydration, high protein, sugar, sodium diet, obesity and some disease conditions such as hyperparathyroidism are also risk factors. A previous history of kidney stone increases the risk of developing subsequent stones.” The following tips can help prevent kidney stones. Stay hydrated: This is the best way to avoid kidney stones. When one consumes less water, their urine output decreases making it more concentrated and less likely to dissolve urine salts that cause stones. Consume calcium in right amounts: Eat a moderate amount of foods with calcium, such as milk, cheese and other dairy food. Calcium oxalate stones are the most common type of kidney stone, hence, people believe that they should avoid eating calcium. Reduce dietary sodium: Increased salt in urine prevents calcium from being reabsorbed from the urine to the blood. This causes high urine calcium, leading to kidney stones. Limit foods rich in oxalate: Dietary oxalate is typically found in spinach, chocolate, beets, nuts, rhubarb, strawberries, tea and wheat bran. Eat less animal protein: Foods high in animal protein are acidic and increase uric acid. High uric acid levels may cause both uric acid and calcium oxalate kidney stones. Maintain a healthy body weight through diet and exercise.

Tuesday, 22 August 2017

Who can give consent?

Who can give consent? Dr KK Aggarwal Informed consent is an integral and crucial part of medical treatment today. It is not only a procedural requirement, but also a legal requirement. Not taking consent is gross negligence. Consent has to be taken before starting a treatment or a procedure. For consent to be valid, it should be voluntary i.e. given without coercion, informed and the patient should be competent to understand the information given. Consent indicates a respect for patient autonomy, a very important principle of medical ethics. This means that patients have the decision making capacity and doctors need to respect their right to make decision regarding their care. And, no doctor treats a patient without informed consent. Who can give the consent? Informed consent must ideally be taken from the patient himself/herself. In a traditional Indian setting, if the husband is hospitalized, the wife, at times, may not be taken into confidence by the relatives about the gravity of the situation or otherwise. Most often, it is one of the family members who usually sign the consent in such cases. If the patient is unconscious, then the spouse should authorize one person as a legal heir to take legal decisions, in case the spouse does not want to take decisions or is not informed. In an emergency situation when the patient is not able to give consent, then treatment may be given without consent, if there is no other person available to give consent. But, the onus lies on the doctor to prove that the treatment given was lifesaving. The facts of the case must be documented. The Medical Council of India (regulation 7.16) states that “Before performing an operation the physician should obtain in writing the consent from the husband or wife, parent or guardian in the case of minor, or the patient himself as the case may be. In an operation which may result in sterility the consent of both husband and wife is needed”. The MCI should revisit the regulation 7.16 and come out with a clause of “next of kin” consent or “surrogacy” consent, which should also include “all legal heirs” and not just one as part of the consent. Disclaimer: The views expressed in this write up are entirely my own

Stress is a major cause for temporomandibular joint disorders

Stress is a major cause for temporomandibular joint disorders Practicing relaxation techniques can help relieve symptoms New Delhi, 21 August 2017: As per recent studies carried out throughout India, there is a rise in the number of people suffering from TMD (temporomandibular joint) disorders. About 52% of the Indian population suffers from varying degrees of TMD and of these, 22% are affected both in the right and left TMJ. As per the IMA, a lot of these disorders can be attributed to increase in stress levels, especially among the young. TMJ connects the lower jaw to the skull. Although there are many reasons for TMJ disorders, including improper alignment of the teeth or trauma, it can get aggravated by stress as well. This is the only moveable joint in the entire face. 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 TMJ is a ball-and-socket joint which can erode due to many reasons. Under stress, a person tends to clench their jaw or grind their teeth (bruxism). Due to this, the muscles become taut and the joint does not get any rest leading to inflammation, pain, and dysfunction. TMJ disorders can lead to a clicking sound or grating sensation when a person opens their mouth or chews. However, provided there is no pain or limitation of movement associated with this jaw clicking, treatment may not be necessary. Many symptoms of TMJ syndrome can respond well to home remedies or stress reduction and relaxation techniques.” Some symptoms of TMJ disorders include pain the jaw, dull ache or radiating pain towards the cheek, ear or neck, a tired feeling to the face, toothaches, headaches, clicking or popping sounds while yawning or even limited movement of the jaw. Adding further, Dr Aggarwal, said, “There are many other conditions which cause symptoms similar to TMJ disorders. These include a toothache, sinus problems, arthritis, or gum disease. A dentist will conduct a careful patient history and clinical examination to find out the exact cause and ascertain whether the symptoms are due to any TMJ disorder. Treatments for TMJ disorders range from simple self-help advice and conservative treatments to injections and surgery.” Some home treatments for these disorders include the following. • Over-the-counter medications: NSAIDs such as naproxen or ibuprofen help relieve muscle pain and swelling. • Heat or cold packs: Applying an ice pack to the side of the face and temple area for about 10 minutes can help. • Eat soft foods: Yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans, and grains are good choices. • Avoid extreme jaw movements: It is good to keep yawning and chewing to a minimum. Avoid any activity that requires you to open your mouth wide. • Posture: Practice good posture to reduce neck and facial pain. • Learn relaxation techniques: As stress is a major cause for these disorders, it is better to consider some stress reduction therapy and techniques such as yoga and meditation.

Monday, 21 August 2017

Affordability or quality of service? Choose both

Affordability or quality of service? Choose both Every citizen in the country has a right to receive safe and quality medical treatment. Achieving universal health coverage is a target (3.8) under the Sustainable Development Goal (SDG 3). All member states of the UN including India have committed to try to provide universal health coverage to all their citizens by the year 2030. Universal health coverage means good quality health care that is Available, Accessible, Affordable and Accountable. The Institute of Medicine, USA (IOM, 1990) has defined quality in health care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. The American Medical Association (AMA, 1991) has defined quality as “the degree to which care services influence the probability of optimal patient outcome”. When a patient seeks health care, he/she looks for availability, quality and affordability. Safety, desired outcome of treatment and respect are becoming more and more important to the patients today. It’s not just clinical care based on best practices alone that decides quality of care. Several other factors also constitute patients’ perception of quality of care such as cleanliness, reliability, responsiveness, communication, empathy, patient-centered with patient as an equal partner is decision making. But, quality always comes at a price. Quality treatment is costlier but in the long-term, it is economical as it is associated with fewer hospital-acquired infections, complications, adverse drug reactions, re-hospitalization, as well as fewer system failures. Quality is always preferred but it may not always be feasible because quality care may increase the cost of treatment. So, should we focus on affordability or should we focus on quality? Every hospital or health care establishment must try to improve and maximize quality within the resources that are available to them and with the best use of those resources. Poor quality service indicates poor utilization of resources. Both quality and affordability need to be balanced, especially in a country like ours, which has one of the highest out of expenditures on health in the world. Disclaimer: The views expressed in this write up are entirely my own

Lifestyle changes and stress can cause premature ovarian failure in women

Lifestyle changes and stress can cause premature ovarian failure in women Although the condition cannot be reversed, certain treatments and lifestyle changes can control associated symptoms and risks New Delhi, 20 August 2017: A recent survey has indicated that about 4% of Indian women experience signs of menopause between 29 and 34 years of age. This is alarming given the fact that most women reach menopause between the age of 45 and 55. As per the IMA, the reason behind this is likely to be Premature Ovarian Failure (POF), some contributing factors for which include changing food habits and work culture with increased stress. POF is a loss of normal function of the ovaries before the age of 40. Women with this condition can have irregular or occasional periods for years and might even become pregnant.However, it is not the same as premature menopause. 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, "POF results from the loss of eggs (oocytes). The atmosphere today, lifestyle habits, food adulteration as well as consumption of processed food can lead to many changes in a woman’s body. These factors are responsible for the rise in the number of cases of POF in young adults. It is a good idea for women who have missed their period for three months or more to consult a doctor and determine the exact cause. Changes in period cycle may be due to pregnancy, stress, or a change in diet or exercise habits. However, it is best to get evaluated on time.” The symptoms of POF resemble those of a natural menopause and include change in the pattern of periods, hot flashes, mood swings, crying spells, and sleeplessness. A woman can have POF if her FSH level (follicle stimulating hormone) after a blood test is more than 25mIU/L. Adding further, Dr Aggarwal, said, “Although there is no proven treatment for POF, there are other alternatives such as adopting a healthier lifestyle which can help to a certain extent. Certain treatment procedures focus on the problems that arise from estrogen deficiency. Apart from this, assisted reproductive techniques have shown a ray of hope for those with issues such as these.” Some natural treatment methods can be tried to relieve hot flashes. Here are some tips. • Eat soy as it contains phytoestrogens. Some of the best sources of soy are tofu, soy powder, soymilk, and soy nuts. • Exercise, as an active lifestyle can lower the risk of premature menopause. About 30 minutes of aerobic exercise thrice a week is ideal. • Make sure that you get an ample supply of Vitamin D, E, zinc, and magnesium. • Eat foods that are rich in calcium such as cheese, almonds, green leafy vegetables, milk, fortified cereals like corn flakes, and raisin bran.

Sunday, 20 August 2017

Govt. move to fix ceiling prices of knee implants: The need of the hour

Govt. move to fix ceiling prices of knee implants: The need of the hour Dr KK Aggarwal Early this week, the National Pharmaceutical Pricing Authority (NPPA) fixed and notified the ceiling prices (inclusive of trade margins) of orthopedic implants used in knee surgeries, both primary knee replacement surgery as well as revision surgery, under para 19 of Drugs (prices control) order (DPCO 2013) with immediate effect. In 2005, orthopaedic implants were notified as ‘drugs’ by the Ministry of Health and Family Welfare vide its S.O. 1468 dated 6th October 2005. Consequent to this, Drug (Prices Control) Order (DPCO) 2013 became applicable to these implants, which also came under the purview of the NPPA, which is mandated to monitor the prices of all notified drugs including notified devices. An estimated 1.5 to 2 crores patients require arthroplasty; however, out of these which only about 1 lakh plus well off patients are in a position to pay for it every year because of the very high cost of orthopedic implants (NPPA Notification, August 16, 2017). As per WHO estimates, osteoarthritis will be the fourth leading cause of disability by the year 2020. The ceiling price of different materials and components used in the implant in primary knee replacement system has been fixed between Rs. 4,090/- to Rs 38,740/-. Similarly, the ceiling price of different materials and components used in the implant in revision knee replacement system has been fixed between Rs. 4,090/- to Rs 62,770/-. As per the notification, “All manufacturers/marketers of knee implants having MRP lower than the ceiling price specified plus goods and services tax as applicable, if any, shall continue to maintain the existing MRP in accordance with paragraph 13 (2) of the DPCO, 2013”. The earlier average MRP of cobalt chromium, the most commonly used knee implant has reduced by an average of 65%. The MRP has been capped at Rs. 54,720/- now Wfrom the earlier 1,58,324/-Knee implants made up of special metals like titanium and oxidised Zirconium has been capped at Rs 76,600/- with price reduction by 69%. The price of high flexibility implants have been capped at Rs. 56,490/-, again with a price reduction by 69% (Press Information Bureau, August 16, 2017). All hospitals/nursing homes/clinics performing orthopedic surgical procedures using knee implants are now required to comply with the ceiling prices notified. The patients cannot be charged any additional charge over and above the ceiling price notified “except applicable goods and services tax, if any, paid or payable”. The Indian Medical Association (IMA) welcomes this move of the govt. to fix the ceiling price of knee implants as now these implants have become more affordable and within reach of the common people. Many more patients will now be able to undergo the procedure, which earlier they could not because of the very high costs of the implants. Earlier this year, the Govt. had fixed the ceiling prices of coronary stents, which also came as a relief to the general public. Disclaimer: The views expressed in this write up are entirely my own.

Collective action a must to prevent mosquito-borne diseases

Collective action a must to prevent mosquito-borne diseases • On World Mosquito Day, IMA encourages people to indicate that their premises are free of mosquitoes • This is only possible if there is community participation in the efforts made by the government New Delhi, 19 August 2017: Statistics indicate that mosquito-borne diseases are prevalent in more than 100 countries. Mosquitoes infect about 300 to 500 million people, causing 1 million deaths every year around the world. More than 40 million people suffer from mosquito-borne diseases annually in India alone. According to the IMA, on World Mosquito Day, the need of the hour is to take collective action to prevent the breeding of mosquitoes, both on a larger scale and at an individual level. Malaria, filaria and dengue are the most prevalent diseases spread by mosquitoes in India with over 2 million cases of malaria alone reported in the country. The mosquito that transmits dengue fever and chikungunya is also responsible for spreading Zika. All these diseases result in high fever and excruciating joint pains, which have been a common occurrence in the country over the last two decades. 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, “Failure to control the mosquito menace is a collective failure and therefore, the mosquitoes transmitting diseases are still at large around the country. The Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, Private sector, and individuals must act together to prevent mosquitoes from breeding. A mosquito container index above 5% requires a community-integrated cluster approach to reduce mosquito density together with effective anti-larval measures. On World Mosquito Day, it is time to remind ourselves that we need to act against all the mosquitoes, be it Aedes, Culex, or Anopheles. Action against only the Aedes mosquito will not work.” Rain water is the most important source for mosquito breeding 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 rain water collections providing an ideal atmosphere for mosquito breeding. Adding further, Dr Aggarwal, said, “A community approach that involves 100% of the society needs to be adopted. Every house and establishment must indicate that their premises are mosquito-free. When you are invited to somebody’s place, you should ask ‘I hope your premises are mosquito-free’ and when you invite somebody, write ‘Welcome to my house. It is mosquito-free’.” IMA’s approach is a war against indoor or outdoor mosquitoes; fresh stagnant or dirty water mosquitoes; 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); scrubbing clean the utensils. One should not clean their premises once a week. Rather, it should become a habit to look for the breeding places daily. Here are some tips to follow. • Avoid stagnation of water in and around the house to prevent mosquitoes from breeding. • Cover all containers that have water stored in them. • Use mosquito screens, nets, meshes and insect repellent screens regularly. • Do not venture out immediately after dusk. If you need to go out, make sure to wear full-sleeved clothing and apply a mosquito repellent cream. • If you are affected by any of these diseases, ensure that you are hydrated and well rested. • Follow the doctor’s advice completely and do not compromise on any checkups, etc.

Saturday, 19 August 2017

Gorakhpur Tragedy: Findings of the IMA Inquiry Committee

Gorakhpur Tragedy: Findings of the IMA Inquiry Committee Dr KK Aggarwal National President, IMA The Gorakhpur tragedy, where many innocent lives were lost, has shaken the nation and stirred a debate in the country. Taking cognizance of the seriousness of the situation, Indian Medical Association (IMA) HQs constituted an Inquiry Committee comprising of Prof KP Kushwaha, Former Principal & Head, Dept of Pediatrics, Medical College Gorakhpur; Dr Ashok Agarwal, National Vice President IMA and Dr BB Gupta, President IMA Gorakhpur Branch. The committee also asked the following doctors to appear before it to present their case. • Prof Dr Rajiv Mishra, Principal BRD Medical College, Gorakhpur at the time of the incident • Prof Dr Satish Kumar, Head, Dept. of Anaesthesia, Medical College, Gorakhpur • Dr Mahima Mittal, Associate Prof, Dept. of Paediatrics, Medical College, Gorakhpur • Dr Kafeel Khan, Asst. Prof and Nodal Officer, Encephalitis Ward, Dept. of Paediatrics, Medical College, Gorakhpur • Dr AK Shrivastava, Superintendent in Chief, Nehru Hospital, Medical College, Gorakhpur But, the above doctors failed to appear before the Inquiry Committee, which then decided to visit the Dept. of Pediatrics in the Medical College. People there were hesitant to speak. The scope of the Committee was to only examine the working of the doctors as other issues such as lack of oxygen, inadequate staff and any structural deficiency were being investigated by the Chief Secy, UP Govt. The committee also took note of the various reports published in the newspapers and other media. The following conclusions were arrived at: • Oxygen supply was interrupted for a short time on the night of August 10, 2017. • The liquid oxygen supplier had not been paid his dues since last 5-6 months. • Cleanliness of hospital and ward was unsatisfactory. Presence of dogs and rats in hospitals is not acceptable by any standards in the hospital premises. • The hospital was handling these cases and other critically ill patients much more than its capacity. • There is no facility in Gorakhpur and nearby districts to manage encephalitis. • There is a lack of staff – paediatricians, nurses and other paramedical staff – in PHCs/CHCs. • ICUs in 10 districts of Poorvanchal area are not functioning because of lack of staff and other resources. • No alert was issued by the hospital administration regarding shortage of oxygen, The traeting doctors should have been alerted seven days before the fresh oxygen supply was not received. According to the IMA, although there is no evidence of medical clinical negligence against Dr Rajiv Mishra and Dr Kafeel Khan, prima facie it appears that a case of administrative negligence against them cannot be ruled out. Hence, administrative inquiry and action may be taken against them. The recent movie ‘Airlift’ was based on the true story of evacuation – airlifted - of several hundreds of Indians from Kuwait during the first Gulf war and brought back to the country. Similarly, we read about ‘green corridors’ without any traffic disruptions being set up to transport harvested organs like heart to reach another hospital, where there is a patient waiting to receive the organ. It’s an emergency where time is of utmost importance. Why can’t the same be done in situations such as the Gorakhpur tragedy, where an epidemic of encephalitis recurs every year and, many children lose their lives every year because of the illness? In view of this tragedy, IMA has suggested the following to avoid similar situation in the future. • There should be a state policy to airlift such critically patients in a timely manner to nearby best facilities. • All patients denied treatment at government hospitals should be reimbursed for the cost of treatment in the private sector at pre-defined rates. • All hospitals should have back up of one-week supply of all essential drugs, investigations and oxygen. • IRDA has made it mandatory for all private hospitals to get NABH accreditation. The same should be extended to all government set ups. • Essential drugs and investigations, not non-essential drugs and tests, should constitute the bulk of the expenditure of the allocated budget to reduce the cost of treatment. • All payments for health care services should be made either in advance or in time. • Doctors are clinicians as well as administrators. It is important to make a distinction between clinical medical negligence and administrative negligence. Disclaimer: The views expressed in this write up are entirely my own

Immunization in infants and children a must to avoid hearing disabilities

Immunization in infants and children a must to avoid hearing disabilities Childhood hearing loss goes undetected mostly due to lack of awareness and appropriate interventions New Delhi, 18 August 2017: As per recent reports, about 5% of the world's population suffers from disabling hearing loss, of which 32 million are children. About 6.3% of the Indian population suffers from hearing impairment and this percentage includes roughly 50 lakh children. As per the IMA, most of these hearing problems can be prevented through immunization against various diseases, by controlling noise pollution, and regulating the use of certain medicines. Deafness is primarily of two kinds. Nerve deafness is caused due to sound pollution and problems during birth. Conductive deafness is a result of socio-economic factors such as poor hygiene and lack of treatment, leading to chronic infection and deafness. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “It is alarming to note that the number of infants and youngsters with hearing impairment has increased substantially over the last few years. Hearing impairment is not recognizable easily during infancy and therefore is highly neglected. The need of the hour is to educate people and create awareness that hearing loss can be combated through early identification and appropriate intervention. Apart from congenital defects, hearing loss can also be the result of external factors. It is imperative to control these with support from a good healthcare system and control over noise levels.” Universal Newborn Hearing Screening (UNHS) is a medical test for early detection of congenital hearing loss. India still lacks such a system that can identify congenital hearing problems in infants. Adding further, Dr Aggarwal, said, “There is a lack of communication, low awareness, and lack of understanding about the importance of early diagnosis and intervention in case of a hearing loss. Delay in identifying this condition can affect language acquisition, social interaction, emotional development, and education in children. Neonatal hearing screening for every newborn is a must and highly recommended.” Here are some ways to prevent hearing loss in infants. • Avoid any shock and trauma to the ears as it can cause severe damage to the ear drums resulting in loss of hearing. • Ensure that water does not enter the infant’s ears while bathing. • Get them medically tested as early detection can lead to better treatment outcomes. • Never insert any sharp object in the infant’s ears. • Keep them away from loud music or other sounds as this can impact their hearing capability. Loud music causes acoustic trauma. • Make sure that children are immunized against infections like measles, mumps, rubella, and meningitis as per schedule. These infections can also cause hearing loss in children.