Viral hepatitis is a serious health problem in the country, IMA

Viral hepatitis is a serious health problem in the country, IMA • If not diagnosed in time, it can lead to cirrhosis or liver cancer • About 90% of hepatitis C cases can be cured with treatment New Delhi, 26 July 2017: According to statistics, about 400 million people are infected with Hepatitis B and C around the world. In India, about 40 million people are chronically infected with Hepatitis B and another 6 to 12 million with Hepatitis C. Most of the acute cases of liver failure can be attributed to Hepatitis E Virus (HEV). As per the IMA, about 90% of the people with Hepatitis C can be cured with treatment. An inflammation of liver is referred to as hepatitis. Caused by hepatitis viruses A, B, C, D, and E, viral hepatitis is a widespread infectious disease. The condition can be self-limiting or can progress to liver fibrosis (scarring), cirrhosis or liver cancer. Viral hepatitis has been recognized as a serious health problem in India. 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, "Hepatitis A virus is the most common cause of acute viral hepatitis, followed by hepatitis B virus. Engaging in certain activities, such as getting a tattoo or body piercing, sharing needles to inject drugs, or having several sex partners, increases the risk of developing hepatitis. The liver is a vital organ which helps process nutrients, filter blood, and fight infections. When the liver is inflamed or damaged, its function can be affected. Hepatitis B can also be transmitted by fomites such as such as finger-stick devices used to obtain blood for glucose measurements, multi-dose medication vials, jet gun injectors, and endoscopes. Hepatitis B is 10 times more infectious than HCV and 50–100 times more infectious than HIV. The HBV can survive in dried blood for up to 7 days and remains capable of causing infection. This makes hepatitis B a more dangerous infection than HIV.” Some symptoms of acute viral hepatitis include fatigue, flu-like symptoms, dark urine, light-colored stools, fever, and jaundice; however, acute viral hepatitis can also occur with minimal symptoms which can go unrecognized. In rare cases, acute viral hepatitis causes fulminant hepatic failure. Adding further, Dr Aggarwal, said, “The initial treatment for acute viral hepatitis involves relieving the symptoms of nausea, vomiting, and abdominal pain. It is better to avoid medications or compounds, which can have adverse effects in patients with abnormal liver function. Only necessary medication should be prescribed as the impaired liver cannot eliminate drugs normally, making them accumulate in the blood and reach toxic levels.” The following tips can help in preventing hepatitis. Get vaccinated Hepatitis A and B vaccines are very effective and can be given as separate injections, or combined. It is better to consult your doctor and get vaccinated on time to avoid any infection. Inculcate the habit of washing hands Make sure that everyone in the family washes hands thoroughly after using the bathroom (or changing a diaper) and before handling food or eating. Avoid contact with foreign blood Any blood exposure can transmit hepatitis B and C and therefore, ensure to wash off any blood thoroughly if you happen to come in contact with it. Beware of the tattoo Get tattooed only by a licensed professional. It is possible to get hepatitis from hypodermic needles and the tools used to create tattoos and piercings. Indulge in safe sex Use appropriate contraception options. The chances of hepatitis infection increase with the number of sexual partners.

High cesarean section rates in the country

High cesarean section rates in the country The rates of cesarean section deliveries are increasing in the country and there is a perception amongst the public that many of these are unnecessary cesarean sections. According to a World Health Organization (WHO) report published in 2010, the cesarean section rate in India was 8.5%. The percentage of cesarean section deliveries in the country is 17.2% as per the National Family Health Survey (NFHS)-4 (2015-16) released earlier this year (Press Information Bureau, Ministry of Health and Family Welfare, March 28, 2017). This latest figure is apparently higher than the “ideal” rate between 10% and 15% as that recommended by the WHO in 1985. The high cesarean rates in the country, as a number, cannot be viewed in isolation. There are several reasons why a cesarean section delivery may be chosen over a vaginal birth. There are the medical indications, the absolute and relative indications, because of which a doctor may recommend an elective caesarean section. At times, in conditions such as obstructed labor or other obstetrical emergencies, a caesarean section is done as an emergency procedure, where it is lifesaving for both the mother and the child. Then there are the non-medical reasons. The decision to perform a caesarean section is not solely in the hands of the doctor. Patient preferences or caesarean on maternal request also play a part. Anxiety about vaginal birth, fear of vaginal birth (tocophobia), precious child are some factors which influence the choice of cesarean section by the expectant mother as a mode of delivery, in the absence of any medical or obstetrical contraindication to vaginal birth. Some women want to deliver on an auspicious date or even time. This is another reason why they opt for an elective cesarean. Cesarean section rates are higher in tertiary institutes or superspecialty hospitals. Similar is the case with senior and experienced doctors, who may not do routine vaginal deliveries. If you take informed consent, then again the cesarean section rates may be higher. All these non-medical factors contribute to the increase in cesarean section rates. And, while they are not the sole cause, they do need to be taken into account. Then again it is important to evaluate the correlation between cesarean section rates and the infant mortality rate (IMR) and maternal mortality rate (MMR). Data from NFHS-4 showed that private hospitals carried out 40.9% cesarean sections, while this rate in government hospitals was 11.9%. The two cannot be compared. It is important to assess the corresponding IMR and MMR. Many women doctors may choose to have a cesarean section instead of vaginal birth, which also needs to be computed. Unless it can be proved that the cesarean rate in doctors and VIPs is low compared to the general population, it cannot be said that the cesarean rates are unnecessarily high. This is not so. Cesarean section is a surgical procedure, with potential complications for both the mother and the child. An informed consent needs to be taken before proceeding with the procedure. The decision of the United Kingdom (UK) Supreme Court in the case of Montgomery v Lanarkshire Health Board was a landmark judgement, which made the patient an active partner in decision making as far as his/her treatment is concerned. It ruled that the doctor has a duty “to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments”. The doctor has to inform the patient of all possible risks, even though rare, and let the patient take a decision. The patient should be informed that even elective CS is not risk-free and carries serious risks for mother and child. An audit of deliveries cesarean sections, in the private as well as public health facilities, is needed to find out the reasons for the decision to perform each cesarean section before judging that economics and not medicine, influence a doctor’s decision to do a cesarean delivery. Dr KK Aggarwal National President IMA & HCFI Recipient of Padma Shri, Dr BC Roy National Award,Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO) Past Honorary Secretary General IMA Past Senior National Vice President IMA President Heart Care Foundation of India Gold Medallist Nagpur University Limca Book of Record Holder in CPR 10 Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand Editor in Chief IJCP Group of Publications & eMedinewS Member Ethics Committee Medical Council of India (2013-14) Chairman Ethics Committee Delhi Medical Council (2009-15) Elected Member Delhi Medical Council (2004-2009) Chairman IMSA Delhi Chapter (March 10- March 13) Director IMA AKN Sinha Institute (08-09) Finance Secretary IMA (07-08) Chairman IMAAMS (06-07) President Delhi Medical Association (05-06)

Increasing suicides in India are a testimony to the faulty mental health policies of the country

Increasing suicides in India are a testimony to the faulty mental health policies of the country According to recent reports, over 50 million people suffer from mental illness like depression, suicidal ideation and anxiety in India Over 7,000 people end up committing suicide because of lack of adequate counseling and other medical assistance New Delhi, 4th April 2017: The Indian constitution grants us seven fundamental rights, out of which the most basic one is the ‘Right to Life’. The taboo in the society, which often exists when it comes to mental illnesses like anxiety and depression, has become a deterrent to this very basic right. The increasing number of suicide cases making the headlines has caused severe uproar in the medical fraternity and government for better facilities to mental health patients, however despite deliberations, no conclusion has come to light yet. India is right on the top of the list in regards to the maximum cases of suicides recorded every year across Southeast Asia. The average suicide rate in India is 10.9 for every lakh people and the majority of people who commit suicide are below 44 years of age, said a World Health Organisation (WHO) report. Suicidal ideation and behavior are among the most serious and common psychiatric emergencies. Patients at imminent risk for suicide require immediate psychiatric services and must be monitored continuously until they are in a safe situation. After a suicide attempt, psychotherapy may prevent subsequent attempts. Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement said that,, “Suicide cases are not only prevalent amongst the general population, teenagers, youngsters and adults alike, but they are also found to be common within the medical fraternity. Medical professionals, both students and doctors are also found to end their lives because of increased stress, depression and anxiety issues. As World Mental Health Day is nearing, we would like to highlight that an inadequate support system is the major cause behind the increased suicide rates in our country. The need of the hour is for the Government to focus on building comprehensive mental health counseling facilities. On examining carefully mental health patients from across professions, it has been found that the highest rate of suicide is found amongst the medical fraternity. And further elaborating, it is the physicians, pathologists and anesthetists who take their own lives most commonly. Additionally, female doctor suicides significantly outnumber male doctor suicides. The primary reasons being the stress and strain one has go through in order to be a doctor and carry on in the medical profession. Doctors also given the easy access to medication, often misuse this to take their own lives. In a country with such high rates of mental health patients, it is imperative that necessary steps are taken to reduce the number of deaths. Adequate counseling services must be provided and awareness raised that it is okay to find oneself in a difficult situation but there are other ways of dealing with stress than taking ones life. We live in the 21st century and it is essential that parents realize that they must not force their children to become a doctor before being sure of their caliber and interest. Additionally there is no harm or shame in admitting one’s state of mind and help must be sought. A healthy state of mind