More than half of the allopathic doctors in India lack medical qualification

More than half of the allopathic doctors in India lack medical qualification
IMA urges people to beware of quacks and have faith in qualified doctors

New Delhi, 18 December 2017: As per a study published by the WHO, only 58.4% of doctors have a medical qualification in urban India. The condition is worse in rural areas with only 18.8% having a proper medical qualification. India has lakhs of quacks and about 60,000 work out of Delhi alone. Additionally, the study also indicates that 57.3% allopathic doctors do not have a medical qualification and another 31.4% are educated only up to the secondary school level.

A quack or charlatan, as defined by the Supreme Court in 1996,is anyone practicing modern medicine without proper training in the discipline. The large number of quacks in both the rural and urban areas of India are a threat to the people and society at large. What exacerbates the situation is that if anything goes wrong, only few have the resources to file a complaint against them. Many just accept it as fate, particularly in the rural areas.

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, “In many parts of India, 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. It is a settled law that quacks are untrained and cannot diagnose or treat routine and emergency situations. They will invariably miss diagnosis of acute heart attack, paralysis, meningitis, early cancer, early rheumatoid arthritis, appendicitis, acute abdomen, acute pregnancy situations, dissection of aorta, pulmonary embolism etc. leading to a high mortality and morbidity. Their modus operandi is based on referral practice to corporate set ups with a desire of getting commissions.”

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, “It takes over a decade for a modern medicine doctor to acquire sufficient knowledge to decide which antibiotic should be prescribed in a certain situation and which should be avoided. It’s not mathematics. One cannot learn medicine via Google or following the prescriptions of modern medicine doctors. Every case is different; hence, we say individualize treatment according to that particular patient. Most preventable deaths can be traced to ignoring warning signals or self-prescriptions or relying on medicines by quacks or chemists.”

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.

Straight from the Heart: IMA-IAP-NNF Policy on viability in India

Straight from the Heart: IMA-IAP-NNF Policy on viability in India

As per the ILCOR / AAP / AHA 2015 Neonatal Resuscitation Guidelines Subsection on Withholding Resuscitation we quote:

“There is a no evidence to support the use of any particular delivery room prognostic score presently available over gestational age assessment alone, in preterm infants at less than 25 weeks gestation”.

As per the NRP Guidelines 3rd Edition (India) “Neonatal Resuscitation: India

“Questions about initiation of Resuscitation for extremely premature babies is a grey area. Babies born between 24+ to 28 weeks has been increasing in the developed countries, it may still not be true for most parts of our country. Non initiation of Resuscitation may be considered appropriate in confirmed gestation below 25 weeks (20 weeks to 24 completed weeks), anencephaly, and confirmed lethal genetic malformation disorder”.

The most read textbook of community medicine in India ‘Park’s Textbook of Preventive and Social Medicine’ states that “viability is a stage when foetus becomes capable of living independently, this has been fixed administratively at 28 weeks, when the foetus weighs approximately 1000 g”.[1]

IMA-IAP-NNF Policy

Viability is defined as >28 weeks and more than 1000 grams. Anything less than that level of treatment has to be decided on case to case basis based on chances of intact survival, informed consent taking into consideration social determinants of health. Basic care should not be compromised.

Reference

1.      Park K. Demography and Family Planning. In: Park K, editor. Park’s Textbook of Preventive and Social Medicine. 24th ed. Jabalpur: Bhanot; 2017.p.539.

Seasonal flu to hit India hard in the coming year

Seasonal flu to hit India hard in the coming year
 
It is imperative to get vaccinated in a timely manner to avoid getting infected

New Delhi, 13 December 2017: Seasonal influenza outbreaks each year cause 3 million to 5 million severe cases and 300,000 to 500,000 deaths globally, estimates the WHO. Recent predictions by flu-trackers have indicated that seasonal flu will hit India and the rest of the northern hemisphere hard next year. This prediction is based on outbreak trends in the winter of the southern hemisphere, where Australia has reported record-high numbers of cases, hospitalizations and deaths.

Seasonal flu shows a minor peak from December to February in India. It causes symptoms of fever, cough, breathlessness, lethargy, headache and nausea. Most people recover within a week without ill-effects, but complications such as pneumonia and multi-organ failure can kill people at risk, such as young children with respiratory problems, pregnant women, older adults above age 65 years, and those with chronic disorders such as asthma, lung diseases, heart disease and diabetes.

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, “Influenza (flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness. Serious outcomes of flu infection can result in hospitalization or death. Most flu outbreaks happen in late fall and winter. The symptoms may not show up for a couple of days and thus, it is possible for a person to pass on the flu to someone even before this. Flu is usually caused by influenza viruses A and B. The strains vary each year. One may often confuse flu with a common cold as the symptoms are very similar. It is imperative to get a shot of the flu vaccine every year to prevent any incidence particularly in children, pregnant women, and older citizens.”

As viruses adapt and change, so do those contained within the vaccines – what is included in them is based on international surveillance and scientists’ calculations about which virus types and strains will circulate in a given year.

Adding further, Dr Aggarwal, said, “Flu is primarily treated with rest and fluid intake to allow the body to fight the infection on its own. Paracetamol may help cure the symptoms but NSAIDs should be avoided. An annual vaccine can help prevent the flu and limit its complications.”

Here are some tips to prevent spreading of seasonal flu.

Those who are not sick should avoid close contact with people who are sick.
People with flu should cover their mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.
Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.
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India has the highest number of TB patients across the world

India has the highest number of TB patients across the world

Missing doses can defeat the purpose of DOTS therapy

New Delhi, 12 December 2017: According to recent reports, with 2.79 million cases, 4.23 lakh deaths, and an average of 211 new infections diagnosed per 100,000 people, India currently has the highest number of tuberculosis (TB) patients across the globe. India also has the most number of MDR-TB patients in the world as well as the largest number of ‘missing’ TB patients. There are several million who have not been identified, notified, or treated and these people remain off radar.

TB is a highly infectious disease cured by providing proper medication at the right time for the full duration of the treatment. The drug regimen is called DOTS and is provided free under the Revised National TB Control Programme (RNTCP). It is based on the principle that a regular and uninterrupted supply of high-quality anti-TB drugs must be administered to cure the disease and prevent the occurrence of the MDR-TB.

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, “TB is a major public health concern in India. Not only is it a major cause of morbidity and mortality but also poses a huge economic burden on the country. Elimination, which is defined as restricting new infections to less than one case per 100,000 people, is possible only when patients get diagnosed and cured without any break in treatment. Any interruption in treatment can exponentially raise the patient’s risk of developing MDR-TB, which is harder to treat. Missing doses defeats the very purpose of DOTS therapy, which is meant to ensure strict compliance through supervised consumption of medicines. As many as 900,000 people with TB do not have access to proper treatment, which means they risk developing drug-resistant TB and infecting others.”

Reporting is important to trace contacts of the person with infectious TB. All contacts of the patient should be screened for TB and put on treatment if required. This cascade of screening of contacts, at home and workplace, identifies individuals at risk and prevents further spread of TB, including MDR TB.

Adding further, Dr Aggarwal, said, “The approach to all notifiable diseases should be based on DTR: Diagnose, Treat, and Report. Diagnose early, using sputum Gene Xpert test; Treat: Complete and effective treatment based on national guidelines, using FDC; and Report: Mandatory reporting.”

Here are some tips that can help avoid TB infection from spreading.

Wash your hands after sneezing, coughing or holding your hands near your mouth or nose.
Cover your mouth with a tissue when you cough, sneeze or laugh. Discard used tissues in a plastic bag, then seal and throw it away.
Do not attend work or school.
Avoid close contact with others.
Sleep in a room away from other family members.
Ventilate your room regularly. TB spreads in small closed spaces. Put a fan in your window to blow out air that may contain bacteria. 

About 90% of the estimated malaria cases in the Southeast region are from India

About 90% of the estimated malaria cases in the Southeast region are from India

India also needs a stronger malaria surveillance system to combat the disease

New Delhi, 02 December 2017: As per recent reports, India accounts for about 6% of the world’s new cases of malaria and 7% of deaths caused by the disease. India accounts for about 90% of the estimated number of malaria cases followed by Indonesia (9%) and Myanmar (1%) in the Southeast Asia region. The country has also been found to be one of the weakest in terms of malaria surveillance systems. Despite efforts at various levels, malaria remains an acute public health challenge in India.

Malaria is a life-threatening mosquito-borne blood disease caused by a Plasmodium parasite. It is transmitted to humans through the bite of the Anopheles mosquito. Once an infected mosquito bites a human, the parasites multiply in the host's liver before infecting and destroying red blood 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, "Malaria is transmitted by the bite of a female anopheles mosquito. The mosquito bite occurs mainly between dusk and dawn. Five types of Plasmodium parasite can infect humans. They are found in different parts of the world. Some cause a more severe type of malaria than others. Malaria can also be transmitted through blood transfusion, or via sharing of contaminated needles. The behavior of the mosquitoes may differ. Some may prefer to rest indoors and feed indoors in the night. Some may prefer to rest and feed outdoors earlier in the day. Preventive therapy of malaria can be instituted during pregnancy in high risk areas. The malarial mosquito feeds every third day compared to the dengue mosquito, which feeds three times in a day.”

Symptoms of severe malaria include the following: fever and chills; impaired consciousness, prostration, or adopting a prone position; multiple convulsions; deep breathing and respiratory distress; abnormal bleeding and signs of anemia; and clinical jaundice and evidence of vital organ dysfunction.

Adding further, Dr Aggarwal, said, “Pregnant travelers should defer travel to areas where risk of malaria is high until after delivery. For non-immune pregnant women who cannot defer travel, chemoprophylaxis with chloroquine and mefloquine depending on travel to areas with chloroquine-sensitive or resistant malaria is recommended. Pregnant women from endemic areas, who due to prolonged exposure to malaria, have developed natural immunity benefit from chemoprophylaxis.”

Here are some tips to prevent malaria.

• Malaria mosquitoes grow in fresh water collected in the house. It is therefore important to not let water stagnate in your house and the surrounding areas. Mosquito cycle takes 7-12 days to complete. So, if any utensil or container that stores water is cleaned properly once in a week, there are no chances of mosquito breeding.
• Mosquitoes can lay eggs in money plant pots or in water tanks on the terrace if they are not properly covered. If the water pots for birds kept on terraces are not cleaned every week, then mosquitoes can lay eggs in them.
• Using mosquito nets/repellents in the night may not prevent malaria because these mosquitoes bite during the day time.
• Malaria mosquitoes do not make a sound. Therefore, mosquitoes that do not produce a sound do not cause diseases.
•  Wearing full sleeves shirt and trousers can prevent mosquito bites. Mosquito repellent can be helpful during the day. 

Medical tourism is showing a steady growth in India

Medical tourism is showing a steady growth in India

Lower cost of treatment, government policies to make conditions conducive for tourists, form some of the reasons for this growth

New Delhi, 07 November 2017: Medical tourism is seeing a steady growth in the country as per recent statistics. What currently stands at 3 billion dollars is expected to grow to about 7 to 8 billion dollars by the year 2020. India issued more than 1.78 lakh medical visas in the year 2016. As per the IMA, some of the major reasons for this increase in medical tourism in the country include the presence of world-class hospitals and skilled medical professionals. Apart from this, the cost of treatment for various major surgeries in India is only a fraction or even as low as 10% of that in many developed countries.

Medical tourism is the process of traveling outside the country of residence for receiving medical care. This originally referred to the travel of patients from less-developed countries to developed nations in pursuit of the treatments not available in their homeland. Another major reason for the rise in medical tourism in India is the availability of alternative treatment options such as Ayurveda and Naturopathy.

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, “Medical tourism has been a major growth sector globally. The exorbitant healthcare costs in the affluent Western countries have made healthcare out of reach for even their citizens. Consequently, they are now looking beyond their borders to seek medical treatment. India has emerged as a prime destination in the last few years for people across the globe in need of medical treatment. Affordability, high quality healthcare, availability of specialist treatment and advanced technologies are just a few reasons that have made India a much sought-after destination. Furthermore, the diversity of its flora and fauna, its natural beauty including a rich and vibrant cultural heritage has already put India on the tourist map. Many facilities in India have become a destination for learning and healing together. One can opt for a complete body detox using Yoga techniques and learn them too.”

India now has a simplified e-medical visa facility which allows three visits to the country. The government is also taking steps to address other areas such as standardization and accreditation of services.

Adding further, Dr Aggarwal, said, “Tourism also contributes a fair share to the economy of a country. Therefore, the government has important roles to play in the development and refinement of medical tourism in India, not only as a regulator but also as a facilitator. In view of this, the government of India has constituted a Medical and Wellness Tourism Board as a dedicated institution to guide the promotion and positioning of India as a competent and credible medical and wellness tourism destination.”

IMA is a member of National Medical and Wellness Tourism Board. The following recommendations are likely to be implemented.

• Government to facilitate e-Medical Visa.
• Normally e-Visa given for 60 days but e-Medical Visa will be for 6 months.
• e-Visa will have a permission for double entry, but e-Medical Visa will permit Triple entry.
• e-Visa will be extendable to e-Medical Visa.
• e-Medical Visa will be available at five major Indian Ports i.e. Mumbai, Cochin, Goa, Chennai and Mangalore.
• e-Medical Visa will be available for 161 countries.
• Presently, medical attendants are given Visa, but the Committee has recommended that medical attendants should also be given e-Medical Visa.
• The Committee also recommended that all hospitals should have a common Greet and Meet Counter and it should be at major Airports / Ports.
• Free SIM card at entry will be given to e-Medical Visa patient.
• Committee have recommended a Translation App at Airports/ Ports.
• All Medical Tourism Hospitals will have to be NABH or JCI Accredited. We are pushing for IMA accreditation also.
• The Committee also recommended that fee for e-Visa and e-Medical Visa should be the same.

India has improved its global action plan for prevention and control of pneumonia

India has improved its global action plan for prevention and control of pneumonia

Pneumonia can be mild to life threatening and preventive action is a must

New Delhi, 01 November 2017: As per recent statistics, India is responsible for 20% of all pneumonia deaths, which is nearly 3.5 lakh. Of all the states, Uttar Pradesh tops the list in terms of these deaths. However, reports also indicate that India is among the 12 nations that have improved their Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) score this year. The health ministry recently announced a partial introduction of the vaccine in five states including Bihar, Uttar Pradesh, Rajasthan and Madhya Pradesh, and Himachal Pradesh.

Pneumonia is a form of acute respiratory infection affecting the lungs. In a healthy person, the small sacs called alveoli in the lungs fill with air while breathing. However, in pneumonia, these get filled with pus and fluid, making breathing painful and limiting oxygen intake. Pneumonia can be caused by viruses, bacteria, and fungi.

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, “Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems. Many germs can cause pneumonia. The most common are bacteria and viruses in the air we breathe. The body usually prevents these germs from infecting your lungs. However, sometimes these can overpower the immune system, even if a person’s general health is good. The most common type is community-acquired pneumonia which occurs outside of hospitals or other health care facilities. The other forms of pneumonia are hospital-acquired pneumonia, healthcare acquired pneumonia, and aspiration pneumonia.”

The signs and symptoms of this condition include chest pain while breathing or coughing; confusion or changes in mental awareness (in adults age 65 and older); cough, which may produce phlegm; fatigue; fever, sweating, and shaking chills; lower than normal body temperature; nausea, vomiting or diarrhea; and shortness of breath.

Adding further, Dr Aggarwal, said, “While most cases of pneumonia can be treated at home, babies, children, and people with severe pneumonia may need to be admitted to hospital for treatment. Pneumonia is usually treated with antibiotics, even if viral pneumonia is suspected as there may be a degree of bacterial infection as well. The type of antibiotic used and the way it is given will be determined by the severity and cause of the pneumonia.”

The following tips can help prevent pneumonia.

• Get vaccinated. There are vaccines that can prevent some types of pneumonia and the flu. The vaccination guidelines have changed over time and should be reviewed with the doctor even if one has received a pneumonia vaccine earlier.
• Ensure that children get vaccinated. Doctors recommend a different pneumonia vaccine for children younger than age 2 and for children ages 2 to 5 years who are at particular risk of pneumococcal disease.
• Practice good hygiene to protect yourself against respiratory infections that may lead to pneumonia. Wash your hands regularly or use an alcohol-based hand sanitizer.
• Don't smoke as it candamage the natural defense of the lungs against respiratory infections.
• Keep the immune system strong by getting enough sleep, exercising regularly, and eating a healthy diet.

Lack of awareness about dementia in India, says IMA

Lack of awareness about dementia in India, says IMA The problem is more in rural areas where there are not enough medical facilities available for timely diagnosis New Delhi, 01 August 2017: According to statistics from a recent research, more than 4 million Indians above the age of 60 suffer from dementia. Add to this the fact that about 1 in 16 households with an elderly person have a dementia patient. However, many people fail to recognize and understand the symptoms, says the IMA. In approximately 70% of the population in rural areas as well, dementia remains unrecognized and this can be largely attributed to limited medical facilities. Dementia is a general term for a decline in mental ability. This can become severe enough to interfere with daily life. Memory loss is an example. Alzheimer's is the most common type of dementia. Dementia is an umbrella term describing a wide range of symptoms associated with a decline in memory or other thinking skills. These can later become severe enough to reduce a person's ability to perform everyday activities. 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 awareness about dementia is a major reason why those who experience forgetfulness, confusion, or difficulty in doing something do not consult doctors. There are also those individuals who may not choose to talk about it considering it shameful or a normal part of the ageing process. Dementia is caused by a damage to brain cells which further interferes with their ability to communicate with each other. This can affect thinking, behavior, and feelings in those with this condition. Dementia in most cases is not reversible but medication can provide some relief to the symptoms. At times, symptoms may appear due to reversible problems like vitamin or hormone deficiencies. These can be treated with timely consultation.” While symptoms of dementia vary in people, there are some basic signs which are significant in the diagnosis of dementia: loss of memory, problems with communication and language, decreased ability to focus and pay attention, impaired reasoning and judgment, and decreased visual perception. Adding further, Dr Aggarwal, said, “Mini-Mental State Examination (MMSE) is the most widely used cognitive test for dementia. The examination takes approximately 7 minutes to complete. It tests a broad range of cognitive functions including orientation, recall, attention, calculation, language manipulation, and constructional praxis. A total maximal score on the MMSE is 30 points. A score of less than 24 points is suggestive of dementia or delirium. t is also recommended that people with dementia be screened for depression because it is a common treatable co-morbidity that may also masquerade as dementia.” Although there is no specific way to prevent dementia, following a healthy lifestyle can help lower the risk. The following steps can be taken towards this direction. • Consume a healthy diet • Maintain a healthy weight • Indulge in regularly physical activity • Do not consume alcohol in excess • Quit smoking right away • Maintain a healthy blood pressure level

Paradigm shift in blood donation

Paradigm shift in blood donation India has huge population of more than 1.3 billion, but is still short of blood by 20-25%. Blood donation is a requirement of the society. All donations should be voluntary. Blood donation camps are often organized by hospitals and NGOs. But these are whole blood donation camps. But, now no camp should be organized for ‘whole blood donation’. Instead components-only blood donation camps should be organised. One unit of blood collected can be used to help 3 to 4 patients, instead it is being wasted as whole blood depriving another patient in need. And, voluntary blood donation camps should be now called “blood component donation” camp and not just blood donation camp. So, if the blood being donated is collected in a single bag, do not give blood. Usually two component bags are used. 100 ml bags should be promoted for pediatric use. People with rare blood groups should not donate in camps. They should instead donate only when needed. Under the new National Blood Transfusion Council regulations, no blood is to be wasted. The surplus left over plasma is fractionated to manufacture products like albumin and intravenous immunoglobulins (IVIG). The blood that is donated in voluntary blood donation should be maximally utilized. The tests done are for blood groups (A, B, O) and Rh factor and five transfusion-transmitted infections namely hepatitis B and C viruses, HIV 1 & 2, VDRL and malaria. Tests with the shortest window should be chosen as per affordability. For safe blood transfusion, tests other than those prescribed by the government should also be available such as minor blood groups, nucleic acid amplification testing (NAT). NAT detects very low levels of viral RNA or DNA that may be present in donated blood and reduces the window period of detection of viruses like hepatitis C, hepatitis B, HIV, which may otherwise be undetected by 3rd generation or even 4th generation ELISA-based tests. The prevalence of hepatitis B, C and HIV is very high in India. The doctor has a duty to inform the donor that facilities for these other tests are also available and the donor or the recipient should have the right to ask for extra tests. Till they a national policy is formulated in this regard, a doctor can help the donor or the recipient to decide. An informed consent must be taken from the donor or the recipient explaining the risks by not doing these tests, however small and rare they might be. These tests may add to the cost of the blood transfusion, but patient safety is foremost. The donor’s blood should also be tested for lipids, liver enzymes (SGOT, SGPT), kidney function (creatinine); a complete hemogram can be done, so that the donor gets a comprehensive panel of tests done, when he/she volunteers to donate blood. Rational blood transfusion is safe blood transfusion… Transfuse blood only when necessary. If only one unit is required, don’t transfuse blood; if two units are required, transfuse one. If hemoglobin is more than 7, give a trial of intravenous iron first. This is also a very important way by which the transfusion-transmitted infections can be reduced. 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)

Prevalence of thyroid disorders increasing in India

Prevalence of thyroid disorders increasing in India Women more likely to get affected, with increased risk of various side effects in pregnant women New Delhi, 07 July 2017: According to a recent report, about 32% of Indians suffer from various kinds of thyroid disorders including thyroid nodules, hyperthyroidism, goiter, thyroiditis, and thyroid cancer. The most prevalent form of thyroid disorders across the country is sub-clinical hypothyroidism, which is a milder form of hypothyroidism and what is more alarming is that it is a silent disease. It is often diagnosed by chance. Subclinical hypothyroidism is defined as serum thyroid stimulating hormone (TSH) above the upper reference limit in combination with a normal free thyroxine (fT4). Thyroid diseases are more prevalent in women and can cause many problems including weight gain and hormonal imbalance. The chances of men suffering from thyroid disease are comparatively lesser. In the developed countries, the prevalence of thyroid disorders is about 4% to 5%. 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, "Hypothyroidism can affect all organ systems. Genetics has a major role in determining thyroid hormones and TSH concentrations as well as susceptibility to autoimmune thyroid disease. Those with a family history are likely to be predisposed to thyroid abnormalities. Therefore, it is imperative for a person to be aware of their family’s medical history. If left untreated, hypothyroidism can cause elevated cholesterol levels, an increase in blood pressure, cardiovascular complications, decreased fertility, and depression. In pregnant women, this condition can increase the risk of premature birth, low birth weight, and miscarriage." Adding further, Dr Aggarwal, said, "The need of the hour is to reach out and create awareness among people about the causes, symptoms, treatment, and importance of testing for thyroid problems. This is particularly significant for women as the incidence of acquiring this disease is more in them. Pregnant women or those planning to conceive should get themselves checked to ensure that their thyroid functions are normal." Here are some tips for those living with thyroid disorders. • Eat healthy Hypothyroidism is linked to weight gain. Thus, a person with this condition can find it difficult to lose weight. Consume a diet rich in fibre and low in fat to maintain a healthy weight. • Exercise Although it may be difficult to get moving in those with a sluggish thyroid, it is a good idea to push yourself to do some physical activity. • De-¬stress Stress is known to exacerbate thyroid disorders. Do something to reduce those stress levels. It could be yoga, meditation, dance, or anything.

Postnatal depression is a silent killer in India

Postnatal depression is a silent killer in India Timely intervention can help cure 80% of such cases New Delhi 24 May 2017: Postnatal depression is an illness that affects about 20% of mothers in developing countries like India, according to the World Health Organization. However, this kind of depression is still not recognized much. There are roughly 130 million births every year in India and provided this situation is addressed, the number or women with clinical depression is only likely to increase in the coming years. There are many factors that trigger depression in new mothers, some of them being unplanned pregnancy, an abusive relationship, alcoholic spouse, pressures to have a male child, and hormonal changes. The symptoms of postnatal depression tend to often go unnoticed. Some of them include anxiety, crying spells, mood swings, lack of sleep, difficulty in bonding with the baby, and negative thoughts and hallucinations. 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, "A majority of new mothers experience some amount of distress. This may sometimes require medical help and counseling. However, the symptoms often go unnoticed in the excitement of welcoming a baby. Postnatal depression is often accompanied by phobia and anxiety. Timely intervention can help cure 80% of such cases in a matter of 5 to 6 months. However, the remaining 20% can develop severe mental depression and other related ailments." Postnatal depression can have other related effects as well. Stress can affect milk production in new mothers thereby hindering lactation. As a result, the baby may become irritable and not achieve adequate physical and mental growth. Dr Aggarwal further added, "One of the major challenges in addressing postnatal depression is the lack of awareness, ignorance and social stigma surrounding this condition. A majority of women do not recognize or are unable to understand the symptom that follow childbirth. Even if they do, many are unwilling to seek medical help as psychiatric problems are not taken very well in the Indian society even today. The need of the hour is to create awareness among pregnant women, new mothers, and the family and counsel them on how they can support the women through this phase. " Here are few things one can do as a new mother to understand and cope with their anxiety. • Get enough rest. Tiredness can make anxiety worse and give you a constant gloomy feeling. Try catching small naps when the baby is asleep. • Eat at smaller intervals. Low energy levels can impact mental health. • Try not to feel guilty about not helping around the house. Understand that this is a temporary phase and it is not wrong to ask for help. • Indulge in activities that can help you in getting distracted from any negative thoughts, such as reading a book and listening to music. Take a short walk if it helps you feel better • Lastly, do not compare yourself with other mothers. Each pregnancy is different and understanding this will help you feel better.

Healthcare shame: India ranked 154th out of 195 countries ranked by Lancet Medical Journal: DNA

Healthcare shame: India ranked 154th out of 195 countries ranked by Lancet Medical Journal: DNA This is not true: Indian Medical Association Dr KK Aggarwal National President IMA DNA has reported a Lancet study that India's poor ranking is primarily because of the rise in cases of tuberculosis (TB), diabetes, rheumatic heart disease and chronic kidney disease. India has failed to achieve in healthcare goals, badly lagging behind China, Sri Lanka and Bangladesh in terms of accessibility and quality. India was ranked 154th position in the ranking of healthcare quality amongst 195 countries, whereas some countries like South Korea, Peru and China have seen greatest improvements in healthcare access and quality since 1990. China, with a score of 74 on the index, has been ranked at 82 - far ahead of India, and Sri Lanka has scored 73 on the index. Similarly, Brazil and Bangladesh have score 65 and 52, respectively. India performed worse than expected in TB, diabetes, rheumatic heart disease and chronic kidney disease. The 32 diseases for which death rates were tracked included TB and other respiratory infections, illnesses that can be prevented with vaccines - such as diphtheria, whooping cough, tetanus and measles - several forms of treatable cancer and heart disease, and maternal or neonatal disorders. I do not agree. This is not the correct picture. Government statistics are based on data from government set ups, which cater to only 20% of the society. The remaining 80% are seen by the private sector. When we say 10 million cases of TB are missing from government data, this does not automatically mean they do not get treatment. In fact they might be getting better treatment than the government sector. Private sector results for all these 32 diseases may be better than in the government sector. We should not extrapolate any inference from such studies. Unfortunately, British media is always negative with regard to the Indian health scenario. Why, we do not know? Most of their stories against India are negative. Is medical tourism in India responsible for it?

First uterus transplant in India

First uterus transplant in India Dr KK Aggarwal National President IMA & HCFI The Milann Fertility Centre in Bangalore has received permission for uterus transplant from ICMR in two female patients and the procedure will be undertaken as a research project as per the ICMR guidelines. The minimum requisite of experience to carry out this procedure, as per the Human Organ Transplant Act, by a Clinical team is not available in any group outside the Swedish group. Milann has obtained permission from Medical council of India (MCI) for the participation of Swedish doctors for the procedure which is yet another mandatory requirement. In 2012, the world’s first successful uterus transplant with a live donor was conducted by a team led by Dr Mats Brannstrom, Professor of Obstetrics and Gynaecology at the University of Gothenburg in Sweden. In October 2014, a woman who had received a uterine transplant gave birth to a healthy baby boy. About uterus transplant • Uterus transplantation is a complex, multi-step procedure for the treatment of absolute uterine factor infertility (AUFI). • AUFI refers to infertility that is fully attributable to the uterus because of absence (congenital or surgical) or abnormalities (anatomic or functional) that prevent embryo implantation or completion of a pregnancy to term. • About 1 in 500 women of childbearing age are affected by AUFI, defined as an absent or non-functional uterus • Uterus transplantation is a highly experimental procedure to treat absolute uterine factor infertility. o Once the intended uterus recipient and organ donor have been identified, the process begins with in vitro fertilization (IVF) to create and freeze embryos for the intended recipient. o Next the organ donor undergoes a radical-type hysterectomy followed by implantation of the donor organ into the recipient. o After at least 12 months of immunosuppressive treatment, the recipient undergoes embryo transfer, pregnancy, and, if the pregnancy is successful, delivery via cesarean delivery. o At the conclusion of childbearing, the transplanted organ is removed to avoid the need for lifelong immunosuppression. • Since initial attempts at Saudi Arabia and Turkey, uterus transplantation has been successfully performed in Sweden and attempted in the United States, the Czech Republic, China, Brazil and Germany. • Keys ethical points in considering uterus transplantation include the non-life-saving nature of the procedure; existence of proven alternatives; the experimental nature of uterus transplantation; and the risks and benefits to the donor, recipient, and developing fetus. • Gestational surrogacy and adoption both exist as alternative paths to parenthood • The uterus donor may be alive or deceased. o Advantages of living donors include larger potential supply of organs and ample time for preoperative testing, screening, and assembly of a multi-specialty surgical team. The main disadvantage is the extensive pelvic surgery for organ removal. o Use of deceased donors avoids the donor's surgical risk and allows for a more extensive graft harvest. Disadvantages of a deceased-donor organ include the limited availability of organs, unpredictable timing of organ procurement, potential that the donor uterus has not yet produced a term pregnancy, and potential ethical uncertainties regarding consent. • As human uterus transplantation is in the beginning stages, the optimal inclusion and exclusion criteria for both donors and recipients are not yet known. • Living donors and recipients undergo extensive testing to ensure medical and psychological appropriateness. • Protocol includes consultation by the following services: gynecology, transplantation surgery, psychology, clinical immunology, anesthesiology, internal medicine, and radiology. • Prior to removal, the donor uterus is evaluated with ultrasound and magnetic resonance imaging (if technically possible) to estimate the uterus size, rule out uterine pathology, exclude Müllerian anomalies and evaluate the vasculature. • The goals for the evaluation of the future genetic father are to exclude male-factor causes of infertility, exclude infectious diseases that could be transmitted to the immunosuppressed mother, and to identify relationship challenges that could negatively impact the outcome of uterus transplantation. • As part of the informed consent process, the uterus donor must be free from coercion; be fully informed of the risks, benefits, and alternatives for both the donor and the recipient; have access to an independent donor advocate; and be informed of the early and late surgical risks. The uterus recipient must be educated to the risks and benefits of uterus transplantation and then consented for the multiple steps of the process that will ultimately result in a live-born child, including gonadotropin stimulation, egg retrieval for the creation of embryos, uterus transplantation, immunosuppression, embryo transfer, pregnancy, cesarean delivery, and uterus removal. The consent for the genetic father mainly pertains to the in vitro fertilization treatments that he must undergo to create embryos prior to uterus transplantation. (Source: Uptodate)

World TB Day: Some key messages on TB

World TB Day: Some key messages on TB • India has the highest TB burden country in the world in terms of the absolute numbers of incidence cases each year. Mortality due to TB is the third leading cause of years of life lost (YLLs) lost, in the country. • TB is caused by bacilli spread through droplet nuclei (less than 5 microns) infection. Droplet nuclei can remain suspended in the air for extended periods, and thus are a source of exposure to susceptible individuals. • Split AC is not the right atmosphere for sputum-positive cases. Natural windows and fans are better alternatives. • TB does not spread through handshakes, using public toilets, sharing food and utensils, blood transfusion and casual contact. • TB can be of lungs (pulmonary), or outside the lungs (extra pulmonary). In 85% of cases, lungs are involved. • TB infection and TB disease are not the same; 90% of those infected may not develop TB in their life time. • Although TB is an infectious disease, all cases of TB are not infectious. Only sputum–positive TB patients are infectious to others. • Extra-pulmonary TB is not infectious. • All open TB patients need to immediately identified and treated till they become sputum negative and non-infective. • Most TB-positive patients do not disclose their TB status due to the fear of social stigma and so keep spreading the disease to others. • The public needs to be informed that every open case of TB will cause 15 new cases of TB, if not treated in time. • TB is a curable disease. Full and adequate treatment is important for complete recovery. • About 2-3% of TB cases have primary MDR TB. Whenever MDR TB is suspected, refer the patient to TB specialist • Do not ignore a cough of more than two weeks. • Every cough with or without sputum is not TB. • Any person with symptoms and signs suggestive of TB including cough >2 weeks, fever >2 weeks, significant weight loss, blood in sputum etc. and any abnormality in chest X-ray must be evaluated for TB. • Children with persistent fever and/or cough >2 weeks, loss of weight / no weight gain, and/or contact with pulmonary TB cases must be evaluated for TB. • If the first sputum is positive, a second sample should also be tested; if both are positive, this indicates heavy infection load. • Sputum should always be collected early in the morning as the first sample. Rinse the mouth with water and cough out the sputum. Do not use mouthwash. Move away from people, when collecting the sputum sample. • Patients with TB should dispose their sputum by burning, burying it in the soil or disinfecting them with a disinfectant. • All patient with cough should be provided with simple mask at the reception of a hospital. Doctors should wear N 95 mask for TB prevention • 10% of HIV–positive patients will develop TB every year. • If an elderly develops TB, rule out diabetes and if an elderly develops diabetes, rule out TB. • Rule out TB in every case of uncontrolled diabetes. • A minimum six months of treatment is required for a patient with TB. • In TB meningitis, treatment duration of 9 months is required • Bone TB requires treatment for 9 months. • Diagnosis and treatment for both, drug sensitive and drug resistant TB, under RNTCP, is free of cost. • The first-line drugs used for new TB cases under RNTCP are a combination of rifampicin, isoniazid, ethambutol and pyrazinamide, administered as standardized treatment regimen. Injection Streptomycin is an additional drug given to re-treatment cases. • The main second-line anti-TB drugs for treatment of MDR-TB are kanamycin, levofloxacin, ethionamide, pyrazinamide, ethambutol and cycloserine. • TB drugs are often taken as single dose. Divided doses are not recommended. • It takes up to 15 days for a sputum-positive case to make non-infectious case. The first 15 days before a person becomes non-infectious are most dangerous to the family members as the bacilli is most infectious during this period. • A sputum-positive case, if not treated, remains infective for the coming 2 to 3 years. • If untreated, two-thirds of people with full blown TB will die. • It is very important to trace or track every contact of TB. • If the patient stops treatment within one month, restart the treatment & complete it. • If the patient stops the treatment for more than one month, he/she should be treated as re-treatment case. Cases where the gap in treatment is more than one month should be referred to and treated by TB Specialists. • Treatment of sputum-negative TB is similar to that of a new sputum-positive case. • Treatment of extra pulmonary TB is similar to that of a new sputum-positive case. • Presumptive TB patients without microbiological confirmation (smear microscopy, culture and molecular diagnosis), but with strong clinical and other evidence (e.g. X-ray, Fine Needle Aspiration Cytology (FNAC, histopathology) may be diagnosed as “Probable TB” and should be treated. • In children, anti-TB drugs are to be given as per weight for each child. • Vide letter number Z-28015/2/2012-TB, the Government of India, Ministry of Health and Family Welfare on 7th May 2012 declared TB as a notifiable disease. • Not notifying TB is a violation of MCI Act (5.2, 7.14), Municipal Corporation Act and Sections 269 & 270 of the Indian Penal Code. • In adults starting ATT only on the basis of X-day or tuberculin test may amount to deficiency in service under CPA. • Compliance of treatment should be counseled. Not counseling a patient about compliance may amount to violation of Indian Penal Code under Clauses 269 and 270. • Maintenance of written records in TB care is very important. • Government of India has released Standards for TB Care in India (STCI), an initiative to introduce uniform standards for TB care in all sectors. • Serological tests for TB are banned in the country. • In 2016, Bedaquiline, a new anti-TB drug for treatment of MDR TB was launched as part of the RNTCP. It is being introduced at six identified tertiary care centres across India. • Cartridge Based Nucleic Acid Amplification Test (CBNAAT) was also introduced in the program in 2016. CBNAAT is a rapid molecular test which detects Mycobacterium tuberculosis and rifampicin drug resistance, simultaneously. • IMA plans to open IMA Surveillance Cell, IMA Single Window Disease Surveillance and Adverse Events Reporting Cell under one roof for Notifiable diseases such as TB and other communicable diseases. • IMA is committed to the SDG target (3.3) of ending the epidemic of TB by 2030. Dr KK Aggarwal National President IMA & HCFI

Ozone-related premature mortality highest in India

Ozone-related premature mortality highest in India Air pollution has been under spotlight for quite some time now. Air quality in Delhi, in particular, has often been in the ‘poor’ or ‘very poor’ category since Diwali last year. Environmental pollution adds to the global burden of disease, both morbidity and mortality. High air pollution levels have been implicated in many diseases including respiratory disease, diabetes and heart disease. Air Quality Index (AQI) takes into account eight air pollutants: PM10, PM2.5, nitrogen dioxide (NO2), sulphur dioxide (SO2), Ozone (O3), Lead (Pb), Ammonia (NH3), carbon monoxide (CO). There are six AQI categories: Good (0-50), Satisfactory (51-100), Moderately polluted (101–200), Poor (201–300), Very Poor (301–400) and Severe (401-500). A new report ‘State of Global Air 2017’ released by the Health Effects Institute (HEI) and Institute for Health Metrics and Evaluation (IHME) last week states that 92% of the world’s population lives in areas with unhealthy air. All told, long-term exposure to fine particulate matter-- the most significant element of air pollution-- contributed to 4.2 million premature deaths and to a loss of 103 million healthy years of life in 2015, making air pollution the 5th highest cause of death among all health risks, including smoking, diet, and high blood pressure. As per the report, India along with China accounted for more than half of the total global attributable deaths. This report also highlighted ozone-related mortality. Globally there was a 60% increase in ozone-attributable deaths, with a striking 67% of this increase occurring in India. An estimated 2.54 lakh deaths were attributable to exposure to ozone and its impact on chronic lung disease. India recorded the highest number of premature deaths due to ozone pollution (107,800), its toll 13 times higher than Bangladesh (7900) and 21 times higher than Pakistan (5000). This report quantified air pollution using two main pollutants: PM2.5 and ozone. Surface or ground ozone is harmful, unlike the ozone layer high up in the atmosphere, which acts as a shield and protects from harmful UV rays. Ground ozone is formed by the reaction of pollutants in the vehicular and industrial emissions with sunlight. Nitrogen oxides (NOx) and volatile organic compounds (VOC) are the ozone precursors. Traffic emissions constitute more than 50% of the ozone precursors. While this report defined ozone-related deaths in numbers, it did not clarify as to how these deaths were confirmed to be due to ozone. Also, paradoxically, the levels of ozone are higher in rural areas compared to urban areas. This is because the levels of NOx are lower in rural areas. Cities have a higher NOx levels due to traffic, which neutralize ozone and keep it in or near permissible limits. Levels of PM2.5 are higher in cities. Ozone is associated with respiratory disease independent of exposure to PM2.5. Dr KK Aggarwal National President IMA and HCFI

Prevent India from becoming the heart disease capital of the world

Prevent India from becoming the heart disease capital of the world

New Delhi, June 20, 2016: Cardiovascular disease (CVD) is one of the leading causes of morbidity and premature mortality in the world contributing to over 17.5 million deaths every year. The disease poses a great risk in a developing country like India, which is not only one of the most densely populated nations in the world but is also beset with extreme differences in terms of the social, economic and regional divisions. Given the high economic burden of cardiovascular disease on the patient and his family; the increase in disease incidence runs the risk of the rich becoming poor and the poor dying just because they could not afford the treatment. India already holds the title of the diabetic capital of the world. Estimates indicate that by 2025, we will also be the CVD capital of the world with estimation of 69.8 million disease cases. While there exist various types of cardiovascular diseases plaguing the Indian society, the most rapidly growing form coronary artery disease. Speaking about this, Padma Shri Awardee Dr. KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA, said, “Coronary artery disease (CAD) is caused due to the narrowing and choking of the heart artery walls over a period due to the deposit of plaque. The primary cause of this is irregularities in lifestyle. People in today's day and age are faced with high levels of stress causing them to eat an unhealthy diet, sleepless, are more dependent on toxic substances such as alcohol and cigarettes and exercise less. All these lead to an increase in the incidence of CAD.” Indians due to their genetic predisposition are anyways at a high risk of premature coronary artery disease due to the presence of high levels of lipoprotein. They further add to their misery by living an extremely unhealthy lifestyle. The risk of CAD in Indians is 3–4 times higher than Americans, six times higher than Chinese and 20 times higher than Japanese. CAD affects Indians 5–10 years earlier than any other community in the world. One can take the following steps to reduce their chances of suffering from cardiac diseases in the future · Eat healthily, sleep right: A healthy and balanced diet is key for a healthy heart. An over-dependence on junk food, consumption of saturated and trans fats, food containing high salt and sugar levels - lead an increased incidence of obesity, high cholesterol, hypertension and diabetes, all key risk factors of heart disease. A healthy diet must consist of items, which have low levels of saturated fats, fresh fruits and vegetables. · Exercise Regularly – Regular exercise is important to strengthen one's, heart, lower blood pressure, keep obesity under control, burn off stress, boost your self-esteem and help you sleep better. By regularly exercising for at least 30 minutes three to four times a week, one can keep their heart healthy. Aerobic exercise particularly is beneficial for patients with a tendency to get heart disease. · Kick the butt – Smoking damages the lining of your arteries, leading to a build-up of fatty material (atheroma), which narrows the artery. This can cause angina, heart attack or a stroke. The carbon monoxide in tobacco smoke reduces the amount of oxygen in your blood. Thus, smoking is extremely dangerous for a heart and is a leading cause of heart attacks amongst the young. · Limit the intake of alcohol - If you have to consume alcohol, drink in moderation. Drinking excessive amounts of alcohol causes raised blood pressure, which is one of the most important risk factors for having a heart attack or a stroke. Increases in your blood pressure can also be caused by weight gain from excessive drinking. Obesity too leads to cardiovascular ailments · De-stress - High levels of stress make other risk factors for heart disease such as high cholesterol or high blood pressure worse and push you to lead an unhealthy lifestyle. For instance, if you are under stress, your blood pressure goes up, you may overeat, you may exercise less, and you may be more likely to smoke. Engaging in deep breathing exercises, doing yoga all help decrease stress and the temptation to indulge in bad habits. · Get regular health check-ups - Lastly, one must get regular health check-ups to ensure that their blood pressure, hypertension, cholesterol are all under control and to rule out the risk of heart disease in the future. If at risk, necessary lifestyle changes must be made

Prevent India from becoming the heart disease capital of the world

Prevent India from becoming the heart disease capital of the world

New Delhi, June 20, 2016: Cardiovascular disease (CVD) is one of the leading causes of morbidity and premature mortality in the world contributing to over 17.5 million deaths every year. The disease poses a great risk in a developing country like India, which is not only one of the most densely populated nations in the world but is also beset with extreme differences in terms of the social, economic and regional divisions. Given the high economic burden of cardiovascular disease on the patient and his family; the increase in disease incidence runs the risk of the rich becoming poor and the poor dying just because they could not afford the treatment. India already holds the title of the diabetic capital of the world. Estimates indicate that by 2025, we will also be the CVD capital of the world with estimation of 69.8 million disease cases. While there exist various types of cardiovascular diseases plaguing the Indian society, the most rapidly growing form coronary artery disease. Speaking about this, Padma Shri Awardee Dr. KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA, said, “Coronary artery disease (CAD) is caused due to the narrowing and choking of the heart artery walls over a period due to the deposit of plaque. The primary cause of this is irregularities in lifestyle. People in today's day and age are faced with high levels of stress causing them to eat an unhealthy diet, sleepless, are more dependent on toxic substances such as alcohol and cigarettes and exercise less. All these lead to an increase in the incidence of CAD.” Indians due to their genetic predisposition are anyways at a high risk of premature coronary artery disease due to the presence of high levels of lipoprotein. They further add to their misery by living an extremely unhealthy lifestyle. The risk of CAD in Indians is 3–4 times higher than Americans, six times higher than Chinese and 20 times higher than Japanese. CAD affects Indians 5–10 years earlier than any other community in the world. One can take the following steps to reduce their chances of suffering from cardiac diseases in the future · Eat healthily, sleep right: A healthy and balanced diet is key for a healthy heart. An over-dependence on junk food, consumption of saturated and trans fats, food containing high salt and sugar levels - lead an increased incidence of obesity, high cholesterol, hypertension and diabetes, all key risk factors of heart disease. A healthy diet must consist of items, which have low levels of saturated fats, fresh fruits and vegetables. · Exercise Regularly – Regular exercise is important to strengthen one's, heart, lower blood pressure, keep obesity under control, burn off stress, boost your self-esteem and help you sleep better. By regularly exercising for at least 30 minutes three to four times a week, one can keep their heart healthy. Aerobic exercise particularly is beneficial for patients with a tendency to get heart disease. · Kick the butt – Smoking damages the lining of your arteries, leading to a build-up of fatty material (atheroma), which narrows the artery. This can cause angina, heart attack or a stroke. The carbon monoxide in tobacco smoke reduces the amount of oxygen in your blood. Thus, smoking is extremely dangerous for a heart and is a leading cause of heart attacks amongst the young. · Limit the intake of alcohol - If you have to consume alcohol, drink in moderation. Drinking excessive amounts of alcohol causes raised blood pressure, which is one of the most important risk factors for having a heart attack or a stroke. Increases in your blood pressure can also be caused by weight gain from excessive drinking. Obesity too leads to cardiovascular ailments · De-stress - High levels of stress make other risk factors for heart disease such as high cholesterol or high blood pressure worse and push you to lead an unhealthy lifestyle. For instance, if you are under stress, your blood pressure goes up, you may overeat, you may exercise less, and you may be more likely to smoke. Engaging in deep breathing exercises, doing yoga all help decrease stress and the temptation to indulge in bad habits. · Get regular health check-ups - Lastly, one must get regular health check-ups to ensure that their blood pressure, hypertension, cholesterol are all under control and to rule out the risk of heart disease in the future. If at risk, necessary lifestyle changes must be made

ZIKA and Indian Athletes going to Brazil Olympics

Zika, a viral infection causes fever, rash, joint pain, red eyes. It spreads mainly through aedes mosquito bites. But can also spread from a pregnant mother to her unborn baby, and through anal, oral or vaginal sex. 

If acquired during pregnancy it can cause microcephaly in foetus. If one is not pregnant or not planning to get pregnant it is likely to be harmless. 

ZIKA and Indian Athletes going to Brazil Olympics

Dr KK Aggarwal

Zika is seen in Africa, Southeast Asia, Pacific Islands, Central and South America, Mexico, Caribbean, Puerto Rico and the US Virgin Islands. No cases have yet been reported in India.

Most (80%) people infected with Zika have no or only mild symptoms. If there are symptoms, they usually happen 2 to 12 days after being bitten by a mosquito that has the virus.

It can also cause Guillain-Barré syndrome.

If you are pregnant or trying to get pregnant avoid traveling to countries where there is Zika virus.

There is no specific treatment. Treatment involves rest, drink plenty of fluids & paracetamol. Do not take aspirin. In children, aspirin can cause a serious problem called Reye syndrome.

For prevention stay inside when the aedes are most active. They bite during the daytime, in the very early morning, and in the few hours before sunset. Buildings with screens and air conditioning are safest. Wear shoes, long-sleeved shirts, and long pants when you go outside. Wear bug spray or cream that contains DEET or a chemical called picaridin. Do not use DEET on babies younger than 2 months. On your clothes and gear, use bug repellants that have a chemical permethrin. Drain any standing water. Avoid mosquito bites if you have already gotten Zika to stop further spread.

If you have been to a country where there is Zika virus, you should not donate blood for at least 4 weeks afterwards. There is no vaccine for Zika virus infection.

Travellers returning from areas with Zika virus transmission should abstain from or have only protected sex for at least eight weeks. Couples planning to conceive should also wait eight weeks—or six months if the male partner has symptoms of the virus. Previously, IMA recommended abstinence or protected sex for four weeks following a person’s return from an area where Zika is circulating. All Indian athletes and visitors attending this summer’s Olympic and Paralympic Games Rio 2016 should use condoms while in Rio and for eight weeks after returning home.

WHO has already ruled out any change in timing or the location of the upcoming Olympic Games in Rio de Janeiro. In last common wealth games also in India there was a threat of deadly dengue virus.  unnecessary risk is posed when 500,000 foreign tourists from all countries attend the Games, potentially acquire that strain, and return home to places where it can become endemic.

IMA has warned to all those travelling to Brazil to take precautions against mosquito bites, and have said pregnant women should avoid areas where Zika is circulating, including Rio.