AES Update: This is not the time for a “blame game” The recent tragic deaths of children due to encephalitis in Gorakhpur medical college have hit the headlines in the last few days. These deaths also generated a lot of debate on the issue. Unfortunately much of the debate centered on “finger pointing”. This is not the time for a “blame game”. This is not the first outbreak of acute encephalitis syndrome (AES) in the region. Many such outbreaks have been occurring for several years now and each epidemic has taken a heavy toll of lives. By now there should have been a state of the art hospital to manage AES patients. There should have also been a research facility to examine why the area is vulnerable to AES, establish effective surveillance systems, plan a response plan, predict future outbreaks etc. This is the time to look to the future and not talk of the past or even the present outbreak. Drawing from the lessons of the past years, we must be able to anticipate such local outbreaks and be ready to respond to them systematically and in a timely manner to contain them. A research center focusing on AES will help to identify early warning signals for such impending outbreaks. Anticipation and preparedness will enhance efforts to control and prevent future outbreaks of AES. All stakeholders have equally important roles to play in prevention of any epidemic. Some key points on AES • Encephalitis is inflammation of the brain parenchyma. It presents clinically as neurologic dysfunction (altered mental status, behavior, or personality; motor or sensory deficits; speech or movement disorders; seizure) • Viruses are the most commonly identified infectious causes of encephalitis. Around 10% cases may be due to Japanese encephalitis, scrub typhus and herpes simplex each. Enterovirus and other viruses also cause AES. Bacteria, fungi, and parasites may also cause encephalitis. In many cases of encephalitis, the etiology remains unknown despite extensive evaluation. • The WHO’s guidelines for JE surveillance recommend syndromic surveillance for JE meaning that all AES cases should be reported (NVBDCP, 2009). • The NVBDCP 2009 guidelines on management of AES have recommended classification of a suspected case as follows: o Laboratory-confirmed JE: A suspected case that has been laboratory-confirmed as JE. o Probable JE: A suspected case that occurs in close geographic and temporal relationship to laboratory-confirmed case of JE, in the context of an outbreak. o Acute encephalitis syndrome (due to agent other than JE): A suspected case in which diagnostic testing is performed and an etiological agent other than JE virus is identified. o Acute encephalitis syndrome (due to unknown agent ) A suspected case in which no diagnostic testing is performed or in which testing was performed but no etiological agent was identified or in which the test results were indeterminate. • The incidence is highest among infants <1 year. • Status epilepticus, cerebral edema, fluid and electrolyte disturbance, and cardiorespiratory failure are some of the complications of AES. • ICU care is essential for patients with severe encephalitis (i.e., those with seizures, cardiorespiratory compromise, coma, or severe neurologic compromise) with close cardiorespiratory monitoring and careful attention to neurologic status, fluid balance, and electrolyte status. • Prognosis of viral encephalitis depends upon the age of the patient, neurologic findings at the time of presentation and the etiopathogen. • The case fatality and morbidity is very high among various viral encephalitis especially in JE or enterovirus encephalitis. • Survivors of childhood encephalitis should be monitored for long-term sequelae. • Scrub typhus encephalitis: Curable with doxycycline or erythromycin if diagnosed early. Look for fever, rash, local black eschar in the legs with enlarged, lymph nodes. • Japanese encephalitis: Mortality is 20% in the best of the centers. Preventable by vaccination. • Herpes simplex encephalitis: Can be diagnosed due to temporal lobe localization and can be managed with antivirals. • Lichi encephalitis is manageable with intravenous glucose. • Enteroviral encephalitis has limited therapeutic options. Intravenous immunoglobulin (IVIG) is often administered despite a lack of convincing evidence for efficacy. • All children who present with suspected encephalitis should be treated with acyclovir pending viral studies. • Empiric treatment for bacterial meningitis pending bacterial cultures also may be warranted if bacterial meningitis cannot be excluded. • Empiric treatment with doxycycline or erythromycin should be given till scrub typhus is ruled out. • Prevention strategies include hand hygiene, appropriate management of pregnant women with active herpes simplex virus lesions, routine childhood immunizations, JE vaccine, traveling immunizations, and insect control and avoidance measures. Control of culex mosquito. • All children who are hospitalized with encephalitis should be placed on airborne, droplet, and contact precautions at the time of admission, pending identification of a pathogen. Disclaimer: The views expressed in this write up are entirely my own. Dr KK Aggarwal
Thursday, 17 August 2017
Fatty liver can lead to liver cancer in the long run It is important to follow a healthy diet free of alcohol to prevent build-up of fat in the liver New Delhi, 16 August 2017: Studies indicate an alarming increase in the number of people suffering from fatty liver. As per available statistics, 1 in 5 people in India have excess fat in their liver and 1 in 10 have fatty liver disease. This is a cause of concern as fatty liver can lead to liver damage and even liver cancer if undiagnosed and untreated. As per the IMA, about 20% of those with non-alcoholic fatty liver disease (NAFLD) are likely to get liver cirrhosis in 20 years. This percentage is akin to that among alcoholics. NAFLD is caused due to a build-up of fat in liver cells. The first stage of this disease is called simple fatty liver. Although excess fat builds up in the liver in this stage, it remains harmless and has no evident symptoms unless it develops into inflammation or damage. The second stage is called non-alcoholic stea to hepatitis (NASH) which is similar to alcoholic liver disease. However, those affected drink little or no alcohol. 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, “NAFLD may progress to cirrhosis and is likely an important cause of cryptogenic cirrhosis. As little as two drinks per day in those who are overweight (and one drink per day in those who are obese) is associated in hepatic injury. Liver cancer is associated with cirrhosis due to NAFLD and heart disease is the most common cause of death among patients with this condition. NAFLD is not caused by alcohol but its consumption can make the condition worse. The disease can stop or reverse, especially in the early stages. Once it progresses to cirrhosis, the liver becomes unable to function causing symptoms like fluid retention, muscle wasting, internal bleeding, jaundice (yellowing of skin and eyes), liver failure.” Some symptoms of NAFLD that emerge in the long run include fatigue, weight loss or loss of appetite, weakness, nausea, confusion and impaired judgment, pain in the centre or right upper part of the abdomen below the ribs, an enlarged liver, and patchy or dark skin on the neck or underarm. Adding further, Dr Aggarwal, said, “NAFLD is often diagnosed after liver function tests produce an abnormal result and other liver conditions such as hepatitis are ruled out. However, NAFLD can be present even when routine liver blood tests are normal. One needs to make certain lifestyle changes to prevent the disease from progressing to a more serious stage and lower the risk of having a heart attack or stroke.” Here are some simple lifestyle changes one can make to avoid this condition. • Maintain a healthy weight. • Consume a healthy diet rich in fruits and vegetables. • Get minimum of 30 minutes of physical activity every day. • Limit alcohol intake or avoid consuming it at all. • Only take medicines that are required and follow dosage recommendations.
Wednesday, 16 August 2017
Should a learning curve be allowed in medical education today? For a doctor, it’s not enough to just know facts; application of that knowledge into clinical skills is even more important. Traditionally, medical students have relied on acquiring these skills by learning on real patients during their clinical postings as undergraduates and then as part of postgraduate training. In this hands-on, often experimental, way of learning, raises ethical and legal concerns. Mistakes are bound to occur during the learning process. We learn from our mistakes more than our successes. But patients today are empowered and enlightened. They are unwilling to accept this experimentation on their body. Primum non cere – “above all, do no harm” is fundamental to the practice of medicine. We do cadaveric dissections to learn anatomy. But, surgical procedures are learned on live cases. When we learn something new, performance improves with experience... as also with a surgical procedure, where complication rates depend on the experience of a surgeon. There is therefore a learning curve. An expert surgeon is defined by the number of similar surgeries done; complication rates, success rates, re-hospitalization rates are all factors that also define an expert surgeon. Patients today can ask the doctors to disclose these numbers before consenting to a procedure. A single center study published in the year 2013 in the journal Circulation reported that 75-125 minimally invasive mitral valve surgeries were required to be performed by an average cardiac surgeon to gain mastery in the procedure. And, more than one such surgery per week was required to maintain good results. In this age of digitization, all procedure-based skills should now be learnt via simulation lab. Although they are not a replacement for the actual patient-based operative experience, simulation labs provide a safe environment for learning. Practicing on a simulator, which has all possible simulations of a variety of real life clinical scenarios, ranging from low to high fidelity, shortens the learning curve and avoids “preventable” errors. Learning by trial and error is no longer a feasible approach in this age of patient-centric medicine, where doctors have to work with patients as equal partners. Simulation-based training is the need of the hour in both undergraduate and postgraduate studies and even continuing medical education, when students and doctors can refine their knowledge, skills, without compromising patient safety. Disclaimer: The views expressed in this write up are entirely my own. Dr KK Aggarwal
Measles needs a vaccination strategy like polio It is a deadly disease and still a cause of major child mortality in the country New Delhi, 15 August 2017: Statistics indicate that about 1,34,200 children, mostly under the age of five years, died due to measles around the world in the year 2015. In India, it killed 49,200 children. As per the IMA, measles is a deadly disease and one of the main causes behind child mortality in the country. Eliminating measles will help achieve Sustainable Development Goal’s target 3.2, which aims to end preventable deaths of children under 5 years by 2030. Measles is a highly infectious illness caused by the rubeola virus. As many as 21 strains of the virus have been identified to date. The virus takes about 1 to 3 weeks to establish itself. While there is no specific treatment for this, getting vaccination at the right time can be affective. Pregnant women are advised taking the vaccine. 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 rubeolavirus lives in the mucus of the nose and throat of an infected child or adult. The disease is contagious for 4 days before the rash appears. It then continues to be contagious for about 4 to 5 days after.A person can get infected through physical contact with an infected person, being near an infected people when they cough or sneeze, touching a surface that has infected droplets of mucus. When the virus enters the body, it multiplies in the back of the throat, lungs, and the lymphatic system. The infection then replicates in the urinary tract, eyes, blood vessels, and central nervous system.” The symptoms of measles include runny nose, dry hacking cough, swollen eyelids, and inflamed and watery eyes, sensitivity to light, sneezing, a reddish-brown rash, Koplik's spots, and generalized body aches. Adding further, Dr Aggarwal, said, “A highly contagious disease, measles spreads like wildfire in communities where children are unvaccinated. Since the virus reduces immunity, children who have had measles - especially those who are undernourished - may die of pneumonia, diarrhea and encephalitis later on. India should build on its polio eradication campaign experience to ensure more children get vaccinated against measles. Awareness needs to be created about the need and safety of measles vaccination.” Some tips to ease the symptoms of measles include the following. • Get adequate rest and avoid heavy activities. • Drink plenty of water, fruit juice, and herbal tea to replace fluids lost by fever and sweating. • Seek respiratory relief and use a humidifier to relieve cough and sore throat. • Rest your eyes by keeping the lights low, and avoid reading and watching the television.
Tuesday, 15 August 2017
“Nothing is impossible”: My philosophy of life Dr KK Aggarwal I was given the name Krishan as the day I was born, 5th September, was the auspicious day of Krishna Janmashtami, the birthday of Lord Krishna. 5th September is also celebrated in our country as Teacher’s Day. Lord Krishna holds special significance for me…evidently so, because of my given name; but, more importantly, because he has helped me define my guiding philosophy of life. Lord Krishna is always depicted in blue color and with yellow clothes. He always holds a flute in his hands. The blue color, like the sky or the ocean, denotes vastness i.e. something which is much larger than what we can see or perceive. To me, this means nothing is impossible. His yellow clothes denote vigor or persistence. The flute in his hands denotes humility. “Take up challenging tasks because nothing is impossible. You can always win with humility.” This according to me is the message from Lord Krishna. This has been my constant endeavor all my life, including my years in the Indian Medical Association (IMA), particularly the last two years, first as the Honorary Secretary General and now as National President. I have always believed that we must try to develop habits and behaviors as befitting one’s given name. Name carries a lot of significance as Akshar in Sanskrit has a vibration and if that positive vibration matches with the vibrations of universe at the time of your birth, it helps in healing. On both my birthdays, Janmashtami and Teacher’s Day, as also today, I try to seek forgiveness from all my colleagues and friends. “Knowingly or unknowingly, if I have hurt your consciousness in my writings, speech, actions or thoughts, please forgive me.” Our medical profession is going through tough times. We are facing an onslaught of atrocities, violence both physical and mental, criminal prosecution, media trials, pubic defamation, to name a few. We need ‘azaadi” from these. We are fighting for the rights of the patients, community as well as our profession. On this Independence Day, let’s pledge to work together and speak together in “One voice” in the best interests of and towards betterment of the community and the fraternity. A Happy Janmashtami & Independence Day to you all! Disclaimer: The views expressed in this write up are entirely my own
Make changes at the personal level to ensure ‘freedom’ from diseases Independence Day should also be an occasion to pledge making healthy changes at the personal level and commitment towards eradicating the burden of lifestyle diseases New Delhi, 14 August 2017: As per statistics, India ranks very high among the nations affected by the rising wave of premature deaths due to non-communicable diseases (NCDs), which account for 60% of all deaths in India. About 5.8 million Indians die due to diabetes, cancer, stroke, heart, and lung diseases each year and 1 out of 4 Indians is at a risk of dying from an NCD before the age of 70. As per the IMA, this Independence Day, one should pledge to make lifestyle changes and take preventive healthcare measures at a personal level, to ensure freedom from the burden of NCDs. A healthy diet, regular physical activity, avoiding the use of tobacco and alcohol, and preventive screening can prevent at least 80% of premature deaths from heart diseases and strokes and 40% of cancer related deaths. 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, “Every year, 15th of August is celebrated as the day India got independence from the British rule. However, it is time that we work towards that day when we celebrate independence from diseases. The 15th of August should not just be a reminder of independence from the British but also a commitment on a yearly basis to eradicate one more disease or other problems faced by our country. And change begins at the personal level. It is important to keep a check on the body’s functioning by going for regular health checkups. This will help in assessing risk factors and diagnosing diseases at the right time which will further enable effective treatment and better management of the condition.” Although healthcare in India has undergone massive changes, there is a lot more that needs to be done. The challenge lies in enabling both the private and public sectors to work together and enable a healthy and disease-free India. Adding further, Dr Aggarwal, said, “The Father of Nation, Mahatma Gandhi was absolutely right when he said, ‘be the change you want to see in the world’. This change also applies to our lifestyle patterns, which will encourage others to follow suit and adopt a healthier lifestyle and in turn obtain freedom from diseases and ailments.” One can follow the Formula of 80 to prevent NCDs and live up the ripe age of 80. • It is important to keep your fasting sugar lower than 80 mg % • It is best to refrain from consuming alcohol. For those who still wish to drink, they should restrict it to not more than 80 ml of alcohol in a day or 80 grams in a week • To not consume more than 80 grams of caloric solid or liquid food in one meal, rather eat frequent but small meals • Restrict your soft drink consumption to 80ml in one go. The tip is to add soda and dilute it to make it 200 ml • Do not consume tobacco products otherwise you will end up with a surgery bill of over Rs 80,000 • It is important to keep one’s blood pressure lower than 80 mm Hg and heart rate lower than 80 per minute. • Do aerobic exercises for 80 minutes a week. • Do stretching exercises for 80 minutes in a week. • Consume at least 80 fruits and vegetables servings in a week. • Do not consume more than 80 ml/gram of ghee, oil and butter in a week.
Monday, 14 August 2017
Optimum Noise levels for class room teaching Everyday exposure to noise over time has an impact upon our ability to hear and on the degree of hearing loss that develops. Continuous exposure to sounds above 85 db can cause progressive hearing loss. Noise-induced hearing loss is the most common and obvious outcome of noise pollution. It is also an important occupational health concern due to high workplace noise levels. However, noise pollution has also been associated with other health problems such as stress, anxiety, high blood pressure, increases heart rate, heart disease. It may manifest as disturbed sleep/ insomnia, headache, fatigue, irritability, loss of concentration and decreased work efficiency. Noise levels are also an increasing concern in class rooms. The source of noise can be external such as street traffic, playground noise, airplanes, etc. The source of noise can be indoor, such as hallway noises, noise from other rooms etc. or noise within the classroom itself such as conversation, noise from fans, lights, paper, etc. Noise in a class room is not conducive to learning. Background noise in classroomsinterferes with auditory communication and adversely affects speech perception and speech recognition. It interferes with language and reading development and hampers academic performance. Attention and memory are also adversely affected. Speech intelligibility or understanding is determined by the signal to noise ratio, which should be at least 15dB i.e. the teacher should speak at least 15 db louder than the noise in the classroom for the student to optimally comprehend what he/she is hearing. For clear speech perception the background noise levels should not exceed 35 dB in schools as recommended by the WHO. The reverberation time in the classroom should be about 0.6 sec. Reverberation time is the length of time required for sound to decay 60 db from its initial level in a room. A longer reverberation time together with background noise increases noise levels and makes speech perception even more difficult. Hospitals are noisy and high stress work environment places. Because of high background noise, such as in emergency dept. and OTs, the conversation has to be conducted at higher dbs for clear speech communication (normal conversation is between 60-70 db). Noise can interfere with oral communication leading to mediation errors as a result of orders that are misunderstood. A noisy environment affects performance of any complex task in a hospital as it reduces concentration. It has been shown that “mental activities requiring a lot of working memory, such as paying attention to a variety of different cues or performing a complex analysis, are especially noise-sensitive”. Failure to hear a warning signal or alarm over the general background noise in an ICU may have potentially catastrophic outcome. Noise affects effectiveness of health care. Hence, hospitals too should have similar noise levels as educational institutes. Schools and hospitals are “silence zones”. Silence zone is an area comprising not less than 100 m around hospitals, educational institutions, courts, religious places or any other area as per the Noise Pollution (Regulation and Control) Rules, 2000. Every effort should be made to reduce noise levels in hospitals for optimum delivery of health care.
MDR TB should be declared a public health emergency Not adhering to prescribed medications can lead to MDR TB in existing TB patients New Delhi, 13 August 2017: As per available statistics, India accounts for one-fourth of the global TB burden of both TB and MDR TB. About 1.3 lakh incident multi-drug resistant (MDR) TB cases occur in India every year, including 79,000 MDR-TB cases among the notified pulmonary cases. As per the IMA, to prevent the epidemic of MDR TB, it should be declared a public health emergency. Multidrug resistant (MDR) TB is TB resistant to both isoniazid and rifampicin with or without resistance to other first-line anti-TB drugs. Extensive drug resistant (XDR) TB is TB resistant also to a fluoroquinolone (ofloxacin, levofloxacin or moxifloxacin) and a second-line injectable anti TB drug (kanamycin, amikacin or capreomycin). 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, “Tuberculosis (TB) is a major public health concern in the country. Despite advances in TB care, the disease continues to be a major cause of morbidity and mortality. And, it takes a heavy toll on the economy too. Emergence and spread of drug-resistant TB has become a major public health concern now. A person can acquire MDR TB in two ways. First is when a person does not take drugs as instructed by the health care provider or does not take the correct drugs. This situation is likely when the bacteria are resistant to more drugs than the health care provider has prescribed. One can also get MDRTB if they become infected with TB bacteria from another person who already has MDRTB. This is known as primary TB.” The symptoms of MDR TB are similar toregular TB: severe cough lasting for three weeks or more, bloody or discolored sputum, night sweats, fever, fatigue and weakness, pain in the chest, loss of appetite, pain in breathing or coughing, and weight loss. Adding further, Dr Aggarwal, said, “A person can develop XDR-TB if the treatment for MDR TB fails. The treatment for this acquired disease is lengthier, more complex, and expensive. At time, XDR TB can even be impossible to treat and be a death sentence. It is difficult to estimate the incidence of XDR-TB is as many laboratories are ill-equipped to detect and diagnose it. As a result, many of the cases go undocumented.” Here are some tips prevent TB. • Vaccination Newborns must be given the BCG vaccine to protect them against TB. • Keep your immunity high Vaccines may not be able to provide life-long protection. Thus, it is important to maintain a healthy lifestyle and consume a healthy diet rich in fresh fruits and vegetables. Quit smoking and drinking alcohol, exercise regularly, and stay fit. • Maintain good hygiene Certain simple hygienic practices such as covering the mouth while coughing, not spitting in public places, etc. are good ways to avoid infections from spreading. Wash your hands before eating and drink clean water. If you are around someone you know is suffering from TB, avoid direct contact with them. • Take medications on time This is one of the major reasons for acquiring MDR TB. People who have the infection are carriers of the disease. If they don’t adhere to the prescription, the TB bacteria can develop resistance to the drugs.
Sunday, 13 August 2017
IMA Updates • Medical Council of India (MCI) with inputs from IMA has drafted a document for Indian Medical services. The same will be placed in the next executive committee meeting of MCI. • MCI with inputs from IMA has finalized a draft for Guidelines to govern the prosecution of medical doctors for offences of which criminal rashness or criminal negligence is an ingredient. The same will be placed in the next executive committee meeting of MCI. • MCI with inputs from IMA has drafted standard medicolegal check list so that doctor’s diary may be sufficient to be taken up as an evidence (based on Pt. Parmanand Katara vs Union of India & Ors on 28 August, 1989). • MCI with inputs from IMA is in process of drafting guidelines for deciding negligence (8.6 Professional incompetence shall be judged by peer group as per guidelines prescribed by Medical Council of India). Practice changing IMA policies IMA TB Initiative: GTN • GeneXpert (sputum diagnosis) • Treat and Trace (treat with daily fixed dose combination regimen and trace all contacts) • Notify @ Nikshay Organ transplant • Mandatory required request for organ donation at death • 100% IMA members should pledge their organs / tissues after cardiac or brain death Blood Transfusion • IMA blood donation camps should only be component donation camps IMA-PMSMA: 9th of every month • Provider antenatal care to all pregnant mothers on 9th of every month, for nine months, checking for nine parameters (blood tests, urine tests, blood pressure, ultrasound, weight, vaccination, high risk stratification, arrangements for institutional delivery, lifestyle counseling [diet, rest, breathing, relaxation]) and involving the paediatrician at ninth month IMA Aao School Chale • 5th of every month lets us sensitise school children Ao Gaon/Slum Chalen: On first Sunday of the Month, let us sensitize the community and the families (Aao Ghar Ghar Chale) IMA PvPI Initiative: Call and report any adverse event, side effect of treatment at 9717776514 Physicians’ Health First: All IMA members to have their annual check-up done between 30th July and 5th September. Dr KK Aggarwal
A big breakfast may be key to losing weight Breakfast with a high glycemic index is harmful and can lead to cravings later in the day New Delhi, 12 August 2017: In a recently conducted study, sedentary, obese women lost almost 5 times as much weight on the “big breakfast” diet compared to women following a traditional, restrictive low-carbohydrate diet. As per the IMA, having a good breakfast made up of carbohydrates and lean protein, can help lessen cravings and hunger during the rest of the day, which can lead to significant weight loss. Eating breakfast with high glycemic foods may be harmful. After eating cereals or a doughnut, the blood sugar and insulin levels spike. Once this blood sugar is used up, the body will still have excess insulin circulating, which leads to hunger pangs and craving for carbohydrates. 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, “Treating obese people should entail treatment for carb cravings and hunger first. In the morning, the body is primed to look for food. Metabolism is revived and the levels of cortisol and adrenaline are at the highest. The brain needs energy instantly, and if one doesn’t eat or eats too little, the brain tried to find another fuel source. To do this, it activates an emergency system that pulls energy from muscle, destroying muscle tissue in the process. Then when you eat later, the body and brain are still in high-alert mode, so the body saves energy from the food as fat.” The levels of the brain chemical serotonin are highest in the morning. Craving levels are at the lowest and one may not feel like eating. As the day wears on, serotonin levels dip, and one craves for chocolate or cookies, and such similar foods. Adding further, Dr Aggarwal, said, “Eating processed food causes an increase in the serotonin levels, and the body begins to associate good feelings with them, making it an addictive cycle. A high protein-carbohydrate mix in breakfast gives the body the initial energy boost it needs in the morning. As protein is digested slowly, it reduces hunger pangs. If you crave chocolate, eat it in the morning as having a small piece of chocolate or candy when serotonin levels are high, won’t make it taste as good. The brain, thus, won’t feel the same serotonin boost, and this will eventually help cut down any cravings.” Here are some tips for smarter snacking. • Go for the grain Whole-grain snacks and whole-grain cereals can give you some energy with staying power. • Repurpose food Many breakfast foods can be repurposed as a nutritious snack later in the day. • Try a “hi–low combination” Combine a small amount of something with healthy fat, like peanut butter, with a larger amount of something very light, like apple slices or celery sticks. • Go nuts Unsalted nuts and seeds make for great snacks. Almonds, walnuts, peanuts, roasted pumpkin seeds, cashews, hazelnuts, filberts, and other nuts and seeds contain many beneficial nutrients and are more likely to leave you feeling full. • Snack mindfully Don’t eat your snack while doing something else like surfing the Web, watching TV, or working at your desk. • Carry healthy snacks Carry a small bag of healthful snacks in your pocket or purse to avoid unhealthy snacking at work.
Saturday, 12 August 2017
MDR-TB is a public health emergency Over the years, there has been an alarming increase in cases of drug-resistant TB in India. The prevalence of MDR TB is more than 2% in primary TB cases. India has the highest burden of TB patients, including drug resistant patients in the world. MDR-TB is a public health emergency, not only for patients but also for doctors, who are at risk of acquiring the infection from their patients. Control of TB should therefore be of immediate priority for all stakeholders including health care providers and policy makers. Inaccurate diagnosis and/or delayed diagnosis, especially detection of infected but asymptomatic patients (latent TB) as well as incomplete treatment are fueling this epidemic of MDR TB. The entire country is in a state of “angina” with an impending “TB attack”. GTN (glyceryl trinitrate) is used to relieve angina and prevent an anticipated heart attack such as before exercise. A similar “GTN” is needed to prevent “TB attack”. It’s time to adopt and implement an intensive strategy to control this preventable and curable disease. Yesterday, I had spoken about the IMA TB Initiative “DTR-C” “Diagnose, Treat, Report to track Contacts”. We received suggestions and inputs on this, following which, we have altered the message of our campaign to “IMA TB Initiative: GTN”. G: GeneXpert test (diagnose) T: Treat (patients) & Trace (contacts) N: Notify (mandatory) Dr KK Aggarwal
Varicose veins is a highly ignored condition • Timely treatment is imperative to avoid complications • It is better to avoid tight clothes and high heels New Delhi, 11 August 2017: According to a recent study, varicose veins are a growing concern in Indians with about 7% of India's youth suffering from this condition. Women are four times more likely to suffer from this condition than men. As per the IMA, some of the major reasons for varicose veins include a sedentary lifestyle and wearing tight clothes and high heels. Varicose veins are formed when the valves of the superficial veins of the lower limbs get damaged. As a result, blood flow from the lower limbs to the heart is decreased resulting in retention of blood in the veins. It is most commonly found in legs and feet, particularly calves. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “The legs contain multiple valves that help the blood to flow in the direction of the heart. Varicose ulcer can be found in both legs. Blood starts accumulating in the legs, when these valves get damaged, resulting in swelling, pain, fatigue, skin discoloration, itching, and varicosities. This a slow but progressing condition. Although the symptoms are mild in the beginning, people usually delay in getting themselves tested, which can lead to complications that become difficult to treat. It is imperative to treat this condition on time failing which it can develop a non-healing ulcer on the leg.” Some factors that influence the onset of varicose veins are age, sex, genetics, obesity, and the position of legs for longer periods. Ageing can also result in wear and tear of the veins. Pregnancy, pre-menstruation, and menopause are some factors influencing varicose veins in women. Adding further, Dr Aggarwal, said, “There is a lack of awareness in many people about this condition. What is alarming is that this is an under treated disease. Lack of timely treatment can lead to chronic venous insufficiency, venous ulcers, eczema, cosmetic disfigurement, and systemic hypertension. Provided the patient has no symptoms or discomfort, treatment should be accorded on time. Some patients may also undergo treatment for cosmetic reasons.” Certain self-help tips can help in preventing varicose veins. • Get moving Stimulate blood circulation in your legs by taking regular walks. • Control your weight and diet It is important to lose that excess weight to avoid pressure on the legs. Follow a low-salt diet to prevent swelling caused from water retention. • Wear comfortable clothes and footwear Low-heeled help exercise the calf muscles more and are hence, better for the veins. Avoid wearing clothes that are tight around the waist, legs, or groin. • Elevate your legs Take short breaks between work to elevate your legs above the level of your heart. You can lie down with your legs resting on three or four pillows. • Don’t sit or stand for a long time Change your position frequently to encourage blood flow.
Friday, 11 August 2017
IMA TB Initiative: DTR-C Tuberculosis (TB) is a major public health concern in the country. Despite advances in TB care, the disease continues to be a major cause of morbidity and mortality. And, it takes a heavy toll on the economy too. Emergence and spread of drug-resistant TB has become a major public health concern now. India accounts for one fourth of the global TB burden, both TB and MDR TB, as reported in Global TB Report 2016. Every year, about 1.3 lakh incident multi-drug resistant (MDR) TB cases occur in India, including 79000 MDR-TB cases among the notified pulmonary cases (TB India 2017 Report). The incidence of primary MDR TB may be higher in selected states like Maharashtra. To prevent the epidemic of MDR TB, it should be declared a public health emergency. Multidrug resistant (MDR) TB is TB resistant to both isoniazid and rifampicin with or without resistance to other first-line anti-TB drugs. Extensive drug resistant (XDR) TB is TB resistant also to a fluoroquinolone (ofloxacin, levofloxacin or moxifloxacin) and a second-line injectable anti TB drug (kanamycin, amikacin or capreomycin). Early and complete treatment is important to prevent emergence of drug-resistant cases. This year, there has been a shift in policy under the government’s Revised National TB Control Programme (RNTCP) from the “intermittent thrice weekly” regimen to a “daily fixed-dose combination (FDC) drugs” regimen for drug-sensitive TB to improve patient compliance to treatment, prevent relapse and minimize chances of developing drug resistance. All cases of TB, whether in the public and private health care sector, should uniformly adopt and follow these standards. Bedaquiline, a new anti-TB drug to be used in the treatment of MDR-TB and XDR-TB was added to the RNTCP, at six identified tertiary care centres across India. 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. All GPs should focus on tracing the contacts of their TB patients and screen them for latent TB infection. Accurate diagnosis is important in this endeavor. The rapid diagnostic molecular sputum GeneXpert test should be used to diagnosing TB including drug-resistant TB. Contact tracing increases community awareness about the disease. Contact tracing interrupts the chain of transmission of the disease by early diagnosis of cases as well as timely and complete treatment. Early diagnosis and complete treatment is important to prevent and control TB. To address the problem of rising drug resistance, TB is a notifiable disease. It was declared a notifiable disease in 2012. Every case of TB has to be notified to the local authorities. The approach to all notifiable diseases should therefore be based on DTR “Diagnose, Treat & Report”. • Diagnose early, using sputum GeneXpert test • Treat: Complete and effective treatment based on national guidelines, using FDC • Report: Mandatory reporting The Indian Medical Association (IMA) is launching a new campaign “IMA-TB Initiative: DTR-C” i.e. Diagnose, Treat, Report to track Contacts. IMA requests all its members to actively participate and support this initiative. It is only through a united and concerted effort that this public health menace can be controlled.
Urinary incontinence is a silent problem in many Indians Those with the disorder face much stigma, with people isolating such patients due to lack of awareness New Delhi, 10 August, 2017: Statistics indicate that as many as 24 million Indian adults suffer from urinary incontinence and another 27 million suffer from fecal or bowel incontinence. Although the loss of bladder and bowel control is common in people over the age of 40, it can start at the age of 20 as well. As per the IMA, people are not very kind towards those who lose bladder control and can even go to the extent of isolating such people. Old people, in particular, suffer much stigma due to this condition. Urinary incontinence is a condition in which a person suffers from leaking of urine especially while coughing or sneezing loudly. They may also have a strong urge to urinate, which leads to leakage. However, the condition can be managed or even eliminated altogether with some simple lifestyle changes or medical 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, “Urinary incontinence can be an outcome of many other conditions. In women, the causes could include weak bladder muscles, pregnancy, child birth, forceps delivery, and removal of uterus. Some general reasons are complications from surgery, stroke, or chronic diseases like diabetes, multiple sclerosis (MS), and Parkinson's disease. Diseases that weaken the bladder nerves or spinal cord can also lead to this condition. Incontinence is a disorder and can be treated and managed. Body shaming a person for this or isolating them can lead to embarrassment for them, and sometimes, even depression in the longer run. The fact, however, is that not many people are aware of this condition and need to be educated on the causative factors.” Urinary incontinence is more common among women than men. About 30%of women between the age of 30 and 60 are thought to suffer from it, compared to 1.5% to 5% of men. Two of risk factors for this condition are obesity and smoking. Adding further, Dr Aggarwal, said, “Treatment for urinary incontinence depends on factors such as the type of incontinence, patient's age, general health, and mental state. Bladder training can help people get back their bladder control. In some cases, medication is prescribed in combination with exercises for the pelvic muscle. Surgery is done if other treatments are not effective. Some simple steps can help maintain bladder and urinary health. • Behavioural therapies This includes educating patients about how urine is formed, stored, and expelled. • Pelvic floor muscles exercises These are called Kegels and they help strengthen the muscles that control urination. • Dietary changes Avoid caffeine, alcohol, and acidic drinks. Some things like chocolates, artificial sweeteners, and spices can irritate the bladder. • Weight control Excess weight can put added pressure on the bladder and surrounding muscles. Therefore, maintain an ideal weight or lose weight if you are overweight. • Fluid intake Drink at least eight glasses of water a day to keep the bladder healthy. Drinking less water makes the urine more concentrated and this can irritate the lining of the urethra and bladder.
Thursday, 10 August 2017
Difference between Wrong and Different: It’s not ‘wrong’ to be ‘different’ Dr KK Aggarwal We are all different as individuals given our diverse backgrounds, skills, thoughts, etc. Yet our actions or thoughts are often influenced by what the majority does or thinks... doing what the others are doing. This is the “herd mentality” that many of us are often guilty of. Herd mentality is a barrier to originality as it does not encourage independent thinking. It is easy to fade into the background or get lost in the crowd. ‘Fitting in’ may seem more safe and comfortable, yet it may not give you a sense of satisfaction, which you might be subconsciously seeking. Only when you think differently, can you be creative. But, creativity is not just about getting great and original ideas. Implementing these ideas is innovation. If you get an idea and you believe in it strongly, trust yourself and work to make it a reality, even if it does not conform to “accepted norms”. Children have vivid imaginations, free of set patterns. Their imaginations and creativity should be nurtured. Don’t be afraid of not doing “what is expected of you”. Successful people have challenged assumptions and popular practices on their journey to success. Being different is how innovations happen. It requires courage to be creative. Instead of trying to fit in, dare to be different from others. Keep an open mind and don’t be too ready to judge. This may be why very few original researches in medicine are being done in the country. We look to western data and accept them unquestioned. It’s not ‘wrong’ to be ‘different’… This is how you can make a difference. Disclaimer: The views expressed in this write up are entirely my own.
Platelet transfusion in dengue should not be done without proper assessment It is imperative to carry out proper diagnosis to confirm dengue in patients with a low platelet count New Delhi, 09 August, 2017: Statistics indicate that India has recorded over 18,700 cases of dengue in 2017, thus far. Apart from other symptoms, dengue causes a drop in a person’s platelet count. However, as per international guidelines, unless the platelet count is below 10,000/or there is spontaneous active bleeding, no platelet transfusion is required in case of dengue patients. According to the IMA, the cause of death in dengue is capillary leakage, which causes blood deficiency in the intravascular compartment, leading to multiorgan failure. Many viral infections, which are not dangerous, can also lead to a drop in the platelet count. A proper diagnosis must be done to confirm whether it is dengue. 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, “At the first instance of plasma leakage from intravascular compartment to extra vascular compartment, 20 ml per kg body weight per hour of fluid replacement should be administered to the patient till the difference between upper and lower blood pressure is more than 40 mmHg or the patient passes adequate urine. Giving unnecessary platelet transfusion to the patient can harm the individual. The normal count of platelets is 1.5 lakh to 4.5 lakh per microlitre of blood. In dengue, this comes down to 20,000 or even lower, but reaches the normal once dengue is cured.” It is estimated that dengue causes about 50 to 100 million infections per year worldwide. It is a viral disease transmitted by mosquitoes. There is no vaccine for the disease yet and the most effective protective measure is to avoid mosquito bites. Adding further, Dr Aggarwal, said, “Family doctors should remember the ‘Formula of 20’ to understand the severity of dengue. Rise in pulse by 20,fall in upper blood pressure by 20 mmHg, pulse pressure lower than 20, hematocrit increase by 20%, platelet count less than 20,000, and more than 20 petechiae in the tourniquet test. Dengue takes on an epidemic form almost every year and creates panic among the public. It is a preventable disease and prevention is the first step in its management.” Human beings are primarily responsible for the presence of Aedes aegypti in their environment through poor sanitation practices; improper solid-waste disposal practices; unsafe water storage practices and poor pool management. The government cannot employ enough persons to search every backyard to identify and destroy breeding sites on a consistent basis to prevent this mosquito from breeding. At an individual level, the following measures can be taken to prevent dengue. • Avoid stagnation of water in and around the house to prevent mosquitoes from breeding. • Close 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 repellant cream.
Wednesday, 9 August 2017
Opinion or judgement? Dr KK Aggarwal Doctors often tell their patients that “your disease has no cure”. They should never say that there is no cure for this illness. Instead, doctors should say “I have no cure for your disease.” Or an even better answer is “I have no cure for your disease in my system of medicine.” One of these statements is a judgement and the other is an opinion. What is the difference between opinion and judgement? One can have an opinion on any subject or issue. An opinion need not be based on facts or on evidence. Opinions are subjective as they are personal based on one’s beliefs or emotions. Others may agree or disagree with it. Judgement, on the other hand, is an opinion, about the subject or issue in question, expressed as a fact. Judgement is supported by evidence i.e. there is no room for any doubt. Hence, it implies authority and gives a sense of certainty and finality. “There is no cure for this disease” is a judgement. “I do not have treatment for this disease”, this is an opinion. There may be treatments available, which I may not be aware of. Patient care is foremost for the doctor. Hence, always express an opinion and not a judgement. Disclaimer: The views expressed in this write up are entirely my own.
Cerebral venous thrombosis is more common in women This condition can be cured in 80% of the patients, says IMA New Delhi, 08 August 2017: Cerebral (brain) venous thrombosis is an uncommon disorder and going by available statistics, it occurs in 1 per lakh of population. About 5% of those who suffer from this condition die of acute illness and 10% die over time. This condition is also more common in women than men. As per the IMA, complete recovery is possible in about 80% of the patients, and the rate of recurrence is about 2% to 4%. Cerebral venous thrombosis occurs when a blood clot forms in the brain’s venous sinuses. This prevents blood from draining out of the brain. This leads to breaking of blood cells and blood leaking into the brain tissues, forming a hemorrhage. The onset can be acute, subacute, or chronic. The mean age of onset of this condition in adults is 39 years. 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, “Thrombosis of cerebral veins or dural sinus leads to increased venous and capillary pressure, which in turn leads to brain swelling, venous hemorrhage, and/or ischemia with cytotoxic edema. Occlusion of dural sinus causes decreased brain cerebrospinal fluid absorption and elevated brain pressure. Although it is possible to cure majority of those diagnosed with this condition, a certain percentage may die, the reason for which is brain herniation. One of the most common symptoms in which occurs in about 25% of the cases is headache.” Some of the risk factors of this condition are hypercoagulable states, oral contraceptives, pregnancy, cancer, infection, and head injury.Symptoms may include focal neurologic deficits, focal or generalized fits, altered mental status, stupor, or coma. Adding further, Dr Aggarwal, said, “For diagnosis, doctors take a medical history and a physical examination. Description of the symptoms may help to a certain extent, particularly if the person who has had a stroke is unconscious. The final diagnosis is done basis how the blood is flowing in the brain. This is done through imaging tests that show areas of blood flow. Some such tests include MRI and CT scan, Venography, Angiography, Ultrasound, and Blood tests. There are few things that people can do to prevent this condition from occurring. • Consume a healthy diet It is good to follow a diet that is low in fat. Include a lot of fresh fruits and vegetables in your meal plan. • Get enough physical activity Exercising for about 30 minutes every day is not only beneficial in preventing this condition but also in keeping the body healthy overall. • Quit smoking Smoking increases the chances of cancer, which is one of the risk factors for cerebral venous thrombosis. • Keep chronic conditions under control It is important to keep conditions like diabetes under control by regulating daily lifestyle. This will help keep associated risks at bay.
Tuesday, 8 August 2017
A health journalist is a health worker too Dr KK Aggarwal Communication, as we know, is how we acquire information, how we disseminate information. Effective health communication is crucial for health promotion. Health journalists have an important role to play in health promotion by increasing health literacy. The reach of the media, whether print, radio, television and/or internet is phenomenal. In our country, people usually visit their doctors only when they fall sick. News reports on health and medicine are thus their major sources of information and influence health-related behaviors and attitudes. Health journalists increase the level of awareness and knowledge of the general public about any health issue and in this process, they often dispel myths and misconceptions prevalent in the society. It is via news reports that we come to know of the latest advances in medicine, be it drugs, devices, techniques etc. Particularly during times of outbreaks or epidemics, journalists can help to quickly deliver important health-related messages to the public about the disease in question, the Dos and Don’ts, so that people can take adequate measures to stay safe or when they should seek a doctor’s help. Diseases such as type 2 diabetes, once considered to be a disease of the affluent countries are now a major cause of morbidity and mortality in developing countries. India, as we know, has the second highest population of people with type 2 diabetes in the world. As diabetes is a lifestyle disorder, it is important that people are aware of the risk factors and how they can be modified. Health journalists can educate the general public about the need to adopt a healthy lifestyle to check the rising prevalence of the disease. When reporting stories related to health, journalists should ensure that the message should be clear, accurate, complete, factual and relevant as people often make important health care decisions based on what they read or see. The message has to be tailored to the needs of the public. Health journalists are an important link between the patient and the doctor. As health care communicators, they can be considered as health workers and therefore an integral part of health care delivery. Disclaimer: The views expressed in this write up are entirely my own.
Rural India lacks access to safe drinking water Need of the hour is to address the issue on an urgent basis and reduce the prevalence of water-borne diseases New Delhi, 07 August 2017: As per a global report released recently, about 63 million people in rural India lack access to clean water.Add to this the fact that only about 26.9 million out of 167.8 million households (16%) in rural areas have access to piped water. Studies have also found the presence of iron in water supplied to 30% rural Indian households. As per the IMA, iron when mixed with water, can cause respiratory system hemorrhage. Lack of access to clean water can also lead to multiple diseases. Unclean water can increase the prevalence of diseases such as cholera, blinding trachoma, malaria, and dengue in the rural areas, not to mention other water-borne problems. India is one of the fastest growing economies and the need of the hour is to address the issue of water security on an urgent basis. 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, “There is a strain on our country’s water resources due to various reasons. Providing access to safe water is one of the sustainable development goals and the government must increase efforts towards meeting this goal. Diseases can become rampant if people drink water that is contaminated or unclean. The presence of contaminants can result in adverse health effects such as gastrointestinal illness, reproductive problems, and neurological disorders. Infants, young children, pregnant women, the elderly, and people with a weak immune system are particularly at risk of illness from some contaminants. Diseases such as amoebiasis, cholera, dysentery, and typhoid are all due to drinking unclean water.” It is alarming to note that about 140,000 children die from diarrheal diseases each yearin the country, as a result ofusing dirty water. There is “chronic underfunding” of vital water resources in the country and access to safe water is not necessarily the top priority in government agendas. Adding further, Dr Aggarwal, said, “There is a need to supplement access to safe water withthe necessary tools, infrastructure, and preparedness to deal with the effects of weather and climate change, particularly in rural India. Awareness must be created on the need to drink clean water and how unclean water affects the system. Schools are a good starting ground for awareness creation and the IMA is already undertaking efforts towards educating children on public health issues through the Aao School Chaleinprogramme.” Some tips to prevent water-borne diseases include the following. • Always ensure to drink boiled and filtered water. • Store water in clean containers and clean them every day. • Avoid consumption of uncovered and openly stored water outside. • Ensure that the pipes and tanks that supply water to your house are properly maintained and clean. • Using detergent and hot water, discard or flush any stool in the toilet.
Monday, 7 August 2017
Personal opinion vs official opinion Dr KK Aggarwal As individuals we all have different opinions or viewpoints at the same time on any situation or a particular topic. At times, opinions may overlap when opinions are similar in some ways but not in every way. These are personal opinions. An official opinion is the opinion of any organization or association i.e. an organized body of authority. It is the collective viewpoint of all members who make up that body and reflects the policy. The National President or Hony Secretary General of the Indian Medical Association (IMA) usually voice the official stand of the association on any issue. But, they may have their personal opinion too or their own interpretation of a situation or issue. When they state that this is the opinion of IMA, it has to be based on the collective consciousness of IMA. The opinion of the house has to be unanimous i.e. everyone is in total agreement with the said opinion. I usually put a viewpoint on an issue/situation in public domain and invite suggestions. Once I receive all suggestions and comments then it becomes IMA's stand. All Spiritual and Mind Body blogs that I write are my personal columns and views and do not reflect the stand of IMA on the topics covered therein. Disclaimer: The views expressed in this write up are entirely my own.
Research underway to prove the effectiveness of stem cell therapy in cerebral palsy About 15% to 20% of physically disabled children suffer from this condition New Delhi, 06 August 2017: One of the most common childhood motor disabilities, statistics indicate that cerebral palsy affects about 15% to 20% of physically disabled children. Its estimated incidence is around 3/1000 live births in India. Though there is no cure for this condition, recent research speaks of the possibilities that stem cell therapy can provide in treating the disorder. Cerebral palsy is a term used to cover certain neurological conditions affecting movement. Children with this condition can find it hard to move certain parts of the body and the condition can vary in severity. Due to the damage to certain parts of the brain, both voluntary and involuntary movements can be affected. 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, “This condition is not contagious and does not affect a child’s intelligence or cognitive ability. It also does not become worse with age. Currently, research is underway to show the effectiveness of stem cell therapy in this condition. This involves two steps: one,taking the patient’s bone marrow and second, injecting it back after it has been multiplied in the lab. The therapy sessions begin after this process. Once the effectiveness of this therapy is established, there could be an effort towards taking up 'autologous' stem cell therapy. Studies have indicated that the progress is quick in children below the age of 10 and this procedure can also cure muscular dystrophy and autism.People with cerebral palsy have a normal lifespan and can lead a good quality of life as well.” Some common symptoms of cerebral palsy include overdeveloped or underdeveloped muscles, poor coordination and balance, involuntary movements, spastic paralysis, crawling in an unusual way, lying down in awkward positions, favoring one side of the body over the other, and limited range of movement. Adding further, Dr Aggarwal, said, “Though stem cell therapy is being spoken of, there is still time to prove its effectiveness in the treatment of this condition. However, other kinds of therapy can help children with this condition achieve their maximum potential in growth and development. As soon as it is diagnosed, a child can begin therapy for movement, and other areas that need help, such as learning, speech, hearing, and social and emotional development.” Some preventive measures can help reduce the risk of cerebral palsy in children. A woman who is planning to become pregnant should ensure that all her vaccinations are up-to-date. Additionally, it is important to: • Attend all antenatal appointments • Quit alcohol, tobacco, and drugs • Indulge in regular exercise • Eat healthy food
Sunday, 6 August 2017
Head of institutes or associations should avoid chairing routine meetings Dr KK Aggarwal Some days back I attended a function, where Prof NK Ganguly, Former Director General (ICMR) also spoke. He said something very interesting. He said that he tried to avoid chairing committee meetings as the head of the organization unless absolutely required to do so. “I preferred constituting expert committees instead as I can’t be an expert in all fields.” The reasoning behind this approach is clear. If the head of the institution is chairing an expert committee meeting, all those attending the meeting hesitate to speak up and they tend to defer to the views of the institute head. “I want their views, not just my views,” he said. It was a lesson for me. At IMA we have different committees, each with different assigned functions such as family welfare, medical education, medical ethics, anti-quackery, rural health and national plans, to name a few and each with a designated Chair. As National President, I have been chairing many meetings and now I personally feel that this may not always be the right way to look for ways to solve a problem or any issue. The more junior staff tend to defer to the Chair or more senior colleagues. The right way to do it is to involve experts. This is what we routinely follow in standing committees for finance and building. Diversity of ideas, even if dissenting views, can change the way we think. Brainstorming or ideas and viewpoints gathered from a group of people give different perspectives, different interpretations of any given situation and different ways of solving that particular situation. Diversity leads to creative and innovative thinking as ideas that come up are often original in thought. In the remaining term of my tenure, this is what I will try to do i.e. chair fewer meetings and attempt to gather more wide ranging ideas by letting experts take the chair and tap into their knowledge for the benefit of the Association and in turn the fraternity as well as the community. Disclaimer: The views expressed in this write up are entirely my own and do not represent in any way the official stand of the IMA.
Diabetic retinopathy must be detected on time to avoid loss of vision Many remain unaware till the issue reaches an advanced stage, where vision once lost cannot be regained New Delhi, 05 August 2017: India has already been accorded the status of the diabetes capital of the world, with about 65 million Indians suffering from this disorder. Statistics indicate that about 40% of those with diabetes will suffer from diabetic retinopathy at some point in time. As per the IMA, although diabetic retinopathy was always one of the associated complications of diabetes, its incidence has seen a rise in recent years. The condition can exacerbate if steps are not taken on time. Diabetic retinopathy occurs from damage to the tiny blood vessels that nourish the retina. They leak blood and other fluids and cause swelling of the retinal tissue thereby leading to clouding of vision. This condition usually affects both the eyes. 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, “Diabetic retinopathy is the major cause of blindness in patients with diabetes mellitus. However, it is largely a preventable or avoidable cause of blindness. Some factors that increase the risk of acquiring this condition include poor glycemic control, high blood pressure, and high cholesterol levels. In most patients, diabetic retinopathy is usually asymptomatic or may cause only very mild symptoms, to begin with. Due to this reason, many people living with diabetes remain unaware until the disease reaches an advanced stage and it becomes too late for treatment. Vision that has been lost cannot be restored. It is imperative that people with diabetes undergo regular screening to detect retinopathy. Early intervention is very important to prevent visual impairment and blindness.” Diabetic retinopathy is included in the list of eye diseases that can be prevented and treated if detected early under ‘VISION 2020: The Right to Sight’ global joint initiative of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB). Adding further, Dr Aggarwal, said, “Although its symptoms become noticeable only once the disease advances, there are some common things one can look out for including sudden changes in vision / blurred vision, eye floaters and spots, double vision, and eye pain. Laser surgery is often used in the treatment of diabetic eye disease, but each stage of diabetic retinopathy can be treated in a different way.” Few steps can reduce the chances of vision loss due to diabetic retinopathy. Controlling blood sugar levels It is good to keep blood sugar levels in a target range through a healthy diet, frequent monitoring of blood sugar levels, and adequate physical activity Control blood pressure One of the associated complications of this disorder is macular edema which occurs in those with high blood pressure. Therefore, keep the levels in the right range. Get an eye examination regularly Get your eyes checked regularly. Though screening for diabetic retinopathy and other eye problems will not prevent diabetic eye disease, it can help you in timely treatment.
Saturday, 5 August 2017
Doctors and hospitals should be governed by a common code of conduct Recently, hoardings “Honest Opinion, No Commission to Doctors” put up by the Asian Heart Institute in Mumbai generated a lot of controversy, with many criticising it as casting a negative shadow over the entire profession. Giving and accepting Rebates and Commission are unethical in the medical profession as laid down in the MCI Code of Ethics under Regulations 1.7, 6.1.1, 6.4 and 7.19,. “1.7 Exposure of Unethical Conduct: A Physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession. 6.1 Advertising: Soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or organizations is unethical (6.1.1). 6.4 Rebates and Commission 6.4.1 A physician shall not give, solicit, or receive nor shall he offer to give solicit or receive, any gift, gratuity, commission or bonus in consideration of or return for the referring, recommending or procuring of any patient for medical, surgical or other treatment. A physician shall not directly or indirectly, participate in or be a party to act of division, transference, assignment, subordination, rebating, splitting or refunding of any fee for medical, surgical or other treatment. 6.4.2 Provisions of para 6.4.1 shall apply with equal force to the referring, recommending or procuring by a physician or any person, specimen or material for diagnostic purposes or other study / work. Nothing in this section, however, shall prohibit payment of salaries by a qualified physician to other duly qualified person rendering medical care under his supervision.” 7.19 A Physician shall not use touts or agents for procuring patients.” Where do doctors stand vis-à-vis the culture of corporate hospitals today? The MCI Code of Ethics are binding on doctors. However, the corporate hospitals are out of the purview of the MCI. Doctors cannot advertise. Hiring agents or touts to solicit is an unethical act on the part of a doctor, but all corporate hospitals have a marketing dept. It is also unethical for a doctor to give rebates and commissions but for a corporate medical establishment, there is no such bar. It is very unfortunate that doctors working in the corporate hospitals and who are bound by a code of conduct, work and report to corporate hospitals, who do not have to abide by a similar code of conduct. Doctors are under pressure to reach the “targets” given to them by the corporate hospitals. There should be a common code of conduct for doctors and hospitals and both should abide by it. Alternatively, hospitals should be owned only by doctors. According to me, there should not have been any controversy on this issue. The hoarding put up by the Asian Heart Institute very daringly showed that the hospital does not indulge in the unethical practice of cuts and commissions. In my opinion, all hospitals in the country should follow suit and declare that they respect the MCI Code of Ethics and will not allow the unethical “cuts and commissions” practice in their premises. Doing so will make their interactions with doctors transparent to the public. This will generate trust resulting in an effective doctor-patient relationship, which is in the interests of both the doctor and the patient. IMA is for “one code of ethics” for doctors and hospitals and had attempted to develop a common code of ethics in collaboration with the Association of Healthcare Providers India (AHPI) and Healthcare Federation of India (NATHEALTH). We undertook this initiative two years back and developed basic documents on code of ethics (as below) as guidelines for members as how to conduct themselves ethically and in a transparent manner in all their interactions with the patients and all others involved in healthcare. IMA & AHPI Code of Ethics for Healthcare Providers • “We comply with all the Regulatory and Statutory requirements. • We respect and uphold the Rights of Patients. • All our doctors abide by MCI code of ethics. • We do not accept expensive gifts, cash benefits or gratification from the drug & equipment suppliers, diagnostic centers or similar agencies. • We do not indulge in any activities that are unethical or illegal such as: o Unjustified admissions o Un-justified reporting or billing to the patient o Sheltering any criminal from the law o Pre natal sex determination o Improper entries in insurance forms o Giving cuts and commissions to any one for soliciting patients o Overbilling in claim cases” IMA & NATHEALTH Code of Ethics for Healthcare “We, the members of IMA and NATHEALTH and signatories to the Code of Ethics for Healthcare, do hereby solemnly declare that we have read and understood the Code of Ethics and shall abide by it to maintain ethical and transparent professional conduct and practices to ensure improved access to and better quality of the healthcare ecosystem in India. • A voluntary and collective commitment to follow ethical practices to ensure that patients are provided access to high quality, cost effective, safe and efficient technologies, products and services. . Comply with all applicable laws and members’ internal policies on the subject and create a mechanism to address violations appropriately. • Recognize and champion the sanctity of patient confidentiality. • Maintain accurate and complete records and ensure their safety and access. • Refrain from offering or accepting any payments/gifts with the objective of influencing a decision making process within the healthcare community. • Desist from engaging in any activity, practice or act which conflicts with, or appears to conflict with the interests of the healthcare community, end users or patients. • Maintain a safe and healthy work environment. • Provide donations only for charitable purposes and not with the intent to influence the healthcare community to purchase, lease or recommend the use of specific products and services or treatment modalities. • Meet all applicable quality standards and accreditations as may be required to provide the appropriate delivery of healthcare services. • Undertake appropriate dissemination of the Code for full applicability and accountability.” But, these apply only to those who are members or signatories as these are voluntary Code of Ethics. There should be a debate on this issue. The same can be adopted by the Govt. The Ministry of Health should discuss with all stakeholders and come out with an Advisory in this regard.
Indian diet is protein deficient Indians not aware of the importance of consuming adequate protein New Delhi, 04 August, 2017: According to a recently conducted study, about 73% of the Indian diet is protein deficient with the deficiency more alarming in a vegetarian diet. About 84% of the vegetarian diet is low on protein compared to 64% in the case of a non-vegetarian diet. Protein is one of the most misunderstood and underestimated nutrients in the Indian scenario, says IMA. Additionally, about 93% Indians have no knowledge of an ideal protein intake. Protein is one the fundamental nutrients required by the human body. The recommended dietary allowance for protein is 1 gram per kg of body weight and our body needs this nutrient to meet the requirement of amino acid. However, the requirement varies with the activity level and also during pregnancy. 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, “One of the reasons why the Indian diet is protein deficient is that 60% of it is composed of cereals. Cereals are good sources of protein as well, however, they are short of an essential amino acid. Methionine, which is needed for growth and tissue repair is missing in pulses and dals, otherwise rich in protein. Thus, it is important to consume a combination of cereals and pulsesin an ideal ratio of 5:1. However, even with this combination, there can be problems with digesting the protein. To counter this, it is a good idea to consume combination of cereals, pulses, and animal protein such as milk, meat, eggs, etc.” On the other hand, too much of protein, such as that consumed by fitness freaks, is also harmful to the body. This can put a lot of pressure on the liver and kidneys to get it out of the system. Adding further, Dr Aggarwal, said, “For many Indians, a bowl of dal suffices as a protein source, along with rice. However, it is important to take a note of the proportion in which this is eaten. Additionally, a bowl of dal is not enough protein for the body. The best combinations in the typical Indian diet include rice with dal, rajma, kadhi, mushrooms, curd, and soya.” The following foods can help prevent a possible protein deficiency, especially in those with a busy schedule. • Cottage cheese: One cup contains about 25 grams of protein. • Pumpkin seeds: Half cup has about 14 grams of protein. • Chocolate milk: One glass can give you about 8 to 11 grams of protein. • Hard boiled eggs: One egg can provide about 6 grams of protein. • Almonds: Around 25 almonds can give you 6.4 grams of protein. • Oatmeal: One serving has about 5 grams of protein. • Peanut butter: One tablespoon contains about 4 grams of protein.
Friday, 4 August 2017
Celebrate the centenary year of IMA’s All India Medical Conference: Wear Khadi In September this year, the Indian Medical Association (IMA) will hold the 218th meeting of its Central Working Committee (CWC) in New Delhi. This year also marks the 100 years of IMA’s All India Medical Conference, the first of which was held at Calcutta in 1917. The concept of IMA was born out of these conferences in response to a need of a national organization of doctors. A resolution adopted at the 5th All India Medical conference held at Calcutta in the year1928 led to the formation of an All India Medical Association. The objectives were to improve medical education, promote medical and allied sciences in their different branches and safeguard interests of the medical profession. The All Indian Medical Association and the body were duly registered in the year 1930 under the Societies Registration Act, XXI of 1860. At its inception, the Association had only 222 members. But since then it has only grown from strength to strength. Today, IMA has more than 2.5 lakh doctors as its members through more than 1765 active local branches spread across the country. It is the only national voluntary organization representing the collective consciousness of doctors of modern scientific system of medicine in the country, with its Headquarters in New Delhi. This is also a time to remember the struggles and sacrifices of the founding members, both before and post-independence, not only in the formation of the Association, but also for the independence of our country as many of the stalwarts of the medical profession in those days had also served time in jail for their participation in India’s freedom movement. In this centenary year of the All India Medical Conference, we can pay our tribute to our founding fathers by promoting our national heritage. Khadi is one way by which we can do this. It is not merely a piece of fabric, khadi is a powerful symbol of “self-rule” and “self-reliance” of the freedom movement propagated by Mahatma Gandhi as a means to boycott the British textiles. Khadi is made of natural fiber and is non-allergenic; it keeps the body cool as it allows better air circulation with less sweating. Being hand woven and hand spun makes it environment-friendly. By virtue of these properties, does khadi prevent skin infections? This can be a subject of research. All of us should consider wearing Khadi voluntarily, and include it in our daily wear, as much as possible. And, I request all members to wear a ‘Khadi apron’, particularly during the centenary celebrations. And, also on 2nd October, when all doctors of modern medicine in the country will undertake a dawn to dusk fast in continuation of our Dilli Chalo movement. This initiative will be a good way to not only honor our cultural heritage, but also preserve this invaluable legacy and carry it forward. Also, by wearing khadi, doctors can make their contribution in empowering khadi weavers. Wear Khadi with flair, wear khadi with pride…
Deaths due to NCDs see an upward trend in the country IMA recommends following a healthy lifestyle to prevent the onset of these diseases New Delhi, 03 August 2017: As per recent statistics, premature deaths due to non communicable diseases (NCDs) such as cancer, heart disease, diabetes, and lung disease have increased to 70% of all global deaths. This is up from the 42% incidence three years ago. As per the IMA, the burden of NCDs is on the rise in India, with one in four at risk of dying from the same before they reach the age of 70. An NCD is a medical condition or disease that is non-infectious and non-transmissible among people. The major NCDs are due to four behavioral risk factors: unhealthy diet, lack of physical activity, and use of tobacco and alcohol. Preventive action against NCDs in India is marred due to a lack of understanding their patterns, the prevalence, and the causes. 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, “NCDs are a health and developmental emergency today. They are driven by many external sources including rapid unplanned urbanization, globalization of unhealthy lifestyles, and population ageing. The unhealthy diets that people follow today combined with the lack of physical activity can manifest in the form of high blood pressure, increased blood glucose, elevated blood lipids, and obesity. Called metabolic risk factors, these can further lead to cardiovascular disease, the leading NCD and cause for premature deaths. Reducing the risk factors can help in controlling NCDs to a great extent.” A recent study has outlined that there is likely to be a steady rise in NCD losses until 2030, and then it will increase sharply. Adding to this, the value of life lost, including out-of-pocket expenditure related to these illnesses, and loss of income will likely double over the next 20 years. Adding further, Dr Aggarwal, said, “The medications available to treat most of the NCDs are not very expensive. However, the most effective strategies for reducing the burden of NCDs actually lie outside the health system. It is imperative to take measures such as regulation of advertising, improving access to healthier foods, reducing exposures to tobacco smoke, addressing dietary salt consumption, and encouraging physical activity to combat this group of ailments.” One can follow Dr KK’s Formula of 80 to prevent NCDs. • It is important to keep your fasting sugar lower than 80 mg % • It is best to refrain from consuming alcohol. For those who still wish to drink, they should restrict it to not more than 80 ml of alcohol in a day or 80 grams in a week • To not consume more than 80 grams of caloric solid or liquid food in one meal, rather eat frequent but small meals • Restrict your soft drink consumption to 80ml in one go. The tip is to add soda and dilute it to make it 200 ml • Do not consume tobacco products otherwise you will end up with a surgery bill of over Rs. 80,000 • It is important to keep one’s blood pressure lower than 80 mm Hg and heart rate lower than 80 per minute. • Do aerobic exercises for 80 minutes a week. • Do stretching exercises for 80 minutes in a week. • Consume at least 80 fruits and vegetables servings in a week. • Do not consume more than 80 ml/gram of ghee, oil and butter in a week.
Thursday, 3 August 2017
Straight from the Heart: I am proud of being a "Doctor with a Stethoscope" During my MBBS at MGIMS, Wardha, I was exposed to Vedantic medicine. Later, I also began to write and speak on Vedantic medicine, the science behind vedas. Because, most of my talks include a vedic prescription, I started wearing a stethoscope so that I was not mistaken to be a non-allopathic doctor. I have now been wearing the stethoscope around my neck over the last several years. And, people have often asked me the reason for doing so. I can recall having saved at least 20 unknown lives, just because I was wearing a stethoscope. There are ‘n’ number of instances, where I have done CPR outside the sanctuary of hospitals. I have also handled first aid during air travel dozens of time. I would like to share with you some stories of my experience of wearing the stethoscope. This Monday, I was traveling from Trivandrum to Delhi via Kochi. At Kochi airport, while the aircraft was on the runway and taking off, a lady passenger became breathless. She had a history of deep vein thrombosis (DVT) and had taken heparin one hour before. I checked her oxygen saturation (I always carry a home pulse oximeter with me), which was normal. She was unfit medically to undertake the 3-hour journey and needed medical assistance. The crew saw that I was wearing a stethoscope and they approached me for help. She was off loaded from the flight at the airport under medical care. In March this year, I was in Cyprus to attend the Bioethics 12th World Conference. A car ahead of us had met with an accident. One of the lady passengers was trapped in that car. We stopped and approached the car to offer medical help. We were allowed to intervene only because I was wearing a stethoscope. Once, while we were traveling to Dubai, my wife, suddenly developed air hunger. She almost collapsed but managed to say “Call my doctor, he is the one wearing a stethoscope”. The crew could immediately recognize me. Titles of distinction and honor like Diwan, Raja, Maharaja, Rai Bahadur, etc. were abolished under Article 18 of the Constitution of India as being against the principle of equal status of all. However, we are still allowed the privilege to write ‘Dr’ before our names. But, simply adding the prefix ‘Dr’ before your name does not confer status. Being a doctor means being available 24x7 and ready to help in all emergencies. Use the new emblem when writing a prescription or sport a stethoscope always. There is a Good Samaritan law to protect those who voluntarily come forward to help victims of accidents. It applies to us doctors also. In April 2016, the Govt. notified guidelines regarding protection and examination of “good Samaritans” i.e. bystanders and passers-by who render help to the victims of road accidents. I love being a doctor. It is extremely satisfying and rewarding. All the hard work and long hours put in are worth the effort. Wearing a stethoscope reminds me of my medical dharma, which is to treat and save the life of a person at any cost. This is why we chose to become doctors. We know medicine to be a noble profession. Sporting a stethoscope has now become my signature style. People now identify me as “a Doctor with Stethoscope”. I always wear a stethoscope, will you consider it?
Heart Care Foundation of India’s (HCFI) annual flagship event – the MTNL Perfect Health Mela to focus on ways to wellness, health awareness, and roots of ancient Indian medicine, among other things
Heart Care Foundation of India’s (HCFI) annual flagship event – the MTNL Perfect Health Mela to focus on ways to wellness, health awareness, and roots of ancient Indian medicine, among other things The theme for this year's Perfect Health Mela will be ‘Digital Health', encompassing improving healthcare through technology New Delhi, 02 August 2017: HCFI, a leading national non-profit organization, committed to making India a healthier and disease-free nation, today announced the theme and details of its flagship event, the MTNL Perfect Health Mela 2017. The Mela will be organized from October 4-8, 2017 at the Talkatora Indoor Stadium, New Delhi jointly with the Health and Family Welfare Dept. NCT Delhi, MTNL, NDMC, and other central and Delhi state government departments. The Indian Medical Association will be the knowledge partner for the event. The Perfect Health Mela is an annual event curated to spread mass health awareness using entertainment as a medium. The theme this year is “Digital Health” and will focus on ways to wellness, health awareness, roots of ancient Indian medicine, wellness through music, dancing and health, and saving the girl child, among other things. Speaking about the Mela Padma Shri Awardee Dr KK Aggarwal, President HCFI & National President IMA said, “The theme for this year’s Perfect Health Mela is in alignment with PM Modi’s idea of a digital India. It will lay emphasis on ‘digital health’ which is an umbrella term covering the convergence of digital and genomic revolutions. Digital health encompasses using technology to empower people in tracking, managing, and improving their own health and that of their near and dear ones. This will in turn help them live better and more productive lives, and bring about improvements in the societal health at large.” Started in 1993, the Perfect Health Mela caters to people from all age groups and all walks of life. It showcases activities across categories such as health education seminars, check-ups, entertainment programs, lifestyle exhibitions, lectures, workshops, and competitions. The Mela is attended by over 200 organizations each year including those from the state and central government, PSUs, and leading corporates. Dr RN Tandon – Honorary Secretary General IMA, said, “The IMA wholeheartedly supports any initiative that lays emphasis on the betterment of society’s health and creates awareness on health issues. The Perfect Health Mela is one such event organized every year and the IMA is proud to be the knowledge partner for this event.” Among the various events being organized this year are the Harmony & Ecofest National inter-school competitions, Youth Rock Band/Orchestra Festival, Divya Jyoti Medical Masti Youth Festival, All Pathy Conference, All Religious Conference, and Nukkad Natak. Free medical check-ups will be provided to all visitors. Adding further, Mr A K Sareen, Deputy General Manager Marketing MTNL Corporate Office, said, “With India going the digital way, the theme for the Perfect Health Mela is only too apt. As with every year, this year too we are happy to be sponsoring this event, which will help people know and take advantage of various health care programmes.” Dr P K Sharma, MOH, NDMC & the civic partner of the year’s Perfect Health Mela in a statement added, ‘We laud the Heart Care Foundation of India for this initiative and for continuing to organize this even year after year. We will extend our complete support towards making the event a success". For more information about the event, please visit www.perfecthealthmela.com./ http://www.heartcarefoundation.org/ Entry to the Mela is free for all.
Wednesday, 2 August 2017
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