Thursday, 19 October 2017

WMA TB & HIV-AIDS Resolutions revised in coordination with IMA

WMA TB & HIV-AIDS Resolutions revised in coordination with IMA

Dr KK Aggarwal

In the recently concluded Annual General Assembly in Chicago held from October 11-14, 2017, the World Medical Association (WMA) passed two resolutions on Tuberculosis (TB) and HIV-AIDS, after undergoing major revisions.

Indian Medical Association (IMA) volunteered to be the coordinating national medical association for these resolutions. This was only the right thing to do given the high prevalence of the two diseases in the country and hence, of great public health concern to us.

India accounts for one-fourth of the global TB burden, including MDR TB, as reported in Global TB Report 2016. And, India is among the top three countries with the highest number of people living with HIV. The total number of people living with HIV in India is estimated at 21.17 lakhs (17.11 lakhs–26.49 lakhs) (India HIV Estimation 2015 report). Of these, only 14 lakh are diagnosed.

As the coordinating national medical association for both these resolutions, suggestions from all member national medical associations were sent to IMA, who compiled and finalized the resolutions, which were then passed by the recent Assembly at Chicago.

Both these Resolutions on TB and HIV-AIDS were first adopted in October 2006 by the WMA Annual General Assembly in South Africa.

WMA Assembly also passed a Revised Declaration of Geneva incorporating various changes and additions. IMA was a part of the workgroup that worked on the amendments to ‘The Physician’s Pledge’.

IMA is also coordinating revisions to another WMA document on Reproduction Rights.

Some salient points of the two resolutions are as below:

WMA Resolution on TB

• “Screening of high risk groups including PLHIV (people living with HIV) and vulnerable populations including migrants, prisoners, and the homeless should be considered within each national epidemiological context as a component of tuberculosis prevention.

• Rapid diagnosis with molecular tests and supervised daily treatment started early should help arrest the spread of disease.

• The WMA supports the WHO “End TB Strategy” and its visions, goals and milestones.

• The WMA calls on National Medical Associations to support their National TB Programmes by generating awareness among healthcare professionals about TB management and early reporting of cases in the community.”

WMA Resolution on HIV-AIDS

• “In addition to representing a staggering public health crisis, HIV/AIDS is also fundamentally a human rights issue.

• Discrimination against HIV / AIDS patients by physicians is unacceptable and must be eliminated completely from the practice of medicine.

• Patients with HIV/AIDS must be provided with competent and appropriate medical care at all stages of the disease.

• Physicians must ensure that patients have accurate information regarding the treatment options available to them.”

Better be safe than sorry during the festival of lights

Better be safe than sorry during the festival of lights

Those with cardiac and respiratory ailments should be particularly careful

Eating and drinking should be healthy and in moderation, with adequate physical activity

New Delhi, 18 October 2017: Diwali, the festival of lights and harbinger of prosperity and cheer, is characterized not just by this. It is also that time of the year when health risks escalate. From the ghee-laden sweets to the pollution-inducing crackers, there is a lot to think about in terms of one’s health. According to statistics, the annual carbon dioxide emissions from fireworks is 60,000 tonnes. The IMA says that this is not only to the environment but also to the health. Add to this the sweets and savories and alcohol binge, and one’s weight is sure to catapult.

Diwali is that time of the year when people lose track of their eating, drinking, and fitness habits. Apart from this, noxious gases such as carbon monoxide from crackers can be detrimental for those with asthma or heart ailments.

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 sudden change in both eating and sleeping patterns during Diwali. Late night parties binge-eating, alcohol, and lack of exercise affect health in many ways. People also do not drink enough water to keep themselves hydrated. White sugar in sweets can lead to uncontrolled diabetes and gain weight in individuals. Adulterated khoya can cause GI upset. Artificial coloring in sweets can cause cancer in long run. Those with COPD (adult asthma) need to be careful as the smoke from crackers can worsen respiratory illnesses. Excessive noise pollution during Diwali can cause hearing loss, high blood pressure, and mental irritation. It can also exacerbate heart ailments in people sometimes leading to a cardiac arrest as well. One should also be careful of candle pollution as petroleum is a known human carcinogen and can cause indoor pollution.”

Diwali fire hazards are also not uncommon and can result in burns and loss of life. Particlesof crackers can cause eye burn and irritation. People also indulge in excessive consumption of alcohol which is injurious to health.

Adding further, Dr Aggarwal, said, “The best item for Diwali is fruits and dry fruits. Avoid ‘chhena’ and ‘khoya’ sweets, along with sweets and milk products from roadside shops. One should not drive after consuming more than 30 ml in one hour. While gambling one should not argue with others as someone under the influence of alcohol may cause harm. Those with COPD should use wet clothes whenever they are exposed to smoke. It is imperative to remember that health is above all and no festival or occasion should be an excuse to compromise on health.”

Here are certain things one can observe to stay away from harm and ensure good health during Diwali.
Limit the use of firecrackers and avoid loud explosives. Those with asthma should wear face masks to prevent inhaling the poisonous mix of gases. Those with cardiac problems and hypertension should wear ear plugs to prevent the impact of the cracker explosions.
Check the manufacturing and expiry dates of sweets and snacks before buying them. Avoid buying anything from roadside shops.
Replace oily snacks with a combination of fresh fruits, curd dips, raw salads, roasted food items and nuts like almonds and pistachios. Replace carbohydrates and proteins with fibre and vitamins in your diet. Ensure that you stay hydrated by drinking lots of water through the day.
In case of burns, the affected part should be put in running water till the burning sensation disappears. Blisters should not be punctured, as they work like a natural dressing.

Wednesday, 18 October 2017

Trauma-related deaths can be prevented by timely action

Trauma-related deaths can be prevented by timely action

Need for more trauma centres across cities that are up-to-date and organized

New Delhi, 17 October 2017:In India, one person dies of a road accident every minute, indicate statistics. Road accidents account for about 1,50,000 deaths every year. Injuries and the resultant trauma rank fourth in the causes of death across all age groups children, adolescents, and young adults. These are also reasons for more premature deaths than cancer, heart disease or other such diseases.[1]On World Trauma Day, there is a need to raise awareness on the fact that majority of these trauma-related deaths can be prevented through timey action and medical care.

Many deaths occur either within minutes of the injury, at the scene of accident or injury, before the victim is taken to the medical facility, or immediately upon arrival at the hospital. Some of the reasons for death include massive hemorrhage or severe neurological injury.

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 still a long way to go in terms of immediate trauma care in India. There are many issues in offering critical care to injury victims. India lacks significant pre-hospital care in most cities with the golden hour concept still an ambiguity for many. This is further exacerbated by poor ambulances services and the lack of a centralized agency to monitor them. Hospitals need to ensure availability of casualty medical officers who can do more than just resuscitation. Add to this the fact that there are no dedicated trauma surgeons in India, which often causes delays in clinical decision making. This is because various aspects are handled by various departments and not a single entity. Last but not the least, there is no central trauma registry in any institute.”

In a survey, it was found that the risk of deaths in injured people can be reduced by about 25% if a trauma victim is treated at a dedicated trauma centre.[2]Trauma centres are classified into four levels based on the available resources and the number of patients admitted.

Adding further, Dr Aggarwal, said, “There is a need to have dedicated trauma centres in cities throughout the country that can provide the best emergency services and have up-to-date trauma systems. This means that such a hospital should have high-quality intensive care ward and an operating theatre, learned and dedicated personnel, and updated and latest equipment. Apart from this, it is imperative to make efforts to prevent injury or reduce the severity of injuries, as this will help in preventing many cases of immediate death.”

Prevention is always better than cure. Trauma can be prevented by staying alert at an individual level.

Some do’s and don’ts to consider with regard to accidents and injuries are as follows.

Follow the road safety rules and be aware of warning signs and traffic signals.
Do not forget to wear a helmet and take a break if you are driving for a long distance.
Do not use the mobile phone while driving or listen to loud music.
Keep a first-aid kit ready at home and in your vehicle.
Do not drive if you are sleepy, tired, or have had drinks.
If you notice a person with head or spinal injury, move the person from the site only with professional help to avoid serious back or neck injuries.
Do not give fluids to any unconscious or semi-conscious traumatized person.
Learn basic life support techniques and help the injured.

Global issues discussed during the WMA General Assembly

Global issues discussed during the WMA General Assembly

Dr KK Aggarwal

The World Medical Association (WMA) concluded its annual General Assembly in Chicago held from October 11-14. More than 50 national medical associations attended the annual General Assembly and discussed various global issues.

Dr Yoshitake Yokokura, President of the Japan Medical Association, was installed as President of the WMA for 2017-18. Dr Leonid Eidelman, President of the Israel Medical Association, was elected President elect. He will take office in a year’s time to serve as President in 2018-19.

Hunger strikes: The Assembly agreed that the WMA would support any physician who faces political pressure to take part in forced feeding of hunger strikers against their ethical advice. In a revision of its policy on hunger strikers, the WMA says that national medical associations ‘have a responsibility to make efforts to prevent unethical practices, to take a position against ethical violations, and to investigate them properly’. Delegates agreed that where physicians are pressured to take part in torture, the WMA would protest internationally and publicize information about the case.

Bullying: A policy of zero tolerance towards bullying and harassment in the medical profession was supported by the meeting. Delegates agreed a statement condemning bullying under any circumstances and encouraging all national medical associations members, medical schools, employers, and medical colleges to establish and implement anti-bullying and harassment policies.
WMA President, Dr. Yoshitake Yokokura said: ‘Bullying in the health workplace is entirely unprofessional and destructive, and should not be tolerated. It is time the profession took steps to prevent, confront, report and eliminate such behaviour at any level’.

Armed conflict: Against a background of armed conflicts in many parts of the world, the Assembly issued a strongly worded statement reminding governments of the human consequence of warfare. It says that armed conflict should always be a last resort and physicians should encourage politicians, governments, and others in positions of power to be more aware of the consequence of their decisions to start or continue armed conflict. Efforts to avoid conflicts are often insufficient and inadequate and country leaders may not seek all alternatives. Delegates stressed that avoiding war and seeking constructive alternatives is always desirable.

Access to health care: A call for ethical codes for recruiting health professionals was agreed in a bid to reduce inappropriate recruitment activities by states. The Assembly approved a new policy to combat the problems of a global maldistribution of health care workers. It declared that the global movement of workers, especially from less developed to better developed countries, is leading to continuing shortages. It said that ethical recruitment codes were needed for both governments and commercial recruitment agencies to ensure that countries did not actively recruit from other states.

Alcohol: A worldwide drink drive limit of no more than 50 milligrams per 100 millilitres of blood was called for by the Assembly in a new drive to reduce excessive alcohol consumption. In a statement, the WMA says that key deterrents should be implemented for driving while intoxicated, including a strictly enforced legal maximum blood alcohol concentration for drivers of no more than 50mg/100ml, supported by social marketing campaigns and the power of authorities to impose immediate sanctions. WMA President Dr. Yoshitake Yokokura said: ‘The human cost of drunk driving across the world is appalling. The daily tragedy of death and injury caused by drivers who drink while over the limit is unforgivable. I hope that governments will act to reduce the drink drive limit’.

Child abuse: Guidance to physicians on dealing with child abuse were agreed. In a new policy document, the WMA says that child abuse in all its forms, including exploitation of children in the labour market, is a world health problem and that physicians have a unique and special role in identifying and helping abused children and their families. All physicians should be educated about the overriding importance of the welfare of children. They should act in the best interests of children in all of their contacts with children, young people, families, policy-makers and other professionals.

Fair trade: The Assembly condemned the abuses of labour standards, evidence of modern slavery and unethical working conditions that have been uncovered in the manufacture of many medical products around the world. In a new Declaration, the WMA calls for a fair and ethical purchasing policy for medical goods. It urges all its national medical association members to advocate for human rights to be protected throughout the global supply chains of products used in their healthcare systems.

New members: Five new members were admitted – the Czech Medical Chamber, the Belarusian Association of Physicians, the Pakistan Medical Association, the National Medical Chamber of Russia and the Belize Medical and Dental Association. This increases the total number of medical associations and constituent members in the WMA to 114.

All the policies adopted by the Assembly can be found on the website of the WMA.

(Source: WMA, October 16, 2017)

Tuesday, 17 October 2017

AHA guidance on improving employee health and engagement

AHA guidance on improving employee health and engagement

Dr KK Aggarwal

The American Heart Association (AHA) has released an evidence review report titled “Resilience in the Workplace: An Evidence Review and Implications for Practice”, with practical actionable guidance for employers looking to implement resilience training programs. According to the report, resilience is an emerging, innovative strategy to improve employee health and productivity, and organizational performance.

The CEO Roundtable is the AHA’s leadership collaborative with 30-plus member CEOs who represent some of the nation’s largest employers who are committed to applying evidence-based approaches to improve their employees’ overall health.

Studies suggest resilience training may be a useful primary prevention strategy for employers to improve employee health and engagement. Although there is no consensus on how to define resilience, the report says that “resilience can be considered, in general, the ability to withstand, recover and grow in the face of stressors and changing demands”.

Resilience training aims to develop or strengthen a person’s ability to withstand, recover and bounce back from adversity and may improve the ability to cope with, and recover from negative workplace stressors.

In an online employee of 1,001 working adults within the US, which has also been included in the report, 73% said that their participation in resilience training programs improved their health a great deal or fair amount; specifically, they reported having more energy (51%), exercising regularly (45%), and improved quality of life (41%).

(Source: AHA News Release, October 11, 2017)

IMA stands in solidarity with junior doctors on strike in Poland

IMA stands in solidarity with junior doctors on strike in Poland

New Delhi 16 October2017: Junior doctors in Poland are on hunger strike protesting the poor pay and conditions including poor healthcare funding. Supporting their protest, the World Medical Association (WMA) delegates passed an emergency resolution on October 13, 2017 expressing serious concern about the dispute at the annual assembly of the Association in Chicago. The resolution also urged the Prime Minister of Poland to intervene and negotiate an acceptable solution and further said, ‘It is essential that a resolution is found before these physicians suffer irreversible harm, or die, as they seek to improve working conditions for their colleagues and a better financial basis for health care provision for the population’.

According to the Polish Chamber of Physicians and Dentists, they made several appeals, unsuccessfully, to the Government to take action on all the above issues; hence, the hunger strike. The current level of expenditure did not cover the justified needs of the population and was insufficient to ensure proper working conditions for health care professionals.

Commenting on this, Padma Shri Awardee Dr KK 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, “As part of WMA, the IMA supports the Junior doctors in Poland. Our demands are also similar. Health care spending in India too needs attention as India continues to be among the countries with the lowest relative public expenditure on healthcare. This is very evident from the Union budget for the year 2017-18, which has allocated only 1.3% of the GDP for healthcare. The National Health Policy 2017 has proposed increasing public health expenditure to 2.5% of the GDP. But this is just not enough. Every citizen of this country has a right to receive affordable or free preventive and emergency health care and the best of treatment. The health budget should be 5% of the GDP for universal health coverage. No to adhocism, pay parity and uniform service conditions for service doctors all across India is another of our major demand. ”

Indian Medical Association (IMA) is the only representative, national voluntary organization of doctors of modern scientific system of medicine, which looks after the interest of doctors as well as the well-being of the community at large. IMA represents the collective consciousness of over 3 lakh doctors of modern medicine, spread across 1,700 local branches and 31 State and Territorial branches.

Adding further Dr KK Aggarwal said, “In addition to these, there are several important issues and concerns of doctors that need to be addressed urgently. Criminal prosecution of doctors, increasing violence against doctors, uncapped compensation in negligence cases, unrealistic laws like CEA and PCPNDT, to name a few. Doctors are feeling insecure and live in fear of criminal prosecution or violence. IMA has been fighting for a solution to these problems and had organized the “Dilli Chalo” movement on 6th June this year followed by a Dawn to Dusk fast on 2nd October to bring to the attention of the nation the many problems faced by the doctors today. We had also published an open letter to the Prime Minister prior to the fast seeking his immediate intervention in resolving these issues to better protect the health of the public, which we still await. We also hope that the WMA also passes a resolution supporting our demands.”

Monday, 16 October 2017

WMA approves Modern Physicians Pledge

WMA approves Modern Physicians Pledge

Dr KK Aggarwal

A modern successor to the Hippocratic Oath for physicians around the world has been approved by the World Medical Association.
Physician leaders, meeting at the WMA’s annual General Assembly in Chicago approved revisions to the Declaration of Geneva, which was adopted by the Association in 1948.
The revised Declaration, to be called a pledge, refocuses the text to reflect changes over the decades in the relationship between physicians and their patients and between physicians themselves. As a result, the new pledge makes specific reference for the first time to respecting the autonomy of the patient, which is not included in the current text. It also includes a new obligation for respect between teachers, colleagues and students.
The present Declaration says students must respect their teachers, but there is no reciprocity. There is a new obligation on physicians to share medical knowledge for the benefit of their patients and the advancement of healthcare.
Also added is a requirement for physicians to attend to their own health, well-being and abilities in order to provide care of the highest standard.
The current Declaration of Geneva is used across the world by physicians. In many countries it is actually part of the medical professional code and in some it is legally binding. However, in other countries it is either not used at all or is adapted in some way.
The WMA is now expecting that the revised pledge, agreed following a two-year revision process, including a period for public consultation, will become a global ethical code for all physicians.
WMA President Dr. Yoshitake Yokokura said: ‘The new wording respects the unique character and significance of this Declaration, but focuses more on important ethical principles not in the current version and not expressed explicitly.
‘The life of physicians today is completely different to what it was in 1948 when the original Declaration of Geneva was adopted. Since then, the Declaration has become a core document of medical ethics and a modern version of the 2,500-year old Hippocratic Oath.
‘We hope that the Declaration approved today will be used by all physicians around the world to strengthen the profession’s determination to maintain the highest standard of health care for patients’
(Source: WMA News Release, October 14, 2017)

India still lags behind in child nutrition with a child-wasting prevalence of 21%

India still lags behind in child nutrition with a child-wasting prevalence of 21%

A healthy diet including all food groups is key to preventing this condition

New Delhi, 15 October 2017: Twenty-one percent of children under 5 years of age in India suffer from wasting, according to a report. India has not seen any significant strides in checking the prevalence of this indicator since the last 25 years. Djibouti, Sri Lanka, and South Sudan are the only remaining countries in the Global Hunger Index (GHI) 2017 with a child-wasting prevalence over 20%. Child wasting is one of the four indicators in the GHI.

Statistics indicate that the prevalence of child wasting in India has increased from 17.1% in 1998-2002 to 21% in 2012-16. This is way above the global prevalence. Wasting or thinness in a child is the result of acute and inadequate nutrition along with frequent infections leading to rapid weight loss or failure to gain weight normally.

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, “Wasting is also called as acute malnutrition and as low weight-for-height. A healthy child is normally expected to gain 2 to 3 kg of body weight every year. Wasting occurs when the weight-for-height measurement in a child is less than two standard deviations from the globally accepted reference cut-off point. Severe wasting happens when a child’s weight-for-height measurement is less than three standard deviations from the globally accepted norm. Wasting and stunting are often two separate forms of malnutrition requiring different interventions for prevention and/or treatment. However, they are closely related and often occur together in the same populations and often in the same children.”

Some signs and symptoms of malnutrition include loss of fat, breathing difficulties, abnormally low body temperature, weakened immunity, higher susceptibility to feeling cold, longer healing time for wounds, reduced muscle mass, tiredness and fatigue, and irritability.

Adding further, Dr Aggarwal, said, “Children with severe malnutrition experience slow behavioral and intellectual development, leading to intellectual disabilities later in life. Even when they are treated, under nutrition can have long-term effects in children including impairments in mental function and digestive problems, which can last for their whole life.”

Prevention of malnutrition entails eating a healthy balanced diet. There are four major food groups that should form a part of a child’s diet plan. These include:
Bread, rice, potatoes, and other starchy foods. This forms the largest portion of the diet and provides calories for energy and carbohydrates that are converted to sugars which provide energy.
Milk and dairy foods – Vital sources of fats and simple sugars like lactose as well as minerals like Calcium
Fruit and vegetables – Vital sources of vitamins and minerals as well as fiber and roughage for better digestive health
Meat, poultry, fish, eggs, beans and other non-dairy sources of protein – These form the building blocks of the body and help in numerous body and enzyme functions.
Other factors to be considered include adequate nutrition of the mother during pregnancy and promoting the practice of exclusive breastfeeding.

Sunday, 15 October 2017

Spirituality is friendly to Wellbeing

Spirituality is friendly to Wellbeing

Dr KK Aggarwal

What you believe in may impact health and longevity. Spirituality and religion have been shown to have a positive association with well-being and better health outcomes.

Spirituality and the practice of religion have been associated with a slower progression of Alzheimer’s disease. Positive thinking results in almost 30% decrease in pain perception. People who regularly attend organized religious activities may live longer than those who do not participate. Regular participation in such activities reduces mortality rate by about 12% a year. Satsang is one way of acquiring spiritual well–being. Many scientific studies have shown that when mediation or chanting is done in groups it has more benefits than when done individually.

Spirituality can influence function of the immune system, which can be measured, like an increase in white blood cells.
Patients who undergo cardiac rehabilitation feel more confident and perceive greater improvements in their physical abilities if they keep strong faith. Increased levels of spirituality and religious faith may help substance abusers kick their habit.

Spirituality stimulates the relaxation response. It shifts one from sympathetic to parasympathetic mode, which is the relaxed state. It is healing and allows one to make better and correct, consciousness-based choices. People who are very religious or deeply spiritual have lower cortisol responses. Cortisol is a hormone released in the body in response to stress. When the body is relaxed, the heart rate, blood pressure and breathing rate all go down, which decrease the body’s stress response. This is also why most of our temples are located in distant places. The silence of the spiritual atmosphere reduces the internal noise and helps us onward in our inner journey.

The Mantra to acquire spiritual health is to think positive and differently. It is very difficult to remove negative thoughts but it is very easy to cultivate positive thoughts. Persistent negative thoughts creates sympathetic over activity and leads to lifestyle disorders like blood pressure, acidity, depression, diabetes and heart blockages.

Spirituality is what brings you peace and safety. It can be achieved through God or Goddess, nature, a beautiful sunset, a meditation, Pranayama, religious meeting, chanting, mind body relaxation, etc. Spirituality is something that can help all the way from promoting wellness to helping with recovery.

(Disclaimer: The views expressed in this write up are entirely my own).

Preterm babies are more likely to develop cognitive and other difficulties later

Preterm babies are more likely to develop cognitive and other difficulties later

Such children also more likely to develop ADHD

New Delhi, 14 October 2017: As per a new large-scale study conducted among more than 60,000 children, it has been found that preterm babies are at a higher risk of developing cognitive, motor, and behavioral difficulties in later childhood, affecting even their later school performance. Preterm children are also twice as likely to be diagnosed with attention deficit hyperactivity disorder (ADHD).

The World Health Organization (WHO) estimates that every year, about 15 million babies are born prematurely around the world amounting to more than one in 10 babies born globally. The rate of preterm birth across 184 countries ranges from 5% to 18% of babies born. In India, the figure stands at 3.5 million babies out of the 27 million babies born every year.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “A premature birth is one that happens before 37 weeks of pregnancy. A normal pregnancy usually lasts about 40 weeks.
A baby born prematurely has less time to develop in the womb and often has complicated medical problems. Many preterm babies who survive suffer from various disabilities like cerebral palsy, sensory deficits, learning disabilities and respiratory illnesses. The morbidity often extends to later life, causing physical, psychological, and economic stress to the individual and the family.”

Preterm babies are small in size, sharper looking and have a disproportionately large head, less rounded features than a full-term baby, fine hair covering much of the body and low body temperature. Labored breathing or respiratory distress and lack of reflexes for sucking and swallowing are further signs of a preterm birth.

Adding further, Dr Aggarwal, said, “While preterm births cannot be attributed to one particular reason, the predisposing risk factors include age at pregnancy; previous preterm birth; multiple pregnancies; infections and chronic conditions such as diabetes and high blood pressure; stress; genetic factors and nutritional disorders. Lifestyle is increasingly becoming an important factor for preterm births. Identification of risk factors and educating the pregnant woman about the signs and symptoms of preterm labor during antenatal care can prevent preterm births.”

Here are some measures women can take to avert the risk of preterm delivery.

Do not miss antenatal care This is the best way to avert any preterm labor and identify signs. The doctor should be able to advice on how to eat right, what is the ideal weight, and what can be harmful for the baby.

Understand your risks Some women are at more at risk of delivering early. This is truer for those who have had a prior preterm delivery; who smoke or drink; have pre-existing health problems, etc. Understanding these can help you cope better.

Watch your weight Find out how much weight gain is apt for your body type and the baby. Too much weight gain can also cause complications like gestational diabetes and preeclampsia. Talk to your doctor about the recommended weight and eat accordingly. Ask your doctor about a healthy exercise plan.

Eat right Consume a nutritious diet as it is vital to the development of the fetus. Whole-wheat carbs, healthy sources of protein and dairy, and an abundance of fruits and vegetables is key. Avoid tobacco, alcohol & other non-prescribed drugs.

Saturday, 14 October 2017

AHA survey finds only 25% survivors feel confident in preventing another stroke

AHA survey finds only 25% survivors feel confident in preventing another stroke

Dr KK Aggarwal

Results from a new survey conducted by the American Heart Association/American Stroke Association (AHA/ASA) show that stroke survivors have low confidence in their ability to prevent another stroke.

The survey, which included 1,129 adult participants (survivors, caregivers and healthcare professionals) nationwide, was conducted as part of the American Stroke Association’s Together to End Stroke® second stroke awareness campaign. The specific goals of the campaign include:

• Reducing stroke reoccurrence
• Reducing 30-day hospital readmission
• Increasing stroke patient knowledge of risk factors
• Educating about healthy lifestyle changes and medication adherence
• Educating about rehabilitation options and benefits

Exercising regularly was reported as the biggest challenge by Survivors (23%). The most common changes that survivors made to their lifestyle since their stroke are taking recommended medication (83%) and taking aspirin daily (63%). Only half of Survivors and Caregivers (49%) were aware of FAST. Both Survivors and Caregivers view high blood pressure as the most important factor putting someone at risk for a second stroke (58% and 59%, respectively).

Most strokes, including recurrent stroke are preventable. Physical activity, healthy eating, adherence to prescribed medications along with stroke rehabilitation can prevent another stroke. Educating patients about the risk factors and the necessary lifestyle changes enables patients to take control of their health. The need for regular check-ups and necessity of compliance to the prescribed treatment must also be explained to them. A doctor has to encourage his/her patient at every step and support them in their struggle to cope with the illness and not be judgement or critical of occasional slip ups.
This gives confidence to not only to the patient but also the caregivers so that they are better equipped to prevent a second stroke.

(Source: AHA News Release, October 12, 2017)

People living with lupus are prone to depression

People living with lupus are prone to depression

New Delhi, 13 October 2017: Statistics place the prevalence of Systemic Lupus Erythematosus (SLE) in India at 30 per million people. Women are affected more frequently than men (10:1). SLE is a frequently overlooked disease, primarily due to lack of awareness, with the average diagnostic delay standing at almost 4 years.

A chronic disease, SLE is an autoimmune disease with phases of active disease when the symptoms worsen and phases of remission when the disease is quiet or has minimal symptoms. It is the most common form of lupus. The disease also involves the heart, lungs, kidneys, and brain and can be life threatening. People living with lupus are prone to depression.

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, “SLE is an autoimmune disease. The immune system is designed to fight off infectious agents, bacteria, and foreign microbes. One of the ways that the immune system fights infections is by producing antibodies that bind to the microbes. People with lupus produce abnormal antibodies called ‘autoantibodies’ in their blood, which attack the body’s own healthy tissues and organs rather than foreign infectious agents. While the exact reason for abnormal autoimmunity is unknown, it could be a mix of genes and environmental factors. Sunlight, infections and certain medications such as anti-seizure drugs are known to trigger SLE.”
The symptoms of lupus can vary over time but the common symptoms include fatigue, joint pain and swelling, headaches, a butterfly-shaped rash over the cheeks and nose, skin rashes, hair loss, anemia, increased tendency to form blood clots and poor circulation in fingers and toes, which turn white or blue when cold, known as Raynaud’s phenomenon.

Adding further, Dr Aggarwal, said, “There is no cure for SLE. However, treatment can help ease or control the symptoms and can vary depending on the severity. The common treatment options include nonsteroidal anti-inflammatory medications (NSAIDs) for joint pain and stiffness, corticosteroid creams for rashes, antimalarial drugs for skin and joint problems, oral corticosteroids and immunosuppressant drugs to minimize immune response.”

Some tips to combat SLE symptoms include the following.
Maintain a good doctor-patient relationship. It is also important to get adequate family support.
Take all medications as advised. Visit your physician regularly and get involved in your care.
Stay active as this will help in keeping the joints flexible and prevent cardiovascular complications.
Avoid excessive sun exposure as the ultraviolet rays can cause the skin rash to flare up.
Avoid smoking and try to minimize stress and fatigue.
Maintain normal body weight and bone density.
Young women with lupus should time pregnancies for periods when lupus activity is low. Pregnancies must be carefully monitored and certain medications should be avoided.

Friday, 13 October 2017

Explaining cardiac interventions: Using analogies to improve communication

Explaining cardiac interventions: Using analogies to improve communication

Dr KK Aggarwal

The doctor-patient relationship is the foundation of practice of medicine. And, communication is the key factor that decides the interaction between the doctor and his/her patient and influences outcomes.

Doctors are bound, both ethically and legally, to provide adequate information to the patient so that the patient can participate in the decision making process and are in a position to take an ‘informed’ decision.

Any information given to the patient should be in a language, using words or using terms he/she can understand.

But do patients really comprehend the information that is given to them during the process of informed consent? The science of medicine is abound with complex concepts. Medical terminology uses technical words and jargon that are unfamiliar to the patient and difficult to understand. This may hinder the effectiveness of communication.

One way to improve communication and enhance understanding of medical information is by using analogies. The dictionary meaning of an analogy is a ‘resemblance between two situations, people or objects that are otherwise unlike, especially when used as a basis for explanation’.

Analogies are situations that are familiar to the patient and so easily understood. The information is also better retained. Hence, using analogies to explain complex medical terms or concepts can improve doctor-patient communication.

This is how I explain cardiac interventions to my patients. I take the example of traffic management, a situation familiar to all.

For any traffic management, following are the options:

• Placing traffic signals can be equated to dos and don’ts of lifestyle management.
• Posting a traffic inspector on the crossing. This can be equated with a clinical cardiologist.
• Diverting the traffic from main road to side roads. This can be equated to opening collaterals by drugs and/or exercise.
• Hiring an architect to make maps. This can be equated to an angiographer (cardiologist) doing angiography.
• Looking for the possibility of widening the roads. This can be equated to balloon angioplasty.
• To prevent encroachment of widened roads to place railings around the widened roads can be equated to placement of metallic stent.
• To prevent mishandling of railing, safety grills are put. This can be equated to drug-eluting stents.
• When the roads cannot be widened, flyovers are made, which can be equated to bypass surgery.
• Flyovers can be made by stopping the traffic. This can be equated to open heart bypass surgery.
• Flyovers can be made without disturbing the traffic, this can be equated to heart bypass surgery.
(Disclaimer: The views expressed in this write up are entirely my own)

Every arthritis is different with different treatment methods

Every arthritis is different with different treatment methods

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

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

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

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

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

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

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

Thursday, 12 October 2017

Meaning of Birthday

Meaning of Birthday

Dr KK Aggarwal

A birthday is the day when we should file our Vedic returns of all that we have done, good and bad, in the last one year.

All of us are born with both Sanchit Karma and Prarabdha Karmas. Prarabdha Karma are the part of sanchit karma, a collection of past karmas, which are ready to be experienced through the present body in this lifetime. We have to bear the fruits of Prarabdha Karmas, while Sanchit Karmas can be negated with our positive Karmas, both present and future.

On this day, we must also make a balance sheet of our three debts and pay them if not paid by this time. There are three types of rins (debts): Dev Rin, Pitra Rin and Rishi Rin. God or the devtas gave us the consciousness, parents gave us our body and teachers gave us the knowledge or intellect.

I file my Vedic returns at 6 pm, the time of my birth, every year on my birthday.

Do good karmas to keep the balance in the positive. Do good karmas for a good life!

Disclaimer: The views expressed in this write up are entirely my own.

Bipolar disorder symptoms can be effectively managed with certain lifestyle changes

Bipolar disorder symptoms can be effectively managed with certain lifestyle changes

About 10 to 20 million people in India are affected by this condition

New Delhi, 11 October 2017: As per a recently published study, patients with bipolar depression treated with adjunctive bright white light showed a significantly higher remission rate as compared with the placebo light group. This corresponds to 68.2% vs 22.2%, respectively, at weeks 4 to 6 and significantly lower depression scores at the end of the study period. In India, about 10 to 20 million people suffer from mental disorders, one of them being bipolar disorders.

Bipolar disorder is a condition associated with episodes of mood swings ranging from depressive lows to manic highs. The cycles of mood swings can often last for days, weeks, or months, with the changes being so intense that they interfere with a person’s ability to function properly. The condition not only affects daily activities of life, but also the person’s relationship with others.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “A depressed person feels sad or hopeless and loses interest or pleasure in most activities. When this mood shifts to mania or hypomania, the person can be euphoric, full of energy, unusually irritable or aggressive. These mood swings can affect the person overall in terms of their sleep, energy, activity, judgment, behavior, and the ability to think clearly. Such mood swings may occur rarely or multiple times a year. While most people experience some emotional symptoms between episodes, some may not experience any at all. While the exact cause of bipolar disorder is not known, it could be due to a combination of genetic and environmental factors and altered brain structure and chemistry.”

A person with bipolar disorder may also experience at least three of the following: grandiose ideas or pumped-up self-esteem; far less need for sleep than normal; an urgent desire to talk; racing thoughts and distractibility; increased activity that may be directed to accomplishing a goal or expressed as agitation; and a pleasure-seeking urge that might get funneled into sexual sprees, overspending, or a variety of schemes, often with disastrous consequences.

Adding further, Dr Aggarwal, said, “Bipolar disorder can become worse, if left untreated. However, a good treatment plan including psychotherapy, medications, a healthy lifestyle, a regular schedule, and early identification of symptoms can help people live well even with this condition. There are also certain complementary health approaches like aerobic exercises and meditation, which can support treatment in such people.”

Here are some tips for self-management of symptoms in those with bipolar disorder.
Avoid stress as this is a major trigger. Relieve stress through techniques like yoga and meditation. Talk to your family or friends, if this can help relieve stress.
Stick to a regular schedule as this can help control mood swings to a great extent. People with bipolar disorder are usually affected by too many changes. Have meals, do errands, exercise, and go to bed about the same time every day.
Studies show that regular exercise can help improve mood. Start slowly with walking and get physical activity every day in some form or the other.
Avoid caffeine, alcohol, and drugs. Caffeine is a stimulant and can exacerbate manic episodes by keeping you awake. Alcohol and drugs can affect how your medications work.
Keep a journal in which you make a note of the triggers and schedule. This will help you establish a pattern and prepare yourself accordingly. It will also help your doctor evolve a treatment plan suited to your needs.

Wednesday, 11 October 2017

A Unique Permanent Registration Number for all registered doctors

A Unique Permanent Registration Number for all registered doctors

Dr KK Aggarwal

Under its Digital Mission Mode Project, the Medical Council of India (MCI) is implementing a new Indian Medical Register (IMR) through UPRN (Unique Permanent Registration Number) generation for each registered doctor in India. The UPRN number will be generated for the existing records in IMR, which is approximately 10 lakh.

On implementation of the system, the existing registration numbers of the doctors shall be migrated to a standard system of UPRN. Doctors shall also apply online for additional qualification registration in IMR like post-graduation, super specialty etc. The system can be used to make online applications for services like issue of certificates etc.

Here is how every registered doctor can covert IMR to UPRN.

• Register by Visiting www.mciindia.org and click on “Doctor Login”. Enter basic information like Name and Contact details including email address. A User id and Password will be sent on the email address.
• Doctors need to use this user id & Password to login and enter all the requested details including Personal Details, Contact Details, Aadhar number, and Professional details and upload the latest qualification documents.
• Pay the fees to MCI Online/offline and select Date and time when the Doctor will visit the State Medical Council for verification of the documents.
• Once the Documents are physically verified at State Medical Council (SMC) then the respective SMC will process the record in the system. The system will perform the following tasks automatically
o Aadhar Details will be verified.
o UPRN number will be generated.
o IMR database will be updated with the new UPRN number and will update the latest details of the Doctor
o Email notification will go to Doctor, MCI and SMC

Timely detection of amblyopia in children increases chances of successful treatment

Timely detection of amblyopia in children increases chances of successful treatment

Eye health in both children and adults should not be ignored

New Delhi, 10th October 2017: The prevalence of amblyopia or lazy eye is about 2% to 12% in various parts of India, according to statistics. Studies also indicate that amblyopia is one of the leading causes of visual impairment in children globally.[1]

Amblyopia, also known as lazy eye, is a condition that begins during infancy and early childhood. While it affects only one eye in most of the cases, both eyes can be affected, in some cases. It is a vision development disorder in which one eye fails to achieve normal visual acuity, even with prescription eyeglasses or contact lenses. The brain favors one eye and ignores the image from the affected eye, due to poor vision, which becomes weaker in due course of time, leading to amblyopia.

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, “Amblyopia starts with one eye having better focus than the other. Sometimes, one eye may have significant farsightedness or astigmatism, but the other doesn’t. When a child’s brain receives both a blurry image as well as a clear one, the brain starts ignoring the blurry one. If this is not detected in time and goes on for some months or years in a young child, the vision in the blurry eye worsens. Sometimes a child’s eyes do not align with each other, the eyes may turn in or out while looking at an object. This is called strabismus, and it can lead to amblyopia eventually. Children with this condition cannot focus their eyes together on an image and often see double. It is important that all children be screened for amblyopia before they get to the school age.”

Some symptoms of this condition include blurred and/or double vision, poor depth perception (of vision), eyes not appearing to work together, and an eye turn (upward, downward, outward, or inward).

Some complications of this condition, if left undetected, included blindness, eye turn, and central vision.

Adding further, Dr Aggarwal, said, “The younger the child, the more effective is the treatment for this condition. The likelihood of vision improvement reduces once the child crosses the age of 8. Two approaches to treating lazy eye include treating an underlying eye problem and getting the affected eye to work so that normal vision can develop.”

Here are some general tips for good eye health that one can follow:
Get examined for diabetes and high blood pressure. If left undetected, these diseases can lead to eye problems such as diabetic retinopathy, macular degeneration, and eye strokes (blockage in the blood vessels in the retina).
Look for any changes in your vision. If you notice any warning signs, contact your doctor immediately.
Get plenty of physical activity. If your work involves a lot of screen time, make sure to take breaks frequently and do some eye exercises. It is also a good idea to wash your eyes with some cold water.
Eat a healthy and balanced diet. Antioxidants in fruits and dark green leafy vegetables can possibly reduce the risk of cataracts. Omega-3-fatty acids are also beneficial for eyes.
Get your eyes checked at least every two years. A comprehensive eye exam, including dilating your pupils, can determine your risk for major eye diseases such as diabetic retinopathy, which has no early warning signs or symptoms.
Quit smoking. The many dangers of smoking have been well documented. When it comes to eye health, people who smoke are at greater risk of developing age-related macular degeneration, cataracts, uveitis and other eye problems.

Tuesday, 10 October 2017

High-sugar diet increases risk of heart disease in healthy people

High-sugar diet increases risk of heart disease in healthy people

Dr KK Aggarwal

A study from the UK has shown that healthy people who eat high amounts of sugar are at an increased risk of developing heart disease due to alteration in their fat metabolism.

The study reported October 4, 2017 in the journal Clinical Science examined two groups of men with either high or low levels of liver fat, and fed them a high (650 calories daily) or low sugar (≤140 calories daily) diet to find out if the amount of liver fat influences the impact of sugar on their cardiovascular health.

Men who had high levels of liver fat (non-alcoholic fatty liver disease [NAFLD]) had changes in their fat metabolism that are associated with an increased risk of cardiovascular disease, heart attacks and strokes after 12 weeks on the high sugar diet.

What is important to note in this study is that when the group of healthy men with a low level of liver fat consumed high amounts of sugar, their liver fat increased and their fat metabolism became similar to that of men with NAFLD putting them at risk of heart disease.

With the festive season coming up, we all should take care to not eat too many sweets. Diwali sweets have very high content of white sugar and cause metabolic syndrome, insulin resistance and consequent increase in blood pressure, blood sugar and body weight. Some sweets may be made in trans fats (vanaspati), which lower the good cholesterol and increase bad cholesterol.

The findings of the study are especially relevant for the young who regularly consume foods and drinks high in added sugars. Lifestyle disorders like diabetes, obesity, hypertension, heart disease, stroke, NAFLD are escalating in our country mainly due to an unhealthy lifestyle. What is of more concern is that these diseases are now affecting people at a younger age.

(Source: University of Surrey Press Release, October 4, 2017)

Vitamin D supplements can help cut the risk of asthma attacks

Vitamin D supplements can help cut the risk of asthma attacks

· Over 20 million people in India suffer from asthma

· Airway sensitivity both rural and urban areas has gone up due to many factors

New Delhi, 09 October 2017: As per a recent study, taking oral vitamin D supplements in addition to standard asthma medication causes a 30% reduction in asthma attacks requiring treatment with steroid tablets or injections, in those with mild-to-moderate asthma. As per the findings, there was a 50% reduction in the risk of people experiencing at least one asthma attack requiring hospitalization or visit to emergency Dept with vitamin D supplementation. Vitamin D is thought to protect against attacks triggered by viral upper respiratory infections by boosting immune responses and dampening down harmful airway inflammation.

A chronic lung disease that inflames and narrows the airways, asthma causes recurring episodes of wheezing, chest tightness, shortness of breath and coughing. The coughing often occurs at night or early in the morning. About 15 to 20 million people in India have asthma, and some studies even put this number at 30 million.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “It is important to understand the working of airways to understand asthma. The airways are tubes that carry air into and out of the lungs. In people with asthma, these airways are inflamed, which makes them swollen and very sensitive. Due to this, the airways react strongly to certain inhaled substances, which causes the muscles around them to tighten. As a result, the airways become narrow causing less air to flow into the lungs. The cells in the airways might make more mucus than usual. All these can result in asthma symptoms, which can occur each time the airways are inflamed. Asthma attacks are also known as flare ups or exacerbations.”

Adding further, Dr Aggarwal, said, “Airway sensitivity is going up among people in both rural and urban areas due to sustained exposure to a combination of triggers. Asthma requires continuous medical care and those with moderate-to-severe asthma must take long-term medicines such as anti-inflammatory drugs. These should be taken every day to prevent symptoms and attacks. Short-term medicines such as inhaled short-acting beta2-agonists are also used for quick relief of asthma symptoms.”

Here are some tips to prevent asthma.

Follow your care plan diligently. Asthma needs regular monitoring and following your prescribed medication schedule can help you manage symptoms to a great extent.
Identify what triggers an attack. It could be anything from outdoor allergens and irritants to household dust and mites.
Monitoring your breathing and identifying a possible attack can also help you in taking medications and precautions in a timely manner, thus avoiding flare ups.
Getting vaccination for influenza and pneumonia can prevent asthma flare ups.

Monday, 9 October 2017

One in four people leave work a year after a heart attack

One in four people leave work a year after a heart attack


Dr KK Aggarwal

Most people leave their job within a year of returning to work after having a heart attack, says a study reported in the Journal of the American Heart Association. Patients aged between 30 and 39 years and those between 60 and 65 years reported the highest rate of work dropout after return to work.

About 91% of the 22,394 heart attack patients who were employed before hospitalization for a first-time heart attack, returned to work within a year of the episode. But, within a year of resuming work, 24.2% of them left their jobs and were supported by social benefits.

Comorbid heart failure, arrhythmia, and depression, diabetes were found to be the clinical risk factors for unemployment. Patients with high income and high education level were more likely to remain employed, compared with those with lower educational and income levels.

Several factors – medical, economic, psychosocial – influence return to work following a heart attack. As doctors we take care of the medical factors, drug therapy, managing complications and secondary prevention. But, being part of the multidisciplinary cardiac rehabilitation team, it is equally important to take care of psychosocial factors that may affect recovery of a patient.

This study brings into focus the rehabilitation of post-MI patients and shows that return to work may not be a valid measure of successful recovery of working capacity.

Besides improving functional capacity, cardiac rehabilitation also supports a patient in returning to work following a heart attack. Hence, the rehabilitation of each patient should take into consideration the individual physical, psychological and social challenges of the patient. Post-MI patients, particularly the young patients and those with comorbidities and poorer socioeconomic status should receive increased focus on cardiac rehabilitation so that they continue with their jobs even after a heart attack.

(Source: AHA News Release, October 4, 2017)

The 24th HCFI MTNL Perfect Health Mela concludes with stellar performances and successful mass health awareness initiatives

The 24th HCFI MTNL Perfect Health Mela concludes with stellar performances and successful mass health awareness initiatives
New Delhi,08 October 2017: Heart Care Foundation of India (HCFI), a leading national non-profit organization committed to making India a healthier and disease-free nation concluded its annual flagship event – the 24th MTNL Perfect Health Mela today.The five-day event was organized jointly with the Health and Family Welfare Dept. NCT Delhi, MTNL, NDMC, and other central and Delhi state government departments. The IMA was the knowledge partner for the event. The theme for this year’s event was ‘Digital Health’, a concept which talks about how technology can help in preventive health and creating mass health awareness. Experts at the Mela deliberated and debated on strategies for preventive health and health management.
The Health Mela is a confluence of tradition and modernity and has successfully since the past two and a half decades been working towards creating mass awareness on all aspects of health; using a consumer-driven model as the medium. It began with much fanfare and a grand inauguration by the Hon’ble Chief Minister of Delhi, Shri Arvind Kejriwal on the 4th of October 2017
Speaking at the valedictory, Padma Shri Awardee Dr KK Aggarwal, President HCFI & National President IMA, said, “I am extremely happy at the successful conclusion of the event and the huge participation. It is time to focus on preventing lifestyle diseases by making certain changes to our diet and lifestyles. I also urge everyone to have a healthy Diwali and take necessary precautions to protect oneself and others from injury and harm. Avoid bursting crackers as they can contribute to increasing pollution levels in the city and thereby hamper health.”
The five-day event served as a podium for over 40 on-the-spot competitions in which over 8200 children from various schools and colleges took part with great enthusiasm. Among the competitions were Indian and western dance, fashion show, rock band, Mehendi art, collage making, painting, and slogan writing.There were also special performances by the Punjabi Academy, the Urdu Academy, and the National School of Drama, which added value to the event. The purpose behind these competitions and performances was to use infotainment as a way of imparting health education to the masses.
With lifestyle diseases on the rise, the Mela focused on various aspects of preventive health.The message conveyed was that a healthy diet, physical activity, and stress-free life can go a long way in preventing many lifestyle conditions.Experts also shortlisted some people with heart diseases for support and treatment under the Sameer Malik Heart Care Foundation Fund.Adding further, Dr R N TandonHonorary Secretary General IMA, said, “This is another one of IMA’s efforts in sensitizing the masses on health and connected issues. The IMA has always worked towards preventive health and creating awareness and this year was no different. I am happy to see the youth participate in large numbers and takeaway some valuable lessons from this Mela.”
A one-of-its-kind All Religious Conference titled Asto Ma JyotirGamaya and an All Pathy Conference with the theme Rog EkIlajAnek were also organized on the last day of the Mela. In both the conferences, the panels constituted eminent medical practitioners and Dharma gurus, respectively. They shared valuable insights and enlightened the audience with their rich experience and knowledge. A performance by the Rajasthan Academy added fun and fervor to the last day of the Mela.Speaking at the valedictory,Dr P K Sharma, Medical Health Officer, NDMC and; the civic partner of the year’s Perfect Health Mela, said "We all thank everyone who came and attended the 24th Perfect Health Melaand made it such a success. We are happy to be supporting this event every year and will ensure to extend the same support in the years to come.”
Among other things, the Mela focused on generating oxygen through indoor plants, promoting fast food (easy to eat and quick items like fruits and vegetables) as opposed to traditional fried fast food items, learning to create noise and pollution free environments, importance of doctor-patient relationship, eliminating refined carbs, and misuse of antibiotics. The 24th edition of the Mela being held this year will be a precursor leading up to its silver jubilee celebrations starting the next year.x

Sunday, 8 October 2017

HIV Self-Testing: Comments and suggestions invited

HIV Self-Testing: Comments and suggestions invited


Dr KK Aggarwal

As per HIV estimation 2015, India is estimated to have 21 lakh people infected with HIV and only 15.2 lakh PLHIV know their HIV status (Press Information Bureau, August 4, 2017). This means that around 6-7 lakh are still unaware of their HIV status.

To end AIDS by 2030, the United Nations has set global targets as part of its ‘90-90-90’ strategy – to diagnose 90% of all people living with HIV by 2020, to treating 90% of all people with diagnosed HIV infection with sustained antiretroviral therapy and to maintain viral suppression in 90% of all people receiving ART. Lack of diagnosis has been a major obstacle in achieving these targets. Hence, there is a need for ways to increase access to and use of HIV testing services.

HIV Self-Testing (HIVST) is an innovative way, which can complement the efforts put by NACO in achieving the global target of diagnosing 90% of all people living with HIV by 2020.

Also, HIVST can help in reaching first-time testers, undiagnosed PLHIV and population groups who need frequent retesting and can help countries meet the above targets.

The first global recommendations and Guidelines for HIV Self-testing were released by WHO in December last year.

It is proposed to explore inclusion of HIV self-testing (HIVST) for adoption in the country.

To discuss further on the development of National policy on HIV self -testing, NACO has constituted a Technical Advisory Group, convened by DDG BSD NACO.

The Indian Medical Association (IMA) has been included in the Technical Advisory Group on HIV Self-Testing.

Kindly give your suggestions to finalize IMA Stand on this issue.

Three-day workshop focusing on food for heart health at the 24th Perfect Health Mela

Three-day workshop focusing on food for heart health at the 24th Perfect Health Mela
·         Events and competitions such as 100-m racing and youth court scene competition mark the 4th day of the Mela·         Focus on preventive health and tips for a healthy heartNew Delhi, 07 October 2017: Amidst the plethora of events and competitions being held as part of the 24th MTNL Perfect Health Mela, there was also a three-day workshop by food expert Ms Geeta Anand on Healthy Food for a Healthy Heart. The workshop provided interesting insights into how our eating patterns can affect our heart and what a heart healthy diet is composed of. It was an eye-opener in many respects as many things that we consume as part of our daily lives may not be so good for the heart. The PHM, on till the 8th of October 2017 at Talkatora Stadium, New Delhi, is a one-of-its-kind event combining knowledge and fun.
The 4th day of the Mela continued with newer themes in National Harmony and Eco-Festival competitions, Divya Jyoti and Medico Masti youth competitions, and Heritage – Classical Dance competitions. There were events such inter-school poetry recitation, sports competitions (kho-kho, skipping, and 100-m racing), and youth western dance competition. For the youth court scene competition, the theme was ‘justice delayed is justice denied’. The youth fashion show competition was interesting with youngsters sporting fashion from the 1990s.
Speaking on the day, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) said, “Of the many lifestyle issues today, the incidence of heart disease is perhaps showing the highest trend. Men, women, and children are affected by this condition alike and the only way to prevent heart conditions is to take precautions right at the outset. This Mela is a medium to convey this message to thousands of people, particularly youngsters, who are vulnerable to many factors such as peer pressure, junk food, work stress, and substance addiction. This workshop on heart healthy diet was very insightful and we hope people have taken away learnings from it. Apart from this, one can follow the Formula of 80 for a heathy heart, which entails, maintaining fasting blood sugar (FBS) (mg%), fasting low-density lipoprotein (LDL) bad cholesterol (mg/dL), diastolic lower blood pressure (mm Hg), resting heart rate, and abdominal girth (cm) all below 80. “
Other important attractions during the event include free diagnostic checkups (blood checkups) for all, free exhibitions by government departments and OPDs, and live webcast with prominent doctors.Adding further, Dr Aggarwal, said, “Preventive health also encompasses sanitation. Children should be taught to keep the surroundings environment clean, keep a check on the collection of stagnant water in and outside our houses to prevent mosquito breeding and promote the consumption of safe water to prevent illness. Mass awareness platforms such as the PHM play an important role in encouraging people to adopt a preventive approach.”
Giving his views, Dr Marthanda Pillai Past President IMA & Dr S S Agarwal Past President IMA , said, “This Mela is not only about workshops, lectures, and demonstrations but also engaging youngsters through activities that are interesting for them. The huge participation here is proof that people want to learn more about prevention and health and are willing to go that extra mile for it. I wish the Mela all success in future as well.”PHM is being organized by Heart Care Foundation of India (HCFI), a leading national non-profit organization committed to making India a healthier and disease-free nation. The 24th edition of the Mela being held this year will be a precursor leading up to its silver jubilee celebrations starting the next year.x

Saturday, 7 October 2017

Eat slowly for good health and well-being

Eat slowly for good health and well-being


Dr KK Aggarwal

Most of us lead very busy lives today; we are either working, driving, looking into our smart phone, ipad/tablet etc. In a nutshell, we are too busy to pay attention to what we are eating because we are thinking of the work ahead of us and planning for it and not concentrating on the food.

Eating without awareness or eating while distracted by various activities can be harmful to health. It may cause weight gain, a forerunner to lifestyle diseases such as obesity, type 2 diabetes, heart disease, hypertension etc. Hence, it is important to be aware of the food we are eating. This is called mindful eating.

Mindful eating means being aware of the hunger and satiety signals. It also means using all the five senses while eating: colors (eye), smells (nose), flavors (taste), textures (touch) and sound while chewing (ear) of the food. Mindful eating also relieves stress

In Chapter 6 Shloka 17 of the Bhagwad Gita Krishna says to Arjuna “Yukaharaviharasya yuktachestasya karmasu. Yuktasvapnavabodhasya yoga bhavati duhkhaha”. It means "the one, whose diet and movements are balanced, whose actions are proper, whose hours of sleeping and waking up are regular, and who follows the path of meditation, is the destroyer of pain or unhappiness."

The Bhagwad Gita also says, “While eating, one should concentrate only on eating as the food is served to one's consciousness”.

Eat slowly. The process of digestion begins in the mouth itself. So, you should chew your food at least 15 times. If you chew the food well, you will eat less. You will not only enjoy every bite and savor the food, but also maximally gain the nutritional benefits of the food that you are eating.

Some healthy eating habits

·         Eat only when you are hungry.
·         Do not eat for pleasure, social obligations or emotional satisfaction.
·         Eat at a slow pace. It improves satiety.
·         Eat less; dinner less than lunch.
·         Take small bites of food, chew well, swallow it and only then take the next bite.
·         Do not eat while watching TV, driving a car or watching sports events. The mind is absorbed in these activities and one does not know what and how much one has eaten.
·         Do not talk while eating and never enter into heated arguments. The stomach has ears and can listen to the conversation. It will send signals accordingly to the mind and heart.
·         Plan and decide in advance what and how much you are going to eat.


(Disclaimer: The views expressed in this write up are my own).

Music, dance, and language as a means to good health at the 24th MTNL Perfect Health Mela

Music, dance, and language as a means to good health at the 24th MTNL Perfect Health Mela

Ancient wisdom on health should be revisited and the 3rd day of the Mela focused on this and more

New Delhi, 06 October 2017: The 3rd day of the MTNL Perfect Health Mela (PHM) saw continuation of various events and competitions for schools and colleges. The participation did not seem to lessen with enthusiastic youth pouring in for the event. The PHM is a flagship event organized by the Heart Care Foundation of India (HCFI), a leading national non-profit organization committed to making India a healthier and disease-free nation. The Mela is on till 8th of October at the Talkatora Stadium in New Delhi. Apart from these activities, there is something for everyone such as health checkup camps, live webcasts and consultations with eminent doctors, and even Diwali shopping.

The National Harmony and Eco-Festival, Divya Jyoti and Medico Masti Youth Competitions, and Heritage – a series of National Classical Dance Competitions continued today, although the themes changed. Themes today included language and health, dance as a way to fitness and health, combating water pollution, and leveraging the right to freedom of speech.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) said, “We need to turn to old-age wisdom for good health and the Mela this year will focus on this aspect too. Our ancient systems of medicine have a lot to offer. Natural healing through music, dance, and language therapy needs to be reintroduced. While medication, surgery, and other modern techniques of healthcare have their own place, the beneficiary effects of natural healing cannot be underestimated. Many competitions being held this year are centered around this theme and will help the youth research more about ancient healing techniques. A healthy body houses a healthy mind and this is the basis for long life. The need of the hour is to eat healthy, live a good life, include sufficient physical activity, and do away with dangerous habits such as smoking and drinking.”

Some of the main attractions on this day were the youth skit competition on Puran (way of health awareness), Youth Kavita Path competition with a special performance by the Urdu Academy, and a health debate on the freedom of speech. The health checkup camps being organized on the sidelines saw attendance by 1500 people.

Adding further, Dr Aggarwal, said, “Digital health is one of the ways to bring about complete access to preventive healthcare. Digitization of health will help in bringing the power of health to the hands of people through timely diagnosis of even future health risks due to heredity and lifestyle. Technology can enable people in tracking, managing, and improving their own health and that of their near and dear ones. This will lead to improvement of societal health at large.”

The HCFI released some health sutras also ahead of the PHM which are pointers to good health and lifestyle. The Mela will also have experts shortlisting heart disease patients for free consultation and surgery under the Sameer Malik Heart Care Foundation Fund.

Expressing their opinion, Dr D R Rai and Dr Vinod Khetrapal, said, “This is a one-of-a-kind event which not only educates the masses but also brings in the fun element in good health. The HCFI should be lauded for this initiative as there is no other event that covers everything under one umbrella. There is music, dance, poster making, slogans, debates, health checkups, consultations, workshops, seminars, and what not; and all are connected to health in some way or the other. I am extremely happy to be a part of this event and I am sure I will take away a lot from it too.”

Adding their views, Dr Ramesh Data and Anita Sharma (vedic approach to maths), said, “The vedas and puranas indicate many paths to wellness and good health. We are happy that even such an approach is being taken at the PHM. Not only will this educate the younger generation about the rich tradition of ancient medicine but also make them aware that there is more to health than what meets the eye. We wish the event all the best.”

The 24th edition of the PHM being held this year will be a precursor leading up to its silver jubilee celebrations starting the next year. The first Mela was held in 1993 and was earmarked with the release of a National Commemorative Postal Stamp by the Government of India.

Tuesday, 3 October 2017

Draft salient decisions taken by the IMA Central Working Committee (Part 3)

Draft salient decisions taken by the IMA Central Working Committee (Part 3) • Crosspathy: The House was informed that the suggestions of IMA to the Inter Ministerial Committee have been accepted by them. • Clinical Establishment Act: The suggestions sent by IMA to the Inter Ministerial Committee have been agreed by them. The House thanked the Additional Secretary, Economic Advisor and Dr Dhamija who were physically present in the meeting who informed the House that the decisions and Minutes of the Inter Ministerial Committee have been incorporated in the Minutes of the meeting of the National Council on Clinical Establishments Act held on 8th September, 2017. The House also requested them to incorporate capping of compensations and penalties under the Act in line with the similar provisions under the Drugs & Cosmetics Act in the CEA rules. • PCPNDT Act: The Addl. Secretary, MoHFW assured that in the next meeting of the Central Supervisory Board, the amendments suggested by IMA are being taken up. • Central Act to tackle violence against medical profession: The Addl. Secretary, MoHFW assured that the Central Act is in the process. • Capping of compensation by medical profession under CPA: The House personally requested the Addl. Secretary (Health) to incorporate provisions in CEA rules so that the compensation related to medical negligence is similar to provisions under the Drugs & Cosmetics Act. • Federation of Medical Associations (FOMA): IMA has the full support of all the stakeholders of FOMA. The members advised that FOMA should meet twice in a year so as to discuss and deliberate on all the current issues of the medical profession. • New IMA Awards: All new IMA Awards proposed by IMA HQs were approved by the House. It was also approved to organize a special Awards ceremonies during the State Leadership meet, CWC meetings and Central Council meetings. • The House approved the IMA decision and action to publish community health-related advertisements published and planned to be published in major dailies in association with relevant stakeholders. The House was informed that 14 community health-related advertisements have been published in Indian Express and 4 advertisements have been published in Hindustan Times with the help of M/s. Omron. • All the public health- and hygiene-related agreements of IMA with companies like Omron, Hygia, and State Bank Credit Cards etc. were reported to the CWC, which approved all of them. • Regarding the issue of non-payment of rent by one of the tenants of IMA HQs. M/s. Arth Business News Channel, the House was informed that the matter is sub judice. • Cuts & Commissions: IMA will not tolerate Cuts and Commissions in any form by medical professionals on Ethical grounds. IMA stands for ethical practice. • Sex Selection: IMA is against sex selection in any form and disciplinary and legal action will be initiated against any IMA members found to be indulged in any such procedure. • National Medical Council (NMC) Bill: The House was informed that IMA has been fighting against the proposed NMC Bill. We have achieved partial success. The House was of the opinion that the NMC Bill should be withdrawn. • National Exit Test (NEXT): The House observed that all State branches are sentimental on this issue. Members were of the opinion that it should be withdrawn. • IMA Doctor Logo: The IMA Doctor Logo has been trademarked and it now needs to be promoted amongst the members. IMA requested Economic Advisor, MoHFW to kindly acknowledge it as it is patented by IMA only for use by MBBS doctors. However, the House was informed that an objection has been received from Indian Red Cross Society that IMA cannot use the “+” sign as a logo for doctors practicing modern system of medicine. The House was informed that necessary suitable action will be taken after taking legal advice in this regard. • IMA Emblem: The news that the IMA Emblem has now been patented and cannot be misused by anyone was noted with a thunderous applause by the House. Dr KK Aggarwal Dr RN Tandon National President IMA Hony Secy General IMA

IMA observes fast on 2nd October

IMA observes fast on 2nd October New Delhi, 2nd October 2017: More than one lakh members of the Indian Medical Association (IMA) sat on fast today, from dawn to dusk, from 6 am to 6 pm, in support of fulfillment of their demands by the Government. More than 1000 special General Body Meetings by various IMA Branches were organized during the day all over India and letters addressed to the Prime Minister were released to draw his attention to important issues, confronting the doctors in the country and which need to be addressed urgently. These issues need to be solved to make healthcare accessible and affordable to all by collaborative efforts. IMA, representing over 3 lakh doctors of modern medicine, spread across 1,700 local branches and 31 State and Territorial branches, is working to improve healthcare scenario in our country by promoting Professionalism, Integrity and Medical Ethics. IMA strongly supports the goals set out in the “National Health Policy 2017". However, the above goals are attainable only when the Government and other stakeholders are working together in harmony with mutual trust. Padma Shri Awardee Dr KK Aggarwal, National President Indian Medical Association (IMA) & President Heart Care Foundation of India (HCFI) and Dr RN Tandon Honorary Secretary General IMA in a joint statement on the occasion, said, “IMA has been protesting peacefully against the atrocities faced by the medical profession. We have been asking for the implementation of the recommendations of the inter-ministerial committee and other demands for the past one year, but they have not been implemented up till now. As an outburst of anger and frustration more than 10,000 doctors had marched from Rajghat and over 90,000 had participated digitally in Dilli Chalo Protest on 6th June this year. The fast today is also a peaceful protest by IMA through which we request the Prime Minister that our issues be resolved in a time-bound manner. The increasing incidences violence against doctors, criminal prosecution of doctors and uncapped compensation, in particular, are all serious issues and need his immediate intervention and cannot wait for routine consideration.” Dr Ravi Wankhedkar Incoming President said, “The manner in which various regulatory Acts such as Clinical Establishments Act (CEA) are being implemented is unfavourable not only to the medical profession but also to the community as they ignore the ground realities. Doctors treat patients with good intentions and are the healers for the sufferings of the patients. No doctor intentionally harms a patient. Single doctor establishments should be exempted from the purview of CEA. Establishments that already have entry level NABH accreditation should be exempted from the mandatory pre-registration inspection.” Dr Vinay Aggarwal, Dr A Marthanda Pillai and Dr R V Asokan in a joint statement said, “Provisions in healthcare regulations should be such to identify medical errors and negligence. Clerical errors and minor noncompliance should not attract criminal provisions of the PCPNDT Act. PCPNDT Act is a medical solution for a socio-economic problem, which cannot solve the issue. Without solving the social and economic reasons behind female feticide/infanticide, the proper male-female ratio cannot be maintained.” IMA reiterated the demands of the medical fraternity that need to be resolved. • Stop criminal prosecution of medical negligence and clerical errors • Stringent central act against violence on doctors • Capping the compensation in Consumer Protection Act (CPA) on doctors • Professional autonomy in treatment and prescriptions • Amendments in PC PNDT, Central CEA, West Bengal CEA Acts • No unscientific mixing of systems of medicine • Empower MBBS graduates • One drug - One company - One price • Implement inter-ministerial committee recommendations in six weeks • Single window accountability • Single window registration of doctors and medical establishments • No to National Medical Commission (NMC): Amend IMC act to maintain professional autonomy • Uniform final MBBS exam instead of ‘NEXT’ • Uniform service conditions for service doctors & faculty • Same work - Same pay - Pay parity - No to adhocism • Fair conduction of NEET exam • IMA member in every government health committee • Central anti-quackery law • Reimbursement of emergency services provided by private sector • 25000 family medicine PG seats • Aided hospitals and retainership in general practice • Health budget of 5% of GDP for universal health coverage