Monday 31 July 2017

New guidelines on diabetes self-management education and support

New guidelines on diabetes self-management education and support Management of diabetes is multidisciplinary and a team approach is the basis of care of the patient with diabetes, who is at the center of this team. Diabetes self-management education (DSME) is a very important aspect of management in all patients with diabetes, including those with prediabetes. Optimal control of blood sugar is important; but, it is also important to control other risk factors such as hypertension, dyslipidemia in order to prevent the macrovascular and microvascular complications of diabetes. Because of the need for lifestyle modifications, patients with diabetes are themselves responsible for the day to day management of diabetes, but with the support of the doctor. For the first time, the American Diabetes Association (ADA) and American Association of Diabetes Educators (AADE) have combined education and support (DSMES) and released new standards to help diabetes educators and medical providers establish and sustain patient care models, programs and teams for people with diabetes and their caregivers. These guidelines will be published in the September 2017 issues of Diabetes Care and The Diabetes Educator. These standards relate to organizational structure, participation of community stakeholders, access, program coordination, instructional staff, individualizing diabetes education to the need of each patient, monitoring of patient progress and quality improvement. An up-to-date, evidence-based, and flexible curriculum provides education. These standards emphasize that DSME alone does not translate into effective self care. Ongoing support is very important to improve patient outcomes. The standards defined in these recommendations can be applied to both small solo practices, as well as large, multicenter facilities. (ADA Press Release, July 28, 2017) Dr KK Aggarwal National President IMA & HCFI

Children increasingly becoming susceptible to asthma

Children increasingly becoming susceptible to asthma Timely and accurate diagnosis as important as equipping children in being self sufficient to handle this condition New Delhi, 30 July, 2017: Statistics indicate that about 700 million people in India inhale smoke from biomass and kerosene stoves and other sources that spew carbon particles, carbon monoxide, nitrous oxides, sulphur oxides, formaldehyde and cancer-causing substances such as benzene. This smoke is a leading cause of asthma in the country. Estimates by the WHO show that between 15 and 20 million people have asthma in India, and the numbers do not show any signs of decreasing. Studies also indicate that the prevalence is higher in children as they have smaller airways which become constricted due to all the pollutants. Schoolchildren are the worst affected and many are growing up with irreversible lung damage. All this can be blamed on the rising pollution levels which cause fatal lungs disorders, severe respiratory problems, nausea, palpitation, loss of vision, blood pressure, and fatigue. 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 "Asthma is a chronic respiratory disorder triggered by allergic reactions. It leads to breathing difficulties as a result of narrowing of the bronchial passage, which is responsible for carrying oxygen to the lungs. Asthma can have two affects: swelling in the lungs due to accumulation of mucus in the airways; and inflammation due to tightening of the muscles around the airways. What exacerbates the situation is that asthma is often mistaken as a recurrent cough. Due to this, it is not taken seriously or treated with cough syrups. In kids, it is difficult to assess symptoms because they may not show the typical symptoms of asthma such as breathlessness, wheezing, coughing, and chest tightness. Besides, every child’s asthma is different." Certain triggers can make an asthma attack worse. Once asthma is diagnosed in a child, it is imperative to remove triggers from the house or keep the child away from these. Adding further, Dr Aggarwal, said, "Young children may not understand how chronic this condition is or how it can affect their daily life. Education is the key here. Parents of children with asthma should ensure that the child is well aware of his/her condition and teach them steps to be followed during a possible emergency." Some tips for managing asthma and associated symptoms in children are as follows. • Help them take medications daily without fail. • Visit the doctor regularly. • Give them only the prescribed medicines. • Take precautionary measures to avoid any triggers. • Always carry their inhaler with you and encourage them to never feel shy to use it in public. • Inform the doctor if any other health ailment is bothering the child. • Lastly, help them reduce stress and try to remain calm and happy.

Sunday 30 July 2017

Gift a Tulsi plant: Live in harmony with nature

Gift a Tulsi plant: Live in harmony with nature Plants and trees are vital to life and are an integral part of our environment. They provide oxygen, conserve water, improve air quality, reduce noise pollution and help control climate, to name a few. Nature is not called ‘Mother Nature’ for nothing. Nature is life-giving; it nurtures. Nature provides us with food, water and medicines. And, we need to look after it and live in harmony with it. The green cover in the country is fast disappearing in the name of development. Ongoing construction activities clear land and forests of trees. Deforestation is a major contributor to climate change, which directly affects five components of the environment: water, air, weather, oceans, and ecosystems and adversely affects human health. Hence, the disturbed ecological balance needs to be restored. One way to do this is by planting more trees. Another way to create awareness about preserve and protect our environment is by gifting plants. Choose medicinal plants such as Tulsi. We often hear of tree plantation drives in the country. So why not a campaign to gift a tulsi plant? Tulsi is a plant, which is common to most households. There is a saying in Sanskrit: “Tulanaa naasti athaiva tulsi” meaning that which is incomparable in its qualities is the tulsi. It has both spiritual and health significance. The health benefits of Tulsi are known to all since ancient times. It has a multitude of beneficial actions in the body such as antimicrobial, antioxidant, anti-inflammatory, anti-pyretic, anti-allergic, immunomodulatory, diaphoretic, adaptogenic, anti-stress, neuro-protective, cardio-protective, anti-diabetic, anti-hypercholesterolemia, anti-hypertensive, anti-carcinogenic, chemopreventive, radioprotective, to name a few. Gifting plants is environment-friendly. It is a gift for many occasions, be it housewarming, birthdays, weddings, etc. You can also give plant saplings as a return gift for birthdays of your children. This is one way by which you can instill in them the need to look after the environment right from an early age. Gift potted plants instead of gifting flower bouquets or other gifts. Choose Tulsi plant or any other medicinal plant such as Stevia. These are long-lasting gifts. To control the alarming increases in non-communicable diseases, it is important to change our lifestyle and live in harmony with nature by protecting the environment. The proximity with nature helps in the inward spiritual journey and shifts one from the sympathetic (disturbed) to parasympathetic (relaxed) mode described by lowering of blood pressure and pulse rate and rise in skin resistance. A balance between the sympathetic and the parasympathetic modes is required for optimum health and well-being. Dr KK Aggarwal National President IMA & HCFI

IMA starts 80:80 Anti-Pollution Campaign

IMA starts 80:80 Anti-Pollution Campaign Air pollution is a major health and environmental hazard causing about 1.2 million deaths every year New Delhi, 29 July 2017: As per statistics obtained from a report published early this year, about 1.2 million people die due to air pollution in India every year. And, of the 168 cities assessed, none were found to comply with the air quality standards as prescribed by the World Health Organization (WHO). Air pollution is now a matter of great concern as it is affecting not only the health of our citizens but also medical tourism in India, says IMA. Keeping this in consideration, the IMA is starting a campaign “Kahin aapke area mein pollution to nahi?” Under this campaign, all state/local branches as well as medical professionals are requested to make efforts to bring down the atmospheric pollution level to less than 80 μg/m3 on normal days and to less than 90 μg/m3 during festivals such as Diwali. 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, “Air pollution is not only a major environmental hazard but also a major health hazard. It is one of the major causes of non-communicable diseases such as cardiovascular diseases, stroke, chronic obstructive pulmonary disease, lung cancer, and other acute respiratory problems. The need of the hour is to bring out stringent guidelines against inefficient modes of transport, household fuel and waste burning, coal-fired power plants, and industrial activities, as these are some of the major sources of air pollution. At any given time, the PM 2.5 levels should be less than 80 μg/m3 and noise level should be less than 80 dB. We expect all medical professionals to also educate their patients on a daily basis about the hazards of air pollution. Additionally, there is also a need to follow some measures at an individual level because every small contribution can lead to a big change.” Evidence suggests that household air pollution in developing countries can increase risk conditions such as low birth-weight and perinatal mortality (still births and deaths in the first week of life), asthma, otitis media (middle ear infection) and other acute upper respiratory infections, tuberculosis, nasopharyngeal cancer, laryngeal cancer, and cervical cancer. Adding further, Dr Aggarwal, said, “Although there is a provision for environmental protection in our Constitution and steps have been taken by the government to address this issue, there is still a long way to go before the country can breathe clean air. The need of the hour is dedicated and sustained efforts which involve the public as well. And IMA’s current campaign is a first step towards this effort.” Here are some ways in which you can help reduce air pollution at an individual level. • Get your vehicle pollution checked regularly. • Use eco-friendly products at home. • Plant trees around your house. • Avoid smoking inside the house although it is better to quit the habit altogether. • Choose and buy sustainable and recycled products. • Use energy-efficient devices at home.

Saturday 29 July 2017

Universal screening for alcohol misuse at hospitalization is a feasible strategy

Universal screening for alcohol misuse at hospitalization is a feasible strategy A study published online July 27, 2017 in the Journal of Hepatology has demonstrated that universal screening for alcohol misuse at the time of hospitalization to identify patients at risk of developing alcohol-related liver disease, is a feasible strategy. Researchers from the UK screened all admissions to the Acute Medical Unit of a large acute hospital using an electronic data capture system. At the time of admission, information about the amount of alcohol consumed, previous visits and or admissions and whether they were alcohol-related was recorded. Around 91% patients completed the screening; of these, around 3% of the patients were grouped as “increasing”, and 4% as “high” risk of alcohol harm. The high risk group had more frequent emergency room (ER) visits and higher re-admission rates; gastrointestinal bleeding, mental health disorders, poisoning and liver disease were the most common diagnoses for hospitalization. What this study showed was that it is possible to screen patients for alcohol misuse at hospitalization, identify patients with a very high unit consumption and then to refer them for appropriate intervention, potentially reducing the burden of alcohol-related harm. While, lower risk patients can be given brief advice by any trained healthcare professional This study assumes all the more importance because alcohol misuse is a major cause of preventable death. It also offers a solution to the unmet need to identify patients with alcohol-related liver disease at an earlier stage. According to the WHO, 3.3 million deaths (~6% of all deaths) globally every year are due to alcohol-related harm. It is all the more worrisome because alcohol consumption causes death and disability relatively early in life, particularly in the younger age group. Alcohol has been linked to many noncommunicable diseases, including alcohol-related liver disease and injuries. Overall 5.1 % of the global burden of disease and injury is attributable to alcohol, as measured in disability-adjusted life years (DALYs). Source 1. Westwood G, et al. Universal screening for alcohol misuse in acute medical admissions is feasible and identifies patients at high risk of liver disease. Journal of Hepatology, published 27 July 2017. Dr KK Aggarwal National President IMA & HCFI

Children with dyslexia can learn normally with the right approach

Children with dyslexia can learn normally with the right approach Early detection imperative in providing the right treatment and helping manage condition better New Delhi, 28 July, 2017: Statistics indicate that Dyslexia is one of the most common learning disabilities affecting 1 in 10 children worldwide. The Dyslexia Association of India estimates that about 10% to 15% of school-going children in India suffer from some type of Dyslexia. Multilingualism, which is common in the country, can also impact the difficulty. This condition can affect boys and girls alike. If undetected by Class 2, dyslexic children can grow up to be dyslexic adults, at which point, this condition cannot be cured. A developmental reading disorder, Dyslexia occurs in children with normal intelligence. It is caused when the brain is unable to translate images received from the eyes or ears into understandable language. Although there is evidence to suggest that dyslexic children can excel in other areas such as sports and extracurricular activities, lack of awareness is an impediment to the progress of such children in India. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said "The brain of a dyslexic person is structurally and functionally different from others. The inborn wiring system of the brain responsible for development of mental skills is different in a dyslexic person, making this the root cause for this condition. It is due to this that even minor acts of comprehension and usage can take longer in such children. The sad part about this condition in our country is that children can be classified as under achievers. They are also labeled as lazy, having low intellect, and unmotivated. All this affects their personality and results in low confidence and self esteem. Early detection can play a major role in helping such children. Assessment of the child's family history and other related information can help trace the causes." Some symptoms of dyslexia in children include difficulty in verbal skills; abstract reasoning; impaired hand-eye coordination; poor concentration, perception, and memory; and impaired social adjustment. Adding further, Dr Aggarwal, said, "The first line of understanding for a child is his/her parents. They should ensure that instead of running away from the problem, the child undergoes proper assessment to diagnose the difficulty. If the child is diagnosed with dyslexia, understand that it is not the end of everything. Understanding, acknowledging, and supporting your child in his/her efforts can help in handling this condition in a better and more informed manner." There are some techniques that can be used to help dyslexic children overcome their learning and comprehension problems. • Indulge in positive reinforcement. Communicate with your child in a positive manner and be patient with them when they take time to grasp things. • Dyslexic children are more inquisitive and hence, it is important to give them logical answers. Help them in getting their doubts cleared. • Teaching science and math in a tabular manner can help them in understanding the subjects better. • Use more of audio-visual aids as they can grasp things better with this technique. For younger children, flash cards can be used. • Yoga is a good way of increasing concentration in children with this condition. Breathing exercises and alternative therapy can help them cope better than medicines.

Friday 28 July 2017

A healthy lifestyle can reduce risk of dementia

A healthy lifestyle can reduce risk of dementia Lifestyle has a major role to play in the health and well-being of a person. It’s not just physical health that benefits from a healthy lifestyle, but also mental health. Dementia is usually regarded as a part of the normal aging process. But it is not always so. Dementia is also associated with lifestyle factors. And, the risk of dementia can be reduced by simple but effective lifestyle modifications. This is the key message from a new report of The Lancet Commission on Dementia Prevention, Intervention, and Care, presented at the recently concluded Alzheimer's Association International Conference (AAIC) 2017 on July 20, 2017 and also published in The Lancet. The report has identified nine lifestyle factors (as below) during the course of life - early, middle and later – that influence the risk of dementia. Many of these factors can co-occur. The Report has for the first time considered social isolation and hearing as being pertinent to dementia. The level of education was also found to be an important risk factor. Poor education has been correlated with poor cognition. 1. Early life level of education 2. Midlife hypertension 3. Midlife obesity 4. Midlife hearing loss 5. Later life smoking 6. Later life physical inactivity 7. Later life social isolation 8. Later life depression 9. Later life diabetes Prevention is always better than cure. These factors are potentially modifiable and addressing them timely can prevent dementia in a large number of people. In addition to well-controlled hypertension and diabetes, early treatment of depression, weight loss, smoking cessation, being socially active, increasing physical activity, it is also important to engage in mentally stimulating and challenging exercises to keep the brain active. Develop a hobby, solve crossword puzzles, play chess or such challenging games to stay mentally active. A healthy lifestyle adopted early in life builds up cognitive reserve for later life. It is important that we also advise our patients to start making positive lifestyle changes for a healthy old age. (Source: Medscape) Dr KK Aggarwal National President IMA & HCFI

IBD is a chronic relapsing condition

IBD is a chronic relapsing condition Lack of awareness about the condition and its seriousness in India, says IMA New Delhi, 27 July 2017: Statistics indicate that about 50 lakh people around the world have IBD or inflammatory bowel disease. In India, the number of cases exceed 12 lakh annually. However, there is not much awareness on the seriousness and symptoms of this disease in the country. As per the IMA, this is a chronic relapsing condition wherein the symptoms can be managed with a combination of care, medication, hospitalization, and sometimes surgical intervention. IBD is an umbrella term for two diseases namely Ulcerative Colitis (UC) and Crohn's disease. The incidence of UC is very high in India when compared to Crohn's disease. While Crohn’s can affect any part of the digestive system, UC affects only the rectum and the colon. 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, “IBD can be a painful and debilitating condition. If left undetected and untreated, it can lead to serious complications such as fistula intestinal obstruction, bowel dysfunction, and even colon cancer. UC causes long-lasting inflammation in a part of the digestive tract. It occurs only through continuous stretches of the colon and the symptoms show up over time. Crohn’s disease, on the other hand, causes inflammation anywhere along the lining of the digestive tract, spreading deep into affected tissues eventually. This further causes abdominal pain, severe diarrhea, and even malnutrition. Surgery may be required in those with Crohn’s disease to remove a damaged or diseased part of the intestine. Sometimes, the entire large intestine is removed, with or without the rectum.” Some symptoms of inflammation of the intestinal tract include diarrhea, rectal bleeding, urgent need to move bowels, abdominal cramps and pain, sensation of incomplete evacuation, and constipation (which can lead to bowel obstruction). There could also be other general symptoms such as fever, loss of appetite, weight loss, fatigue, night sweats, and loss of normal menstrual cycle. Adding further, Dr Aggarwal, said, “IBD is generally treated with anti-inflammatory drugs which are special derivatives of 5 ASA derivatives. These are used either orally or through enema, corticosteroids, immunosuppressants, biological agents, antibiotics, anti-diarrheal drugs, and laxatives. Regular treatment and frequent tests are imperative.” IBD can be controlled through certain lifestyle modifications as follows. Identify the triggers For some these triggers could be food such as dairy products. Identifying the foods that trigger the symptoms and avoiding them is crucial.
Go for less gassy foods Avoid beans, cabbage, and cauliflower as these can cause gas. Consume more of foods that are rich in omega-3 fatty acids.

Eat smaller meals This will help your digestive system to adjust better to the condition.
Keep yourself adequately hydrated Drink plenty of water and other fluids. However, limit the consumption of caffeine and alcohol.

Thursday 27 July 2017

Vitamin D supplementation: Choose vitamin D3 over D2

Vitamin D supplementation: Choose vitamin D3 over D2 Vitamin D deficiency is highly prevalent in India, almost in epidemic proportions. There are several reasons for deficiency of vitamin D. Lack of food fortification policies and more commonly our sociocultural practices, ‘sun-fleeing’ behavior, are major factors contributing to deficiency of this ‘sunshine vitamin’ in India which has abundant sunshine. Many people are unaware that they are vitamin D deficient. Vitamin D, as we know, is essential for bone health. Evidence has also demonstrated its role in chronic diseases such as cardiovascular disease, cancer, diabetes, infertility, dementia and autism, among others. There are two forms of vitamin D: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). D2 is plant-based and D3 is derived from animal sources. Vitamin D levels below 20 ng/ml need to be treated and are an indication for vitamin D supplementation. The question arises which one to choose: vitamin D2 or D3? Several international guidelines have recommended either D2 or D3 for vitamin D deficient patients stating that the two forms of vitamin D are equivalent and are equivalent in their effectiveness in treating patients with low vitamin D levels. However, findings of a new randomized-controlled trial from the UK have raised questions on these recommendations as the study found that vitamin D3 was twice as effective in increasing levels of serum 25-hydroxyvitamin D (25[OH]D) compared to vitamin D2 at a low dose of 15 μg daily. In the study published online July 5, 2017 in the American Journal of Clinical Nutrition, vitamin D3 fortified foods (juice, biscuits) during winters led to higher serum 25[OH]D levels after 12 weeks of supplementation compared to D2 fortified foods (juice, biscuits) in healthy South Asian and white European women. Vitamin D levels in women who received vitamin D3 via juice or a biscuit increased by 75% and 74%, respectively vs those who were given D2 through the same methods. Those given D2 saw an increase of 33% and 34% over the course of the 12-week intervention. Therefore, D3 should be the preferred form when advising vitamin D supplementation as it is the most effective form of increasing vitamin D levels in the body. Even low doses of vitamin D3 are effective in achieving the desired levels as demonstrated in this study. Sources 1. University of Surrey, Eurekalert Press Release, July 5, 2017. 2. Tripkovic L, et al. Am J Clin Nutr. 2017 Jul 5. Epub ahead of print Dr KK Aggarwal National President IMA & HCFI

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

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

Wednesday 26 July 2017

Share your ideas: Copy-“right” or copy-“left” your idea

Share your ideas: Copy-“right” or copy-“left” your idea “Everything begins with an idea”, said Earl Nightingale, an American motivational speaker and writer. Ideas can change the world. All successful organizations or businesses began with an idea that turned out to be great. If you have had an idea, then chances are that many others would also have had the same idea or a somewhat similar idea and could already be working on it. Ideas arise out of common circumstances or needs. They usually follow the current trends. Yet we are afraid or reluctant to share our ideas lest they be stolen by others. But it is always better to share your ideas. Sharing is gathering information. Brainstorming or debating your ideas with others gives you valuable feedback or insight about the viability of your idea, be it your family, friends, or colleagues, right at the very beginning. You can copy-“right” your idea, if you want. The diversity of their knowledge, skills and experience makes you better informed. You learn more about the pros and cons, you can rework your idea and take that first step on the path of converting your idea into reality. This is how innovations come about. Holding on to your idea, waiting for the right time, may well make your idea outdated. Anybody and everybody can have ideas. How you execute your idea is what makes the difference. The one who implements his/her idea first gets credit for innovation. But, if you do not want to work on your idea or implement it, then share it immediately; you can copy-“left” your idea. Put it up on an open forum where anybody can use it or add to it. Dr KK Aggarwal National President IMA & HCFI

Brain tumor on the rise in Indian children

Brain tumor on the rise in Indian children IMA says 90% of these cases are curable if the right treatment protocol is followed New Delhi, 25 July 2017: According to statistics, every year about 40,000 to 50,000 people are diagnosed with brain tumor, of which 20% are children. What is alarming is that this figure was only about 5% up until a year ago. Additionally, each year about 2,500 Indian children are diagnosed with medulloblastoma. As per the IMA, provided the treatment procedure is followed correctly, about 90% of these cases are curable. Medulloblastoma is a pediatric malignant primary brain tumor. It spreads through the cerebrospinal fluid (CSF) and frequently metastasizes to different locations along the surface of the brain and spinal cord. Studies show that brain tumor is the second most common cancer among children after leukemia. 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, “Brain damage is a serious problem irrespective of age. It can lead to problems with thinking, seeing, or speaking and cause personality changes or seizures. While a small percentage of brain tumors is linked to genetic disorders, others may be due to some known environmental hazards such as exposure to certain toxins or radiations. Long-term use of mobile and cordless phones is associated with an increased risk for brain tumor. If the tumor is in the brain stem or certain other parts, surgery may not be possible. Those who cannot undergo surgery receive radiation therapy or other treatment. Some symptoms are repeated episodes of vomiting, and a morning headache. This sometimes leads to misdiagnosis as a gastrointestinal disease or migraine.” A child with medulloblastoma can have a stumbling gait, frequently falls, diplopia, papilledema, and sixth cranial nerve palsy. In some cases, positional dizziness, and facial sensory loss or motor weakness is also seen. Decerebrate attacks appear in the later stages. Adding further, Dr Aggarwal, said, “Caring for children with medulloblastoma doesn’t end with active treatment. There is a need to ensure that the tumor has not returned, manage side effects, and monitor the child’s overall health. Most children treated for this disease require lifelong follow-up care including regular physical examinations, medical tests, or both. A tumor can recur if small areas of tumor cells remain undetected in the body. Over time, these cells increase in number and cause signs or symptoms.” Here are few tips for preventing cancer in children • Avoid exposure to chemicals and pesticides. This is particularly true for expectant mothers. • Consume a healthy diet including fruits and vegetables and exercise regularly. • Avoid self-medication and over consumption of medicines. • Quit smoking and drinking right away • Give your child immunity-boosting foods.

Tuesday 25 July 2017

CT follow-up of a solitary pulmonary nodule: New recommendations

CT follow-up of a solitary pulmonary nodule: New recommendations Finding a solitary pulmonary nodule on a chest x-ray is common and once detected, it needs to be evaluated promptly and managed because many such nodules can be malignant in nature. A large majority are picked up as asymptomatic lesions. A solitary pulmonary nodule has been referred to as “coin” lesion, a nomenclature first devised by John Steel way back in the 60s. Some of its major characteristic features include solitary nature, circumscribed margins, diameter double the cross-sectional diameter of an adjacent blood vessel adjacent (1.5 cm), homogeneous density and completely surrounded by lung with no regional lymph node enlargement or satellite lesions. There is a long list of conditions that are to be considered in the differential diagnosis of a solitary pulmonary nodule. The most common include lung cancer, benign lung tumor, tuberculoma, fungal granuloma, lung abscess and metastasis. “Wait and Watch”, biopsy of the nodule or immediate thoracotomy are the management options. A thin slice CT (1 mm) is done to accurately describe the characteristics of the nodule and decision is taken on CT findings. The updated 2017 Fleischner Society Guidelines for management of incidental pulmonary nodules detected on CT published in the July 2017 issue of the journal Radiology have recommended a range of time for follow-up CT scans, rather than a precise time period based on estimations of the individual risk of malignancy. According to these guidelines, no routine follow-up is required for patients with a solid or subsolid (pure ground glass or part-solid) solitary pulmonary nodule <6 mm in low risk patients. While, no further diagnostic testing is recommended for patients with solid solitary pulmonary nodules that have remained stable over two years, or subsolid SPNs that have been stable over five years on serial CT scans. A word of caution here. These recommendations do not apply to patients with known cancers at risk for metastases, immunocompromised patients, who are at risk of infections. As these guidelines are Level 1 evidence, these recommendations should be followed (Evidence from a systematic review or meta-analysis of all relevant RCTs or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results). Source 1. Keerat Kaur Sibia et al. Chapter 46. How to manage solitary pulmonary nodule (SPN). Medicine Update. 2017. http://www.apiindia.org/pdf/medicine_update_2017/mu_046.pdf. 2. Gaude GS, et al. Evaluation of solitary pulmonary nodule. J Postgrad Med. 1995;41(2):56-9. 3. MacMahon H, et al. Guidelines for management of incidental pulmonary nodules detected on CT Images: From the Fleischner Society 2017. Radiology. 2017 Jul;284(1):228-243.

Lack of knowledge about hemophilia in India, IMA

Lack of knowledge about hemophilia in India, IMA Though it is not a disorder that kills, adequate care must be taken to curtail bleeding in any form. New Delhi, 24 July 2017: According to a recent study, about half of the world's hemophilia population lives in India. Further, about 70% of those with this disorder don’t have adequate knowledge or access to treatment. Apart from this, there are about 16,000 registered patients suffering from hemophilia in the country. However, studies indicate that the number could be seven times more. A genetic and life-threatening bleeding disorder, in hemophilia, the blood does not clot normally due to the absence of clotting proteins called factors, when there is an injury or a cut. Provided care is taken, recurrent and prolonged bleeding into joints and muscles can even lead to permanent disability and at times, death. 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, “What is peculiar about the transmission of hemophilia is that only males suffer from it and females are only carriers. It is not a killing disorder unless the bleeding extends into a vital organ. However, it can severely cripple a person due to all the pain. There is no known cure for this disorder. About a third of new cases are caused due to a new mutation of the gene in the mother or the child. In such cases, there need not be a previous history of hemophilia in the family. Women with the hemophilia gene can pass it on to their children. In cases where the mother is a carrier and the father does not have the disorder, there is a 50% chance of the male child having hemophilia and 50% chance of the female child being a carrier.” Hemophilia is of three types: A, B, and C and the difference between the three lies in the deficiency of a specific factor. One should see a doctor in case the following symptoms show up: a severe headache, repeated vomiting, neck pain, blurred or doubled vision, extreme sleepiness, and continuous bleeding from an injury. Adding further, Dr Aggarwal, said, “In pregnant women, there is no way of knowing whether the baby has the condition. For women, whose eggs are fertilized in a clinic using in vitro fertilization, this condition can be tested for and the eggs without hemophilia can be implanted. Preconception and prenatal counseling can help in understanding the risk of having a baby with hemophilia.” It is possible to live with hemophilia and manage the condition with the following tips. Get physical activity Adequate physical activity can help maintain body weight and improve muscle and bone strength. However, those with hemophilia should avoid physical activity that can cause injury and resultant bleeding. Avoid certain medications Avoid blood-thinning medication such as warfarin and heparin. It is also better to avoid over-the-counter medicines like aspirin and ibuprofen. Maintain dental hygiene Clean your teeth and gums thoroughly. Get tips from your dentist on how to do this without making the gums bleed. Get yearly checkups and vaccinations Get tested regularly for blood infections and get your doctor’s advice on hepatitis A and B vaccinations.

Monday 24 July 2017

Principles of communication

Principles of communication Communication is the foundation of an effective doctor-patient relationship. It works both ways i.e. it has advantages for both the patient as well as the doctor. Good communication is the key to building trust, patient compliance to the prescribed treatment, patient satisfaction including better clinical outcomes. A good communicator is also a great motivator. Poor communication has been attributed as a major contributor to litigations against doctors. Hence, good communication skills are therefore very important for the doctor. There are certain principles of communication that should be followed for effective outcomes. • Know your target audience. Your audience is made up of diverse group of people, with different cultural backgrounds and health literacy levels. Assess their level of awareness of your audience and tailor your message accordingly. If the level of awareness is low, talk to them at their level and gradually build up the level of your message. Do this even if this is the case with even one member of the audience so that all get the benefit of your message and nobody feels left out. Remember, “One size fits all” messages don’t work always. • Decide your agenda. You must know what message you want to give. The health information should be field tested and should not create any panic or fear in the society. Communication should be concise and focused. • Use multiple channels of communication. Decide how you want to deliver the message. There are several channels of communication. Print – newspapers, posters, press releases etc. Audiovideo – radio/TV interviews, press conferences etc. or internet – email, social media, SMS. • Message should be evidence-based. Your message should be fact-based or evidence-based and not based on opinions or myths. Higher the level of evidence, lesser the chances of your message being contradicted or refuted. While giving a health statement, quote a credible source of information such as meta-analysis, randomized-controlled studies and reviews published in credible journals. • Strike while the iron is still hot. Timing is of great importance in effective communication for desired outcomes. • Follow the cycle of Teach, Reason, Summarize and Revise. Pre and post evaluation of the audience is important. Always revise at the end to find out what is understood. • Word of mouth communication. Involve “community leaders” or “celebrities” people who count in the community, who are considered reliable by the people, who people look up to as role models.

IMA adopts Aao School Chalen Project

IMA adopts Aao School Chalen Project • Emphasizes on the importance of imparting public health education in schools • Fifth day of every month to be designated to activities under this project New Delhi, 23 July 2017: According to statistics, about 60% of the country’s population is below the age of 45 including the sub-group of schoolchildren. The health and well-being of the country’s young people is not a matter of luck and neither is it a chance or random event. It must be a planned outcome. Considering this, the IMA has adopted the "Aao School Chalen Project" initiated by Delhi Medical Association in the recent past as a National Project. Under the project, the 5th day of every month has been designated for any activity related to this project. The IMA has always stressed on the importance of imparting public health education in schools and this is a step in that direction. As a part of the 'Aao School Chalen' project, lectures and awareness campaigns will be held in schools to sensitize school children on various public health issues. 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, "School health is very important as schools are not just centers that impart formal education, but also influence overall development of a child. To enjoy good health during adulthood, healthy lifestyle including hygiene habits must be inculcated in childhood itself. These habits learned during childhood last through to adulthood and then through life. Moreover, children are naturally inquisitive and keen learners. Thus, they are not only beneficiaries of any health-related activity but also agents of change in their family.” School health education programmes can help reduce health risk behaviors such as tobacco use, poor nutrition, lack of physical activity, drug and alcohol use. It is imperative to impart quality public health education in schools and promote positive health behavior among children and adolescents alike. Adding further, Dr Aggarwal, said, “Visit your old school if you can or any nearby school during the school assembly and interact with students and teachers to sensitize them on issues of public health importance. Speak to the principal of the school beforehand about this. It need not be a long-drawn talk, but a short talk of 10 to 15 minutes. Get a certificate (proforma) signed by the Principal. Send the proforma to IMA HQs along with the photographs taken with students during assembly for records.” The schedule of the lectures to be organized is as under. • 5 August - Vector-borne diseases • 5 September – Lifestyle • 5 October - Menstruation myths • 5 November - Health and hygiene • 5 December – Substance abuse IMA adopts Aao School Chalen Project • Emphasizes on the importance of imparting public health education in schools • Fifth day of every month to be designated to activities under this project New Delhi, 23 July 2017: According to statistics, about 60% of the country’s population is below the age of 45 including the sub-group of schoolchildren. The health and well-being of the country’s young people is not a matter of luck and neither is it a chance or random event. It must be a planned outcome. Considering this, the IMA has adopted the "Aao School Chalen Project" initiated by Delhi Medical Association in the recent past as a National Project. Under the project, the 5th day of every month has been designated for any activity related to this project. The IMA has always stressed on the importance of imparting public health education in schools and this is a step in that direction. As a part of the 'Aao School Chalen' project, lectures and awareness campaigns will be held in schools to sensitize school children on various public health issues. 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, "School health is very important as schools are not just centers that impart formal education, but also influence overall development of a child. To enjoy good health during adulthood, healthy lifestyle including hygiene habits must be inculcated in childhood itself. These habits learned during childhood last through to adulthood and then through life. Moreover, children are naturally inquisitive and keen learners. Thus, they are not only beneficiaries of any health-related activity but also agents of change in their family.” School health education programmes can help reduce health risk behaviors such as tobacco use, poor nutrition, lack of physical activity, drug and alcohol use. It is imperative to impart quality public health education in schools and promote positive health behavior among children and adolescents alike. Adding further, Dr Aggarwal, said, “Visit your old school if you can or any nearby school during the school assembly and interact with students and teachers to sensitize them on issues of public health importance. Speak to the principal of the school beforehand about this. It need not be a long-drawn talk, but a short talk of 10 to 15 minutes. Get a certificate (proforma) signed by the Principal. Send the proforma to IMA HQs along with the photographs taken with students during assembly for records.” The schedule of the lectures to be organized is as under. • 5 August - Vector-borne diseases • 5 September – Lifestyle • 5 October - Menstruation myths • 5 November - Health and hygiene • 5 December – Substance abuse

Sunday 23 July 2017

“Time Churao” campaign: “Steal” time out of your busy schedule

“Time Churao” campaign: “Steal” time out of your busy schedule Almost everybody today complains of lack of time… “There is so much to do and too little time to do”. Everybody seems to be busier than ever. Well, being a doctor is not an easy job, it’s also a busy job. Being a doctor also means multifaceted responsibilities. A doctor not only has to treat his patients, he is also a teacher, researcher, manager, communicator, community leader. Health education is an important component of the duties and responsibilities of a doctor. It has a direct link to patient satisfaction. However, in a busy practice, doctors often lack the time to educate their patients and families about different health-related issues. Juggling both practice and home often leaves doctors with no time left for community health activities. Here is what I do. Whenever I am invited to a function and the chief guest is running late, I ask the organizers for the mike and start ‘zero hour’. Instead of sitting on the dais, I like to walk around the room, among the audience and interact with them. Being on the same level as the audience breaks a barrier and people may find it less intimidating to raise questions. During Zero hour in the Parliament, members can raise any important matter that is relevant to the public. These questions do not require any prior notice. Similarly, I ask them questions on any health-related topic – of current interest or any other - and try to engage them in discussion. I find that a lively Q &A session is a good way to disseminate information and educating the people as I also come to know their level of awareness about a topic. I avoid speaking too much of medical jargon or scientific terms because the audience soon loses interest. This is how I “steal” time out of my busy schedule to converse with the public. I encourage all of you to do such activity to educate your patients, their families and friends and the public. Dr KK Aggarwal National President IMA & HCFI Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO) Past Honorary Secretary General IMA Past Senior National Vice President IMA President Heart Care Foundation of India Gold Medalist Nagpur University Limca Book of Record Holder in CPR 10 Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand Editor in Chief IJCP Group of Publications & eMedinewS Member Ethics Committee Medical Council of India (2013-14) Chairman Ethics Committee Delhi Medical Council (2009-15) Elected Member Delhi Medical Council (2004-2009) Chairman IMSA Delhi Chapter (March 10- March 13) Director IMA AKN Sinha Institute (08-09) Finance Secretary IMA (07-08) Chairman IMAAMS (06-07) President Delhi Medical Association (05-06)

IMA delegation visits and congratulates the newly elected President of India

IMA delegation visits and congratulates the newly elected President of India The Association is hopeful of some positive changes in the healthcare scenario in the country under the President’s leadership New Delhi, 22 July 2017: An IMA delegation led by its National President, DR K K Aggarwal, visited the newly elected 14th President of India, Shri Ram Nath Kovind. The visit was aimed towards not only congratulating the President but also to take a step ahead in working together for the betterment of the medical profession. IMA has since long been actively fighting to restore the nobility and dignity of the medical profession and recently concluded the Dilli Chalo movement to voice the concerns of the fraternity at large. Both India’s healthcare sector and the medical fraternity have many challenges to address. Not only is there a dearth of adequate doctors but the existing ones also face issues such as violence at the hands of the public. All this requires urgent consideration and by meeting the President, the IMA hoped to make a head start to address them. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI), Dr RN Tandon – Honorary Secretary General IMA and Dr Narender Saini, Former Secretary General IMA in a joint statement, said, “At the outset, we would like to congratulate Shri Ram Nath Kovind for assuming office as the 14th President of India. It is indeed an honor to have a leader like him working for the welfare of the nation. Healthcare delivery in India is undergoing many changes be it in terms of prevention, diagnosis, or treatment. All entities in the healthcare sector need to work in tandem with each other to resolve the issues that our profession is facing today. The medical profession is facing one of the toughest times today. Repeated pleas and appeals by the medical fraternity have not materialized into anything except reassurances. It is in these areas that we seek the Hon’ble President’s cooperation and support.” The last few months have seen several other initiatives by the IMA on this front such as STOP NMC Sathyagraha, two National Protest Days against violence on doctors, NO to NEXT strike in medical colleges, and the National Black Day against West Bengal Clinical Establishments Act. Other than this, 3 action committee meetings and 2 meetings of FOMA were also conducted. Adding further, Dr Aggarwal, said, “For any movement to be successful, the leadership should fall in the right hands. And we believe that with Shri Kovind as the President, IMA’s efforts will be adequately supported. The need of the hour is collective action and decision which would do justice to this profession.” The IMA is working towards resolving the following issues. • Criminal prosecution of medical negligence and clerical errors • Stringent central act against violence on doctors • Capping the compensation in 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 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 retainer ship in general practice • Health budget of 5 % of GDP for universal health coverage

Saturday 22 July 2017

Aao School Chalen: A national project undertaken by IMA

Aao School Chalen: A national project undertaken by IMA School health is very important as schools are not just centers that impart formal education, they also influence overall development of a child. To enjoy good health during adulthood, healthy lifestyle including hygiene habits must be inculcated during childhood. These habits learned during childhood last through to adulthood and all their lives. Moreover, children are naturally inquisitive and keen learners. So, they are both beneficiaries of any health-related activity and agents of change in their family. To this end, the Indian Medical Association (IMA) has adopted “Aao School Chalen Project” initiated by Delhi Medical Association in the recent past as a National Project. The 5th of every month has been designated for any activity related to this project. Visit your old school if you can or any nearby school during the school assembly and interact with students and teachers to sensitize them on issues of public health importance. Speak to the principal of the school beforehand about this. It need not be long-drawn talk, but should be a short talk of 10-15 min duration. Get a certificate (proforma) signed by the Principal. Send the proforma to IMA HQs along with the photographs taken with students during assembly for records. We have identified few topics for the coming months and there will be common points for discussion for uniformity. The first topic for 5th August is “vector-borne diseases”. The 10 uniform messages for first lecture are as follows: 1. Mosquito-borne diseases are preventable and manageable if detected early. 2. Do not allow water to stagnate in or around the houses, particularly in plastic containers. 3. Wear full sleeves clothes during monsoon season. 4. All patients suffering from dengue, malaria, chikungunya, Japanese encephalitis should use bed nets while sleeping. 5. Treatment of malaria should be started early; it can be for 3 days or 14 days depending on the type of malaria. 6. All patients with dengue do not require platelet transfusion. 7. IMA Slogans: “Katwaieyga to nahi” (I hope you will not get me bitten by a mosquito) or “My premises are mosquito-free, you are invited at my premises”. 8. Look for mosquitoes: inside or outside the house; both small and big containers, during day or night; in the room or on the roof; floor or up on the walls; larvae or the mosquito. 9. Let all schools be declared by the principal as being mosquito-free. 10. Let every child speak a slogan: “From now onwards my house will be mosquito free”. The schedule of the talks is as under: • 5th September: Lifestyle • 5th October: Menstruation myths • 5th November: Health and Hygiene • 5th December: Substance Abuse States and Local Branches of IMA are requested to circulate this information to all the members. Since, this is a national health project, IMA requests all its members to participate to make it a success. Dr KK Aggarwal National President IMA & HCFI

Proper diabetes care essential to keep diabetic foot at bay

Proper diabetes care essential to keep diabetic foot at bay Even a small injury can lead to complications and it is imperative to get feet checked annually in those with diabetes New Delhi, 21st July 2017: According to statistics, during the diagnosis of Type 2 diabetes, at least 1 in 10 people, possess risk factors for foot damage. Studies also estimate the prevalence of diabetic foot in India between 7.4% and 15.3%. It is important to identify this condition at the earliest and provide treatment failing which the condition can lead to serious health issues. A small injury can later develop infections and even end up in amputations. The WHO defines diabetic foot as, "The foot of a diabetes patient that has potential risk of pathologic consequences including infection, ulceration and /or destruction of deep tissues associated with neurologic abnormalities, various degrees of peripheral vascular disease and/or metabolic complications of diabetes in the lower limb." Speaking about this condition, 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 imperative to check the feet every day once diabetes has been diagnosed. Factors such as callus, corn, infections of skin or nailbed, onychocryptosis or ingrown toe-nail can lead to ulcers and must be prevented. Diabetes leads to damage of nerves in the feet. In the absence of pain, such small injuries can go unnoticed. Additionally, other associated conditions such as high blood pressure, smoking, cholesterol, and obesity tend to reduce the blood flow to the feet, in a person with diabetes. All these predispose a person to secondary infections thereby aggravating the problem further. Some other complications associated with diabetic foot include ulceration, infection, septicaemia, gangrene, deformity, and limb loss." Some probable causes of a diabetic foot include peripheral neuropathy (nerve damage), vasculopathy, (obstruction of blood vessels), foot deformity, infection, and oedema (swollen feet). Treating a diabetic foot includes addressing three basic issues: debridement, offloading, and infection control. Adding further, Dr Aggarwal, said, "Those with diabetes should get their feet examined on an annual basis. It is important to notify the doctor if there are any cuts or breaks in the skin, or an ingrown nail, or if the feet become less sensitive or start hurting. It is possible to prevent development of diabetic foot by optimizing glycaemic control, offering patient education including daily feet examination, nail care, proper foot wear, and utilizing emollients to moisturize the feet." Follow these tips to take care of your feet if you have been diagnosed with diabetes: • Keep sugar levels under check: Follow lifestyle tips suggested by your doctor to keep your blood glucose levels in the correct range. • Check your feet every day: Watch out for any red spots, cuts, swelling, or blisters. • Be physically active: Engage in at least 30 minutes of physical activity every day. • Keep your feet clean: Wash your feet every day and dry them carefully, especially the area between toes. • Moisturize feet well: Apply a thin coat of moisturizer over the top and bottom of your feet every day after you wash them. • Trim your nails regularly. • Wear comfortable shoes and socks: It is a good idea to not walk barefoot. Buy footwear that is comfortable and fit well. Ensure that the lining is smooth and there are no objects inside your footwear. • Keep the blood flowing to your feet: Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, two (2) or three (3) times a day. Don't cross your legs for long periods of time.

Friday 21 July 2017

What is team work?

What is team work? What is team work? When asked this question, the usual answer would be “a group of people with the ability to work effectively in a group with the objective of achieving a common goal”. Each member has a role to play within the team. How well a team works together can spell success and failure of a project. Several success stories have been credited to “team effort” and rightly so. Trust, mutual respect, commitment, communication, taking responsibility, cooperation are some of the skills that are usually listed as required as team work skills to achieve desired results. These are qualities that employers often seek in prospective employees. A team comprises a group of people, each with their own personality. And it is the personality of each team member more than the individual expertise or ability that each has to offer, which determines how well a team works together and delivers desired results in time. Each one of us has a physical profile (defined by our height, complexion, collar number, waist size, etc.), intellectual profile and ego profile (my bank balance, car, job designation, locality of residence, size of house, contacts, power, clothes, etc.). Then there is the “soul profile”. This is most important. Soul profile defines your uniqueness, your strengths. Your occupation or your position in the society or physical profile do not define you. It is your soul profile, which defines you, who you are as a person. According to Dr Deepak Chopra, to know your soul profile, ask yourself the following seven questions while sitting in a meditative poise or in state of relaxation. The answer to each question should be either in three words or three phrases. 1. What is my purpose of life? 2. What is my contribution going to be for my friends and family? 3. Three instances in my life when I had my peak experiences. 4. Names of three people who inspire me the most. 5. Three qualities which I admire in others the most. 6. Three of my unique talents. 7. Three qualities I best express in my relationship The 21 answers to these seven questions characterize your soul profile and define every action you perform in your life. A team therefore should be a right mix of personalities (profiles) with jobs assigned that match their profile. These profiles influence team performance and the dynamics within a team. But, when these profiles match, success becomes a natural and automatic outcome. Conflict results when these profiles are mismatched. A person with a stronger ego profile may be assigned a leadership role. Never put two egoistic people together. To build a great team, a team leader must harness the strength of each member of his/her team. Match these profiles for a more cohesive working. This is also how each member of a team can maximize his/her strengths. Dr KK Aggarwal National President IMA & HCFI

Indians do not take dental health seriously, says IMA

Indians do not take dental health seriously, says IMA
Sensitivity, teeth staining, cavities, and nursing bottle caries common among Indians due to lack of awareness
New Delhi, 20 July 2017: A study conducted recently has indicated that about 95%of Indians have gum diseases, 50% do not use a toothbrush, and 70% of children under the age of 15 have dental caries. It is alarming to note the high incidence of oral health ailments in Indians. Sensitivity is another major problem, with only 4% of those with the issue visiting the dentist for consultation. According to the IMA, Indians tend to indulge in self-treatment by avoiding certain food and drinks, rather than paying a visit to the dentist regularly. Some of the most common dental problems among Indians are tooth sensitivity, staining of teeth, and cavities. This can be attributed to eating habits and other habits such as smoking. Consumption of alcohol and aerated drinks, and smoking can make the teeth lose their natural whiteness. Loss of enamel can also lead to sensitivity. 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, “Dental health is often ignored by many people. Stress can have lasting effects on the teeth as on the overall system. Under stress, many people pick up the habit of smoking and consuming alcohol, which can have serious implications on dental health at a later stage. There is also a high prevalence of dental problems in rural areas due to lack of adequate knowledge. In cities, junk food and other lifestyle habits cause dental cavities and other issues. The increase in the consumption of refined sugars by way of processed food is also affecting the teeth negatively particularly in the younger generation.” One should not ignore warning signs and visit a dentist as soon as possible. A dull tooth ache, which does not subside, bleeding gums, and sensitivity to certain eatables are signs that should not be ignored. Apart from adults, dental problems are also common in babies who drink out of a feeding bottle. This is known as Nursing Bottle Caries and can spoil the upper front four milk teeth. Adding further, Dr Aggarwal, said, “Prolonged exposure to nursing bottles containing juices can cause caries in babies. Mothers should wipe the gums and teeth with a clean cloth after every feed. If left unchecked, dental infections can also lead to systemic diseases including cardiac problems.” Here are some tips to take care of your teeth and prevent decay. • Brush twice a day Brushing helps in preventing the build-up of plaque and bacteria which can cause tooth decay and periodontal diseases. • Floss Flossing helps clean the crevices where the brush can’t reach. • Avoid too much sugar Sugary and starchy foods can cause tooth decay as sugar reacts with the bacteria in saliva to form an acid that erodes the tooth enamel. • Brush your tongue The tongue harbors bacteria too. Therefore, it is a good idea to invest in a tongue scraper and clean it. • Don’t ignore any unusual signs Consult a dentist if your gums are inflamed or if they bleed. It is also important to not ignore any pain in the teeth and gums. • Get your teeth checked every six months Dental cleaning and check-up twice a year is imperative.

Thursday 20 July 2017

Application of evidence-based medicine in negligence claims

Application of evidence-based medicine in negligence claims Medical negligence is established when a doctor had a duty of care to the patient, there was a breach in the duty of care and the patient suffered damage as a direct result of the breach in duty of care. The Bolam test has been traditionally used to assess two main issues of medical negligence - the standard of care as required by the law and whether the doctor accused of medical negligence has complied with that standard of care. This is decided by the medical opinion of expert ‘experienced’ doctors. The Bolam test is satisfied if it is the opinion of the experts that the medical practice followed by the doctor is proper, even in the event of a mishap. Then he/she is not guilty of medical negligence. “A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art… a doctor is not negligent if he is acting in accordance with such a practice, merely because there is a body of opinion that takes a contrary view.” (Bolam v Friern Hospital) In 2015, the UK Supreme Court passed a judgement in the case of Montgomery v Lanarkshire Health Board as a result of which doctors in UK are now required to ensure that the patient is aware of all possible risks associated with a treatment, howsoever, rare. The Montgomery judgement, unlike the Bolam test, is based on evidence The Montgomery judgement has now made the Bolam test redundant ‘as a test to assess standard of care’. It is the court now which will review the available evidence and reach its own conclusion whether the line of treatment adopted was the required standard of care or not. In this age of information, the practice of medicine has become evidence-based. Even the Courts require evidence to defend/prove an allegation of professional negligence. Evidence-based medicine avoids professional bias and conflict, which is a risk in experience-based medicine as it is the expert testimony of individuals. But, it is just not enough to present evidence in your defence. What is important is the level of evidence. The level of evidence that you present before the law strengthens or weakens your defence. A hierarchy of seven levels of evidence have been defined in declining order of significance from Level I to Level VII. Level I is evidence from a systematic review or meta-analysis of all relevant randomized-controlled trials or clinical practice guidelines that have been developed on the basis of evidence. It ranks highest and cannot be challenged by an expert. Opinions of experts or expert committee reports are ranked lowest at level VII. With evidence-based medicine fast becoming the norm, this shift from the Bolam test holds relevance for all doctors. Calling in a large number of experts to give their opinion on what is “accepted clinical practice” may no longer be a good defence when defending a complaint of medical negligence. Dr KK Aggarwal National President IMA & HCFI

Self-medication can make allergic symptoms worse, says IMA

Self-medication can make allergic symptoms worse, says IMA Incidence of allergic disorders is on the rise in the country due to various factors New Delhi, 19 July 2017: Statistics indicate that about 20% to 30% of the Indian population is afflicted with allergic rhinitis. Allergic disorders have increased markedly in the country in the past two decades. As per the IMA, almost one in two people exhibit an allergic response to some common environmental factor. Allergic rhinitis is a chronic inflammatory respiratory disease affecting one-third of the worldwide population. Low acceptance level for the disease exacerbates the condition. What is more alarming is that many people indulge in self-medication by using over-the-counter drugs, which do not provide any relief most of the time. 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, “Allergic rhinitis is associated with a group of symptoms that affect the nose. These symptoms show up when a person breathes in some allergen such as dust, animal dander, or pollen. Symptoms can also arise when a person consumes certain food items that he/she is allergic to. The body releases histamines upon contact with an allergen. This is a natural chemical that defends the body from the allergen. When histamines are released, it manifests as symptoms of allergic rhinitis including a runny nose, sneezing, and itchy eyes.Although anyone can be affected by allergies, those with a history of allergies in the family are at greater risk. People with asthma or atopic eczema also stand a greater chance of getting allergies.” Some of the most common symptoms of allergic rhinitis include sneezing, runny nose, coughing, a sore throat, itchy and watery eyes, frequent headaches, extremely dry and itchy skin, hives, and excessive fatigue. Certain external factors can make these symptoms worse and include smoke, chemicals, pollution, and fumes. Adding further, Dr Aggarwal, said, “Allergic rhinitis can be seasonal (during certain seasons such as spring) or perennial (round the year). Seasonal allergic rhinitis is more common in children and adolescents. The symptoms begin to show before the age of 20, stay constant through early adulthood, but begin improving during middle age and beyond. The best way to avoid an allergic reaction is to not expose the body to any possible triggers.” Certain drugs such as antihistamines, decongestants, and nasal corticosteroid sprays can help in controlling the symptoms of allergic rhinitis. However, these should only be taken in consultation with a doctor. There are also certain alternative therapies which can be used to manage symptoms. Additionally, following these tips can help in the prevention of allergic rhinitis, more so in those who are susceptible to allergies. • Stay indoors when pollen countis high • Avoid exercising outdoors particularly early in the morning. • Take a shower immediately after being outside. • Keep windows and doors shut as much as possible during the allergy season. • Keep your mouth and nose covered when you go out. • Bathe your dog at least twice a week. • Avoid carpeting the house to reduce dust mites.

Wednesday 19 July 2017

Unconditional beneficence and absolute non maleficence: The hallmarks of a doctor

Unconditional beneficence and absolute non maleficence: The hallmarks of a doctor “Doctors are next to God”, “Doctors heal, God treats”. These are some oft-repeated well-known phrases. And, much has been written about how doctors have been accorded a ‘God-like’ status in society, which places them “on a pedestal” at a level higher than other profession, though this image of a doctor seems to have slowly eroded over the years. God is omniscient, omnipotent and omnipresent. We seek His refuge in our hard times all the time and have absolute trust in him because he is all-knowing, all-powerful and present everywhere. God is the person in whom one has blind belief and faith. He is there for all of us. Doctors are professionally trained to take care of the sick, look after the health of their patients and also of the community. During illness or in a life-threatening situation, doctors remain the last hope for families and patients put the same belief and faith in doctors to help them as they do in God. Non-maleficence (do no harm) and beneficence (do good) are the two of the four major principles of medical ethics, the other two being respect for autonomy and justice. These are the guiding values of medical practice. Doctors act in the best interests of the patients for their well-being and prevent harm to the patients i.e. treat the patient in a way that does not harm the patient. But, patients are more than just their disease. Doctors should have unconditional compassion and empathy towards their patients to give the best possible care to them, without being judgemental or biased or prejudiced. These are factors that influence patients’ perception of their doctor, sometimes even more than the actual science of medicine. Therefore, I add two adjectives “unconditional” and “absolute” to the two guiding bioethics principles i.e. “unconditional beneficence” and “absolute non maleficence”… just as God loves us all unconditionally and anybody can seek Him. A doctor who has these two qualities perhaps can be said to be God-like. Almost a century ago, in 1927, Dr FW Peabody wrote in an article in JAMA “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient”. This is as relevant today as it was then. Dr KK Aggarwal National President IMA & HCFI

Some simple sodium salt reduction strategies can avert many disorders, says IMA

Some simple sodium salt reduction strategies can avert many disorders, says IMA Indian diet has changed over the years and it is imperative to reduce the consumption of processed food, which is high in sodium content New Delhi, 18th July 2017: As per a recent study, an average Indian consumes 10.98 grams of salt per day, which is 119% more than the recommended limit of 5 grams per day by the World Health Organization (WHO). An excess of salt can result in high blood pressure, which is a leading cause of cardiovascular diseases (CVDs) and the resultant deaths. According to the IMA, making certain lifestyle changes and limiting the intake of dietary sodiumcan help avoid risk factors for these diseases. The Indian cuisine is high on salt. The "salt to taste" phrase becomes a misnomer in the Indian context what with its usage in curries, salads, and other dishes, and reaching extremely high levels in foods like pickles. Add to this the consumption of fast food and processed food, which further increases the chances of acquiring certain disorders. 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 Indian diet has undergone a drastic change over the last many years. We eat less of pulses, fruits and vegetables, and the quantity of processed and fast foods is on the rise. This kind of diet is rich in salt, sugar, and harmful fats and therefore, the likelihood of high blood pressure, obesity, and CVDs is also on the rise in Indians today. With the fast-paced lives that we lead, there is no time to cook food at home and therefore, people prefer eating out. Instant food options are available everywhere but people do not make it a point to read the food labels and understand what the food items constitute. Many of these contain excess sodium salt which can be detrimental to our health.” About 40% sodium is found in common table salt. Sodium is used by the body in small amounts to maintain fluid balance. It is extremely imperative for diabetics to consume a diet low in salt because diabetic hypertensive patients can develop coronary artery disease or an enlarged heart. Adding further, Dr Aggarwal, said, “Packaged and prepared food is high on salt content. Salt is used as a preservative to make food taste good. Restaurant food is also high in salt as are certain food items masked as healthy. It is a good idea to read the nutrition facts mentioned on the label to gauge the amount of salt in it. With some effort, it is possible to adjust to eating less salt in 6 to 8 weeks”. Few strategies for sodium salt reduction are as follows. • Make reading food labels a habit • Stick to fresh foods rather than their packaged counterparts • Avoid spices and seasonings that contain added sodium • Check restaurant websites before dining out; request that your food be prepared without any added salt • Cook rice, pasta, and hot cereals without salt • Choose ready-to-eat breakfast cereals that are lower in sodium • Rinse canned foods to remove some sodium • Buy low-sodium, reduced-sodium, or no-sodium versions of foods • Do not put salt, even on the dining table • Avoid APC, Achar Papar Chatni, as all these are high in salt

Tuesday 18 July 2017

Levels of awareness

Levels of awareness Doctors meet people from all walks of life and social strata in their day to day practice. And, these patients have different levels of awareness about their illnesses. Broadly speaking, patients can be classified as either “aware” or “unaware” about their illness. But, this is a very simplistic classification. There are four levels of awareness – ignorant, informed, empowered and enlightened. These levels have been defined based on the ability of the person to retain the knowledge or information that has been taught or given to them. • Ignorant patients depend on the doctor to make their decisions about the necessary interventions and treatments, with no questions asked. They are ignorant of their disease and do not participate in decision making. • Then there are informed patients. These patients have some information about their disease and will have few questions for the doctor following which they usually accept the line of management as suggested by the doctor. • The next level is empowered patients. These patients have several more questions for the doctor, they cross check facts and are an equal partner in decision making regarding their treatment. • Enlightened patients seek the opinions of many. They experiment and are only then convinced about the proposed line of treatment. Realization takes time for patients with this level of awareness. There will be multiple sessions of counselling, before these patients are convinced. Patients can also be classified on the principle of “suno – samjho – jano - karo” given by the sages. This means hearing, listening, knowing and wisdom. We should hear, listen, understand and convert it into wisdom. Hearing means that you hear anything but listening means that you should learn its meaning. Understanding means you should understand its value in your context and wisdom means you should practice it, re-practice it and learn intricacies of its implications The Bhagavad Gita has described four types of devotees comes from Bhagvat Gita where Krishna says to Arjuna (7.16) “Chaturvidha bhajante mam janah sukrtino rjuna, Arto jiijnasurarthasthi jnani cha bharatasabha”. This means that there are four types of beings who worship me: those who are unhappy, those who are desirous to have knowledge, those who desire worldly objects, and those who have acquired knowledge. In the next shloka, Krishna says that among them only those who have acquired knowledge (wisdom) are the best because they are always engrossed in worshipping me. He said those who have a knowledge love me, and I love them. A true Bhakt is a person who asks his guru the same question again and again till he understands and implements it. Rabbi Dovid Rosenfeld, a known scholar has classified four types of students in a different way. He describes them as a sponge, a funnel, a strainer, and a sifter according to their ability to retain the knowledge taught to them. • The sponge retains everything, but is unable to distinguish between correct and incorrect points or between significant and insignificant ones. He is devoid of Viveka, the power of discrimination. • The funnel brings in on one side and brings out on the other side. So, a funnel is the one for whom information goes in one ear and out the other. He has no focus on the lecture. His hearing and the mind are in different directions. • The strainer discards the wine – the significant material, and retains the lees – the incorrect or insignificant points. He’s the sort who remembers all sorts of trivial or useless details of the material he studied. Most students try to remember the foot notes of a book and forget the common things. • Finally, the sieve retains the fine flour – the significant material, and discards the dust – the inconsequential details. He is the one who understands the lecture by its main five points and remembers them in the form of sutras. There can also be three types of doctors. One, those who expect patients to accept what they say, second, who give choices to patients and ask them to choose and thirdly, there are doctors who give choices, but help the patient to choose the best option. Miscommunication is at the root of many doctor-patient disputes. When counseling a patient, the doctor has to understand the level of awareness of his patient and his level of awareness has to match with that of his patient to avoid any discordance in communication. (Inputs from Dr Ved P Mishra) Dr KK Aggarwal National President IMA & HCFI

Dietary calcium should be preferred over supplements, IMA

Dietary calcium should be preferred over supplements, IMA Young girls increasingly deficient in calcium, which can cause many health issues at a young age New Delhi, 17 July 2017: According to a recent study, calcium deficiency in women is becoming a prevalent problem in both rural and urban India. This can be blamed on the changing dietary habits, particularly in urban Indians, which has undergone a major change in the last few decades. As per the IMA, people are increasingly relying on processed and packaged foods and consequently, their intake of whole foods has gone down by a major proportion. About 20% of adolescent girls in the age group of 14 to 17 suffer from calcium deficiency, according to statistics. About 70% of our bone weight is due to calcium phosphate crystals, the reason why calcium is the most important nutrient for good bone health. Women need more calcium than men as they are more prone to bone health problems with age. 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, “Our body requires vitamin D to absorb calcium efficiently. In people with vitamin D deficiency, the chances of a calcium deficiency are more even if they their calcium intake is not low. This is because the body is unable to absorb the calcium from your food. Vitamin D is responsible for regulating the amount of calcium in the blood. Sufficient intake of Vitamin D not only helps improve calcium absorption but also helps in decreasing bone loss, lowers the risk of fractures, and helps prevent osteoporosis. Deficiency of calcium can cause many problems such as: issues with blood clotting, blood pressure, and heart rhythm, delayed development in children, and overall weakness and fatigue.” Young girls have a higher requirement of calcium when compared to older women. Girls in the age group of 9 to 18 require 1300 mg of calcium, while those in the age group of 19 to 50 require 1000 mg of calcium. Those above the age of 50 need 1200 mg. Adding further, Dr Aggarwal, said, “Many people resort to calcium supplements sometimes even without consulting a doctor. Supplemental calcium is safe for cardiovascular health if consumed in recommended amounts. However, dietary calcium should be recommended over supplements. Calcium intake over the recommended dietary allowance is not better than intakes that just meet the allowance.” Here are some ways you can boost your calcium intake naturally. Eat foods high in calcium every day. Drink low-fat or fat-free milk to boost your calcium consumption without adding too much fat to your diet. Other dairy products that contain calcium are yogurt and cheese; again, choose varieties that are low in fat. Eat more leafy greens, especially kale, collard greens and dark green lettuce, and green herbs such as basil, parsley and dill. Sardines and salmon are good sources of calcium, as are oats and black, pinto and kidney beans.

Monday 17 July 2017

Dietary calcium should be preferred over supplements, IMA

Dietary calcium should be preferred over supplements, IMA Young girls increasingly deficient in calcium, which can cause many health issues at a young age New Delhi, 16 July 2017: According to a recent study, calcium deficiency in women is becoming a prevalent problem in both rural and urban India. This can be blamed on the changing dietary habits, particularly in urban Indians, which has undergone a major change in the last few decades. As per the IMA, people are increasingly relying on processed and packaged foods and consequently, their intake of whole foods has gone down by a major proportion. About 20% of adolescent girls in the age group of 14 to 17 suffer from calcium deficiency, according to statistics. About 70% of our bone weight is due to calcium phosphate crystals, the reason why calcium is the most important nutrient for good bone health. Women need more calcium than men as they are more prone to bone health problems with age. 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, “Our body requires vitamin D to absorb calcium efficiently. In people with vitamin D deficiency, the chances of a calcium deficiency are more even if they their calcium intake is not low. This is because the body is unable to absorb the calcium from your food. Vitamin D is responsible for regulating the amount of calcium in the blood. Sufficient intake of Vitamin D not only helps improve calcium absorption but also helps in decreasing bone loss, lowers the risk of fractures, and helps prevent osteoporosis. Deficiency of calcium can cause many problems such as: issues with blood clotting, blood pressure, and heart rhythm, delayed development in children, and overall weakness and fatigue.” Young girls have a higher requirement of calcium when compared to older women. Girls in the age group of 9 to 18 require 1300 mg of calcium, while those in the age group of 19 to 50 require 1000 mg of calcium. Those above the age of 50 need 1200 mg. Adding further, Dr Aggarwal, said, “Many people resort to calcium supplements sometimes even without consulting a doctor. Supplemental calcium is safe for cardiovascular health if consumed in recommended amounts. However, dietary calcium should be recommended over supplements. Calcium intake over the recommended dietary allowance is not better than intakes that just meet the allowance.” Here are some ways you can boost your calcium intake naturally. Eat foods high in calcium every day. Drink low-fat or fat-free milk to boost your calcium consumption without adding too much fat to your diet. Other dairy products that contain calcium are yogurt and cheese; again, choose varieties that are low in fat. Eat more leafy greens, especially kale, collard greens and dark green lettuce, and green herbs such as basil, parsley and dill. Sardines and salmon are good sources of calcium, as are oats and black, pinto and kidney beans.

Do not ignore “trends” in lab reports

Do not ignore “trends” in lab reports Laboratory tests have become routine. Not only do doctors order lab tests, often patients or even otherwise healthy people get them done of their own accord. What is important is how we interpret these reports. Often the results of the tests are interpreted in relation to the normal reference range mentioned alongside, whether the values are within the reference range “normal” or fall outside it “abnormal”. Labs usually have their own reference range. Generally, we tend to give too much weight to a normal result and are reassured by it. But, here it is important to keep in mind the fact that a normal result is just a picture at that point of time. It can change. And, what is equally important is that instead of looking at a single test result, one should look for trends in the results. Always compare the results of a particular test with previous reports even when a result is normal. Results that show change over time i.e. show a rising or declining trend are important and should not be ignored. Any result which has been in the low normal range for the last many years, but is now in the high normal range even though still normal, should be taken cognizance of and investigated accordingly. This can be most commonly illustrated by blood sugar. A fasting blood sugar level higher than 126 mg/dL can be diagnosed as diabetes, according to the recommendations of the American Diabetes Association (ADA). Prediabetes is fasting blood sugar ranging between 100 and 125 mg/dL. If your patient usually has had his blood sugar around 80, but in the latest report, the blood sugar is now, say 98 or 106. This is still not higher than the diagnostic cut-off. But, this is the time, when you can advise lifestyle modifications to your patient – a healthy diet, increasing physical activity, quitting smoking etc. This will keep the blood sugar in check and prevent progression to prediabetes or even full blown type 2 diabetes. Another example is thyroid stimulating hormone (TSH). The normal range is between 1.0 and 4.0. A TSH value greater than 2.5 indicates a risk of hypothyroidism and a value of 4.0 is an indicator of mild hypothyroidism. PSA velocity is another important test in prostate cancer screening. It is the change in the level of prostate specific antigen (PSA) over time. It has been shown that PSA elevations can precede clinical disease by 5 to 10 years. PSA velocity greater than 0.75 ng/mL per year indicates a higher risk of a diagnosis of prostate cancer than the actual PSA level itself. Liver chemistry, kidney function tests, electrolytes, lipid profiles, reticulocyte count, SGOT/SGPT ratio are some tests, which should be interpreted carefully, taking into consideration the previous reports, before labeling them as normal. An example of declining trend is hemoglobin. If the hemoglobin has been slowly decreasing, but within the normal range, then evaluate the patient for the cause of anemia. In dengue patients, more than the falling platelet count, it is the "rapidity" of fall in platelet count, which is significant. A rapid fall of platelets is a warning sign of impending severe dengue. Be alert to changing trends in lab results even if within normal limits. Take note of the family history. Repeat the test and/or investigate your patient further. This is how diseases can be diagnosed early and treated timely. Dr KK Aggarwal National President IMA & HCFI