Saturday, August 18, 2018

Differences between Alzheimer's dementia and vascular dementia

Dementia is an umbrella term for a syndrome marked by deterioration in memory, other cognitive abilities and the ability to perform everyday activities. Although dementia mainly affects older people, it is not a normal part of aging. It is one of the major causes of disability and dependency among older people worldwide (WHO). There are several types of dementia. The most common is Alzheimer’s disease. Vascular dementia is another type of dementia.

While Alzheimer’s disease and vascular dementia are both types of dementia, their causes, symptoms and prognosis differ.

·         Vascular dementia is caused by an acute event such as stroke or transient ischemic attack (TIA), while the cause of Alzheimer’s disease still remains unknown.

·         Diabetes, hypertension, coronary artery disease, high cholesterol levels are risk factors for vascular dementia. Alzheimer’s disease is an irreversible, degenerative disease of the brain. Age is the best known risk factor for Alzheimer’s disease. Genetics may also have a role.

·         In vascular dementia, cognitive impairment occurs more suddenly and then remains stable for some time (step-like decline) and is related to an acute event like stroke or TIA. Whereas, in Alzheimer’s disease, memory problems are characteristically one of the first warning signs of cognitive loss and memory gradually declines over time.

·         Physical disability occurs at the same time as cognitive impairment in vascular dementia. In Alzheimer’s, cognitive impairment occurs first followed by physical disability.

·         A CT scan or MRI can detect an area of brain affected by stroke or TIA (infarcts). Alzheimer’s disease, on the other hand, is a diagnosis of exclusion. All other causes of dementia such as B12 deficiency (reversible) need to be ruled out before diagnosing a person with Alzheimer’s disease.

·         Prognosis of vascular dementia depends on the extent of damage in brain. Alzheimer’s disease progresses over the years. Survival after a diagnosis of Alzheimer’s disease is usually 8.4 years.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Friday, August 17, 2018

Former Prime Minister Shri Atal Bihari Vajpayee passes away

One should learn to fight illness like Shri Atal Bihari Vajpayee

Former Prime Minister Shri Atal Bihari Vajpayee passed away yesterday at the age of 93 years. He had been in a critical state and was on a life support system. He had been undergoing treatment at AIIMS, New Delhi since June 11 this year for chest congestion, urinary tract infection and low urine output.

The 93-year-old former prime minister had one kidney, prostate cancer and he had developed dementia following a stroke in 2009. He also had long-standing diabetes.

Shri Vajpayee, who became India’s prime minister thrice was conferred the Bharat Ratna, India's highest civilian honor, by the President of India in 2014.

A Parliamentarian for more than four decades, he was loved and respected by all, his colleagues and political foes alike.

A poet, orator par excellence and a true statesman, Shri Vajpayee had been a fighter all his life and had been ‘atal’ in his battle against his illnesses.

The power of inner strength is tremendous. Inner strength gives us resilience to fight the many battles that life throws our way.

One should learn to fight illness like Shri Atal Bihari Vajpayee. May his soul rest in peace…

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Thursday, August 16, 2018

Dr Bawa-Garba Case Update: Dr Bawa-Garba successfully appeals to be allowed to practice again

Dr Hadiza Bawa-Garba who had been convicted of gross negligence manslaughter after the death of six-year-old boy has successfully appeals to be allowed to practice again.

A Bench of three judges in the Court of Appeal overturned the decision of the High Court in saying that “… It holds that the Divisional Court was wrong to interfere with the decision of the Tribunal. The Court of Appeal sets aside the order of the Divisional Court that Dr Bawa-Garba should be erased from the Medical Register and restores the order of the Tribunal that she be suspended from practice for 12 months subject to review.” The Court of Appeal restored the lesser sanction of a one-year suspension.

Announcing the ruling, Master of the Rolls Sir Terence Etherton expressed their “deep sympathy with the parents and respect for the dignified and resolute way in which they have coped with a terrible loss in traumatic circumstances”.

The judgement said, “No concerns have ever been raised about the clinical competence of Dr Bawa-Garba, other than in relation to Jack’s death, even though she continued to be employed at the Hospital until her conviction. The evidence before the Tribunal was that she was in the top third of her Specialist Trainee cohort.

The Tribunal was satisfied that her deficient actions in relation to Jack were neither deliberate nor reckless, that she had remedied the deficiencies in her clinical skills and did not present a continuing risk to patients, and that the risk of her clinical practice suddenly and without explanation falling below the standards expected on any given day was no higher than for any other reasonably competent doctor.”

The Tribunal was an expert body entitled to reach all those conclusions, including the important factor weighing in favour of Dr Bawa-Garba that she is a competent and useful doctor, who presents no material continuing danger to the public, and can provide considerable useful future service to society.”

Here is a brief recap of the case:

lIn February 2011, a six-year-old boy with Down syndrome died due to sepsis

lIn November 2015, Dr Bawa-Garba and also a nurse on duty at that time were convicted of gross negligence manslaughter. On the basis of the legal test for that offence, the jury found their conduct to be “truly exceptionally bad”.

lIn 2017, the Medical Practitioners Tribunal (MPT) had imposed a sanction of immediate suspension for a period of 12 months rather than striking her name off the register after hearing and taking into account the various systemic failings at the hospital. But, the GMC appealed in the High Court against this decision.

lIn January 2018, the High Court quashed the order of suspension of the Tribunal and substituted an order of erasure to protect public confidence in the profession in January this year following an appeal from the GMC, which argued that suspension was "not sufficient" to protect the public or maintain public confidence in the medical profession.

lIn March 2018, Dr Bawa-Garba was granted leave to challenge her erasure from the medical register in the Court of Appeal.

We had extensively deliberated on this case in eMedinewS. The relevant links are as below:

(Source: Telegraph UK; Judiciary UK Media statement, August 13, 2018)

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Wednesday, August 15, 2018

We need ‘azadi’ from doctor-patient disputes on this Independence Day: Dr KK Aggarwal on TEDx Talks

The doctor-patient relationship is facing turbulent times these days. Trust forms the foundation of the doctor-patient relationship and determines the outcome. However, this trust has corroded over the last few years and must be restored urgently, as it is crucial to the survival of this very important relationship.

This is how I began my talk that I gave at TEDxMansarovarPark in Rohtak.

TEDxMansaroverPark is an independently organized TEDx event operated under license from TED Talks to propagate its mission of “ideas worth spreading”. It focuses on local voices and local community.

Here is a gist of my talk.

The doctor-patient relationship too needs CPR to revive it. And, it is revivable, just as a dying person or a clinical dead person can be revived by CPR.

Doctors are professionals and are accountable to a code of conduct. As professionals, we have to be different from others. I am allowed to write ‘Dr’ before my name. The constitution does not allow me to prefix ‘Dr’ before my name. But the society has allowed me to do so and has accepted it. I always wear a stethoscope around my neck. These signs make me different from others so that I can be easily identified as a doctor in an emergency.

A doctor has only two purposes: absolute beneficence and non maleficence. So, it’s my job to always work in the interest of the patient.

We had conducted a survey of thousands of doctors and patients. Doctors were not happy. They said, “we are living in fear that if the patient dies, we will be beaten up”. The incidence of violence against doctors are increasing. When we talked to the patients, we found that they too were not happy. When asked why, majority said that doctors do not communicate with us.

When we started to analyze the cause of unhappiness, we turned to our Vedic literature to find out the types of patients. There are four types of patients: Ignorant, informed, empowered and enlightened.

·         Ignorant patients have 100% trust in their doctor with no questions asked.
·         Informed patients are aware of their disease and rights, but they usually accept what the doctor tells them. They say, my doctor is the best.
·         Empowered patients have several more questions for the doctor.
·         Enlightened patients want an explanation and justification of every information they are given.

Similarly, there are three types of doctors.

·         Doctors, who expect patients to accept what they say without questions.
·         Doctors, who give choices to patients and ask them to choose and
·         Doctors, who give choices to their patients, but take time and help the patients in taking a decision.

This is the discord and the number one cause of miscommunication and disputes. While the types of patients have changed very rapidly from ignorant to enlightened, doctors are still in the first phase, where they feel that they don’t need to spend time with the patient.

Non fulfillment of desires, expectations and aspirations is the main cause of anger. As a doctor, patient satisfaction is my priority. I have to live up to the expectations of my patient and heal him. How can I do this? The answer to this lies in the 18 chapters of Bhagwad Gita.

In the first chapter, Lord Krishna only listens to Arjuna, his concerns, his doubts. We must learn to listen patiently to our patients without interrupting or showing anger.

From Chapter 2, Krishna starts explaining to Arjuna, who is confused. Patients are confused as they do are not expected to have the knowledge that doctors have.  

From Chapters 3 to 17, Krishna explains in great detail, giving reasons for the doubts Arjuna had. He said that don’t worry. I am here, if you make a mistake.

In the 18th Chapter, Krishna revises everything with Arjuna.

So, the first principle required for a better doctor-patient relationship is to understand that I need to spend time with the patient, explain, reason out and review.

‘ALERT’ is a concept that every doctor and patient must remember.

·         Acknowledge: When the patient enters your office, greet him/her by name and introduce yourself or your staff who would be involved in patient care.
·         Listen to your patient.
·         Explain to the patient about the disease.
·         Review the information given with the patient to make sure that they have been understood correctly.
·         Thank you: This is most important. Doctors must thank their patients for giving an opportunity to serve.

Doctors must also spread the message of “sutras” or one-line messages e.g. “Foods of plant in origin have zero cholesterol”, “Anything which is green and bitter is antidiabetic and antiobesity.”

Remember the ‘Formula of 10’ to save a life by using hands-only CPR and ‘Formula of 80’ for living up to 80 without a heart attack and teach them to patients.

Formula of 10 is “within 10 minutes of death (earlier the better), at least for at least 10 minutes, longer the better (adults 25 minutes and children 35 minutes), compress the centre of the chest of the deceased person continuously (uninterrupted) and effectively (1½ inch) with a speed of 10×10 = 100 per minute”.

Formula of 80: “Keep your heart rate, LDL cholesterol, fasting blood sugar, abdominal circumference and lower BP below 80”. For this, “walk 80 minutes a day, brisk walk 80 minutes in a week and walk 80 steps in a minute; keep PM2.5/10 levels below 80, do 80 cycles of parasympathetic breathing in a day; sit under the sun for 80 days in a year; do not take refined carbohydrates 80 days in a year.”

There are many systems of medicine in India. We need to respect each other. Let the patient choose.

Any sound, which is a combination of a vowel and a nasal consonant, is a healing sound. Chanting vowels produces interleukin-2, a natural painkiller, which is 200 times stronger than aspirin. Chanting nasal consonants produces delta activity in EEG, which produces tranquilizers and which tranquilize the mind.

The purpose of a doctor is to health with minimum number of medications. For this, he/she needs the help of patients.

You can view the video at: 

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Tuesday, August 14, 2018

Meditation is a journey ... The journey continues

1.    Is having a dialogue with Para Brahma
2.    Of experiencing critical mass effects
3.    Of knowing the unknown
4.    Of experiencing synchrodestiny
5.    Of experiencing meaningful coincidences
6.    Of experiencing spontaneous fulfilment of desires
7.    Of experiencing exaggerated telepathy
8.    Of experiencing exaggerated reverse telepathy
9.    Of experiencing a state of no enmity
10. Of experiencing a state of fearlessness
11. Of experiencing a state of truthfulness
12. Of experiencing a state of getting detached to the results of your actions
13. Of being able to spontaneously reduce the mental noise
14. Of being able to spontaneously neutralize or reduce the mental noise
15. Of being able to spontaneously ignore the mental noise
16. Of improving your concentration power
17. Of experiencing Tyaga
18. Of experiencing Vairagya
19. Of experiencing Sanyasi
20. Of understanding who we are
21. Of experiencing Aham Brahmasmi
22. Of experiencing Tat-tvam-asi
23. Of experiencing Pragnanam Brahma
24. Of achieving a state where God talks to you
25. Of achieving a state of Para Brahma, Para experiences and para language

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Monday, August 13, 2018

Heart attack is often the first manifestation of heart disease in young

Anant Bajaj, MD of Bajaj Electricals dies at 41

Anant Bajaj, managing director of Bajaj Electricals, passed away on Friday after suffering a cardiac arrest. He was only 41.

Coronary heart disease mainly occurs in patients over the age of 40, but younger men and women can be affected. An age cut-off of 40 to 45 years has been used in many studies to define “young” patients with heart disease or acute heart attack.

In the Framingham Heart Study, the incidence of a heart attack over a 10-year follow-up was 12.9/1000 in men 30 to 34 years old and 5.2/1000 in women 35 to 44 years old. The incidence of heart attack was eight to nine times greater in men and women aged 55 to 64 years. In other studies, 4 to 10 percent of patients with myocardial infarction were ≤40 or 45 years of age.

Although heart attacks are uncommon in young patients, yet they pose an important problem for the patient as well as the treating physician because of the devastating effect of this disease on the more active lifestyle of young patients.

Younger patients with heart disease more often have a family history of premature heart disease.

The most common and most modifiable risk factor in young patients is cigarette smoking. Cocaine use, factor V Leiden and oral contraceptive (females) use are other risk factors that are more common in younger individuals. Diabetes and hypertension are less common in young patients with heart disease in comparison to older patients.

The clinical presentation of heart disease in younger patients differs from that in older patients. A higher proportion of young patients do not experience chest pain and often heart attack is the first manifestation of heart disease. Younger patients have a higher incidence of normal coronary arteries, mild luminal irregularities, and single vessel blockage than do older patients.


lIf you can walk 500 meters in six minutes, you do not have significant underlying heart disease.
lEveryone should learn the life saving technique of hands-only CPR.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA