Thursday, January 31, 2013

CPR should be both effective and continuous

Conducting a camp on Hands Only Hands On CPR 10 camp at Lady Reading Nursing School, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India said that over 24 lakh people die in India every year because of cardiac arrest, 18 lakh of them die before they reach the hospital and 12 lakh can be revived by the bystander by learning the technique of Hands Only CPR 10.

Internationally, it is a must for every health care worker to learn Hands on CPR and renew their learning every year.

Conducting a camp where 150 nursing students were trained, Dr. KK Aggarwal said that nurses are the backbone of the society and are amongst the first ones to come in contact with a cardiac arrest victim in a health care setting. They should start CPR at the very onset of sudden cardiac arrest and not wait for the resident doctor to come. Call to the emergency team can be given by a ward boy or safai karamchari.

Most people die either because of bad performing CPR or low quality performance of CPR.

Following are the important factors:

1. Early recognition of sudden cardiac arrest by noting absence of respiration or gasping breathing.

2. Providing adequate and effective CPR by remembering the words “Push Hard and Push Fast” by focusing on the quality of chest compressions.

3. Allowing no interruption in CPR

4. Taking not more than ten seconds to check for pulse.

5. The rate of compression should be at least hundred compressions per minute.

6. The Chest should be compressed for at least 2 inches with each compression.

7. Chest should be allowed to recoil completely after compression.

8. Chest compression should only be given with a person on a hard bed or on floor.

9. To avoid rescuer fatigue, one may alternate the chest compressions.

10. If more than one rescuers are available, one should not attempt more than two minutes of resuscitation.

The Science behind Violent Communication – The Hate Speech by Owaisi

The hate speech by MIM leader Akhruddin Owasi prompted me to revisit the subject of non-violent communication. The basic Vedic teaching is that we should be non-violent in our thoughts, action and speech.

The violent speech is often described with 3 Cs i.e. condemnation, complaint and criticism. Anything which is based on facts, spoken as it under quote unquote, and is based on observations is non-violent in nature.

For example, if you are to talk about a leader, say XYZ, you should start with ‘in my opinion’ this leader is perfect in all respect. If you do not personalize your remarks, it will amount to making judgments which means that we want all our listeners to agree to our views which may create conflict and end up into violence.

One should always give benefit of doubt while communicating. For example, never say “he insulted me” but always say that “he spoke some words and I got hurt”.

Lord Buddha described three components of right speech – (1) is it the truth? (2) is it necessary? and (3) is it kind? The current speech of Owaisi may have been his personal opinion but the way it was communicated, it made his communication violent and he ended up in jail. His statements were neither based on facts, nor were necessary and kind.

Gossip which is talking about somebody in his or her absence without facts is another form of violent communication.

Recall a few recent statements of people which created controversy. A recent statement by an Indian politician that Biwiyan umar ke saath dhal jaate hain, may be his personal opinion but the way he had put it, it became a judgmental statement which was rejected by the collective consciousness of the people.

The recent statement of a soc called spiritual Guru that Taali ek haath se nahin bajti, again is a violent communication. The recent statement of RSS Chief that rapes happen only in India and not in Bharat, is also a violent communication as it was not based on facts.

In health advertisements, it is always taught to us that whenever we are communicating a message, it should be in the language of the public which they can understand, based on facts, is necessary and is field tested. The words ‘field tested’ involve that you randomly get the statement vetted by people across the population and see to it that it is acceptable. If the statement is rejected by the collective consciousness of the group you have surveyed, it is likely that it will be rejected by the collective consciousness of the entire population and should not be spoken.

It is clearly written in mythology that the words are like arrow in a bow, once released they never come back.

Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA

You Can Die Because Of Treatment and Availability of Medical Technology

Medscape gives the following ten examples

1. Surgical Fires: There are an estimated 600 surgical fires per year in US alone leading to devastating consequences, including disfigurement and death. The fire triangle is oxidizers, ignition.

2. Texting While Performing Surgical Procedures:Mobiledevices now make it easier for clinicians to be interrupted for non-work-related reasons. Half of the respondents to a 2010 survey of perfusionists acknowledged texting during heart-lung bypass procedures 2]with 15% further admitting that they accessed the Internet and 3% reporting that they visited social networking sites during procedures. These devices can can divert the caregiver’s attention away from the patient or the task at hand.

3. Dirty Endoscopes and Surgical Instruments: Cross-contamination hazards can occur when flexible endoscopes aren’t properly reprocessed.

4. Using Technology for Adults on Children: Technology designed for adults are used on children as no alternatives exist. They can be risky

5. Air Embolism Hazards: Intravascular air embolism is a potentially lethal complication of certain medical and surgical procedures. The largest percentage of reported events is associated with the use of central venous access devices.

6. Devices and IT Systems That Don’t Interface: Interfaces between medical devices don’t always function as intended and can allow dangerous conditions to exist. For example monitoring system may not communicate audible or visual alarms from an interfaced ventilator to warn caregivers of a critical patient circuit disconnection.

7. Patient Data Errors in EHRs and Health IT: One patient’s data can end up in another patient’s record.

8. Radiation Burns From Diagnostic Radiology Procedures: Inappropriate use and dose levels of CT can lead to unnecessary radiation exposure for patients. Image quality typically improves as the dose increases. As a result, there is a tendency to use higher doses that are associated with greater risk to the patient. Acute reactions such as radiation burns and hair loss are relatively rare but still occur too frequently.

9. Medication Administration Errors Using Infusion Pumps: Infusion devices are the subject of more adverse incident reports to the US Food and Drug Administration than any other medical technology, according to the Association for the Advancement of Medical Instrumentation. From 2005 through 2009, more than 700 deaths associated with infusion devices were reported.

10. Alarm Hazards Alarms on infusion pumps, ventilators, and other devices; sheer number of alarms in a hospital can overwhelm staff, leading to complacency and delayed response. Caregivers often turn down the volume of alarms. Too many alarms sounding, can lose its purpose.

Ask Dr KK: I am an asthmatic. Do I need steroid inhalers? My age is 19 years.

Ans: Remember the formula of 2. If you get asthma attack twice in a month in night or twice in a week in day time or if you consume more than 2 canisters of inhaler in a year, you need continuous treatment with bronchodilator along with an inhaled steroid.

Wednesday, January 30, 2013

Bharat versus India

Dr. DPS Toor is a surgeon friend of mine who always says that he practices in ‘Bharat’ and not in ‘India’. He provides all surgeries @ Rs. 6,000/- .

His concept was appreciated by me and I also started dividing my society into ‘India’ and ‘Bharat’. For me, Indians are the ones who live a western lifestyle and the Bhartiya are the ones who follow the traditional Bhartiya lifestyle observing all customs and rituals.

There are diseases linked to western life style and culture and were absent in our mythology era. The examples are heart attack, diabetes, blood pressure etc. People who observe traditional mythological fasts and do not eat cereals on the fast days do not or suffer less from lifestyle disorders.

Statement of RSS Chief Mohan Bhagwat that ‘rapes happen inIndiaand no in Bharat’ is not acceptable to the society and, therefore, became a controversy of the country. The collective consciousness of the people rejected this statement.

Even in our mythological era, we had cases of abduction (not rape) both in Mahabharata and Ramayana.

In the era, when India was ruled by Emperors, in some cases, cases of a newly married women forcibly spending her first night with the emperor has been described in the history.

Medically, sexual urges have nothing to do with poverty or westernization. Sexual urges are universal phenomenon.

If you see the statistics ofDelhi, maximum cases of pending sexual assault are seen in North East Delhi (152) and North West Delhi (154). Out of 1034 cases pending inDelhi, 25% belong to these two areas. In both these areas, we have a large number of JJ Clusters.

Also over 70% cases of sexual assault cases are reported from JJ clusters.

Whether ‘Indian’ or ‘Bharatiya’, every girl in the society has a right and has the freedom to live the way she wants and with a right to be safe.

Dead Rat in Hostel Meal, Kids Take Ill

Some children took severely ill when a dead rat was allegedly found in dinner served at a government residential school in Hardauli village in Banda district on Sunday. The students started vomiting after which a team of government doctors was rushed to the school. The students are feeling better now reports TOI.

In this case it looks like the people vomited after they came to know about the rat and not because of the rat poisoning. If the rat is boiled and cooked in the food it cannot cause poisoning. If a dead rat is put in the boiled food again it is unlikely to cause poisoning. In any way if it was poisoning it was staph bacteria poisoning, which is self-limiting and causes no death.

One can classify food poisoning depending on the onset of symptoms as follows:

Rapid symptoms within 6-12 hours: are due to organisms that make a toxin in the food before the food is consumed. Symptom is predominantly vomiting. Examples are Staphylococcus aureus, Bacillus cereus emetic toxin and botulism.
Symptoms after 24 hours: are due to pathogens that make toxin once they have been ingested. They mainly cause diarrhea that may be watery (Vibrio cholerae or E. coli) or bloody (Shiga toxin-producing E. coli).
Symptoms after variable time: are due to microbes that cause pathology by either damaging the epithelial cell surface or by actually invading across the intestinal epithelial cell barrier. They can produce a wide spectrum of clinical presentations from watery diarrhea (Cryptosporidium parvum, enteric viruses) to inflammatory diarrhea (Salmonella, Campylobacter, Shigella) or systemic disease (L. monocytogenes).

Food poisoning can also be classified depending on the type of symptoms vomiting or diarrhea. A sudden onset of nausea and vomiting is likely due to the ingestion of a preformed toxin, such as S. aureus enterotoxin or B. cereus emetic toxin, or a chemical irritant. There is no risk of person-to-person spread.

When the poisoning presents with diarrhea, the organisms are V. cholerae, Clostridium perfringens, enterotoxigenic E. coli, B. cereus, rotavirus, astroviruses, enteric adenoviruses and Noroviruses, and the parasitic organisms, Cryptosporidium parvum and Cyclospora cayetanensis.

There are clinical clues that should increase suspicion that a food-borne microbe is causing inflammatory diarrhea. Such symptoms and signs include: Passage of diarrhea with blood or mucus; presence of severe abdominal pain and occurrence of fever. The most likely pathogens in patients with inflammatory diarrhea are Salmonella or Campylobacter.

Monday, January 28, 2013

Paste CPR mantra in every notice board of schools

Conducting a Hands Only Hands on CPR 10 camp at St. Froebel Public School, Paschim Vihar, Padamshri & Dr. B C Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA, said that origin of CPR in our country goes back to our mythology when Savitri saved Satyavan as the first person in the history of mankind.

Over 1000 school children were trained on the spot.

Dr. Aggarwal said that the CPR mantra “within 10 minutes of death (earlier the better), at least for the next 10 minutes (longer the better – upto 25 minutes in adults and 35 minutes in children), compress the centre of the chest of the victim effectively and continuously with a speed of 10x10 i.e. 100 per minutes” should be pasted in every school and college wall. He said that all security persons, PCR vans should be taught Hands Only CPR because they are the first ones to arrive whenever there is a incidence of sudden death. Dr. Aggarwal said that CPR technique should be incorporated in the school syllabus.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 26098 people since 1^st November 2012.

Were we more western in our mythological era?

The answer is ‘yes’.

India was much more advanced than today’s western culture in our mythological era. Following are the examples:

There were incidents of unmarried pregnancy (Kunti in Mahabharata); of polygamy i.e. a person having more than one wife (Dashrath) and polyandry i.e. a woman having more than one husband (Draupadi); of separation without divorce (Ram and Sita); of live-in relationship (Radha and Krishna, they are still worshipped today together in any temple0; OF fight between brothers (Mahabharata); of fights for properties (Mahabharata); of friendships with girls (Krishna).

One way to understand mythology is to co-relate it with the human body mind and soul with internal Ramayana or internal Mahabharata where Krishna and Rama both indicate consciousness and Kans and Ravana as ego.

But if we take them as the human beings, then probably they live in more advanced era.

There were examples of brain transplant (Ganesha), surrogacy (birth of Balrama), IVF (birth of Kartikaya), asexual reproduction through pluripotent stem cells (Ganesha) and IUI (birth of many via Bhabhuti)

These are only personal views of the author.

Help the victim do not worry about the police

The Delhi Police have released an adv assuring citizens they can now rush a trauma victim on city roads to hospital and leave immediately, with or without revealing their identity.

The adv says “The priority is the victim. So, now save a life readily, it is free of harassment.”

It reads: When seconds count, questions don’t.

Saving an accident victim is now easy. The very first golden hour is critical, it decides the victim’s fate.

Police is also reaching out to hospital staff and doctors.

Doctors have no business questioning a Good Samaritan. They should focus on the victim. There’s no need to wait for the police to reach the hospital before accepting a medico-legal case.

There are clear directions from the Supreme Court that doctors in government and private hospitals must promptly attend to accident victims without waiting for the police to arrive. [Source TOI]

The link between Om Shanti Om and 3 Idiots

Both the movies talked about the main importance of life. While 3 Idiots tells that one should listen from the heart.

When you listen from the heart, you may face difficulties but you can make impossible as possible by following the lesson from the Movie Om Shanti Om which tells, “Kehte hain agar kisi cheez ko dil se chaho to saari kayanath tumhe usse milane ki koshish me lag jaati hai…”.

This is what the principle of Synchrodestiny is. Whatever you decide honestly and if it is positive automatically people start getting attached to it to make it a success. Anna Hazare’s movement against corruption is a classical example. He came with a common cause to fight corruption and everybody started joining him.

IMA Suggestions for Health Budget 2013-2014

A meeting on the Health Budget for the year 2013-14 was held on 21^st January, 2013 at IMA House. The following were present:-

Dr Narendra Saini, Hony Secretary General, IMA; Dr D R Rai, Sr. National Vice President, IMA; Dr K K Aggarwal, National Vice-President (Elect) IMA; Dr Atul Arora, Hony. Joint Secretary, IMA; Dr Nipun Choudhury, Apollo Hospital; Dr Atul Gandotra, Consultant Pharmaceutical; Dr S C Pandey, Central Govt. Hospital; Dr K K Kalra, NABH; Dr Chander Prakash, Sunder Lal Jain Hospital; Dr Girdhar Gyani, AHPI; Dr Vijay Aggarwal, PCH; Dr Zainab Zaidi, NABH; Dr B K Rana, NABH ; Dr Vijay Kohli, DMA; Dr R K Katharya, Hony Joint Secretary, IMA; Dr R K Gupta, Hony. Joint Secretary, IMACGP; Dr K K Kalra, NABH; Dr B K Rao, SGRM; Dr M K Singhal, IMA Rohini IMA; Dr Kalra, MS Hedgewar Hospital ; Mr Atul Gandotra; Dr Himanshu Jain, HRH and Dr M Bakshi, HRH

Basic issues

1. Food security, primary education, primary justice and primary healthcare are the minimum requirement of common man.

2. Health care needs coordinated effort of all healthcare workers.

3. The benchmark set for the standard health care: accessible, affordable and quality health care.

4. Current situation: Central Budgetary allocation of health- 0.9% of GDP; State expenditure on health- 5.5% of the budget; Central funding in the state for public health- 15%; 75-80% out of pocket expenditure; 70% of patients are managed by private sector and around 15 lakh doctors only 1.5 lakh in Govt.

IMA Recommendations

Health care Status

a. Health should be given infrastructure status and should be notified.

b. No commercial rates for electricity and water consumption for healthcare sector. It should be flat domestic rate without any slabs.

c. Upgrade districts hospitals to medical colleges or super- specialty hospitals.

d. Encourage PPP

e. Incentives for healthcare infrastructure providers: tax holidays, income tax rebates, provision of cheap medicine and instruments.

f. Easy Visa for patient who want to come for treatment from other countries.

Health budget allocation

a. Increase the budget for the Health to 2.5 % of GDP as envisaged in National Health Policy 2002.

b. No allocated funds for equipments, schemes, campaigns, projects should lapse. Accountability should be there.

c. Increased budgetary provisions for: drugs in govt. hospitals (at present only 15%); non communicable diseases; disease surveillance; safe drinking water; sanitation; mental health; child and maternal health; geriatric care; cancer.

d. Separate new fund provisions for reimbursements of emergency treatment given in private sector; for production of indigenous drugs, equipments and products.

e. More fund allocation for telemedicine and mobile units.

f. More fund allocation for new medical, nursing, dental and paramedical colleges.

g. Generic medicine should be available freely and their retail price should be properly monitored.

Taxes, custom Duty

a. Tax rebate on Preventive health check-up and health insurance at present is Rs.10,000 it should be increased to Rs. 25,000

b. Zero duty on medical equipments, drugs and reagents. Govt. get only Rs. 2 24 crore as duty through life saving equipment which is a meager amount.

c. Research and development should be given tax rebate. Special incentive should be provided for R & D.

d. No tax should be imposed on indigenous medicine and equipments.

e. Hospital should not be treated as “commercial venture” so property tax and land taxes should be charge as normal taxes.

f. Income tax free income for doctors willing to serve the rural areas.

g. Income tax reliefs for doctors who document 10% free service in their practice.

2. Insurance

a. Remove Service Tax on Medical Insurance.

b. Free insurance for the elderly

c. Soft loans for medical education and for opening of medical establishment.

d. Micro insurance (low premium for low income group) must be addressed.

Sunday, January 27, 2013

Congrates and saluates to all Padma Awardees Doctor of the year 2013

Padma Bhushan
Dr. Maharaj Kishan Bhan, Civil Service, Delhi

Padma Shri

Dr. Sudarshan K. Aggarwal, Medicine, Delhi
Dr. C. Venkata S. Ram alias Chitta Venkata Sundara Ram Medicine, Andhra Pradesh
Dr. Rajendra Achyut Badwe, Medicine, Maharashtra
Dr. Taraprasad Das, Medicine, Orissa
Prof. (Dr.) T.V. Devarajan, Medicine, Tamil Nadu
Prof. (Dr.) Saroj Chooramani Gopal, Medicine, Uttar Pradesh
Dr. Pramod Kumar Julka, Medicine, Delhi
Dr. Gulshan Rai Khatri, Medicine, Delhi
Dr. Ganesh Kumar Mani, Medicine, Delhi
Dr. Amit Prabhakar Maydeo, Medicine, Maharashtra
Dr. Sundaram Natarajan, Medicine, Maharashtra
Prof. Krishna Chandra Chunekar, Medicine, Uttar Pradesh
Dr. Vishwa Kumar Gupta Medicine (Homeopathy), Delhi

Friday, January 25, 2013

My answer is yes, not tell me your problem

This was the best statement I have ever come across in my life. One of the medical superintendents at Moolchand Hospital when he joined had this statement on the wall above his head. It clearly indicates that he was sitting to solve the problem and not to create problems.

If all the service provider agencies follow this statement, the scenario of the country can change. Our job should be to solve the problems and not find mistakes. None of us is 100% truthful, honest or hardworking. Each one of us will have some positive points and some negative points. Our job should be to remove our negative points and convert them into positive.

Remembers SWOT analysis taught in marketing i.e. “Strength, Weakness,Opportunityand Threat”. Our job should be to convert our weakness into strength and threat into opportunities.

Can Blood Pressure Be Higher In One Arm?

A small difference in blood pressure readings between arms is normal. However, a difference of more than 20 mm Hg for systolic pressure (top number) or more than 10 mm Hg for diastolic pressure (bottom number) can be a sign of an underlying narrowing of the main arteries to that arm.

A difference of 10 to 15 mm Hg for upper systolic pressure that shows up repeatedly is a risk marker for vascular disease and future heart attacks.

Always have your doctor check your both arms for blood pressure and whichever is higher, use that arm for future blood pressure readings.

Thursday, January 24, 2013

CPR Training Camp at St Mathew Public School, Paschim Vihar

At St Mathew Public School, Paschim Vihar, New Delhi, Conducting a CPR Camp Padma Shri and Dr BC Roy National Awardee Dr. K K Aggarwal, President, Heart Care Foundation of India and National Vice President Elect IMA said that even physically and mentally challenged students can learn CPR.

Dr Aggarwal said that every chowkidaar, Security Guard, Ward Boy and helpers in Healthcare setting should be trained in CPR so that hospital can provide resuscitation right at the gate.

Mrs Anita Sethi Principal of the school said that over 400 students were trained today. She said that the Guru Dakshina which students can give is to make 10 other people learn the CPR10 mantra –

“within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

Think positive and think different

The Mantra to acquire spiritual health is to think positive and differently. When you think positive, it creates positive hormones and takes you from sympathetic mode to parasympathetic mode. When you think different, it gives you opportunities and from multiple options available, you can ask your heart to choose one of them.

Thinking positive was a message given by Lord Buddha and thinking different by Adi Shankracharya.

The candle light march which was done for fighting justice in Jessica Lal murder case has been picked up by most of the protest campaigns because it was positive and different.

I have seen three examples in my life where I used this and prolonged the life of those persons. My grandfather-in-law at the age of 85 thought it is time to go but when we made him work positively and differently, he die at the age of 100 years. He was asked to teach youngsters law, write to Prime Minister everyday on certain issues and find matrimonial matches for the youngest persons in the family.

In other two cases, one was suffering from terminal prostate cancer and the other terminal brain cancer. The first one lived for ten years and the other is still alive.

Both were told that they had a very early cancer and that was cured by a surgery.

When you think different, it creates creativity and when it is with positive attitude, it is accepted by all.

Treatment of Fatty Liver

Treatment of Fatty Liver

• 10 % weight loss can improve fatty liver and possibly inflammation.
• Metformin and ursodeoxycholic acid are not recommended.
• Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
• Omega-3 fatty acids have been tried
• Pioglitazone is useful in the treatment of biopsy-proven fatty liver with inflammation
• Vitamin E at a dose of 800 IU/day improves liver inflammation
• Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.

Wednesday, January 23, 2013

What is the difference between smile, hug and laugh.

Smile is a sign of joy while hug is a sign of love. Laughter on the other hand is a sign of inner happiness. None of them are at the level of mind or intellect. All comes from within the heart.
They are only the gradations of your expressions of your happiness.
It is said you are incomplete in your dress if you are not wearing smile on your phase.
Hug comes next. And laughter the last. Laughter is like an internal jogging and has benefits like that of doing meditation.
But be careful we must know when not to laugh. The most difficult is to laugh on oneself.

Flu fighting foods

Beyond the flu shot, and avoiding physical contact like handshakes one can also build up the immune system with foods.

1. Proteins is lean meat, poultry, seafood, eggs, beans and soy products can boost immunity

2. Vitamin A protects from infections and is present in colorful carrots, kale, spinach, sweet potatoes, and red bell peppers.

3. Vitamin C boosts immunity and is present in citrus fruits.

4. Vitamin E in nuts works as an antioxidant neutralizing free radicals. Throw in some almonds or sunflower seeds for a little healthy Zinc. Other sources are lean beef, crab, black eye peas and tofu! [Source Medline Plus]

Tuesday, January 22, 2013

CPR 10 training at School at Janakpuri

Conducting a CPR 10 Camp at Modern Era Convent School, Janakpuri, Padamshri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA said that in last 2 ½ months at least two lives have been saved by public who has learnt Cardiopulmonary Resuscitation.

Dr. Aggarwal said that 50 people die every day in Delhi of a cardiac illness and 5-6 lives should be saved every day if general public learns CPR. He said that Heart Care Foundation of India plans to train one lakh people within this year.

Over 1200 school children were trained in CPR which is based on the mantra – “within 10 minutes of sudden cardiac death (earlier the better) for the next 10 minutes (longer the better) compress the centre of the chest of the victim with a speed of 10 x 10 i.e. 100.”

Addressing the gathering Ms K.G. Modi, Principal of the school said that as a good Samaritan, it is the duty of every teacher to learn CPR and in turn train parents and school children so that every child learns that CPR 10 training is not only for organization but is also for each and every person and family.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

Doctors are for patients safety

Doctors are for patient’s safety and properly documented medical doctors are for doctor’s safety was the concluding remarks of the JCI team who recently concluded their inspection at Moolchand Medcity.

The importance of timely and accurate documentation cannot be over emphasized.

Imagine you are on the round and you say to your junior that this patient is suffering from a rare fungal brain infection but you fail to document the same. In the evening round your another junior thinks the same but documents it on the record. When the case report is published the name of your junior will be before your name. On paper it will be taken as his research and not yours.

Believe in Jangal Me Mor Nacha Sabne Dekha.

All of us come across lot of instances where we say “didn’t I say this last week what’s new if the politicians are talking about it today”. If you have an idea document it.

In terms of medical records thy can save one from medico legal problems.

Exercise: a prescription

1. Reduces the chances of getting heart disease. For those who already have heart disease, exercise reduces the chances of dying from it.

2. Lower the risk of developing hypertension and diabetes.

3. Reduce the risk for colon cancer and some other forms of cancer.

4. Improve mood and mental functioning.

5. Keeps the bones strong and joints healthy.

6. Helps you to maintain a healthy weight.

7. Help maintain independence into later years

8. Age is no bar; there is abundant evidence that exercise can enhance health and well-being. But today for most watching TV, surfing the Internet, or playing computer and video games is replacing the helpful exercises.

9. The minimum threshold for good health is to burn at least 700 to 1,000 calories a week through physical pursuits.

10. Exercise improves health and can extend life. Adding as little as half an hour of moderately intense daily physical activity can help one avoid a host of serious ailments, including heart disease, diabetes, depression, and several types of cancer, particularly breast and colon cancers.

11. Regular exercise can also help one sleep better, reduce stress, control weight, brighten mood, sharpen mental functioning, and improve sex life.

As per Harvard researchers a well-rounded exercise program must have all the four components-

1. Aerobic activity

2. Strength training

3. Flexibility training

4. Balance exercises

Aerobic activity: is the centrepiece of any fitness program. Most benefits of exercise revolve around aerobic cardiovascular activity, which includes walking, jogging, swimming, and cycling. One should work out at moderate intensity when performing aerobic exercise—brisk walking that quickens the breathing is one example. This level of activity is safe.

Strength training protects bone: Strength or resistance training, such as elastic-band workouts and the use of weight machines or free weights, are important for building muscle and protecting bone. Bones lose calcium and weaken with age, but strength training can help slow or sometimes even reverse this trend.

Flexibility exercises ease back pains: Muscles tend to shorten and weaken with age. Shorter, stiffer muscle fibres make one vulnerable to injuries, back pain, and stress. But regularly performing exercises that isolate and stretch the elastic fibres surrounding the muscles and tendons can counteract this process. And stretching improves posture and balance.

Balancing exercises prevents fall: Balance erode over time, and regularly performing balance exercises is one of the best ways to protect against falls that lead to temporary or permanent disability. Balance exercises take only a few minutes and often fit easily into the warm-up portion of a workout. Many strength-training exercises also serve as balance exercises. Or balance-enhancing movements may simply be woven into other forms of exercise, such as tai chi, yoga, and Pilates.

Patient treated and then referred from a private hospital or other Government hospital with complications of surgery or delivery or bleeding, where the cause of death is unexplained.

Relatives of the patient assault the treating doctor or other staff of the hospital.
Any other case not falling under the above mentioned category but has legal implications like medical examination of arrested accused without consent of person.

In case of death of a medicolegal case, the treating doctor has to only handover the body to the concerned police officer with written recommendation for medicolegal (Forensic) autopsy in final death summary/discharge report and a receipt must be obtained for record.

Sunday, January 20, 2013

eMedinewS Revisitng 2012: Document your medical records carefully, punctually and timely

Inaugurating a daylong conference, eMedinewS Revisiting 2012, organized by eMedinewS, Heart Care Foundation of India and World Fellowship of Religions, Dr. A.K. Agarwal, President, Delhi Medical Council, said that all doctors should document their medical records, carefully, punctually and timely. He said that doctors are for patient’s safety and medical records are for doctors’ safety. He said as far as possible, doctors and medical establishments should go for electronic records so that chances of mistakes are lower.

The conference was attended by over 1000 doctors from NCR. Briefing about the conference, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & Vice President Elect IMA, said that eminent faculty participated in the conference and listed the happenings in the year 2012.

The faculty included: Dr Brig A K Dhar, Dr. AS Bath, Dr Ambrish Mithal,Dr Anil Goel, Dr Ashish Jain, Dr Deepak Khurana, Dr Ganesh Mani, Dr IM Chugh, Dr. JPS Sawhney, Dr Kaberi Banerjee, Dr Kailash Singla, Dr Manju Gupta, Dr NK Bhatia, Dr Neeraj Jain, Dr Praveen Chandra, Dr PC Joshi, Dr Praveen Bhatia, Dr Rajnish Malhotra,Dr SK Parashar, Dr Sanjay Chaudhary, Dr Sukhendy Roy, (Maj.Gen) Dr. SK Mittal, Dr Vivek Bhatia and Dr Yugal Mishra.

Following were the highlights:
1. It is now possible to give a blood transfusion to a person without getting in any blood transfusion reaction.
2. Nobody should suffer from pain and it is possible to get rid of painkillers in 2-3 months’ time.

3. It is now possible to do an aortic valve replacement without surgery using a catheter.
4. It is now possible to save 40 lives from a brain dead donor.
5. Intestinal transplant is now possible in the country.
6. If you have one ova and one sperm, fertility is now possible.
7. Midline incision in the chest is no more required for bypass surgery and for valvular surgery.
8. It is now possible to combine the bypass surgery with stent angioplasty in one sitting and give better results to the patients.
9. It is now possible to do cataract surgery practically without stitches and with near normal vision without spectacles.
10. It is now possible to do surgery in very high obesity using a robot both in adult and in children successfully.
11. With capsule endoscopy it is now possible to examine small intestine of a patient.

Doctor of the year awards were also distributed and the recipients included:
Dr. Ramesh Kumar Bapna, Dr. Harish Gupta, Dr. Narender Saini, Dr. (Maj. Gen.) AS Bath, Dr. JPS Sawhney, Dr. SM Chugh, Dr. Naveen Tuli, Dr KS Bhagotia, Dr Sukrit Sharma, Dr SK Mittal and Dr AK Bansal

Saturday, January 19, 2013

Maha Kumbh: Period of Holy Baths (Makarsankranti To Maha Shivaratri)

The ancient sage knew that Indians are prone to vitamin D deficiency and made rituals to prevent them in the form of “snans or holy baths in sun” at sun rise or sunset.

The ritual is “Maha Kumbh” held every 12 years, “Ardha Kumbh” held every Six years or “ Mii Kumbh held in on Kumbh years) in the months of January- February, on the banks of the holy confluence (Sangam) of rivers Ganga, Yamuna and the mythical Saraswati.

During this period a tent city comes up for more than a month, where large number of devotees live for the whole duration of the mela and lead a sacred life. This is called KALPAVAS and these people are called KALPVASEE.

The main bathing days are Makar Sankranti, Paush Purnima, Mauni Amavasya, Basant Panchmi, Maghi Poornima and Maha Shivratri. Mauni Amavasya being the main bathing day attracts the largest number of devotees.

Other than Magh month other auspicious months for holy bath are the months of Vaisakh and Kartik.

The ritual is holy bath in the Brahma muhurta (the period with maximum non toxic UVB) rays and eating calcium rich foods.

The spiritual recommendation has been to have 1, 2 or 3 baths per day. If one should be sun rise and if two sun rise and sunset and if three the additional being in the mid day.

Facts about vitamin D

1. Vitamin D deficiency causes severe bone loss in adults across northernIndiadespite abundant sunlight in the region.

2. The factors are inadequate exposure to sunlight and poor nutrition.

3. The resultant disease is osteomalacia, the loss of calcium from bones brought about by vitamin D deficiency.

4. It can lead to life threatening emergencies in young adults. The examples are acute respiratory failure caused by a grossly deformed thoracic cage resulting from advanced bone loss in the spine and thoracic cage and pregnant women with poor intake of calcium and excessive demand leading to bone pains.

5. Over 50% of healthy people have low vitamin D levels.

6. Sun is the main source of Vitamin D.

7. Human body makes Vitamin D when sunlight touches the bare skin.

8. However, too much exposure to direct sunlight increases the risk of skin cancer and premature aging of the skin.

9. Despite the harmful effects up to 40 minutes of sunlight per day, is actually good for the health.

10. The sun gives off three types of ultraviolet radiation based on the wavelength: UVC – 100 to 290 nm; UVB – 290 to 320 nm and UVA – 320 to 400 nm.

11. It’s the ultraviolet B rays which produces vitamin D in the body and also responsible for sunburns.

12. It is most intense between 10:00 am and 2:00 pm when the sunlight is brightest. It is also more intense in the summer months accounting for 70% of a person’s yearly UVB dose.

13. UVB does not penetrate glass and cotton cloths.

About the author: Dr K K Aggarwal is Padma Shri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA.

Deep Frying Of Potato Can Cause Cancer But Soaking Potatoes in Water before Frying Can Nullify These Effects

A study has shown that soaking potatoes in water before frying cuts down on the formation of the suspected carcinogen acrylamide.

Acrylamide is created when starch-rich foods are cooked at high temperatures, (120 C) such as frying, baking, grilling, broiling or roasting. Raw or even boiled potatoes test negative for the chemical. Boiling and microwaving appear less likely to form acrylamide as the coking does not involve very high temperatures. Longer cooking times increase the amount of acrylamide produced when the temperature is high enough.

Potato chips and French fries contain high levels of acrylamide compared to other foods, with lower levels also present in bread and cereals.

Acrylamide, is harmful to health and may cause cancer in animals.

In a study published in Journal of the Science of Food and Agriculture it has been found that simply soaking potatoes before frying can significantly reduce the formation of acrylamide. The researchers tried three different approaches. They washed raw French fries, soaked them for 30 minutes, and soaked them for two hours. This reduced acrylamide levels by up to 23 percent, 38 percent and 48 percent, respectively, but only if the fries were cooked to a light color. It’s not clear whether the same reductions could be achieved if French fries are cooked to a deep, dark brown.

The cooking and re-cooking of fried foods in the same fry pan or broiler is the main cause. Even the thoroughly washed iron skillet can continue to contain submerged carcinogens collected from previous use. Most restaurants uses the same rancid cooking oil for days or even weeks and even reusing it after washing the pot.

Traditional ayurveda has been advocating against deep frying and has been advocating low temperature cooking for centuries.

However occasional consumption of these products is not likely to be a health concern. Apart from foods, cigarette smoking is the other source of acrylamide.