Wednesday, July 31, 2019

Suicidal ideation is a medical emergency: Types of indirect deaths (Part 1)



Dr KK Aggarwal

Café Coffee Day founder VG Siddhartha, who has been missing since Monday night, had reportedly written a letter to CCD staff, in which he mentioned about his financial struggles and his failed business model. In the letter, the coffee baron indicated that he was facing huge financial burden and was under tremendous pressure from one of his private equity partners. As reported in the Times of India, in the letter, he writes: "I am very very sorry to let down all the people who had put their trust in me. I have failed as an entrepreneur. I fought for a long time, but today I gave up as I could not take any more pressure from one of the private equity partners forcing me to buy back shares, a transaction I had completed six months ago by borrowing a large sum of money from a friend. Tremendous pressure from other lenders led to me succumbing to the situation... My intention was never to cheat or mislead anybody, I have failed as an entrepreneur. This is my sincere submission, I hope someday you will understand, forgive and pardon me...”

Several factors increase the risk of suicide, for example, living alone, unemployment, a recent sense of failure, childhood abuse and adverse childhood experiences, psychiatric disorders, medical illnesses, prior history of suicidal attempts or family history of attempted suicide. Suicidal ideation is also a risk factor for suicide.

Suicidal ideation is thinking about, considering, or planning suicide. Simply put, suicidal ideation means suicidal thoughts. Hence, identification of suicidal ideation is important for prevention.

There are two dimensions of attempt motivations: Internal motivation such as hopelessness, extreme emotional pain, a need to escape, and other distressing emotional or cognitive states. The other is communication motivation, such as a desire to communicate with, influence, or seek help from others. Understanding the motivation of the individual for suicide attempts also help prevents a suicide (Annu Rev Clin Psychol. 2016;12:307-30).

Sri Ramcharitmanas has described 14 traits, which if present, makes a person like dead even if he or she is alive. These traits were communicated by Angad to Ravana, when he went to Lanka as Rama’s emissary to Ravana with a message asking Ravana to return Sita.

सदा रोगबस संतत क्रोधी। 
बिष्नु बिमुख श्रुति संत बिरोधी॥ 
तनु पोषक निंदक अघ खानी 
जीवत सव सम चौदह प्रानी॥2  

भावार्थ:- नित्य का रोगी, निरंतर क्रोधयुक्त रहने वाला, भगवान्विष्णु से विमुख, वेद और संतों का विरोधी, अपना ही शरीर पोषण करने वाला, पराई निंदा करने वाला और पाप की खान (महान्पापी)- ये चौदह प्राणी जीते ही मुरदे के समान हैं॥2 

These 14 traits or the types of indirect death (tum mere liye mar gaye) are: Vama Margi (Kaul or the one who follows the path of tantra); Kamuk (full of Vasanas]; Krapan (Maha Kanjoos); Vimud (Murkha); Dradra ( poor); Ajasi ( Badnami); old (no intellect left); ever sick (Santata Krodhi ) always angry); Vishnu Vimukh (abuses Vishnu); Shrutu and Sant Virodhi (opposes Vedas); Tanu Poshak (Swartha) and adh Khani (the one who earns by sins)


जौं अस करौं तदपि  बड़ाई। 
मुएहि बधें नहिं कछु मनुसाई॥
कौल कामबस कृपिन बिमूढ़ा। 
अति दरिद्र अजसी अति बूढ़ा॥1 

भावार्थ:- यदि ऐसा करूँतो भी इसमें कोई बड़ाई नहीं है। मरे हुए को मारने में कुछ भी पुरुषत्व (बहादुरीनहीं है। वाममार्गीकामीकंजूसअत्यंत मूढ़अति दरिद्र,बदनामबहुत बूढ़ा,1

If the letter to CCD staff is correct, it sounds like a person who is at the end of his tether and would clutch at straws to solve a problem or to remedy the situation, but was not able to find any.

A person who is facing genuine financial difficulties or other such events needs help and not rejection. If no support is forthcoming and the person sees no way out, he or she may commit suicide. Timely support can prevent a crisis from becoming a tragedy.

Suicidal ideation is a medical emergency. All depressed patients must be specifically enquired about suicidal ideations.


Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA


IMA calls for nationwide 24-hour strike today to protest against NMC Bill 2019



Non essential services will be withdrawn from 6am today to 6am Thursday

Dr KK Aggarwal

The Indian Medical Association (IMA) has called for a strike today, across the country, to protest against the National Medical Commission Bill 2019 passed by the Lok Sabha on Monday.

All non-essential services will be withdrawn from 6 am on Wednesday, 31st July till 6 am on 1st August, Thursday. Emergency, Casualty, ICU and related services will function normally.

Public demonstrations and hunger strikes will be organized by all the state and local branches.

Approval of this undemocratic NMC Bill 2019 has jeopardized the healthcare and medical education in the country. It also provides for licensing of unqualified non medical persons enabling them to practice modern medicine, under Section 32 ‘Community Health Provider’ of the Bill.

“The Community Health Provider may prescribe specified medicine independently, only in primary and preventive healthcare, but in cases other than primary and preventive healthcare, he may prescribe medicine only under the supervision of medical practitioners registered under sub-section (I) of section 32.”

Patient benefit and safety is first and foremost for us. Now by getting a license, even persons without a medical background will be eligible to practice modern medicine and prescribe independently. This will promote quackery and endanger the lives of patients, especially the poor and the marginalized sections of the society.

IMA rejects the draconian NMC Bill 2019 in toto in its present format. It is unacceptable to us.

This Bill affects us all. It takes away our professional autonomy, which is not in the interest of society. Therefore, I request all of you to join in this protest and express solidarity with the movement.  



Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

Tuesday, July 30, 2019

Being overweight or obese in 60s may accelerate aging in the brain by a decade



Having a bigger waistline and a high body mass index (BMI) in your 60s may be linked with greater signs of brain aging years later, according to a study published in the July 24, 2019, online issue of Neurology, which suggests that these factors may accelerate brain aging by at least a decade.

Participants’ BMI and waist circumference were measured at the beginning of the study. An average of six years later, participants had MRI brain scans to measure the thickness of the cortex area of the brain, overall brain volume and other factors.

For waist circumference, which can be different for men and women, the normal weight group (BMI < 25), which was 54% women, had an average of 33 inches. The overweight group (BMI 25-30), which was 56% women, had an average of 36 inches, and the obese group (BMI ≥30), which was 73% women, had an average of 41 inches.

  • Having a higher BMI was associated with having a thinner cortex, even    after researchers adjusted for other factors that could affect the cortex, such as high BP, alcohol use and smoking.
  • In overweight people, every unit increase in BMI was associated with a 0.098 mm thinner cortex and in obese people with a 0.207 mm thinner cortex.
  • Having a thinner cortex has been tied to an increased risk of Alzheimer’s disease.
  • Having a bigger waist was also associated with a thinner cortex after adjusting for other factors.

Even the elderly should exercise. However a word of caution, if an elderly is walking or entering into an exercise program, he or she should have a cardiac evaluation to rule out underlying heart blockages. Older adults who exercise daily or stay physically active have better memory and thinking skills.

Walking is the best form of exercise; it requires no special training, no special equipment. Walking in natural environments such as parks also reduces mental stress and fatigue and improve mood via the release of the ‘feel good’ endorphins. This proximity to nature also helps in the inward spiritual journey and shifts one from the sympathetic to parasympathetic mode manifested by lowering of blood pressure and pulse rate.


Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

Use of smartphones for more than 5 hours daily increases risk of obesity



Dr KK Aggarwal

Use of smartphones for 5 or more hours daily increases the risk of obesity, suggests a new study presented at the recently concluded ACC Latin America Conference 2019 in Cartagena, Colombia.
Students who used their smartphones for 5 or more hours daily had a 43% increased risk of obesity and were more likely to have other lifestyle habits that increase the risk of heart disease.

Researchers analyzed 1060 students (700 women and 360 men with an average age of 19 years and 20 years respectively) of the Health Sciences Faculty at the Simón Bolívar University during June to December 2018.

·         Participating men were 36.1% likely to be overweight and 42.6% likely to be obese.
·         Women were around 64% likely to be overweight and 57.4% likely to be obese.
·         The risk of obesity increased by 43% if a smartphone was used 5 or more hours a day, as participating students were twice as likely to drink more sugary drinks, fast food, sweets, snacks and have decreased physical activity.
·         26% of the subjects who were overweight and 4.6% who were obese spent more than 5 hours using their device.

This rise in the incidence of obesity among people who use their smartphones for prolonged hours daily has been attributed to a decrease in physical activity.

Smartphones have become an integral part of our daily life now; one cannot imagine a life without them. They have certainly made life easy and convenient, but is life really better now than what it was before we all had a smartphone? This revolution has come at the cost of our health, both physical and social. People who use phones a lot seem to suffer from increased levels of feeling isolated, loneliness, depression and anxiety. Dependence on technology has adversely affected our memory and attention span. Terms like “text claw,” “Blackberry thumb,” “cellphone elbow”, “tech neck”, “nomophobia” are becoming a part of our conversations.

The above study is another in the list of emerging evidence about the negative repercussions of too much use of technology. There is a need to create awareness that excess use of smartphones or any gadget does not give enough time to relax between activities and rejuvenate, particularly mentally.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA