Supreme Court decriminalizes Section 377: Heart Care Foundation of India welcomes this historic judgment

'Section 377 is irrational, arbitrary and incomprehensible', says Supreme Court.

In a historic and unanimous judgment, the Supreme Court of India has decriminalized section 377 of the Indian Penal Code (IPC), as per which homosexuality is a punishable offence. The five-judge constitutional bench was unanimous in its decision.

The medical community has always considered homosexuality as a normal and natural phenomenon and not a disease or crime.

It becomes important now for a medical doctor to know if the person is a LGBT. Till now, many of them did not come forward and disclose their orientation fearing the law.  

The job of a doctor or the judiciary is to change with the changing times and broaden, delete or re-interpret the laws as per the changing needs of the society.

It is indeed heartening to note that the Court is now coming to the rescue of people, which will help reduce the mental and social disorders in the society.

Following are some key observations of the Supreme Court (TOI).

“Progressive and pragmatic view should be taken by the court to come to the rescue of the oppressed section of society. The law must be interpreted as per the requirement of changing times”, says Supreme Court.

“The court must try to protect the dignity of every individual of the society, including people from LGBT community. Sexual orientation is natural and people have no control on it.”

“Consensual sex between adults in private space, which is not harmful to women or children, cannot be denied as it is a matter of individual choice.”

“It amounts to a retrograde step if we accept the verdict on criminalizing gay sex”

“Section 377 of the IPC was a weapon to harass members of the LGBT community, resulting in discrimination.”

“Any kind of sexual activity with animals shall remain penal offence under Section 377 of the IPC.”

SC terms “sexual orientation as biological phenomenon, says any discrimination on this grounds is violative of fundamental rights.”

“Constitution nurtures dissent as safety valve of society, we can't change history but can pass way for better future.”

Chief Justice Dipak Misra: “Sustenance of identity is the pyramid of life. Right to privacy as part of right to life applies fully to LGBT community. Suresh Koushal judgment of SC in 2013 is retrograde.”

Justice RF Nariman: Homosexuality is not a mental disorder, which has been also recognised by Parliament. Centre must give wide periodic publicity to the SC judgment to eliminate stigma attached to LGBT community.”

Justice Chandrachud: “State has no business to get into controlling the private lives of LGBT community members or for that matter, any citizen... Decriminalising gay sex is only the first step to bury the Colonial Ghost, adding that time has come to move forward and give the LGBT community the other constitutional rights…Denial of right to sexual orientation is akin to denial of right to privacy.”

Justice Indu Malhotra: “History owes an apology to members of LGBT community and their families for ostracisation and persecution they faced because of society's ignorance that homosexuality is a natural trait; its penal suppression infringes a host of fundamental rights.”

Related links

·         http://kkaggarwal.com/Editorial/homosexuality-is-not-a-medical-disorder/

·         http://kkaggarwal.com/Editorial/court-has-a-duty-to-strike-down-law-if-it-violates-fundamental-right-sc/

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

Who is a teacher?

Sadhu, Sant, Rishi, Pandit, Acharya, Mahatma, Parmatma are different types of teachers described in literature.

The knowledge you seek, depends on your learning objectives; whether you want to satisfy your indriyas or mind, body and soul or attain ananda.

A teacher is one who takes us to true knowledge, which can be knowledge of self as well as of the subject. The knowledge so gained must be used for the benefit of all and it should not harm anybody. To understand it and discriminate between the knowledge gained, we need the help of a teacher.

A teacher may be different from a Guru.

A true guru can be at the level of Tyagi, Vairagi and Sanyasi…These are at the level of the physical body, mind and the soul respectively.

Tyaga or giving up worldly desires gives us physical happiness and vairagya or giving up desires and attachments, gives us mental happiness. A sanyasi is at the level of the soul and shows the path to achieve ananda.

You can become a scholar or teacher without actually understanding what you are studying or teaching. To prevent this, the answer is suno, samjho, jaano, karo. This is the gist of our Vedas.

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. Once knowledge has been converted into wisdom it is of no use unless it is made use of in day-to-day practice.

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

Kya Khoya Kya Paaya: It’s time to file my Vedic returns

Dr K K Aggarwal

Once again, it’s time to file my annual Vedic returns. I was born on 5th September, day of Janmashthmi. On this day, every year, I file my Vedic returns of all that I have done or achieved in the last one year.

A birthday is a reminder of our true purpose in life, towards which our actions should be directed. These are Dharma, Artha, Kama and Moksha. 

Dharma is righteousness – doing our duty; artha is righteous earning of the means to do our duty; these righteous acts should be directed towards fulfilling the desires of acquiring inner happiness…Kama and Moksha.

We must also draw up a balance sheet of the three debts that we have to pay in our lifetime and repay them, if not paid by this time. These are: Dev rin, Pitra rin and Rishi/Guru rin.

Our body has been given to us by our parents, they take care of us when we are young and so should we as they grow old; this is pitra rin. Rishi/Guru rin is our debt to our teachers who give us knowledge and Dev rin is our debt to God, who has given us consciousness.

The first step is to calculate my last year’s Vedic earnings. Money alone does not constitute all my wealth; my soul and ego-based earnings are also a part of my total wealth.

·      Soul earnings (soul profile): Good will, respect, happiness, peace of mind, health, blessings, friendships and knowledge

·      Ego earnings: Position and status earned, fixed assets (car, house, money), name, fame and awards

Both soul and ego earnings, positive and minus, should be computed in the form of returns and submitted to the consciousness. If the result is balance, you need to pay 30% tax to God by passing on 30% of net happiness to others. Keep everything in circulation. This is the Law of Giving & Receiving.

Every year on our birthday, we should contemplate on the year that has gone by and take stock of what all has been achieved or what is left unfulfilled and define new goals for ourselves.

Doctors are like batsmen. Like the batsmen, doctors too cannot afford to make mistakes. I was told by a senior mentor that to be successful at this stage in life, you cannot afford to make mistakes. I did make a mistake last year and by the time, I realized it, it was too late.

I am satisified that my returns were more on the positive side and less on the negative side.  

I thank each one of you for the blessings and wishes today.

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

Think before you prescribe

Avoid concomitant use of fluoroquinolones with corticosteroids as much as possible: Monitor your patient for signs of tendon injury

The broad-spectrum fluoroquinolone antibiotics are used to treat common infections such as respiratory tract infections, urinary tract infections. However, their use is associated with serious adverse events regarding which the US FDA has issued safety communications.

In July 2008, the FDA mandated the first black box warning for fluoroquinolone antibiotics for increased risk of tendinitis and tendon rupture. Since then, other black box warnings have been issued: August 2013 (peripheral neuropathy), May 2016 (restricting use for certain uncomplicated infections), July 2016 (disabling side effects) and the most recent being in July 2018 (hypoglycemia and mental health side effects including disturbances in attention, disorientation, agitation, nervousness, memory impairment and delirium).

A study conducted in 2012 showed the strong association of fluoroquinolones with increased risk of Achilles tendonitis and tendon rupture, especially in those who also used oral glucocorticoids at the same time (Am J Med. 2012;125(12):1228.e23-1228.e28). In a study from Italy, concomitant use of corticosteroids and fluoroquinolones was associated with a threefold increased risk for tendon rupture and a 43-fold greater risk of rupture of Achilles tendon (Drug Saf. 2006;29(10):889-96).

Patient safety is a very important aspect of delivery of health care. Hence, the use of fluoroquinolones with corticosteroid must be avoided as much as possible, especially in the elderly patients with renal insufficiency or other risk factors, due to increased risk of potentially disabling fluoroquinolone-associated tendinitis (Pharmacy Times. April 11, 2016). Patients receiving this combination should be carefully monitored for any sign of tendon injury. Discontinue the drugs as soon as signs are detected and minimize activity until the symptoms resolve.

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

The role of a judge is to make sure that fundamental rights of the people are protected

The 2nd GL Sanghi Memorial Lecture was delivered by Hon’ble Justice AK Sikri on 1st September, 2018 at Nagpur. The event was presided over by Hon’ble Justice Sharad Bobde.

Hon’ble Justice Vipin Sanghi, Hon'ble Justice Bhushan Gavai, Hon'ble Justice Bhushan Dharmadhikari and Shri Mukul Rohatgi, Former Attorney General of India were among the Guests of Honor.

Here are some excerpts from the lecture.

·         The role of a law school is to make great lawyers.

·         The first role of a judge is to uphold the constitution and the rules of the law. His second role is to bridge the gap between the law and the society. His third role is, in view of globalization, to connect the law with economics in decision-making process and to be a person who contributes to the economic progress of the nation.

·         Rule of the law is the basic feature of the constitution and a judge is its guardian.

·         A judge must see that

o The democratic principles are followed by the government in power

o There is good governance

o Fundamental rights of the people are protected

o The centre-state relationship is respected

o Rights of the marginalized section of society and their dignity are translated into reality

The courts can

o Create law in enforcing the public rights (Vishakha case). These are "hard cases". A judge must make them by applying constitutional norms.

o Enforce public rights (child labor)

o Appropriately interpret the rights of the people or can broaden the scope of such norms by interpretative process

All the above principles are true for the medical profession also.

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

Pioneering AHA training kiosks provide hands-only CPR skills

Heart Care Foundation of India too is actively engaged in teaching this life-saving skill to the public

More than 100,000 people have been trained in the life-saving skill of hands-only cardiopulmonary resuscitation (CPR) since the American Heart Association (AHA) launched its hands-only CPR training kiosk program in 2016.

As part of the program that is nationally supported by Anthem Foundation, AHA has placed 30 of these interactive devices in cities across the country.  The majority of the hands-only CPR training kiosks are located in high-traffic, public locations, such as airport, across the US.

A pilot kiosk was developed in 2013, which was placed at Dallas-Fort Worth International (DFW) airport. Research published in journal Resuscitation showed there was noticeable interest by the public to learn Hands-Only CPR through the use of the kiosk. During a 32-month period from July 2013 to Feb. 2016, nearly 23,500 visitors tried the device.

Each kiosk has a touch screen that displays a brief instructional video about Hands-Only CPR, followed by a practice session and a 30-second test. With the help of a practice manikin, the kiosk gives precise training feedback about the depth and rate of compressions -- factors that influence the effectiveness of CPR. The training session takes about five minutes. Data from the kiosks, including the Association’s pilot kiosk at DFW Airport, recorded 230,547 visits and 110,649 people trained through June 30, 2018. The AHA had launched a hands-only CPR campaign to raise awareness about CPR in 2009. And, nearly 10.1 million people have been trained in hands-only CPR since 2012 through various events.

The Heart Care Foundation of India (HCFI) too has been actively engaged in teaching the life-saving skill of hands-only CPR to the public since 2014 via weekly camps at schools, colleges including government sectors like MCD, NDMC. It is an ongoing training program.

HCFI has also been creating awareness on the need to install automated external defibrillators (AEDs) in public places.

In 2015, the Foundation undertook a program to train all operational PCR vans constables in hands-only CPR as they are usually the first responders.

To educate the general public, we created a Formula of 10 for easier recall “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 victim, effectively and continuously, with a speed of 10×10 i.e. 100 per minute”. 

CPR 10 is an effective way for the public to remember the process of cardiopulmonary resuscitation or revival after sudden cardiac death.

So far, we have trained around two lakh people in CPR 10. We have 1300 CPR training manikins. At a time, two people can be trained on one manikin.

HCFI was recognized by the Limca Book of World Records in three distinct categories in its 2014 edition.

·         Most people trained in hands-only CPR 10 in a short time span: 11,453 students (8,193 female and 2630 males) trained in less than 8 hours on April 6, 2013

·         Maximum number of people trained in hands-only CPR during an event: 10,932 people trained in hands-only CPR 10 during the 19th Perfect Health Mela from November 1 to 16, 2013

·         Maximum number of people trained in hands-only CPR: 20,592 people in hands-only CPR in 43 days

The Hon’ble Chief Justice of Delhi High Court has recently accepted and converted a representation filed by the Heart Care Foundation of India (HCFI) into Public Interest Litigation (PIL) on the issue of CPR and Automated External Defibrillator (AED) machine in public places such as courts, railways and metro. The move comes after various applications were filed by the HCFI to several bodies indicating the absence of AED machines in public places and lack of training in CPR technique.

Over the years, I have seen many success stories of lives being saved using this technique and I hope that I can train more and more people in the future

So, when you come across a victim of cardiac arrest, three simple rules must be followed:

·         Call the ambulance

·         Check if the person is breathing or has a pulse and

·         If not, then start chest compressions and continue for at least 30 minutes till medical help arrives.

Remember, don’t stop CPR too soon …

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

Think before you prescribe - Monitor electrolytes in hypertensive patients on thiazide diuretics

Think before you prescribe

Monitor electrolytes in hypertensive patients on thiazide diuretics

Thiazide diuretics have been widely used for the treatment of hypertension. Their efficacy and cost-effectiveness often makes them a first-line choice in treating hypertensive patients. However, their effectiveness in patients with chronic kidney disease (CKD), especially those with a glomerular filtration rate less than 30 ml/min/1.73 m2, has been of concern. Consequently, they were thought to be ineffective in patients with advanced CKD.

There have been studies, which have documented the beneficial effects of thiazide diuretics in moderate to advanced CKD challenging this widely held belief. Chlorthalidone was found to significantly reduce BP among people with moderate to advanced CKD with poorly controlled hypertension in a small study. Albuminuria was significantly reduced by 40-45% (Am J Nephrol. 2014;39(2):171-82). But, the 2017 ACC/AHA guideline for treatment of hypertension recommend loop diuretics in patients with moderate to severe CKD.

Thiazide diuretics are a common cause of hyponatremia. When prescribed to elderly patients who are also taking drugs e.g. selective serotonin reuptake inhibitors, the resulting hyponatremia can be more severe. Hence, electrolytes should be monitored in these patients.