From Navratri to Diwali: A one-month long spiritual Yagna

Any festival in India consists of rituals which directly or indirectly teach the society how to remain happy and healthy.

The process of the spiritual yagna in Hinduism begins from the first day of Navratri on Amavasya and ends up on Diwali, again on Amavasya.

The first 10 days of this yagna involve intense spiritual practice and the remaining 20 days entail receiving its benefits.

The first nine days, called Navratri, are devoted to a process of purification and detoxification of mind, body and soul.

During this period a person is required to lead a Satvik spiritual life devoting first three days into activities, which reduce negativity in the mind and the body. Thinking differently, thinking positively and thinking opposite is how the negativity in the mind can be reduced.

In the next three days, he should practice positive behavior and in the last three days he should read and learn about spiritual positive things in life.

The spiritual purification process involves eating only Satvik food, one which is offered to God, and following the principles of Satwik lifestyle, which are Satvik Ahaar, Satvik Vichar, Satvik Vyavahaar and Satvik Achaar. There is a custom of worshiping wheat and barley grass during this period. They are detoxifying grasses when consumed in the form of juices. The Satvik fast observed during this period helps in internal cleansing of the body.

Upon completion of this 9-day purification process, the person starts getting the benefits on the tenth day symbolized as Vijayadashmi or dusshera, when one gains victory over Tamas (Kumbhakaran), Rajas (Meghnad) and Ego (Ravana). Victory over the ego entails the ruling of Satwa (Vibhishan) and reunion of Mind (Lakshamana), Body (Sita) and Soul (Rama).

As per the Yoga Sutras of Patanjali, when one attains an ego-free mind, then one is likely to get benefits over a period of time.

The first benefit is seen on the fourth day after Vijayadashmi, on Sharad Purnima. Kheer is traditionally prepared on this day and is kept under the moonlight because moon rays have healing properties. Moon is closest to the earth on Sharad Purnima

Four days later, on the day of karva chauth when married women pray for long life of their husbands, one gets the benefit of the longevity of the spouse, which gives safety to the family.

Four days later on “hoi ashtami”, one prays for the longevity of their children. This ensures protection for the family in their old age.

Then, four days later on “dhanteras”, one gets the benefit of wealth. On this days people worship silver items. On this day, no dealings are done and people spend only to invest in silver and gold items for the future needs of the family.

By this time the person, who has undergone the process of purification, learns the true purpose of his or her existence. The inner ignorance and darkness goes away and one learns the true meaning of wealth and that is inner happiness (spiritual knowledge). The day this happens is called Diwali, when on the day of Amavasya (darkness) one gets internal lighting (Diwali).

These three phases of purification are symbolized as worshiping the Goddess Kali, Laxmi and Saraswati, respectively.

Diwali, therefore, is a one-month long spiritual Yagna, from Amavasya to Amavasya, with 9 days of purification and 21 days of acquiring spiritual benefits out of it.

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

Immediate Past National President IMA

 

What is Corporate Social Responsibility?

 Every corporate is responsible for some social or environmental cause.

The term Corporate Social Responsibility or CSR, as it is commonly known as, has been derived from the Vedas.

We all are aware of the commonly spoken maxim “Neki kar dariya me daal”. This means do your karma, forget about results. Do good and expect nothing. This is called “Nishkam Karma”.

It is now mandatory for all companies above a given defined size to spend 2% of their net profits of the last three financial years to charity (CSR activities) under Section 135 of the Indian Companies Act.

In Islam, all Muslims who meet the necessary criteria of wealth are required to give 2.5% of their total wealth to the needy as ‘Zakat’. Sikhism also requires Sikhs to donate one-tenth of their earnings as "Daan" towards the common resources of the community. 

The Gandhian principle of “Sarvodaya” or welfare of all advocates that the aim in life therefore should be to work not for oneself but for the welfare of the others. The basic fundamental teaching of the Vedic science is also based on sarvodaya. It talks about “bahujan hitay-bahujan sukhay” i.e. “the good of the masses, the benefit of the masses”.

“Vasudhaiva kutumbakam” i.e. the whole world is one family is derived from the Rig Veda and forms one of the fundamentals of Vedic philosophy.

It has been an IMA Policy that doctors should give 10% of their time to charity in the form of free OPDs or camps. Real charity is 100% free, but when corporates entered, this changed to “camps with conversion”. Charity has to be unconditional. Consultation alone should not be free. The entire treatment should be free and it should be transparent. Even the MCI Code of Ethics Regulations has said, “The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration (1.1.2).” 

A Devta is someone who gives and shares. Anybody who gives can be said to be a devta. Doctors can be likened to devtas, as they help the patient to heal.

All doctors do CSR. Every doctor is a “Trust” as he is a trustee of his patient.

This is why the medical profession is called a noble profession.

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

Immediate Past National President IMA

Unless an adolescent learns coping skills, there is a high risk of depression in this age group

In conversation with Dr Swati Bhave

As per WHO estimates, globally 10-20% of children and adolescents experience mental disorders. Half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s. But most cases are undetected and untreated. If not tackled early, their impact extends to adulthood, impairing both physical and mental health and adversely affect the adolescent’s development, education and consequently their potential to live fulfilling and productive lives.

The World Mental Health Day, observed on 10^th October has also focused on adolescent mental health with its theme as “Young people and mental health in a changing world”.

I spoke to Dr Swati Bhave, who is a renowned expert in adolescent health, for her views on mental health issues in adolescence.

Dr Swati Bhave is Executive Director AACCI, Adjunct Prof in Dr DY Patil Medical College and Dr DY Patil Vidyapeeth in Pune and Head of Adolescent Clinic, Jehangir Hospital Pune. She is also the Editor of our Asian Journal of Paediatric Practice.

Here are the 10 salient points on adolescent mental health.

1.    In the past, it was thought that at 18 years the brain is fully mature and hence driving, voting etc. were permitted at this age.

2.    Now it is known by MRI and functional MRI, PET etc. adolescent brain is under development right up to 25 years.

3.    The “emotional brain” or the limbic system is normally under control of the “thinking brain” i.e. the prefrontal cortex and the impulsive behavior is controlled in adults.

4.    In adolescents, the limbic system is well-developed, while prefrontal cortex matures much later. This is the reason adolescents are prone to high risk behavior and experimentations like drinking, smoking, substance abuse, driving under alcohol influence.

5.    They are also very prone to labile emotions and need help to stabilize and handle failures or rejections.

6.    This is done by proper parental, teacher or other adult guidance.

7.    WHO has a program called the Life Skill Education (LSE). This is also under UNFPA and UNICEF. The ten life skills empower adolescents to deal with all problems, they can face during normal adolescent development.

The ten core life skills are: Self-awareness, empathy, communication skills – interpersonal relationships, decision making, problem solving, critical and creative thinking, coping with stress and emotions and negotiating skills.

8.    Unless an adolescent learns the coping skills, there is a high risk of depression in this age group. Severe depression leads to high rates of suicides in this age group on very trivial triggers. We need to empower adolescents to prevent suicides by becoming resilient.

9.    The dopamine reward pathway is also very highly developed in adolescents, which makes their brain very vulnerable to substance abuse, tobacco and alcohol. Children who start smoking and drinking below age 12 years are more likely to be adult-addicts.

10. NCDs or noncommunicable diseases are increasing globally. WHO has identified four behavioral risk factors in adolescent age group: Consumption of junk food, increased sedentary lifestyle, tobacco and alcohol. If these behaviors are checked in adolescence, we will prevent adult-onset NCDs.

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

Immediate Past National President IMA

Swine Flu: Messages of public health importance for the public

·         Fever with cough and cold is flu, unless proved otherwise.

·         No fever, no flu

·         In low risk patients (no pregnancy, not a newborn/elderly or no comorbidity), with no breathlessness, no testing, hospital admission and/or Tamiflu is required.

·         People with co-morbid conditions, pregnant women and the elderly should not ignore flu

·         No breathlessness, then only digital consultation to avoid crossinfection.

·         For the general public, simple surgical mask; for doctors, N95 mask

·         Wearing a mask is a must in registration counters

·         There should be separate line for labs/x-ray, with people wearing a mask.

·         Children suffering from flu should be allowed leave from school.

·         Office workers suffering from flu should be given paid holiday.

·         Flu patients should enter the doctor’s chamber wearing a mask.

·         In low risk patients, it does not matter, if it is swine flu or the common flu. Cough hygiene is same for both. Keep distance of 3 feet; hand wash with soap and water after coughing or sneezing, cover your nose or mouth with a tissue when coughing, promptly dispose used tissues; throw the used tissue in a waste basket and if you don't have a tissue, cough or sneeze into your upper sleeve, not your hands

·         Tamiflu is effective only if given in the first 48 hours unless you are a high risk patient. Even then, it only shortens the duration by one day.

·         Tamiflu is not given without testing, which costs around Rs. 4000/-. So if you are a low risk patient, why spend this amount?

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

Immediate Past National President IMA

Understanding harm reduction as a public health strategy

Harm reduction is a public health strategy, which aims to mitigate the dangers or harms associated with an action or condition. A criticism of harm reduction as a concept has been that it allows individuals to pursue harmful behaviour. But, this is not so. According to the National Health Care for the Homeless Council (2010),“harm reduction is not at odds with abstinence; instead it includes it as one possible goal across a continuum of possibilities... Harm reduction neither condones nor condemns any behavior. Instead, it evaluates the consequences of behaviors and tries to reduce the harms that those behaviors pose for individuals, families and communities”.

Harm reduction, to begin with, was used as an alternative to abstinence-only focused interventions in cases of adults with substance abuse problems, who were unwilling to accept abstinence to avoid negative consequence of substance abuse. Since then, it has found other applications such as sexual health education to reduce teen pregnancies as well as to reduce transmission of sexually transmitted diseases, including HIV.

It has also been used as needle and syringe exchange programmes to prevent HIV and hepatitis C among injecting drug users. Areas that have introduced needle-exchange programs have shown mean annual decreases in HIV seroprevalence compared with those areas that have not introduced needle-exchange programs (Addiction. 2006;101:911–2)

Harm reduction can also be applied to diet and weight loss. People often find it difficult to adhere to harsh changes in their diets along with exercise regimen to lose weight. So they stop and restart resulting in cyclical loss and gain of weight ‘yo-yo dieting’ or weight cycling is harmful to health in the long run. A harm reduction approach to weight management means awareness about various options available and recognising that moderate, individualized changes in eating or exercise habits can be beneficial, which can be in the form of either reducing the frequency of eating a particular food item, or reducing the quantity of a food item or adding exercise to the diet to manage weight.

Perhaps, the most recognized use of harm reduction has been with regard to tobacco use, where the aim is to reduce the harmful consequences of tobacco use. Tobacco harm reduction measures include cutting down on the number of cigarettes smoked or switching to non-tobacco nicotine containing products, such as pharmaceutical nicotine replacement therapies such as nicotine patch, nicotine gum or switching to smokeless tobacco products such as snus and electronic cigarettes that deliver a vapor rather than smoke.

Just as clean needles help drug users to avoid infections, vaping can help cigarette smokers to steer clear of health risks such as cancer by reducing how much they smoke.

Therefore, harm reduction accepts that some individuals are unwilling or averse to the idea of quitting risky health behaviors such as smoking or use of drugs and so takes the view, as an alternative strategy, that it is better to reduce the associated harm rather than pressurizing these individual to abide by total abstinence.

The emphasis here is not on the use itself, but on the negative outcomes of use.

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

Immediate Past National President IMA

New ADA-EASD guidelines on type 2 diabetes highlight patient-centered care

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have highlighted “patient-centered care” that accounts for each individual’s health history and status, weight, costs of care and preferences, in a new consensus report on the management of type 2 diabetes.

A “decision cycle” representing a continuum of care for adults with type 2 diabetes throughout their lifetime has been described towards this end. The goals of care, to prevent complications and optimize quality of life, are at the core of this decision cycle.

The steps in the decision cycle are:

1.    Assess key patient characteristics

2.    Consider specific factors that impact choice of treatment

3.    Shared decision-making to create a management plan

4.    Agree on a management plan

5.    Implement management plan

6.    Ongoing monitoring and support including mental health, medication tolerance and adherence, monitoring of blood glucose, weight, nutrition, physical fitness and exercise, and smoking cessation counseling

7.    Review and agree on management plan

Then returning to step 1 and going through the full cycle at least twice each year, and as needed throughout each patient’s life.

The patient remains at the center, and the intensification, deintensification or shift in the diabetes care plan should take into consideration the life and circumstances of the patients. The target A1c is ≤7%.

The stepwise addition of antidiabetic drugs is generally preferred to initial combination therapy. When more than two medications are needed to maintain glycemic target, the impact of medication side effects on comorbidities, as well as the burden of treatment and cost should be taken into consideration. Access, treatment cost and insurance coverage should all be considered when selecting glucose-lowering medications.

Some key recommendations include:

·         All patients should be offered access to ongoing Diabetes self-management education and support (DSMES) programs to help them cope with the daily challenges of living with diabetes and promote treatment adherence.

·         Metformin is the preferred first-line agent for most patients.

·         For patients with type 2 diabetes who have established ASCVD, SGLT2 inhibitors or GLP-1 receptor agonists with proven cardiovascular benefit are recommended.

·         Patients with ASCVD in whom HF coexists or is of special concern, SGLT2 inhibitors are recommended.

·         A SGLT2 inhibitor should be considered for patients with chronic kidney disease.

·         GLP-1 receptor agonists are now recommended as the first injectable medication prior to insulin for most patients, who need the greater blood glucose-lowering of an injectable medication.

·         An individualized program of MNT should be offered to all patients

·         All overweight and obese patients with diabetes should be advised of the health benefits of weight loss and encouraged to engage in a program of intensive lifestyle management, which may include food substitution and increasing physical activity.

·         Metabolic surgery is a recommended treatment option for adults with type 2 diabetes and (1) a BMI ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in people of Asian ancestry) or (2) a BMI of 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in people of Asian ancestry) who do not achieve durable weight loss and improvement in comorbidities with reasonable non-surgical methods.

(Source: Diabetologia, ADA Press Release)

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

Immediate Past National President IMA