March 20  2015, Friday
editorial
The Vedic science behind a divorce
Dr KK AggarwalI was asked by Ms. Vandana Shah, a practicing divorce lawyer in Mumbai to be the Guest of Honour for the release of her book “The Ex Files – the story of my divorce”.

I started wondering, what I should speak. In the night, I closed my eyes and reviewed my Vedic knowledge and I got my insight into my possible dialogues:
  1. Seven years itch is a known phenomenon. Many people even remarry after seven years. It is based on a scientific phenomenon of euphoria, reaction, adjustment, liking and loving.

    Euphoria is the first phase of getting engaged to the period of honeymoon. The chemical reactions are based on release of adrenaline and noradrenaline and amphetamine like chemicals. Both partners feel great, light and on the air.

    This phase of euphoria ends with the next phase of reaction where both the partners start reacting to each other’s behavior and lifestyle. The duration of this period may last for few years.

    The main cause of fight between two couples is this phase. This phase is followed by the phase of adjustment.

    Both phases of reaction and adjustment may carry on for upto 7 years. During this period, both partners are compelled to stay with each other and start adjusting to each other’s needs and lifestyle. By the 7th year, the phase of liking starts and this is the phase when you start feeling dependent on each other. The misunderstandings may end and people may stop thinking about divorce and fight.

    The last phase is phase of love which is soul to soul relationship and this phase may start decades after the marriage and that forms the basis of 25th, 50th & 75th marriage anniversary. People in this phase of marriage are totally dependent on each other and cannot face separation. If one person dies, the other may go into depression and also die within a short period of time. The chemicals involved in this phase are endorphins.
  2. The phase of reaction is dependent on our needs. Every person has five types of needs and they are Physical, Mental, Intellectual, Egoistic and Spiritual Needs.

    Physical needs are needs for physical and sexual intimacy; mental needs are to share one’s emotions and need for a shoulder when in the need of a cry; intellectual needs are the needs to discuss about future, decision making etc.; egoistic needs are the needs to acquire power and spiritual needs are the needs to acquire inner happiness.

    Husbands & wives who fulfil all the above needs of each other are called “made for each other”, which happens only rarely.

    In a joint family concept, marriages are often successful because if one partner is not able to fulfil the non physical needs, the same can be taken over by others in the family. In a single family, if one starts looking for fulfilling non sexual needs from other friend the same may be the start of a conflict between husband and wife.
  3. The phase of reaction always needs proper counselling, which is based on the principal of Bhagavad Gita where Lord Krishna gives 18 counseling sessions to Arjuna. In the first Counseling session, Lord Krishna only listens to Arjuna and in 2nd counseling he briefs Arjuna in detail. From 3rd to 17th counseling sessions, Lord Krishna answers each and every query, frightens as well as consoles Arjuna. In the last 18th session, Krishna revises all what has been counseled.

    Unfortunately, in today’s divorce matters, such type of 18 Sessions are missing. Even Courts recognizes only 3 sessions.
  4. In India, sexual preferences are often not discussed or counted for. People who have preference of the same sex or both the sexes may end up with conflicts unless proper counseling is done.
  5. The concept of Ayurvedic matching is also missing in the country. As per Ayurveda, a person can be Vata, Pitta or Kapha personality. Vata people are thin built with cold and dry hands, emotional and impulsive. Pitta people are medium built with moist and warm hands and are egoistic. Kapha people are heavy weight, with moist and cold hands and they are calculative and manipulative.

    Best marriages are between two kapha partners and worst marriages are between two pitta partners. Vata with Vata marriages are also a ground for divorce but can be easily salvaged with proper counseling.

    India is a Vata-Pita society and hence most marriages can be saved if Ayurveda matchmaking principles are used.
  6. If the disputes in husband and wife continue, over a period of time husband may suffer from erectile dysfunction with wife but not with other partner.
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Rally to create awareness on TB
News
  • • Chronic kidney disease (CKD) rates are estimated to rise substantially during the next 20 years, with more than half of individuals aged 30 to 64 years likely to be affected, reports a simulation study published in the March 2015 issue of the American Journal of Kidney Disease.
  • The first biosimilar product in the United States has been approved by the US Food and Drug Administration. The product approved is the recombinant colony-stimulating factor filgrastim-sndz which has several clinical uses, including aiding recovery from neutropenia in cancer patients undergoing chemotherapy.
  • A new study suggests that concussion is associated with reduced cerebral blood flow, which recovers in most individuals within a few weeks. The findings were published online in JAMA Neurology on March 2.
  • A new study suggests that numbing the sphenopalatine ganglion (SPG) with the aid of fluoroscopy improves headache pain by about a third. The study was presented at the Annual Scientific Meeting of the Society of Interventional Radiology.
Dr KK Spiritual Blog
Do Your Duty with Discipline and Devotion: The Triad Represents Rama, Lakshmana and Hanumana

“Vasudhaiva kutumbakam” (the whole world is one family) and “Ekam Sat Viprah Bahudavanti” (truth is one but the wise call it by various names) are two basic statements, which come from the ancient Rig Veda and form the fundamentals of Vedic philosophy.

One should do one’s duty with devotion and discipline. This principle can be remembered as the principle of three Ds.

In daily routine ‘one should remember the purpose for which one is born, which to fulfill Dharma (duty), Artha (wealth), Kama (desire) and Moksha (liberation). To achieve them, one needs to follow the four Fs: (i) Follow the teacher (ii) Face the negative devils of the mind (iii) Fight till the end and (iv) Finish at the goal.

The essence of Bhagwad Gita can be summarized in one shloka (Chapter 2.48) where Krishna says to Arjuna “yogastha kuru karmani”, which means ‘concentrate on actions’ (do all actions while remaining in yoga). He further says that one should take success and failure in the same stride. (yogastha = steadfast in yoga, kuru = perform, karmani = duties or action).

To acquire spiritual health, one should follow three Ss which are: (i) Satsang (company of good people) (ii) Sadhana (hard work), and (iii) Sanskar (good deeds). Adi Shankaracharya in Bhaj Govindam describes them as Satnam or Simran (bhakti, or reciting the name of their God), Satsang (company of good people) and Seva (good karmas).

Before doing any work, one should follow the principles of three Hs: (i) listen with the Head (ii) follow the Heart to choose one of the choices and (iii) order the Hands to take an action.

The ABCs of a good professional are Availability, Behavior and Competence. Competence comes last; the first is the availability of the professional.

An action should be based on Truth; it should be coming from consciousness and should end in internal bliss. Various Vedic literatures have termed this triad by different names like satha, chitha, ananda, and satyam, shivam sundaram.
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Cardiology eMedinewS
  • In three large cohorts of 40- to 79-year-old mostly low-income men and women, those who ate more peanuts had a lower risk of dying from CVD or all causes in a median follow-up of 5 to 12 years. The report is published online in JAMA Internal Medicine.
  • Patients with MI treated with a high-dose of omega-3 fatty acids besides standard care had significant improvements in cardiac function and structure compared with individuals who received standard medical care alone, reported a new study presented at the American College of Cardiology 2015 Scientific Sessions.
Pediatrics eMedinewS
  • • Long-term improvements in air quality are linked to clinically significant improvements in pediatric lung development and function, suggests a longitudinal cohort study published in the March 5 issue of the New England Journal of Medicine.
  • A cross-sectional study of more than 400 adolescents demonstrated that hopelessness and nonproductive coping were significant risk factors for depression for the girls. On the other hand, positive thinking was a protective factor for girls, whereas self-discovery was protective for boys. Researchers noted that significant risk factors for suicidal behavior for the entire group included depression, hopelessness, or coping problems. The study is published in the Canadian Journal of Psychiatry.
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Make Sure
Situation: A patient developed fainting attack after sublingual nitrate.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.
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Medicolegal
(Contributed by Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS)

Bolam Vs. Friern Hospital Management Committee 1957

Test for establishing medical negligence
  • The doctor is required to exercise the ordinary skill of a competent doctor in his field. He must exercise this skill in accordance with a reasonable body of medical opinion skilled in the area of medicine.
  • According to the Bolman test, negligence is the genus of which rashness is the species.
  • The latest trend of prosecution of the doctors, the term criminal negligence has come to light, which means recklessly acting without reasonable caution, hurting another person at risk of injury or death by negligence.
  • This applies to a medical practitioner when he shows gross negligence in his treatment, boding to severe injury or even death. He should not be held liable criminally for the patient’s death unless his negligence shows such regard for the life and safety of the patient as to amount to a crime.
  • The most important criterion is the degree of negligence required to prosecute them under the charge of criminal negligence, which should be gross or even high degree.
  • The jurisprudential concept of negligence differs in civil and criminal law. Negligence which is neither gross nor of a high degree may provide a ground for action in civil law but cannot form the basis for prosecution in criminal law.
Dr Good Dr Bad
Situation: A patient with hypertension had non–responding cough.
Dr. Bad: Take an X–ray.
Dr. Good: Stop ACE inhibitors.
Lesson: The commonest cause of cough in a patient with high blood pressure is the intake of ACE inhibitors.

(Copyright IJCP)
Quote of the Day
Don't judge each day by the harvest you reap but by the seeds that you plant. -Robert Louis Stevenson
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CPR 10
Total CPR since 1st November 2012 – 101090 trained
Reader Response
1. Dr KK Aggarwal's emedinews is a wholesome newsletter, very very informative. Kudos to you. Keep it up, sir: Dr Shaila Milton Philip, Bilaspur, C.G.

2. Good Message on World TB Day. But the 3 should be replaced by 2 weeks and 2 sputum samples. Thanks & Regards: Dr Anand Narnoliya
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Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh,
SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
IMA NEWS
Facts about Tuberculosis (TB)
How is TB diagnosed?
Tuberculosis is diagnosed by demonstrating TB bacteria in clinical specimen taken from the patient. While other investigations may strongly suggest tuberculosis as the diagnosis, they cannot confirm it.
  • Pulmonary TB is primarily diagnosed through sputum smear microscopy. In this test, the patient’s sputum is examined under a microscope for the presence of TB bacteria.
  • In Extra pulmonary TB, it is usually difficult to demonstrate TB bacteria; hence, the diagnosis is made on the basis of clinical suspicion and special tests depending on the organ affected. e.g. TB of the lymph nodes is diagnosed by a special test called FNAC (Fine Needle Aspiration Cytology)
EIMA NEWS
Dear Friends and Colleagues, The Ministry of Health and Family Welfare (e-Governance Division) is inviting feedback on the proposed National eHealth Authority (NeHA), for developing an Integrated Health Information System in India.

A Concept Note on NeHA can be downloaded at http://mohfw.nic.in/showfile.php?lid=3099
Please email your comments to Shri Jitendra Arora, Director, e-Governance Division -
jitendra.arora@gov.in - by 20 April 2015
Sonal Namaste
Regular handwashing, particularly before and after certain activities, is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others.

Public awareness regarding TB disease - IMA Mumbai Branch

http://imatbnotification.emedinews.in/video/default.aspx
TB sensitisation plan launched
http://www.tribuneindia.com/news/cities/delhi/tb-sensitisation-plan-launched/55653.html

Call for greater role of nurses in fighting TB
http://www.drugtodayonline.com/medical-news/city/1751-call-for-greater-role-of-nurses-in-fighting-tb.html

IMA launches mass sensitisation programme on TB
Press Trust of India | New Delhi
March 18, 2015 Last Updated at 18:22 IST/ Business Standard

Indian Medical Association (IMA) has launched a mass sensitisation programme to educate people including nurses, about tuberculosis

Under the programme, launched ahead of World TB Day on March 24 in collaboration with Central TB Drug Division and Union Health Ministry, IMA today interacted with principals of various nursing schools from Delhi and NCR.

They were informed about various facts of tuberculosis prevention. They were also educated about "respiratory and cough hygiene and etiquettes".

"Nurses are backbone of the society and they are part of an important chain in the process of providing ethical TB Care to the patients. TB is a notifiable disease and the same should be known not only to the doctors but also to the nurses, IMA Secretary General K K Aggarwal said.

He stressed that nurses can provide the best counselling.

"Most of the TB patients feel that it is a stigma. Nurses can play a big role in removing this feeling from the minds of people. Incomplete treatment of TB can be risky, therefore, nurses can play a big role in motivating people to not to stop the treatment in between," he said.

Aggarwal further said all celebrities and important people in the society should come forward and learn to disclose their status of TB, so that there is no more stigma attached to TB care.

Tomorrow, as part of the programme, medical students and principal of several schools and general practitioners would be educated about the various aspects of the disease.

"There is a need for wider dissemination of 'standards for TB care' among the public to hasten the decline of TB incidences and help India reach the WHO target of elimination of tuberculosis (TB) by 2050.

"There is a need to address social determinants of TB such as under-nutrition, overcrowding and poor ventilation in slums and clinical risk factors such as diabetes mellitus, smoking etc," Aggarwal said.
 
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Inspirational Story
Three Ways to Stop Depression and Burn-Out

Our culture seems to be experiencing an epidemic of problems such as depression and burnout, with estimates of more than 10% each year being common.

In my practice as a medical doctor and now as I moved into psychological therapy exclusively, people have come to me with different levels of these problems, from depression bad enough to be actively planning suicide, to more vague thoughts of whether it is worth going on with it all.

Sometimes it's been more about losing confidence with what they are doing, or even having full-on panic attacks. As I've explored their situations I've found there are 3 key factors to stop their state of depression and feeling of burn-out.

1) Set goals with a pre-determined end point -- Life and work can't just be an endless marathon. You need to have sprints as well as rest periods, and have some finish lines along the way. Otherwise the only rest you get is when you collapse from exhaustion, and it's better if you can do that on the other side of a finish line.

Whether you label it a milestone, or a step in the journey, or an exit strategy, you do need to acknowledge the ebb and flow of your motivation and interest and worth with it rather than against it. Even a seemingly powerful motivator such as having more money, can become burnt out when more and more is still never enough because you haven't defined what you want that money to bring you.

2) Have a bigger purpose in mind -- Life is not just about filling your days with whatever happens to get your attention, and yet there is so much around to choose from. With a bigger purpose you can select what is important for you, or it can be the other way around, what is important to you can be your bigger purpose.

Now it doesn't have to be an overly grand purpose, like solving world poverty. It does however need to be something that brings out the passion in you to help you take the day-to-day bumps and the obstacles that are in your way.
Many people can go on for quite a while without asking or finding an answer to the bigger purpose question, because it's only when things get really tough that you can realize you needed that answer. If you don't have a bigger purpose right now then as long as you're happy you're fine. Life will give you setbacks that let you show how badly you want something, and then you'll discover what is really important to you.

3) Create results that last beyond that day -- This is the most important one in my experience as a counselor. You need to build some cumulative benefits to the work you do each day. Otherwise every day is starting from scratch yet again, and it will just feel like you are "never getting anywhere", because you truly won't be.

For example, if you are earning money but spending it or going deeper into debt just as fast, are you better off financially than if you just stayed in bed?

Sometimes it is merely about paying attention to the long-term benefit of what you are already creating. More commonly however you really need to change what you are doing so that on a daily basis you are producing money that you keep, sources of passive rather than active income, habits rather than Band-Aids, prevention rather than fire-fighting, relationships rather than one-off transactions. This way you can sleep knowing you have more to wake up to the next day.

Each of these 3 aspects are vital. Missing even one of them will give you more stress than you need, and if you don't have any of them then you are very likely to be reading this because you really need help, starting with these 3 changes. Begin today.
Wellness Blog
Cinnamon in diabetes

In a new meta–analysis of 10 studies in patients with type 2 diabetes, taking cinnamon supplements improved fasting blood glucose and cholesterol levels, but not HbA1c levels. The report is published in September 9 issue in the Annals of Family Medicine.

Small doses of a cinnamon supplement could be used along with traditional diabetes medication, Cinnamomum cassia, either as natural supplement powder or capsule, was the most common form of cinnamon that was studied in the trials, and 1 tsp of cinnamon is approximately 3 g.

Cinnamon effect is attributed to its active component cinnamaldehyde.

The advantages of cinnamon are its cost, tolerability and relatively safe profile.

Long–term administration of high–dose cinnamon may possibly be unsafe due to the coumarin content of cinnamon, which has been associated with liver damage in animal studies.
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IMA Videos
IMA to develop a Model Health Village – Dr A Marthanda Pillai

https://www.youtube.com/watch?v=-qiOItamelE

IMA with Difference
https://www.youtube.com/watch?v=UI8QP8_K9RI
 
IMA Humor
Price you pay for being Good

Three men were waiting to go to heaven. St Peter was at the gate and said, "However good you were to your wife that is the vehicle you will get in heaven".
The first guy comes up to the gate and says, "I never, ever cheated on my wife and I love her". So St. Peter gives him a Rolls Royce.
The next man comes up and says, "I cheated on my wife a little but I still love her." He gets a mustang and drives off into heaven. The next guy came up and said, "I cheated on my wife a lot". He gets a scooter. Next day the guy that got the scooter was riding along and he saw the guy who owned the Rolls Royce crying. He asked, "Why are you crying you have such a nice car?!" and the man sobbed, "My wife just went by on roller skates".
Rally to create awareness on TB
New Delhi, 19th March, 2015: Dr Jagdish Prasad DGHS and Dr KK Aggarwal Honorary Secretary General IMA today released TB messages to earmark World TB Day falling on 24th March. Addressing a gathering of hundreds of health care professionals coordinated by IMA, Dr Prasad said that the slogan this year is "TB Harega, Desh Jitega".

Dr A Marthanda Pillai National President IMA and Dr Suresh Gutta National Coordinator TB said that it is important to notify TB in every case to stop the spread.

Over 40 Principals from various schools were also sensitized on TB prevention and respiratory hygiene.

Following messages were released
1. TB is curable.
2. Not notifying a TB patient is violation of the MCI Act.
3. It is important to not only notify but also follow notified patients till they are cured
4. Patients notified in private sector and lost in follow up could result in MDR TB, which costs a huge sum of money (Rs. 2 lakhs / patient)
5. Swach Bharat, Swsathya Bharat, TB Mukt Bharat
6. TB harega desh jeetega
7. Two weeks cough can be TB. Consult a Doctor
8. World cup lao, TB ko harao
9. 2 hafte se jyada khansi, wajan ghatana, bukhaar aana, balgam mein khoon aane par turant doctor se salaah karein. Ye TB ho sakti hai
10. Notify all TB cases and make a TB-free India.
11. Notify all TB cases in Nikshay and make TB Mukt Bharat
12. Diagnose and treat TB every case as per the Standards for TB Care in India
13. Kshay rog ka nidaan v ilaaj bharatiya kshay rog manakon ke anusaar hi karayein
14. TB anywhere is TB everywhere.
15. TB sab ko nahin hoti; par kisi ko bhi ho sakti hai.
16. TB isn’t just somebody else’s problem, it could be yours.
17. 9 million new TB cases are detected every year globally
18. 1.5 million people die every year from TB globally.
19. Do not ignore cough of more than 2 weeks, it may be TB.
20. Serological tests for diagnosis of TB are banned and not recommended.
21. Follow the standard IMA Protocol for TB.
22. Not notifying TB is a violation of IMC Act under Section 5.2 and 7.14.
23. 2 consecutive negative sputum samples for AFB at the end of treatment means TB is cured.
24. DOTS provides free treatment to TB patients and their confidentiality is maintained
25. MDR TB means TB that is resistant to INH, Rifampicin.
26. MDR TB requires treatment for 24-27 months
27. "Reach the 3 Million: Reach, Treat, Cure Everyone"
28. All diagnosed TB patients should be offered HIV counselling & testing.
29. TST and IGRA should not be used for diagnosing active TB.
30. TB patients should be given dosages of the drugs depending upon body weight.
31. Patients with pulmonary tuberculosis should be monitored by follow-up sputum microscopy at defined intervals.
33. TB patients living with HIV should receive the same duration of TB treatment with daily regimen
34. ART must be offered to all patients with HIV & TB at the earliest.
35. People living with HIV should be screened for TB
36. Ensure pura course for pakka ilaj
37. Ensure that all contacts of TB patients are screened for TB
38. Less than 6 years contacts of TB patients after excluding active TB, should get INH for 6 months.
39. Counsel all TB patients for cough hygiene, nutrition & treatment adherence
40. Hate TB, not the patient, treat with dignity and confidentiality.
eMedi Quiz
A 20-year-old man complains of difficulty in reading the newspaper with his right eye. Three weeks after sustaining a gunshot injury to his left eye. The most likely diagnosis is:

1. Macular edema.

2. Sympathetic ophthalmia.

3. Optic nerve avulsion.

4. Delayed vitreous hemorrhage.

Yesterday’s Mind Teaser: A vitreous aspirate has been collected in an emergency at 9 pm. What advice would you like to give to the staff on duty regarding the overnight storage of the sample?

1. The sample should be kept at 4°C.
2. The sample should be incubated at 37°C.
3. The sample should be refrigerated deep freezer.
4. The sample should be refrigerated for the initial 3 hours and then incubated at 37°C.

Answer for yesterday’s Mind Teaser: 1. The sample should be kept at 4°C.

Correct Answers received from: Dr Avtar Krishan, Dr KV Sarma

Answer for 18th Mar Mind Teaser: 4. Superior vena caval obstruction. Correct Answers receives: Dr Prabodh K Gupta, Prateek, Daivadheenam Jella, Dr Avtar Krishan, Dr KV Sarma
Rabies News (Dr A K Gupta)
Can the vaccine be injected in gluteal region?

Rabies vaccine must not be administered in gluteal region as the gluteal fat may retard vaccine absorption resulting in delayed and lower seroconversion.