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21st October, 2017
Paradigm shift in medical ethics
 
Dr KK Aggarwal
There has been a paradigm shift in the thinking of the public. There has been a corresponding paradigm shift in the dynamics of doctor-patient relationship; from paternalism to patient-centric. Today, patients want to be equal partners in decisions about their treatment with the doctor acting as a guide and facilitate decision making. Patient autonomy is also now at the forefront of the principles of medical ethics, along with non-maleficence (do no harm) and beneficence (do good).
 
From Vedic point of view, the public perception has rapidly shown a shift from Karma Marg to Bhakti Marg and to Gyan Marg. In Karma Marg, people surrender to the doctor-patient relationship. In the phase of Bhakti Marg, they show faith and Gyan Marg, is marked by suspicion and hunger to know why.
 
There are four types of patients today based on four levels of awareness i.e. their ability to retain knowledge or information that is given to them by the doctor pertaining to their disease.
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Top News
Today is Global Iodine Deficiency Disorders Prevention Day
 
Global Iodine Deficiency Disorders Prevention Day, also known as Global IDD Prevention Day, is observed annually on October 21 with the aim to raise awareness about the dangers of inadequate iodine intake and to highlight the consequences of iodine deficiency. The average daily requirement of iodine for a normal person is 150 micrograms daily... (National Health Portal).

World Medical Association postpones planned assembly in Istanbul
 
The World Medical Association has decided to postpone holding its 2019 annual General Assembly in Istanbul, Turkey because of security concerns. But it has reaffirmed its strong support for the Turkish Medical Association. At their annual Assembly in Chicago, WMA delegates agreed to postpone indefinitely the planned meeting because of concerns over security threats in the city.
 
WMA President Dr. Yoshitake Yokokura said: 'There is considerable doubt over whether we would be able to guarantee the safety of delegates attending the meeting. So, sadly we have decided that we have to postpone our visit. 'The attacks by the Turkish Government on the country's health service and the imprisonment and victimisation of physicians and academics that have taken place since July 2015 are something we cannot tolerate. 'We will continue to condemn any practices that threaten the safety of physicians and the provision of heath care services. 'We remain fully supportive of the achievements of the Turkish Medical Association in upholding democracy, fundamental rights and medical ethics in the country and we hope to be able to hold our Assembly in Turkey sometime in the future'(WMA, October 16, 2017).
Practice Updates
US FDA approves gene therapy for adults with certain types of large B-cell lymphoma
The US Food and Drug Administration (FDA) has approved Yescarta (axicabtagene ciloleucel), a cell-based gene therapy, to treat adult patients with certain types of large B-cell lymphoma who have not responded to or who have relapsed after at least two other kinds of treatment. Yescarta, a chimeric antigen receptor (CAR) T cell therapy, is the second gene therapy approved by the FDA and the first for certain types of non-Hodgkin lymphoma (NHL).

Prochlorperazine superior to hydromorphone for migraine 
 
Prochlorperazine, coadministered with diphenhydramine to prevent restlessness, was superior to hydromorphone, according to a study published online October 18, 2017 in the journal Neurology. After 48 hours, 60% of patients receiving prochlorperazine had sustained headache relief, compared to 31% of patients who received hydromorphone.

Heart attack patients may use inefficient coping methods for stress
 
Patients with a history of heart attack were more likely to use emotion-focused coping strategies for stress such as eating more or drinking alcohol, while patients without a history of heart attack or heart disease used problem-focused coping strategies, according to research to be presented at the 8th Emirates Cardiac Society Congress in collaboration with the American College of Cardiology Middle East Conference October 19-21, 2017 in Dubai.

RA patients are at a higher risk of incident COPD
 
Compared to the general population, patients with rheumatoid arthritis (RA) had a 47% increased risk of hospitalization for COPD, according to a study reported online in the journal Arthritis Care & Research. The guidelines say that new culture-independent molecular tests are much more sensitive than traditional diagnostic methods in detecting the cause of infectious diarrhea.

IDSA updated guidelines on acute gastroenteritis
 
The Infectious Diseases Society of America (IDSA) has updated guidelines on diagnosing and managing infectious diarrhea. These guidelines are available on IDSA website and were also published October 19, 2017 in the journal Clinical Infectious Diseases. Children younger than five, the elderly, people who are immune-compromised and those with bloody diarrhea, severe abdominal pain or tenderness or signs of sepsis particularly need to be tested.
 
eMedi Humor
Prison vs Work 
 
Just in case you ever got these two mixed up, this should make things a bit more clear.
IN PRISON you spend the majority of your time in an 8 x10 cell. 
AT WORK you spend the majority of your time in a 6 x 8 cubicle. 
IN PRISON you get three meals a day. AT WORK you only get a break for one meal and you pay for it.
IN PRISON you get time off for good behavior. AT WORK you get more work for good behavior. 
IN PRISON the guard locks and unlocks all the doors for you. AT WORK you must carry around a security card and open all the doors for yourself. 
IN PRISON you can watch TV and play games. AT WORK you get fired for watching TV and playing games.
Medicolegal Corner
Is it ethical for a doctor to publically endorse any drug or product?
 
Regulation 6.8.1 (h) of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) (Amendment) Regulations, 2009 - Part-I has laid down guidelines on endorsement. "A medical practitioner shall not endorse any drug or product of the industry publically. Any study conducted on the efficacy or otherwise of such products shall be presented to and/or through appropriate scientific bodies or published in appropriate scientific journals in a proper way."
eMedi Quiz
When assessing a patient's cultural beliefs about pain, the pain management nurse asks about:
 
a) A family history of pain.
b) Home remedies used to treat pain. 
c) The frequency of visits to health care facilities. 
d) The patient's dietary preferences.
Lifestyle Updates
 
eWellness: Wet vs Dry winter
 
Winter can be divided into wet and dry winter. Wet or early winter is characterized by fall in temperature along with high humidity. Environmentally, we see fog and smog during this season. Dry or late winter on the other hand is characterized by absence of fog, smog and presence of chilly airy winds.
 
Most hypothermia illnesses occur in dry late winter. The transition phase between wet and dry winter is on the day of Lohri. In terms of Ayurveda, this means shifting from Kapha to Vata atmosphere. The onset of dry winter is also the time for accelerated movement disorders in the body. Accelerated hypertension, arrhythmias, paroxysmal atrial tachycardia, brain hemorrhage, heart attack etc. all occur when dry late winter starts.
 
The correct lifestyle in this season has been defined in Ayurveda and it involves reducing consumption of stringent, bitter and pungent foods
eSpiritual: The science behind Bhai Dooj

Bhai Dooj is celebrated two days after Diwali. Like Raksha Bandhan it's a day dedicated to the sacred love between a brother and sister. Both Raksha Bandhan and Bhai Dooj festival falls in Chaturmas one at the start and the other at the end of this four months of negative state of mind. Jagannath Yatra (another festival of love between brother and sister where Krishna is worshipped with his sister Subhadra) is also held in Chaturmas. All three festivals also signifies purification of mind, getting it lust free and reminding the people a sacred relationship between men and women

The festival is known as "Bhav-Bij" in Marathi and "Bhai-Tika" in Nepal.

On Bhai Dooj, sisters pray for the wellbeing and prosperity of their brothers by putting tika/tilak (vermilion spot) on their forehead and offer sweets (healthy) and perform a ritual of taking their 'Arti'. The brother offers gifts as an expression of love. Some sister may fast on this day; gifts often involve rice, new grass, aab' (a length of flax, knotted into a circular shape and dotted with sugar batashas) etc. Rice in mythology symbolizes with fulfilled desires and again this ritual on this day signifies a non lust based sacred relationship between a man and a woman.

(Disclaimer: The views expressed in this write up are my own).
Inspirational: An Office Boy

A jobless man applied for the position of 'office boy' at a very big company. The employer interviewed him, then a test: clean the floor. "You are hired." -The employer said. "Give me your email address, and I'll send you the application to fill, as well as when you will start."
 
The man replied, "I don't have a computer, neither an email."" I'm sorry," said the employer, "if you don't have an email that means you do not exist. And who doesn't exist, cannot have the job."
 
The man left with no hope. He didn't know what to do, with only $10 USD in his pocket. He then decided to go to the supermarket, bought a 10kg tomato crate, then sold the tomatoes door to door. In less than two hours, he succeeded and doubled his capital.
 
He repeated the operation 3 times and returned home with $60 USD. The man realized that he could survive by this way, and started to go every day earlier, and returned late. Thus, his money doubled or tripled every day. Shortly later, he bought a cart, then a truck, and then he had his own fleet of delivery vehicles.
 
Five years later, the man's company was one of the biggest food retailers. He started to plan his family's future, and decided to have a life insurance. He called an insurance broker and chose a protection plan. When the conversation was concluded, the broker asked him his email. The man replied: "I don't have an email."
 
The broker replied curiously, "You don't have an email, and yet have succeeded to build an empire. Do you imagine what you could have done if you had an email?" The man paused for a while, and replied: "An office boy!"
 
Don't be discouraged if something is not in your favor today. Better opportunities are waiting ahead.
Iodine essential for growth and brain development in infants
Women planning to conceive should get adequate sources of iodine in their diet

New Delhi, 20 October 2017: As per a study, about 42 million Indians have abnormal thyroid hormone levels. It also indicated that India accounts for 21% of the global population with thyroid disorders. The prevalence of thyroid disorders was more in women than men with about 26% women diagnosed with abnormal TSH levels compared to 24% men. Thyroid disorders are a major outcome of iodine deficiency. 
 
On World Iodine Deficiency Day, there is a need to create awareness on the fact that Iodine is an essential micronutrient required for human growth and development. The average daily requirement of iodine for a normal person is 150 micrograms a day. The requirement of iodine is more in pregnant women than normal women, because the effects of iodine deficiency are most severe in pregnant women and for their babies.
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