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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos…
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 7 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial…

28th September 2012, Friday

SYMPOSIUM ON DIET, HEALTH & RELIGION

A symposium on Diet, Health & Religion, second in the series was held at Bharatiya Vidya Bhavan on 5th September, 2012. The Chief Guest was Shri J Veeraraghavan, Chairman, Bhavan’s KM Munshi Institute of Educational Leadership and Management.

Welcoming the gathering, Shri Ashok Pradhan, Director, BVB said that the purpose of this symposium was to examine the relation between what we eat, how it affects our health and how all religions look at this aspect. Nature is also related to our health. Nature tells us what to eat. For example, summer vegetables have a high content of water. Speaking on fasting, he observed that not eating on certain days cleanses our body.

Shri J Veeraraghavan delivered the keynote address.

  • All religions regard food as holy and sacred. Our Vedas mention that all living things come from food.
  • In Christianity, there is a prayer "… Lord give us today our daily bread…".
  • All religions place a great emphasis on moderation in diet. One should not overeat. Fasting is common to all religions. Besides physical health, fasting also helps in gaining control over oneself and for spiritual advancement.
  • Functional requirement of food for each person differs. It is for each person to decide on what is required for him.
  • Each religion has some specific restrictions about food. Some of these restrictions may be historical or geographical, while some may have spiritual aspects.
  • Bhagwad Gita says that the universal spirit – God or Brahman – is bound to nature. There are 3 types of bonding: Satva, Rajas and Tamas. Food is also classified into three: Satvik, Rajasik and Tamasik. No one is pure Satva or Rajas or Tamas. There is a mix with one being predominant.
  • Extreme foods – very hot or very cold – are liked by Rajasik people, who are very active and energetic.
  • Satvik foods are sweet and simple foods.
  • Tamas people are very sleepy and lazy. They don’t take fresh foods, which increases laziness.
  • The relation between one’s values and food is not unidirectional. There is a bidirectional relationship.

Prof Sunil Kumar, Member, Managing Committee, Ramakrishna Mission, spoke on how Hinduism regards food and diet.

  • Hinduism recognizes that people are different because of their ‘ahaara’, which means not just diet or food we eat, but everything that our mind intakes through our 5 sense organs!
  • We are nothing but the food we eat. The subtlest part of the food that we eat goes to form the mind, and therefore the purity and quality of all ahaara not just food is important.
  • Hinduism classifies all foods as Satvik, Rajasik and Tamasik. The Satvik prefer not to eat meat.
  • Purity of food is directly linked to purity of mind.
  • Hinduism gives one the freedom to follow your culture.
  • Austerity and self control along with Satvik food, which is fresh, simple and wholesome, is recommended.
  • Gur or jaggery is preferred to white sugar.
  • We say no to refined flour.
  • Salt should be taken in moderation.
  • Brown rice and seasonal and locally grown fruits and vegetables should be preferred.
  • Hinduism does not restrict eating eggs. Milk is considered a Satvik food.
  • Hinduism does not prohibit use of alcohol, but it recognizes the harmful effects of alcohol.

Dr Shridhar Dwivedi, Dean & Principal, Professor of Medicine/Preventive Cardiology, Hamdard Institute of Medical Sciences and Research, Hamdard University said that according to Islam we are the mere custodian of this body – we have to pass on this body to Allah in the same state as we received it.

  • Islam prohibits all what is detrimental to health.
  • Alcohol is prohibited.
  • Tobacco, gutka, paan masala should also be avoided as they destroy the physical as well as spiritual body.
  • There are no regulations in Islam regarding salt, refined flour, white sugar, and raw vegetables.
  • It does not prohibit eating garlic and/or onions.
  • Islam forbids the eating of pork.
  • Halal meat is preferred.
  • Muslims by and large follow rigid dietary guidelines (no pork, no alcohol) and are required to wash specific parts of the body before offering namaz.
  • Further they observe ‘roja’ for one month during the holy month of ‘Ramadan’, which is again a very healthy practice, if followed as per the strict tenets of Islam.
  • Islam offers perhaps the best prescription – Avoid anything which is detrimental to health.

Sister Prabha Verghese said that we all have a need for harmony and balance in our life.

  • We need a balanced diet. There is a common saying – What you eat is what you become. So, a balanced diet is required for a balanced personality.
  • Christianity believes that all food is a gift from God, so it should be used with great love.
  • The foundation of a healthy body – physical, spiritual and mental – is healthy food. Fasting with good intentions and high motives reduces ego and increases godliness. It brings us closer to God.
  • Some people choose to fast on particular religious holy days. Catholic Christians fast and abstain from eating meat on Ash Wednesday and Good Friday.
  • Some but not all Catholics also abstain from meat on all the Fridays of the year. Christianity forbids alcohol and tobacco.
  • It places no restrictions on garlic and/or onion.
  • Anything which is healthy for the body is recommended in moderation.

Dr AK Merchant of the Baha’i faith said, the Baha’i religion is less than 200 years old and diverse.

  • Baha’u’llah says: "Eat ye, O people, of the good things which God hath allowed you, and deprive not yourselves from the wondrous bounties…".
  • Whatever science has said is healthy for us is welcome.
  • Majority of Baha’is are vegetarian.
  • There is no restriction as such regarding foods.
  • The Baha’i teachings permit the eating of all foods.
  • There is nothing in the Baha’i teachings about whether people should eat their food cooked or raw, nor is it forbidden to eat meat.
  • Moderation is essential.
  • One should eat only when hungry and at a fixed time to allow the body to digest food.
  • Alcohol is strictly prohibited. This includes when alcohol is taken as a drink as well as in cooking.
  • Only medically prescribed drugs should be used.
  • Tobacco and smoking are not strictly prohibited but are highly discouraged.
  • If two diametrically opposite foods are on the plate, choose only one.
  • Baha’is believe that living a simple life, abstaining from the use of alcohol and mind–altering drugs is beneficial to spiritual development, greatly reduces illness and has a good effect on character and conduct.
  • If a person can live on a purely vegetarian diet, it would be most beneficial.
  • Why certain foods are available in certain seasons have a scientific basis.
  • Food should be eaten in a healthy state of mind.
  • Whole wheat and gur are preferred to refined flour (maida) and white sugar.
  • Mother’s milk is the best food for the child. A child who has been breast–fed has a better power of resistance.
  • Most importantly, we should show courtesy to people of other religions i.e. we should be mindful of the eating habits of other religions.
  • Fasting is very important. The Baha’i calendar has 19 days of fasting from March 2–20, which ends with the Baha’i New Year.

Rabbi Ezekiel Isaac Malekar said that Judaism regards body as the temple of soul.

  • Mere absence of disease does not mean a healthy person.
  • In Judaism, mental, physical and spiritual well–being is very important.
  • For each meal, there is a prayer, which should be said from the core of your heart. Food is not only what we eat, it is also what our body absorbs through eyes and senses.
  • The traditional Jews observe dietary restrictions or Kashrut or ‘keeping kosher’ as prescribed by Judaism.
  • Food that is consumed according to Jewish laws is Kosher. This means that they eat only those fish, fowl, and animals allowed in Leviticus 11 and Deuteronomy 14: specifically, fish with scales and fins (no shell fish), domestic fowl (chicken, turkey, etc., no birds of prey), and animals whose hooves are parted and who chew their cud.
  • Moreover, fowl and animals must be slaughtered in a specific way, every drop of blood must be drained out from the meat and poultry, meat cannot be eaten with dairy products.
  • Evening food should be taken before sunset.
  • All fruits and vegetables are allowed but should be carefully examined for insects. He said that waste of food should be made a crime.

Shri J Jolly spoke on the injunctions in Sikh scriptures, which speak about spiritual evolution of soul and earning livelihood with honesty and hard work. Fundamentally, human is composed of body, mind and soul. A healthy body is dependent on the subtle mind, which in turn is dependent on the soul.

  • We must take good care of the body as it is the temple of God – nurture it well. One should not overeat or oversleep.
  • If we are inclined to sensual gratification, our life is cursed.
  • Gurbani does not believe in fasting or observing rituals or religious baths. What is essential is keeping the mind clean, by continuously remembering God.
  • Sweets should not be eaten in excess, the lesser we eat, more better it is for us as it reduces disease.
  • Gurbani says that we should not fight over whether we should eat or not eat meat. A person becomes vegetarian as he evolves spiritually.
  • We should not read religious scriptures and at the same time be involved in hurting others.
  • We should avoid foods that bring suffering to a body and which creates evil currents in the mind.
  • Sikhism does not restrict one to be a vegetarian but with spiritual advancements one automatically shifts towards vegetarianism.
  • Sikhism says big NO to alcohol.
  • Smoking is considered as a cardinal sin.

Samani Charitra Prajna said that the core principle of Jainism is Nonviolence. Food is the main source of energy to survive.

  • Bhagwan Mahavir talked about two types of diet – Hitkari (Beneficial) and Mitkari (Moderate).
  • Jains are vegetarins, lactovegetarian. Many Jains are now vegans. Many avoid root vegetables in their diet.
  • Among the seven prohibited addictions, alcohol is one.
  • Also, beverages and drugs that contaminate our mind are prohibited. Anything which distorts the mind, which produces negative emotions are prohibited by the Jain religion.
  • Jainism believes in fasting as a means to purify the mind and body.
  • Jains observe several days of fasting, where they abstain from food, only water can be taken but not after sunset.
  • There are many ways of fasting like abandon of all kinds of food for a day or more, unodari – that means eat less than hunger, ras parityag – give up food like butter, milk, oil for few days etc.
  • No meals should be taken after sunset. If stomach is heavy at the time of sleep, one cannot sleep soundly.
  • In Jainism, there is a mention of abstinence from night eating. Acharya Hemchandra, in Yoga Shastra, says that the digestive system becomes inactive after sunset.
  • So this time is not suitable to eat.
  • Any food which supports spirituality is recommended.

Dr Shikha Sharma

Eating a balanced diet is important. There is a lot of diversity that we can bring in our food.

  • All vegetables and fruits are a treasure of vitamins and minerals.
  • So if we start eating only one kind of food, these vitamins and mineral are lost leading to deficiencies.
  • A balanced diet is thus not in terms of carbohydrates, but one which has 7 colors and 6 tastes.
  • Fasting acts like a brake on unlimited eating and helps us to come back to our natural rhythm.
  • Our diets may also differ according to blood groups. Each blood group represents a specific genetic profile.
    • Blood group B – should not eat sugary foods as they are very sensitive to high sugars. They should avoid refined flour, white sugar, white rice and breads. Eat more of chana, kala chana and moong dal.
    • Blood group A – should avoid heavy meals. They are low in acid levels and are prone to indigestion. They should eat lean fish, soya, wheat and green vegetables.
    • Blood group AB – There are no restrictions for this blood group. They can have a mixed diet.
    • Blood group O – people with blood group O should not eat too much of acidic food as their body is very acidic. They should avoid tea, coffee, fried food and sour foods.
  • It is important to understand our body and eat food which is in accordance to our body.

Dr KK Aggarwal

As medical fraternity, we must know what dietary religious practices are.

Most religions agree that fasting is good for health. Pot belly obesity, diabetes, hypertension and paralysis are all linked to metabolic syndrome which is characterized by insulin resistance which can be traced to refined carbohydrates, which are white sugar and refined flour. Any food, which is refined is bad for health.

The body has a circadian rhythm. The digestive fire is weakest between 6 and 10 pm, i.e. enzymes for digestion are at lowest levels. Foods that are mismatched should not be combined together. A predigested food such as curd should not be mixed with an undigested food, it will lead to indigestion. Ayurveda recommends against eating fermented food at night. Alcohol is also fermented and so should not be taken after sunset. Alcohol is an evening drink (evening is the period before sunset and with sunset, the night starts. Alcohol is beneficial to the body if it is taken before sunset. About 80% of Indians may have vitamin D deficiency. So, 60000 units of vitamin D should be taken with milk once a month.

Consensus

  • Eat less or in moderation.
  • Eat seasonal and locally grown vegetables.
  • Eat variety and color.
  • Any food that is prohibited by doctors is injuries to health and should not be taken.
  • Food is a gift from God.
  • Eat only when hungry.
  • Most religions have some restriction on combination of food.
  • Avoid alcohol, as per the regulations of your religion.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

What is the role of lactulose in constipation?

Lactulose increases stool frequency, decreases the severity of constipation symptoms and reduces the need for other laxatives in older adult patients. However, in one study, lactulose was less effective than low–dose polyethylene glycol (PEG) and also had a higher incidence of flatus (Gut 1999;44(2):226–30). In another study, PEG 3350 compared with lactulose provided a higher success rate with fewer side effects (Gut 2004 Nov;53(11):1590–4).

For Comments and archives…

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Ventilator-associated tracheobronchitis

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

4th Dil Ka Darbar

The Darbar was organized by Heart Care Foundation of India in association with Indian Oil, Central Bank of India Department of AYUSH and various Departments under Health Ministry, Government of Delhi on Sunday 23rd September 2012 at Talkatora Stadium.

 
Dr K K Aggarwal
    National News

Kolkata tops metros in heart disease risk

KOLKATA: On World Heart Day this Saturday, Kolkatans will have to pledge to take better care of their hearts by growing more healthy food habits and leading a disciplined lifestyle. A recent study showed that 74% of respondents from the city had the risk of developing cardiovascular diseases (CVDs), highest among the metros. The all–India figure stands at 72%, according to Saffolalife Heart Study 2012. Kolkata also emerged the ‘smoking capital’ with 19% of the respondents being smokers, the all–India figure being about 16%. According to doctors, smoking is known to increase blood pressure and release free radicals."Though medical science has advanced now with effective drugs and devices like stents and pacemakers being easily available in the market, there is no substitute for prevention. A healthy lifestyle, including a proper diet and briskly walking 4 to 5 kms daily are effective ways of preventing heart ailments," said Dr D Kahali, senior consultant cardiologist at BM Birla Heart Research Centre.

Around 72% of respondents from the city had very low good cholesterol (HDL) level. A whopping 78% said they consumed less than two helpings of healthy whole grams per day while 67% exercise less than four times a week. "Controlling of obesity, regular exercises along with dietary modification – low–calorie, nutrient–rich food, more fresh vegetables and whole grain cereals – help maintain a healthy life by preventing CVD," said Ipshita Chakravarty, chief dietician at Fortis Hospital. Chakravarty was part of the team that conducted the study.

More alarmingly, the young population is at high risk of developing heart ailments, showed the study. Around 75% of the male population in the age group of 30 to 44 stood the risk of CVD while the corresponding figure for the female population was 57%. "Now we get very young patients with heart ailments. I recently treated a 22–year–old youth for blockage in the main artery," said Kahali. The study conducted across 12 cities had covered more than 1.12 lakh people in the age group of 30 to 80 years. According to experts, the projected number of cardiovascular disease–related deaths in India by 2020 will be more than double the number in 1990, which was 11.75 lakh. Majority of them could in the productive working age group of 30 to 44. (Source: TOI, Sept 27, 2012)

For comments and archives

My Profession My Concern

Include this in your practice

Repeat screening for bone mineral density

In women 65 years of age and older with normal or slightly low bone mass (T–score –1.01 to –1.49) at baseline measurement and no risk factors for accelerated bone loss do follow-up dual-energy x-ray absorptiometry (DXA) in 10 to 15 years.

(Leslie WD, Morin SN, Lix LM, Manitoba Bone Density Program. Rate of bone density change does not enhance fracture prediction in routine clinical practice. J Clin Endocrinol Metab 2012;97:1211)

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    Valvular Heart Disease Update

When is antithrombotic therapy indicated after heart valve replacement?

Treatment with warfarin (or other vitamin K antagonist) and/or aspirin is recommended in patients with prosthetic heart valves to prevent valve thrombosis and thromboembolic events.

(Experts: Dr Ganesh K Mani, Dr. Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For comments and archives

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Mobile phones behind hearing loss in young?

MUMBAI: The jury is still out on the link between new phones, listening devices and hearing loss, but doctors say they are now seeing patients going deaf in their twenties. During World Deafness Week, doctors feel it is time to take a closer look at lifestyle factors. Overusing mobile phones, say doctors, is also associated with the rising incidence of vestibular schwannoma (acoustic neuroma or benign tumour growing on the nerve). "It is felt that the incidence of vestibular schwannoma would be 50% higher in mobile users than non–users," said Prabhat. "Hearing loss depends on the decibel of sound and the duration for which one is exposed," said Prof Hetal Marfatia of KEM Hospital. "If one is listening to sounds over 80 dB for four hours, there would definitely be hearing loss."

'Loud music causes hearing problem' Doctors blame the hearing problems on a favourite habit of youngsters: hanging on to their phones and music players at loud volumes for several hours a day. The World Health Organization has said that noise above 85 db is damaging to human ears and a 3 dB rise above this reduces by half the time needed to cause damage. But another doctor, Nishit Shah, said rapid hearing loss is only caused by viral infections. "Hearing loss occurs over years," he said, adding that the only exception would be instances of terror victims turning deaf on exposure to loud sound. But Prof Marfatia said an angiogram would be a definite way of understanding if hearing loss is caused by noise pollution, be it exposure to sound in the environment or personal music players. A study from Tel Aviv University has shown that youngsters who listened to over four hours of music on their MP3 players or iPpods could be damaging their hearing. Sumaira Abdulali of Awaaz Foundation, which works on creating awareness about noise pollution, said, "The levels of noise we are exposed to could turn us into a nation of deaf people. It’s high time noise pollution was considered a health problem and solutions worked out accordingly." (Source: TOI)

For comments and archives

Physical activity down worldwide

Physical activity levels are dropping around the world, led by declines in occupational activity, researchers found. (Source: Medpage Today)

For comments and archives

Weight gain after bypass not affected by diet

Lifestyle factors –– including dietary intake, physical activity levels, and treadmill time –– were not predictive of weight regain from 2 to 6 years after Roux–en–Y gastric bypass, researchers found. (Source: Medpage Today)

For comments and archives

Nine small meals a day may help you shed kilos

LONDON: Instead of three square meals a day, eating little and often is healthier, and one should have as many as nine meals every day, experts have claimed. Consuming little food at intervals may help lower BP and cholesterol, and even encourage weight loss, the Daily Mail reported. In a recent study, scientists from the Imperial College, London, compared the diets of more than 2,000 people from the UK, Japan, China and the US. While they all had the same calorie intake and food, half the participants ate fewer than six times a day, while the remainder ate more than six times. The study found that the first group had a significantly higher systolic blood pressure – the pressure that blood exerts on vessels while the heart is beating – compared with the more frequent eaters. They were also significantly heavier. Researchers are now planning a larger trial involving 50 patients with high BP who will eat either three or nine meals a day to assess the effects of the different regimens. As well as their blood pressure, patients will have their insulin level, glucose and fatty acids recorded. (Source: TOI)

For comments and archives

 
   Twitter of the Day

@DrKKAggarwal: 5% High Risk Patients Get Heart Attacks During Perioperative
Periodhttp://blog.kkaggarwal.com/2012/09/5–high–risk–patients–get–heart–attacks–
during–perioperative-period/

@DeepakChopra: What were the philosophies of Adi Shankara, the great Indian Philosopher? My #askdeepak reply http://tinyurl.com/bopnmbh

 
    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Symposium on Diet, Health & Religion – Dr Shikha Sharma

A symposium on Diet, Health & Religion, second in a series was held at Bharatiya Vidya Bhavan on 5th September, 2012. The Chief Guest was Shri J Veeraraghavan, Chairman, Bhavan’s KM Munshi Institute of Educational Leadership and Management.

For comments and archives

 
    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is surgical sperm retrieval?

Sperm are usually present in the reproductive tract of spinal cord-injured men. Microsurgical epididymal sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA), testicular sperm extraction (TESE), and percutaneous testicular sperm aspiration are examples of techniques that are used for men with acquired or congenital obstructions along their reproductive tract. Compared to MESA and TESE, the percutaneous methods have the advantage of not requiring an incision into the scrotum; however, MESA is the technique with the lowest amount of contamination with blood cells, and the method that is most likely to obtain sufficient amounts of fluid for immediate use with ICSI as well as for sperm cryopreservation.

For comments and archives

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Blood Donation – Gift of Liquid Love

Blood is the lifeline for any hospital. In India, about 9 million units of blood is required every year. But unfortunately only about 7 million units are collected every year. Thus there is a shortage of more than 25-30%. The gap between the demand and supply is increasing. Therefore, lakhs and lakhs of patients suffer due to non–availability of proper blood at proper time.

Under the directive of honorable Supreme Court of India, it is illegal to take blood from any professional donor. It is best is to take blood from non–remunerative voluntary donors.

For comments and archives

 
    Liver Abscess Update

(Dr Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation Medanta – The Medicity Hospital)

What clinical symptoms distinguish between pyogenic and amoebic liver abscess?

  • Clinical presentations do not distinguish amoebic from a bacterial etiology unless there is an obvious precipitating source for e.g. abdominal infections.
  • It is uncommon to get a positive history of colitic diarrhea from patients of amebic liver abscess.

For comments and archives

 
   An Inspirational Story (Ms Ritu Sinha)

Face difficulties positively

This parable is told of a farmer who owned an old mule. The mule fell into the farmer’s well. The farmer heard the mule praying or whatever mules do when they fall into wells. After carefully assessing the situation, the farmer sympathized with the mule, but decided that neither the mule nor the well was worth the trouble of saving. Instead, he called his neighbors together, told them what had happened, and enlisted them to help haul dirt to bury the old mule in the well and put him out of his misery.

Initially the old mule was hysterical! But as the farmer and his neighbors continued shoveling and the dirt hit his back, a thought struck him. It suddenly dawned on him that every time a shovel load of dirt landed on his back, HE WOULD SHAKE IT OFF AND STEP UP!

This he did, blow after blow. "Shake it off and step up…shake it off and step up…shake it off and step up!" He repeated to encourage himself. No matter how painful the blows, or how distressing the situation seemed, the old mule fought panic and just kept right on SHAKING IT OFF AND STEPPING UP!

It wasn’t long before the old mule, battered and exhausted, stepped triumphantly over the wall of that well! What seemed like it would bury him actually helped him… all because of the manner in which he handled his adversity.

That’s life! If we face our problems and respond to them positively, and refuse to give in to panic, bitterness, or self–pity… the adversities that come along to bury us usually have within them the potential to benefit and bless us!

(http://academictips.org/blogs/face–difficulties–positively/)

For comments and archives

 
   Cardiology eMedinewS

RELAX–AHF: Positive results with new acute HF treatment Read More

Cutting sugary drinks does cut weight gain Read More

 
   Pediatric eMedinewS

‘Gut feelings’ matter in Dx of kids’ infections Read More

AAP reaffirms position against trampoline use Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: One whole family came for typhoid vaccination.
Dr Bad: Bring your family tomorrow for vaccination.
Dr Good: Also bring your servants and food handlers at home for vaccination.
Lesson: Along with vaccinating your family members, it is equally important to simultaneously vaccinate the workers at your home, especially the food handlers to break the cycle.

For comments and archives

Make Sure

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.

For comments and archives

 
  Quote of the Day (Dr GM Singh)

The height of your accomplishments will equal the depth of your convictions. William F. Scolavino.

 
    Legal Question of the Day (Dr M C Gupta)

Q. I am a surgeon in private practice. An organisation recently arranged a medical camp in the city where patients were examined free. Those needing surgery were issued referral cards valid for three months in Civil Hospitals only. Three patients have come to me with such referral slips. They have: gall stones; bladder stone; and inguinal hernia. I propose to perform surgery upon them without charging fees. In the circumstances, will I be liable under the CPA if they sue me?

Ans.

  • This question has been clearly answered in IMA v. V.P. Shantha, decided by a three judge bench of the Supreme Court on 13.11.1995, as follows:

    "8) Service rendered at a non–government hospital/nursing home where charges are required to be paid by persons who are in a position to pay and persons who cannot afford to pay are rendered service free of charge would fall within the ambit of the expression ‘service’ as defined in Section 2(1)(o) of the Act irrespective of the fact that the service is rendered free of charge to persons who are not in a position to pay for such services. Free service, would also be ‘service’ and the recipient a ‘consumer’ under the Act."
  • Besides CPA, they can also sue you under the following Acts:
    • IMC Act, 1956 (Refer MCI Regulations, 2002).
    • IPC (For criminal negligence)
    • Law of torts (In a regular civil court)
    • Clinical Establishments Act/Nursing Home Act, whichever is applicable in the state.
  • CAUTION—Forget about all those notions of serving the poor and alleviating human suffering in the pursuit of a noble/divine profession in a spirit of sacrifice, driven by a religious or spiritual bend of mind. Law does not recognise moral ideals or concepts of sacrifice, nobleness, divinity, religion or spirituality. Law recognises only money (and that is why lawyers do not appear in a case without charging money!). Those in white coats should learn from those in black coats if they want to avoid the need for their services)
 
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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Doctor’s Day Celebration

 
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    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

Adrenocorticotropic Hormone (ACTH)

To help diagnose adrenal and pituitary diseases such as Cushing’s syndrome, Cushing’s disease, Addison’s disease, adrenal tumors, and pituitary tumors.

 
    Rabies Update (Dr. A. K. Gupta, Author of "RABIES – the worst death")

Should modern rabies vaccines meant for use in man be given to animals?

It is advisable to use human vaccines for human use and use the veterinary vaccines for animals because there is no dose-weight correlation of immune response nor the efficacy of human vaccine is known in animals.

 
    Fitness Update (Rajat Bhatnagar, MonaVie, www.mymonavie.com/sonraj)

Preliminary study finds exercise may help overcome genetic predisposition to obesity

It has been accepted among the medical community that obesity is to some extent based on genetics. This means that some people, regardless of the environment, are more likely to be obese than others. However evidence now also suggests that environmental factors like exercise and sugary beverage consumption may be able to alter this risk.

During a recent study, presented at the Obesity Society, researchers looked at date from a national survey representing American youth. They found that high levels of exercise – defined as moderate to vigorous exercise greater than 5 times per week – weakened the link between certain genetic indicators of obesity risk and body mass index (BMI), a common measure of obesity. While the findings are preliminary and more research is needed, these findings are a promising indicator that exercise may be able to reduce obesity risk in those at the highest risk

 
    Mind Teaser

Read this…………………

The nurse is performing an eye examination on an elderly client. The client states ‘My vision is blurred, and I don’t easily see clearly when I get into a dark room." The nurse’s best response is:

A. "You should be grateful you are not blind."
B. "As one ages, visual changes are noted as part of degenerative changes. This is normal."
C. "You should rest your eyes frequently."
D. "You maybe able to improve you vision if you move slowly."

Yesterday’s Mind Teaser: Which of the following activities is not encouraged in a patient after an eye surgery?

A. Sneezing, coughing and blowing the nose
B. Straining to have a bowel movement
C. Wearing tight shirt collars
D. Sexual intercourse

Answer for yesterday’s Mind Teaser: D. Sexual intercourse

Correct answers received from: Prabha Sanghi, y. j. vasavada, Dr. P. C. Das, Dr.(Maj. Gen.) Anil Bairaria, Dr. Yamini Sarwal, DR KANTA JAIN, Dr.K.V.Sarma, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr. Thakor Hitendrsinh G

Answer for 26th September Mind Teaser: C. Relax the bronchial smooth muscle
Correct answers received from: Dr.K.Raju, L. C. Dhoka, Dr Chandresh Jardosh, Dr Sudipto Samaddar, Dr Vishwanath R Hiremath, Dr MK Bhandari, Dr. B. B. Aggarwal, Dr.Bina R.Sawhney

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr. Chandresh Jardosh)

X and Y buy one race horse each after learning about big money in racing. Says Banta, "How do we identify which horse is mine and which one is yours?"

X replies, "I will cut the tail of my horse and so the horse without a tail will be mine and the one with a tail will be yours."

So they cut the tail of the horse. But in the night their naughty kids cut the tail of the other horse too.

And the next day Y is worried and says, "I will cut one of the ears of my horse so the horse with one ear will be mine and the other one will be yours."

The next night the kids cut the other horse’s ears too. And so it goes on until the horses lost their ears, eyes, had broken noses etc.

And in the end both horses were left only with bare legs and were just barely living. Both Santa and Banta were frustrated.

At last Y says, "BAHUT HO GAYA. SAFED WALA GHORA MERA, KALA WALA TERA"

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Doctor must record dying declaration in terminally injured patient

Under section S.32 of Indian Evidence Act a written or oral statement of an injured/sick dying person is called dying declaration, it must be recorded by the doctor attending an injured/sick person/patient who is dying/under medical expectation of death as a result of some unlawful act, relating to the material facts of cause of his death or bearing on the circumstances The dying declaration/statement carries legal importance to identify the offender or to clear innocent persons

  • If there is time, the doctor should call the area Magistrate to record the statement/declaration. The doctor should certify that the person is conscious and his mental faculties are normal at the time of recording the statement. If the victim is very serious, and there is no time to call a Magistrate, the doctor should take the declaration in the presence of two witnesses particularly any attendant of other admitted patient. As far as possible, choosing nurses and paramedics as witness should be avoided to maintain the legal credibility of declaration. While recording the dying declaration, oath is not administered, because of the belief that the dying person will tell the truth. The statement should be recorded in the man’s own words, without any alteration of terms or phrases. Leading questions should not be put.
  • The declarant should be permitted to give his statement without any undue influence, outside prompting or assistance. If a point is not clear, question may be asked to make it clear, but the actual question and the answer received should be recorded. It should then be read over to the declarant, and his signature or thumb impression is taken.
  • The statement made must be of fact and not opinion. If the declaration is made in the form of an opinion or conclusion, questions should be asked by the recorder to bring out the facts that are the basis for the conclusion. While recording the statement, if the declarant becomes unconscious, the doctor recording it must record as much information as he has obtained and sign it. If the dying person is unable to speak, but is able to make signs in answer to questions put to him his can be recorded and it is considered as a "verbal statement".
  • The doctor and the witness should also sign the declaration. If the statement is written by the declarant himself, it should be signed by him, the doctor and the witnesses. The declaration is admissible not only against an accused that killed the declarant, but also against all other persons involved in the same incident which resulted in his death.
  • The declaration is sent to the Magistrate in a sealed cover. It is produced at the trial and accepted as evidence in case of death of the victim in all criminal and civil cases, where the cause of death is under enquiry. The person recording the declaration will have to give evidence in the Court of law under oath to prove it. If the declarant survives, the declaration is not admitted but has corroborative value, and the person is called to give oral evidence under oath.
  • In India, if the declarant is in a sound state of mind at the time of making the declaration, it is admissible in Court as evidence, even if the declarant was not under expectation of death at that time.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Even children can have acidity

Children who have continuing recurrence of cough and croup could be suffering from stomach acid reflux problems said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Croup or ‘Kali Khansi’ as it is called in local parlance is recognized by a loud cough that often sounds like the barking of a seal. It can cause rapid or difficult breathing, and sometimes wheezing. Croup is thought to be caused by a virus, but reflux acidity has been suggested as a possible trigger.

In gastroesophageal reflux disease, stomach acid causes swelling and inflammation of the larynx, which narrows the airway. It can trigger more swelling with any kind of viral or respiratory infection.

Identifying children with gastroesophageal reflux disease could help treat and improve recurring croup. It is unusual for a child to have three or more bouts of croup over a short period of time. These children need to be evaluated.

The same is true for adults also. Patients with non responding asthma should be investigated for underlying acidity as the cause of acute asthma.

 
    Readers Response
  1. .Dear Sir, Dil Ka Darbar was Fabulous. Regards: Dr Ruchi
 
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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Dr Usha K Baveja