eMedinewS30th December 2013, Monday

Dr K K AggarwalPadma 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; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
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Walking 2000 steps extra lower cardiovascular risk

Walking 20 minutes at a moderate pace each day is associated with improved cardiovascular outcomes in patients with impaired glucose tolerance, according to a study in The Lancet.

People who walked 2,000 steps more per day at baseline had a 10% lower risk of cardiovascular death, paralysis or heart attack during an average follow–up of 6 years according to Thomas Yates, PhD, of the University of Leicester in England, and colleagues.

And those who increased the amount they walked by 2,000 steps per day from baseline to 1 year had a similar reduction in risk of cardiovascular events.

The findings from NAVIGATOR trial support both the promotion of increased ambulatory activity, and the avoidance of decreased ambulatory activity irrespective of the starting level, as important targets in the prevention of chronic disease.

Dr. Jayshreeben Mehta, President, Medical Council of India

Ladies and Gentleman,

It gives me immense pleasure and satisfaction to be in the midst of this illustrious gathering that has assembled here. With all emphasis at my disposal I would like to bring it to your kind notice that the development of health sciences is an important component of social and economic development. The basic fundamentals, equality, freedom, justice and dignity of individual as envisaged in the Constitution are required to be kept in mind while planning the socio-economic development of the country. India as a nation is committed to attainment for health for all by 2020 AD through the universal provision of comprehensive primary health care services. In order to materialize this goal of rendering health services, health manpower turns out to be one of the most significant aspects for this attainment.

Health manpower has been defined as the "generation of people who are trained to promote health, to prevent and cure diseases, and to rehabilitate the sick". The important dispensation required to be carried by the trained health manpower thus includes: Promotive health; Preventive health; Curative health and Rehabilitative health.

The primary aim therefore of manpower planning is to make available the "right kind of personnel, in the right number, with appropriate skills, of the right place; at the right time, for doing the right job.” Manpower planning therefore is meant for training and deployment of the types and number of health personnel that is assessed on the basis of 'need and affordability' as well. It is also imperative to ensure that such personnel is "socially responsible’ and possesses an appropriate 'technical, scientific and managerial’ competence. As such, health manpower planning therefore turns out to be an integral component of overall health planning and not an isolated entity.

India has more than 7, 00,000 doctors of modern medicine which is the second largest pool of medical doctors in the world. However, when compared with the population of more than 1,170 million, it is translated into a doctor population ratio of 60: 1 00,000, which is below that of developed countries like USA, UK and Australia. Even if the attributed doctors population ratio is taken at 100: 1 00,000, there would be additional requirement of nearly 400,000 doctors.

The situation in availability of specialists manpower in India's health sectors is even more alarming. Although the number of specialists in broad specialties of Internal Medicine, General Surgery etc., although inadequate, is within manageable proportion, but, the availability of specialists emerging specialties like Psychiatry, Dermatology, Ophthalmology, Anesthesia, Radio-Diagnosis, Occupational Health etc., is much less.

 Another dimension of the problem being faced by India is that of huge urban rural divide. Although nearly 70% of the population lives in rural areas, only about 30% or the medical manpower is available in these or areas.

It is in this context that the health manpower shortage needs to be evaluated. The planning commission has definitely thrown some light on the present manpower crunch plaguing the Indian health care industry, which will be further exaggerated for the high demand for Indian health care professionals around the world.

According to the planning commission of the India report, India is short of six lac doctors, ten lac nurses and two lac dental surgeons, Indian doctors who have migrated to developed countries form nearly 5% of their total medical workforce. This shortage affects the efficiency of the doctors as they are overburdened.

As per the World Health Report 2006, India falls in the categories of countries with critical shortage of health service providers, which is often marked by inappropriate skill mixes and gaps in service coverage. Moreover, the healthcare manpower to population ratio in India is very low as compared to the global norms.

According to the report, doctor to patient ratio stands at 6 per 10,000 population in India which is much below than that of  Australia being 249 : 1, in UK 1,665 : 5 and in US 548 : 9. The shortage of medical practitioners is more acute in States like Chhattisgarh and Jharkhand in India, with just two Doctors for one lac people when with the global average of 15 Doctors per ten thousand populations. Similarly, the number of Dental Surgeons registered in India stands at just over 73,000 as against the requirement of three lakh. Currently, medical colleges in India churn out about 31,000 doctors apart from 20,000 dentists and 45,000 nurses.

It is estimated that to meet the global average of 1.23 physicians and 2.56 Nurses per thousand populations in coming 15 years, India would require to open 600 new medical colleges (100 seats per college) and 1500 nursing colleges as observed by Knowledge  Commission in its report.

As against this backdrop, the brain drain of the qualified health manpower to other countries is yet another issue affecting the already grim health scenario. Almost 60,000 Indian physicians are estimated to be working in countries like U.S., U.K. Canada, and Australia alone, a workforce equivalent to nearly 10 % of the physicians registered with Medical Council of India. There are high rates of 'emigration' found amongst the Nurses and paramedical staff also.

To cope-up with these shortages, one of the strategies adopted by India was vertical and horizontal expansion of medical schools. At the time of independence in 1947, there were 23 medical colleges in India, which increased to 149 by the year 1993. In order to give fillip to the expansion of medical education without compromising the quality of medical education, the Indian Medical Council Act 1956 was amended in 1993 to regulate the medical education in the country by instituting a scheme prescribed under the Act through the Medical Council of India. In order to achieve the desired objectives of the amended Act the Regulations pertaining to the Minimum Standard Requirements in a Medical College, Graduate and Postgraduate Medical Education, Teachers Eligibility etc. were prescribed during 1997-1999.

ln 1999 Regulations, in order to provide better health care facilities in the rural areas, the Council in its Establishment of Medical Colleges Regulations had prescribed certain conditions like the College Regulations had prescribed certain availability of unitary plot of land of 25 acres which would be easier to fulfill in rural areas wherein availability of open stretch of land is not a problem. This was done with a motive to ensure that the tertiary health care facilities which would have to develop in an apex hospital which is affiliated to a medical college would also be available in rural areas and also the graduates who have studied in rural surroundings would not find it a problem to settle in those areas once they graduate.

Another vital change was reduction in the requirement of beds for a medical college of having annual intake capacity of 100 from 700 to 500. This was mainly done as it was observed that in the departments like Ophthalmology and ENT, the services were being provided mainly on daycare basis. In the departments like Psychiatry and Skin & V.D. also, the focus was shifting from inpatient treatment to treatment on outdoor patient basis.

All these measures resulted in the expansion of the medical colleges from 149 in 1993 to 381, at the end of 2013 thereby increasing the number of available undergraduate admissions to nearly 47,000 seats and approximately 30,000 graduates passing out of the medical colleges every year.

However, it is felt that even this increase is not sufficient to fulfill the increasing requirements of the health sector, mainly due to twin factors of providing better secondary and tertiary level services in a large hinterland which was not served with such secondary and tertiary level health care services as would have been desirable and also to color 10 the rising expectations of ever increasing population. Hence in 2008, the Council has proposed several further amendments to the Minimum Standard Requirements Regulations which are briefly enumerated hereunder:-

a.  The 1997 Regulations had prescribed the requirement of land as a unitary piece of land of not less than 25 acres. As such unitary plots of 25 acres were difficult to be acquired in urban  areas having population of more than 25 lakhs, hilly areas and tribal areas, this requirement was relaxed in urban areas having population of more than 25 lakhs, hilly areas and tribal areas wherein the medical college could be set up in two pieces of land.

b.  In order to achieve optimal utilization of the teaching faculty particularly in pre-clinical and para-clinical departments, the faculty requirement was reduced by about 20% in these departments in such a manner that the quality of medical education would not be compromised.

c.       The Companies and Corporates are also permitted to set up the new medical colleges.

 This will not only take care of the increasing requirement due to  increasing population but also will ensure the availability of basic doctors for programs in rural areas like National Rural Health Mission, which are vital for the upliftment of health services in rural areas.

Simultaneously, in order to cater to fulfill the requirement of specialists, the MCI has also made available the total availability of nearly 12,000 seats in different postgraduate degree and diploma courses, including nearly 600 seats in different super specialty courses. Additionally approximately 5,000 openings are available under Diplomat programme in various subjects being offered by National Board of Examinations.

In order to make more specialists available, the teacher student ratio which was I: 1 is proposed to be relaxed to 1:2 in case of professor provided the institute would add 10 beds so that availability of postgraduate seats can be increased without sacrificing the quality of bed side teaching which is on utmost paramount factor in the postgraduate studies would not be compromised.

In order to ensure the availability of doctors in rural areas, the MCI has also proposed that at least 50% of the seats in postgraduate diploma courses should only be made available to those who have completed a specified minimum period of service in such areas for admission into postgraduate diploma courses. The Council has also suggested to the Government that such diploma holders should be given incentives so that they would revert back to their rural areas once they complete the diploma, thereby ensuring continuing availability of specialists in rural areas.

I would also like to mention here that the Indian Medical Association is also keenly alive to these issues. In order to make available expert medical manpower, the Indian Medical Association has introduced "Aao Gaon Chale" which means "Let Us go to the Villages" programme wherein the doctors in their spare time and holidays to villages periodically, in order to provide the medical advice and treatment to the people who otherwise would never have on opportunity or access to the services in their surroundings. This programme has met with huge success wherein so for it has been implemented successfully in 500 villages benefiting more than 1 lakh people.

IMA has also token up Government programmes actively by way of public private partnership initiative. Such programmes include tuberculosis control, family welfare, anemia detection and treatment, prevention of prenatal sex determination and sex selective abortion, etc. Services provided by private practitioners are complementary to Government efforts. These programs are implemented in more than 500 centers in five States.

IMA is also running AKN Sinha Institute of Medical Education and research which imparts postgraduate certificate courses in the form of distant learning programmes on various subjects of common interest for family physician. IMA College of General practitioners looks after continuing medical education programmes for family physicians so as to make better prepared for dealing with all sorts of medical emergencies in rural and backward areas.

As such, it is necessary that the manpower plans are developed as a part of a more ‘bottom up’ process with the requirements for manpower being considered alongside the requirements for other resources. It requires defining the health objectives, the services to be provided and then identifying the resources including personnel requirements.

lt is for these reasons I am of the considered opinion that an appropriate functional unison between Medical Council of India and the Indian Medical Association, is bound to pave good time for the genuine pursuit of quality based medical education in the country resulting in effective generation of trained health manpower so as to deliver meaningful health care services to all the stakeholders to their satisfaction.

I thank the organizers for giving me this opportunity for putting across my candid views and I assure that Medical Council of India would always be open and available for a meaningful cooperation in the larger national and global interest with Indian Medical Association at all times.

88TH National IMA Conference and 74th Annual Meeting of Central Council @ Rajahmundry AP, 27.12.2013

N.V. Ramana, C.J
We have not lost faith, but we have transferred it from God to the medical profession. (George Bernard Shaw)

So declared our ancient rishis! The doctor is verily the Lord Narayana Himself! When I see the galaxy of Doctors today I am engulfed with an ecclesiastical feeling, because the Narayana Himself is present in His Virat Swaroopam.

No wonder, I deem it a singular honour to address you. I stand before you not with any authority to speak but with humility, bowing down to you in the most ancient order of the spiritual culture of India chanting Namo Narayana!

In fact all religions hold the doctor in high esteem. Gautama Buddha said that a doctor is like a mother to each of his patients. As the mother with only child showers all her love and compassion on the child, so the doctor should do the same.

Thus, an exceptionally venerable position is given to the doctor in all societies. It is but natural that greater the veneration given greater is the responsibility attached to live up to such privilege.

I feel privileged to be the Guest today and to inaugurate the 88th National Conference of Indian Medical Association and 74th Annual Meeting of IMA Central Council, to be held today and tomorrow. I thank the organizing committee for inviting me and making me a part of this august gathering.

History of Rajahmundry:

Rajahmundry is a historic city situated on the bank of river Godavari. Its rich heritage and history dates back to 191 AD. Distinctly located, Godavari Districts are known as the rice bowl of A.P. The first Telugu poet Adi Kavi Nannawa is born here and he was the first who translated the epic Mahabharatha into Telugu. Several freedom fighters belonging to this land sacrificed their lives and properties for our freedom struggle against the British Rule. The great Kandukuri Veeresalingam was born here who was an active social reformer, and a huge supporter of widow remarriages in our history. He has encouraged education for women, established a Telugu journal and also was the first among the few writers to write prose for women. Godavari people are known for their hospitality.

Introduction:

The two important things we value are life and health. Doctors have the knowledge and skills that put them in a position to improve our health, treat our illness and prolong or save our lives. The treatment of the patient and the medical information relating to his disease was once privity to the doctor and the medical professions, the advances in technology have made medical information available to any member of the public through internet.
Once the relation of the doctor and patient was that of trust, but today due to high expectations of the patients and non-meeting of such expectations by the doctors is straining their relationship.

We witnessed a pace of commercialization and globalization on all spheres of life and medical profession is no exception to this phenomenon. New advances in medicine and technology have improved health care for both patients and doctors.

Dr. B.M. Hegde, a renowned cardiologist and former Vice Chancellor of Manipal University, in one of his articles, sets out several ills of the present day medical system. One of the main complaints about the present medical system is that it has become money oriented, with service to humanity taking the back seat. This is a serious complaint which we all have to think about. Another complaint is about excessive or unnecessary treatment and in certain cases even wrong treatment. Dr. Hegde quotes Sir William Osler saying "one of the first duties of the physician is to educate the masses not to take drugs". Further quoting Napoleon Bonaparte who said "Medicine is a collection of uncertain prescriptions the results of which, taken collectively, are more fatal than useful to mankind".

Medical Profession and Laws:

The doctor-patient relationship has undergone a sea change in the last two decades. The patient considered himself to be a consumer of the doctor for his professional service. The Consumer Protection Act, 1986, was enacted with the objective of safeguarding the interest of citizens who access health care. Section 2(1) (0) provides services means service of any description, the definition is not "exhaustive" but inclusive. However, it does not include rendering of any service free of charge or under a contract of personal service.

Section 2(1) (9) defines "deficiency" which includes all forms of professional negligence including medical negligence.
Negligence is the failure to exercise reasonable care. Professionals like doctors are expected to exhibit wisdom as well as technical ability and reasonable care to patients.

Medical Negligence:

"Medical negligence" is the breach of reasonable care towards patients. Basically three pertinent issues evolve in cases of medical negligence, which are-

1)  Whether the doctor, who was dealing with the patient at that particular point of time, was having proper medical skills?
2) Whether the doctor used medical skills and practices as responsible practitioner in the field?
3)  Whether the standard of skill or knowledge and duty expected from the doctor was followed when the allegation of negligence occurred?

The Hon'ble Apex Court responding to the need of the hour developed and elaborated the jurisprudence of medical negligence. In Samir Kohli's case, it was held that when the patient is adult and capable of giving consent, the doctor should obtain consent from him when there is no emergency.

In Jacob Mathews case, Supreme Court has laid down the principles on "Medical negligence" and held that it is not possible for every professional to have highest level of experience or skill, but it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular act and further the concept of negligence between civil law and criminal law was also discussed. The Apex Court in Martin F. D‘Souza’s case held that whenever a complaint for medical negligence is filed, the matter should be referred to a competent doctor or committee of doctors specialised in the relevant field, when such experts feel that there is prima facie case, then only notice should be issued to the doctor to avoid harassment to the doctor.

As you all aware, recently on 24th October 2013, in Balaram Prasad’ case, the Apex Court, while rejecting the plea of IMA that medical practitioners cannot be treated as service providers in term of Section 2(1)(0) of the Consumer Protection Act, held that hospitals and doctors are liable for negligence and enhanced the compensation from Rs.1.73 crores to Rs.5.96 crores.

In cases of medical negligence, the Courts in India are following two principles, one is limited liability and the second is based on the highest degree of care towards the patient and his relatives, as the professionals are responsible and accountable. In limited liability 1) mere deviation from normal professional practice is not negligence 2) An error in judgment on the part of professional is not negligence per se and 3) when patient does not respond favourably to a treatment given by a doctor, he cannot be held liable.

Although the field of medical negligence is a new emerging area of law in the context of corporatization of health care, yet what constitutes "medical negligence" has now been well-settled in view of a number of judgments of the Apex Court. I feel doctors practicing ethically and honestly should not have any reason to fear. Doctors claiming to adhere to ethics have always lamented that colleagues stooping to unethical  practices have an unfair advantage because there is no control over those practices. The Consumer Protection Act will help in curbing these unfair advantages and the Act is definitely good for medical practitioners, who believe in principles and ethics. Therefore, the medical professionals need to update their understanding on Consumer Protection Act and its amendments which are on a legally safer side: If doctors would like fewer legal restrictions on themselves they must regulate through adherence to the principles of medical ethics.

Social responsibility and the Constitution:

Success in one's career is certainly a goal to be pursued. We should however not lose sight of the fact that a large number of our less favourable brothers and sisters are in urgent need of help. Ideally all of us should devote a portion of our life to community service. The silent suffering of millions of people in our country cannot be ignored. India is one of the poorest countries in the world. Poverty in India involves poverty in every aspect of life. Inequality continues to destroy India like any other developing countries. The rich become richer while the poor becomes poorer. Without health, no progress is possible. Therefore, a duty is cast upon the State to provide to its citizens a good and healthy life. Article 21 of the Constitution provides for protection of life and personal liberty, which includes in its ambit, right to health and medical care to all its citizens. Article 47 of the directive principles of state policy ordains a duty on the State to raise the level of nutrition and the standard of living and to improve public health. Despite constitutional provisions, providing better health care to citizens was never a top priority in India. To meet the medical needs of millions, we must evolve an integrated system of medicine, which will best suit our country having regard to its geographical conditions and socio-economic needs and keeping in view its available limited resources.

In our country, we have the best physicians and surgeons. But we lack in terms of qualified medical technicians and supporting staff. Although India remained a major supplier of doctors and nurses to the developed countries over the years, domestic scenario looked bleak with the country ranking 67th amongst the developing nations in the case of doctor population ratio. A fees levying private health care sector comprises of 82% of overall health expenditure. While less than 1 % of population is covered by health insurances, the challenges are enormous.

According to the report by the United Nations, 75% of the health infrastructure in India, including doctors, specialists and other health resources are concentrated in urban area, where only 27% of Indian population lives. The rural population of India is around 716 million people i.e. (72%) yet there are no proper medical facilities for them. Today, rural India faces a shortage of more than 12,300 specialized doctors; there are vacancies for 3,880 doctors in the rural health care systems and a need for 9,814 health care centres. 66% of rural population of India lacks access to preventive medicine. 31% of the rural population in India has to travel 30 km. to get needed medical treatment.

Responsibility of Government:

The government on its part needs to take certain policy decisions by allocating sufficient budget for health care. It needs to strengthen public health care system. US, Australia, UK has strong provision for health care. Unfortunately, India being poor, its citizens are paying the price. Government should provide enabling environment and achieve universal health care. The country graduates 27,000 doctors each year, but all of them want to work in major cities or pursue higher studies abroad. I personally feel that there is nothing wrong. If a doctor chooses to work in a remote village with a service motto, he is handicapped because there is no infrastructure; there are no qualified medical technicians and supporting staff. Though the doctor has enough knowledge and skill, practically he is not able to serve the people to the best of his ability and ultimately he is left with dissatisfaction. Whereas his colleagues who are working in the cities and abroad are able to do a better job than him and able to prove themselves. Strengthening the public health care system is the need of the hour. Government should implement a uniform health care policy, wherein we should see a day when all the citizens of India, irrespective of their social status, receive equal medical facilities and no one is deprived of his fundamental rights guaranteed under the Constitution. I would like to appeal to the members that each and every one should make it a point to spend a day in a month in the service of under-privileged people of the society.

Duties of MCI:

The MCI and IMA should make joint effort and improve quality of medical education and effectively enforce medical ethics. The Institutions have failed miserably in curbing rampant quackery. The professional bodies like MCI and IMA need to work efficiently in coordination with each other towards restoration of public faith in the system. Another solution is to educate and empower patients as equal partners, important stakeholder towards delivery of patient centric care. The common man needs to be educated and enlightened on the basic health issues, hygiene, because it is said that "prevention is better than cure" An enormous responsibility is cast upon the doctors in educating the patients and making them understand about the basic precautions to be taken, hygiene and other issues, which will minimize the health related problems.

Expectations:

The modern medicine should aim at a holistic approach following the advice of Hippocrates which says" Cure rarely, Comfort mostly but Console always, With the advent of the corporate culture In the medical world the personal relation between doctor and patient is totally missing which is a vital component in the health care. Hardly anyone talks with the patients these days. Most of the big bosses make what they call the ‘chart rounds’ in the ward side rooms where all the details of patients including the scans and X-rays are kept. Little time is spent on the bed side.

It must be remembered that as professionals, you have the higher ideals and standards to uphold. The medical profession needs input from a belief in humanity and the ethics more than professionalism. There is no definition for a perfect doctor. A good doctor is one who is truly mindful of his/her personal and professional limitations, and treat the patient with utmost compassion and sheer humanity, regardless of who they are, and above all, a doctor should have a human touch, where they can perceive and understand the tone of human relations and their sufferings.

In spite of several issues, still people have lot of faith in doctors and they believe only doctor after God. I hope and trust that the Indian Medical Community, through this Conference, will take fruitful and deliberated discussions in tune with the mottos of the IMA, which are promotion and advancement of medical and allied sciences in all their different branches, Improvement of public health and medical education in India, and maintenance of honor and dignity of the medical profession, for which it was established.

The medical education has to be streamlined, teaching methodology and examination patterns need reforms. The archive methods of testing the talent of medical students have to be changed. As a Judge, I am coming across a vast number of cases from the student community about the harassment made in the hands of professors during awarding marks and so I request the IMA to sensitize the problems of medical students to the teaching community.

As Gurudev Rabindranath Tagore said "let life be beautiful like summer flowers and death like autumn leaves‘. The medical world should precisely aim at that, instead of prolonging a person's life on a ventilator in a vegetative state.

I thank you one and all for your patient hearing. I wish you all the best and in advance, a happy new year 2014.  

Dr K K Aggarwal on Zee TV

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

cpr 10 mantra
VIP’s on CPR 10 Mantra Video
eMedinewS
Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Winter is the Month of depression and Uttarayana Start of an Optimistic Form of Mind

sprritual blog

In Indian mythology, the word "Sankranti" relates to any transformation or change. Makar Sankranti, which falls on 14th of January, one day after Lohri, indicates change in the direction of the sun, as it starts moving north resulting into longer days and shorter nights. In Hindu mythology, it is called Uttarayana. This was the period during Mahabharat when Bhishma Pitamah waited for his death.

The Uttarayana and Dakshinayana are not only time periods mentioned in the Vedic literature but also the state of minds. Uttarayana means a period for a positive state of mind and Dakshinayana a period for relatively negative state of mind. A positive state of mind in Uttarayana makes meditation easier in this period and more fruitful. Beginners should learn the process of meditation and pranayama during this period.

Bhagwad Gita talks about Moksha and liberation. Those who believe in the philosophy of rebirth know that once a soul is liberated at death, a person is not reborn. For others who believe that hell and heaven are in this birth only, liberation means dying peacefully and without sufferings.

The theory of rebirth is well described in Bhagwad Gita in Chapter 8. The gist of Lord Krishna’s teaching is:

1. Whatever you think throughout your life will be your thought at the time of death.
2. Whatever is the state of mind at the time of death will be the atmosphere you will get in the rebirth. For example if your state of mind is in cruelty at the time of death, you will be born in a cruel family.
3. If you are relaxed, thinking of God or chanting AUM at the time of death, there are chances your soul will be liberated.
4. Fire, illumination, daytime, fortnight before full moon and Uttarayana are the paths for liberation. It means these are the periods/ways for spontaneous positive thinking.

From mental health point of view, this knowledge can be converted into medical prescription. Uttarayana means satwik healthy state of mind and dakshinayana means a depressed state of mind. Performing and attending to Yagna, sitting in well–illuminated light or exposing oneself to sunlight during the day can be an adjunct to depression treatment. During the first fortnight of full moon and during Uttarayana, psychotherapy and counseling invariably will work better and the requirement of drugs may get reduced.

Uttarayana is also the period for ‘Snana’ (bath); ‘Daan’ (charity); ‘Dhyana’ (concentration), ‘Upwas’ (detoxification) and ‘Sun worship’ (Sunbath).

Snana means cleansing of the body, mind and the soul and combined with fast or ‘upwas’ and sun bath is the procedure for detoxification. Once the body is detoxified, it’s in a positive state of mind, can concentrate better and gets detached to material things. One should also start donating in charity whatever one has in excess.

Uttarayana can also be described in chakra language. From mooladhara chakra to anahata chakra is the Dakshinayana path and from anahata chakra to ajna chakra is the Uttarayana path. Those who travel on the Uttarayana path travel from anahata chakra. Those who travel on the Dakshinayana path start from mooladhara.

cardiology news

Determining Your True Path

A master was strolling through a field of wheat when a disciple came up to him and asked, "I can’t tell which is the true path. What’s the secret?"

"What does that ring on your right hand mean?" – asked the master.

"My father gave it to me before dying."

"Well, give it to me."

The disciple obeyed, and the master tossed the ring into the middle of the field of wheat.

"Now what?" – shouted the disciple.

"Now I have to stop doing everything I was doing to look for the ring! It’s important to me!"

"When you find it, remember this: You yourself answered the question you asked me. That is how you tell the true path: It is more important than all the rest."

News Around The Globe

GLIMPSES of IMANATCON-2013@RAJHAMUNDRY

  1. IMA's motto:
    A.  100% institutional deliveries & 100 % full immunization & 100 % usage of family planning.
    B.   Providing high quality care to everyone at a lower cost.
    C.   Self-regulation of medical profession by HBI wing of IMA.
    D.   IMA seeking for capping of pecuniary damages. Deep felt concern regarding crippling compensations slapped by the courts.
    E.   Invigorated rededication to RNTCP.
    F.    Sensitization & helping the members with 24/7 medico legal help line and SMS Service.
    G.   Paperless office & Building IMA member’s data and accelerating the membership drive.
  2. Right to health’ the fundamental right: Right to food. Right to live and now the time has ripened for "right to health". Everyone knows, that loosing precious man-hours due to illness, leads to loss of Valuable GDP. Citizen's health is country’s wealth. Dr. Jitendra Bhai Patel, President IMA, demanded the federal govt. to declare and promulgate necessary Sub-Acts needy to implement -RIGHT TO HEALTH". (Actually it is included in the right to life guaranteed by Article 21 of our Constitution).

    Legal standing: our country is a social democratic welfare republic. Providing adequate medical facilities for the people is an obligation undertaken by the government. Our constitution makers were much aware about the public health or right to health, that’s why they imposed liability on State by some provisions (Article 38, 39(e) 41, 42, 47, 48A).

    Article 38 of Indian Constitution imposes liability on State that states will secure a social order for the promotion of welfare of the people but without public health we cannot achieve it. It means without public health welfare of people is impossible. Article 39(e) related with workers to protect their health. Article 41 imposed duty on State to public assistance basically for those who are sick and disable. Article 42 makes provision to protect the health of infant and mother by maternity benefit.

    To bail out the medical profession from the ambit of CPA Act, IMA is trying its best supporting skills by sensitizing the various judiciary luminaries about the vagaries, medical personnel facing day-in & day-out.
    Some more demands of IMA:

    ·  IMA seeks separate tribunal which should be headed by a sitting judge, with medical experts as members, to hear medical negligence cases.

    ·  Federal Medical personnel & medical establishments protection act should be promulgated by union govt.

    (Source: DR.C. SRINIVASA  RAJU; CHAIRMAN- IMA IT Committee; Chairman -   Hospital Board of India - IMA AP STATE)

News

  • Bupropion may put patients at risk for delayed-onset urticaria, a nationwide study from Taiwan has shown. Doctors should consider this possibility in patients on bupropion –– especially patients under 40 and those with a history of urticaria –– to avoid more severe allergic responses, the authors wrote in a report online November 14 in PLoS One.
  • Many persons with diabetes in the United States are receiving care too late to prevent visual impairment, although improved therapies for diabetic macular edema (DME) are now available, according to a cross–sectional analysis published online December 19 in JAMA Ophthalmology. Clinicians need to educate their patients with diabetes that the disease can affect their eyes because DME can lead to substantial vision loss if it is untreated for a year or more.
  • Cinnamon may help remedy lipid profiles and have therapeutic benefits in patients with nonalcoholic fatty liver disease (NAFLD), according to a new Iranian trial. In a study reported in the journal Nutrition Research, 12 weeks consumption of 1.5 grams (half of a teaspoon) cinnamon per day plus a balanced diet improves insulin resistance and NAFLD characteristics. Cinnamon has antioxidant and insulin–sensitizer properties.
  • Hyperthermic intraperitoneal chemotherapy (HIPEC) can be administered with acceptable morbidity and mortality for selected patients with peritoneal carcinomatosis, according to a new report in JAMA Surg 2013.
  • Adding arginine and calcium salt to fluoride toothpaste makes it more effective in preventing dental caries, according to a large new clinical trial in the journal Caries Research. Children using the experimental toothpaste for 2 years had 17.7% fewer decayed, missing, and filled teeth than children using a standard fluoride toothpaste.

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Rabies News (Dr. A K Gupta)

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.

cardiology news

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

  • People who walk enough to meet or exceed current recommendations may be less likely to die early than those who only walk a little. A study in PLoS One found that compared to people who didn’t meet the guidelines, those who walked more than the basic recommendation had a one-third lower chance of dying during the study period. Those who met but didn’t exceed the recommendation had an 11% lower chance. The American Heart Association (AHA) recommends adults be physically active for at least two and a half hours per week. Previous research has shown exercising more than that may bring extra benefits.
  • Major adverse cardiac events were comparable at 5.3% of 1,502 patients who received a zotarolimus–eluting stent with a permanent polymer coating and 5.1% of 1,497 patients who received a biolimus–eluting stent with a biodegradable polymer coating in a population–based randomized trial. The 1–year outcomes in the Scandinavian study, known as the SORT–OUT VI trial, showed that the Resolute Integrity zotarolimus–eluting stent is noninferior to the BioMatrix Flex Biolimus A9–eluting stent.
cardiology news

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

  • A study from China in the journal Pediatrics reports that an early DMSA scan can accurately predict vesicoureteral reflux (VUR) in young children with febrile urinary tract infection (UTI) and could obviate the need for micturating cystourethrography (MCU). VUR has been considered the most important risk factor for post–UTI renal scar formation in children. MCU, the gold standard for diagnosing VUR, is invasive, exposes patients to radiation, and increases the risk of reinfection.
  • Nurses understandably want to reassure kids during a medical procedure. A new Scottish study in the Annals of Behavioral Medicine looking at dental care however suggests that placating words might only increase a child’s anxiety. Reassurances given at the beginning of a routine dental task were tied to more child distress compared to encouraging words offered near the end of the procedure. Children who were not anxious at the start of the visit and who heard reassurances about 15 seconds into the event had a two in three chance of getting more stressed by reassurances. For kids who were anxious at the 15–second mark, the chances jumped to nearly three in four.
cardiology news

Exercise: a prescription

  • Reduces the chances of getting heart disease. For those who already have heart disease, exercise reduces the chances of dying from it.
  • Lowers the risk of developing hypertension and diabetes.
  • Reduces the risk for colon cancer and some other forms of cancer.
  • Improves mood and mental functioning.
  • Keeps the bones strong and joints healthy.
  • Helps you to maintain a healthy weight.
  • Help maintain independence into later years
  • Age is no bar; there is abundant evidence that exercise can enhance health and well–being. But today for most watching TV, surfing the Internet, or playing computer and video games is replacing the helpful exercises.
  • The minimum threshold for good health is to burn at least 700 to 1,000 calories a week through physical pursuits.
  • Exercise improves health and can extend life. Adding as little as 30 min of moderately intense daily physical activity can help one avoid a host of serious ailments, including heart disease, diabetes, depression, and several types of cancer, particularly breast and colon cancers.
  • Regular exercise can also help one sleep better, reduce stress, control weight, brighten mood, sharpen mental functioning, and improve sex life.

As per Harvard researchers a well–rounded exercise program must have all the four components:

  • Aerobic activity: It is the centerpiece of any fitness program. Most benefits of exercise revolve around aerobic cardiovascular activity, which includes walking, jogging, swimming, and cycling. One should work out at moderate intensity when performing aerobic exercise—brisk walking that quickens the breathing is one example. This level of activity is safe.
  • Strength training: Strength or resistance training, such as elastic–band workouts and the use of weight machines or free weights, are important for building muscle and protecting bone. Bones lose calcium and weaken with age, but strength training can help slow or sometimes even reverse this trend
  • Flexibility training: Eases back pain; muscles tend to shorten and weaken with age. Shorter, stiffer muscle fibers make one vulnerable to injuries, back pain, and stress. But regularly performing exercises that isolate and stretch the elastic fibers surrounding the muscles and tendons can counteract this process. And stretching improves posture and balance.
  • Balance exercises: Prevent fall; balance erode over time, and regularly performing balance exercises is one of the best ways to protect against falls that lead to temporary or permanent disability. Balance exercises take only a few minutes and often fit easily into the warm–up portion of a workout. Many strength–training exercises also serve as balance exercises. Or balance–enhancing movements may simply be woven into other forms of exercise, such as tai chi, yoga, and Pilates.
cardiology news

Total CPR since 1st November 2012 – 83037 trained

Media advocacy through Web Media

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press release

Dr K K Aggarwal Takes over As Senior National Vice President of Indian Medical Association

Dr. K K Aggarwal, President Heart Care Foundation of India took over as Senior National Vice President of Indian Medical Association for the year 2014. Dr Jitender B Patel from Ahmadabad took over as the President.  The team changed at Rajahmundry Andhra Pradesh at the central council meeting of IMA.

Dr. Aggarwal is Padma Shri and Dr. BC Roy National Awardee and a Senior Consultant, Physician and Cardiologist at Moolchand Medcity. In the past Dr. Aggarwal has served as the Head of Research wing and Academic wing of IMA and also Finance Secretary of IMA.

He has also served as President of Delhi Medical Association. He also served as President IMA New Delhi branch three times.

Dr. Aggarwal is known for his innovative low cost health awareness modules. In three of his conceptualized events National Commemorative Postal Stamps have been released.

Firstly in 1991, Run for your Heart and secondly in 1993 Perfect Health Mela, on both the occasions Government of India released postal stamps. In 2012 Government of Rajasthan released cancellation stamp on organizing first ever mega health check-up camp at Ajmer.

Dr. Aggarwal was also the first one to have started Clot Dissolving Therapy in acute heart attack in India and also to have started Color Doppler Echocardiography in North India.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 83037 people since 1st November 2012.

The CPR 10 Mantra is – "Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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CPR 10 Utsav at NDMC Premises

press release

Dr KK Aggarwal Speaks on Key points on CKD

vedio of day

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

Injury to radial nerve in lower part of spiral groove:

1. Spares nerve supply to extensor carpi radialis longus.
2. Results in paralysis of anconeus muscle.
3. Leaves extension at elbow joint intact.
4. Weakens pronation movement.

Yesterday’s Mind Teaser: The cells belonging to the following type of epithelium are provided with extra reserve of cell membrane:

1. Transitional
2. Stratified squamous
3. Stratified cuboidal.
4. Stratified columnar.

Answer for yesterday’s Mind Teaser: 1. Transitional

Correct answers received from: Arvind Gajjar, Muthumperumal Thirumalpillai, Dr.K.Raju , Dr. Mihir Vora, DR AVTAR KRISHAN, Dr Jainendra Upadhyay,

Answer for 28th December Mind Teaser: 4. Bronchogenic carcinoma

Correct answers received from: Dr Chandresh Jardosh, Dr Kanta Jain, Dr Prakash Khalap, Dr shashi saini, Dr. P. C. Das, Dr.K.V.Sarma, Dr K P Chandra, Dr ajay gandhi

Send your answer to ijcp12@gmail.com

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medicolegal update

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medicolegal update
medicolegal update

Recently, while I was on a shopping trip in a department store, I heard a little five–year–old talking to his mother on the down escalator.

He said, "Mommy, what do they do when the basement gets full of steps?"

medicolegal update

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medicolegal updatemedicolegal update

medicolegal update

Situation: A patient after sublingual nitrate developed fainting attack.
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.

medicolegal update

Trust the one who can see, these three things in you: Sorrow behind your SMILE, Love behind your ANGER & reason behind your SILENCE!

medicolegal update

Dr KK Aggarwal: Life after death Part 1: http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Joy Peace Knowing are closer to you than your next thought

medicolegal update
  1. Dear Editor, Through the columns of eMedinews we at Ophthacare Eye Centre wish you and all the readers of the informative newsletter a spectacular 2014. Dr. Narendra Kumar

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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, Prof.(Dr).C V Raghuveer

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