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Dr K K Aggarwal

Healthcare for all not possible with the present budget

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In his speech when presenting the budget, the Finance Minister said that health for all and education for all is his priority but the budget allocation is only Rs. 37330 crores, which is an increase of only 7.5% in the last years allocation (planned and non-planned budget together). Medical fraternity expected it to be at least 2-3% of the GDP. Even allocation to AYUSH is only 1069 crores against 1650 crores allocated to six AIIMS-like institutions. If the Government really wanted to do something for promoting healthcare, they could have allocated for six AIIMS-like AYUSH institutions whose purpose should have been prevention so that people do not require allopathic tertiary care.

There are no tax holidays or tax exemptions for doctors living in rural areas in the present budge. Also, there was no relief for making VISA easy for medical tourism.

The Rs. 110 crores allocated for disability is not sufficient. Rs. 6000 crores should have been allocated for providing free generic drugs for people coming to government hospitals. This announcement was lacking in the budget.

Rs. 150 crores have been allocated for the care of the elderly, who constitute 8% of the total population. Elderly people usually do not have insurance as insurance companies do not give them a cover. At least 8% of the total health budget should have been allocated for the elderly.

Allocations to National Health Mission (NHM) (which covers both rural and urban population budget) is only Rs. 21200 crores, which is less than the amount used last year for which rural mission. It aims to provide urban mission money from the money received from the rural mission project. Separate budget should have been allocated for the urban mission.

Rs. 4727 crores allocated for training, education and research is also inadequate as unless you patent your own equipments and drugs, you are going to be dependent on foreign market.

India Medical Association in its recent meeting with Economic Advisor, Ministry of Health, Government of India had offered that every private doctor should be incorporated for providing healthcare facilities across the country, where the Government only had to invest on the human resource.

The government can start MD in Rural Medicine with a curriculum that teaches the art of treating the patients in limited resources. After that people can choose and do their respective post graduation. This way the doctors will not feel that it is a burden on them. There will be additional degree in MD in Rural Medicine Surgery. Such doctors serving in rural areas should be given income tax-free income.

Inaugurating a daylong conference, eMedinewS Revisiting 2012, organized by eMedinewS, Heart Care Foundation of India and World Fellowship of Religions, Dr. A.K. Agarwal, President, Delhi Medical Council, said that all doctors should document their medical records, carefully, punctually and timely. He said that doctors are for patient’s safety and medical records are for doctors’ safety. He said as far as possible, doctors and medical establishments should go for electronic records so that chances of mistakes are lower.

The conference was attended by over 1000 doctors from NCR. Briefing about the conference, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & Vice President Elect IMA, said that eminent faculty participated in the conference and listed the happenings in the year 2012.

The faculty included: Dr Brig A K Dhar, Dr. AS Bath, Dr Ambrish Mithal,Dr Anil Goel, Dr Ashish Jain, Dr Deepak Khurana, Dr Ganesh Mani, Dr IM Chugh, Dr. JPS Sawhney, Dr Kaberi Banerjee, Dr Kailash Singla, Dr Manju Gupta, Dr NK Bhatia, Dr Neeraj Jain,  Dr Praveen Chandra, Dr PC Joshi, Dr Praveen Bhatia, Dr Rajnish Malhotra,Dr SK Parashar, Dr Sanjay Chaudhary, Dr Sukhendy Roy, (Maj.Gen) Dr. SK Mittal, Dr Vivek Bhatia and Dr Yugal Mishra.

Following were the highlights:

1. It is now possible to give a blood transfusion to a person without getting in any blood transfusion reaction.

2. Nobody should suffer from pain and it is possible to get rid of painkillers in 2-3 months’ time.

3. It is now possible to do an aortic valve replacement without surgery using a catheter.

4. It is now possible to save 40 lives from a brain dead donor.

5. Intestinal transplant is now possible in the country.

6. If you have one ova and one sperm, fertility is now possible.

7. Midline incision in the chest is no more required for bypass surgery and for valvular surgery.

8. It is now possible to combine the bypass surgery with stent angioplasty in one sitting and give better results to the patients.

9. It is now possible to do cataract surgery practically without stitches and with near normal vision without spectacles.

10. It is now possible to do surgery in very high obesity using a robot both in adult and in children successfully.

11. With capsule endoscopy it is now possible to examine small intestine of a patient.

Doctor of the year awards were also distributed and the recipients included:

Dr. Ramesh Kumar Bapna, Dr. Harish Gupta, Dr. Narender Saini, Dr. (Maj. Gen.) AS Bath, Dr. JPS Sawhney, Dr. SM Chugh, Dr. Naveen Tuli, Dr KS Bhagotia, Dr Sukrit Sharma, Dr SK Mittal and Dr AK Bansal

eMedinewS and Heart Care Foundation of India will be organizing a daylong conference on 20th January, 2013 at Maulana Azad Medical College and will be attended by over 1000 doctors. The conference will revisit the happenings of the year 2012.

Addressing a press conference here Padmashri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, Group Editor-in-Chief eMedinewS and President Heart Care Foundation of India and Vice President Elect IMA, Dr Ganesh Mani, Dr Ashish Jain, Dr. Vivek Bhatia, Dr. Praveen Bhatia, Dr Yugal Mishra, Dr. N.K.Bhatia, Dr. Neeraj Jain, Dr Kailash Singla, Dr Kaberi Banergee and Dr. Praveen Chandra, in a joint statement said that a lot has changed in the last one year. Following were a few of the new advancements:

1. The new mantra for Cardiopulmonary Resuscitation (CPR10) – Over 25000 people in the city ofDelhialone have been trained in CPR10 to revive people out of sudden death. The mantra created by Dr. KK Aggarwal simplifies the course of action to be taken by people – “within 10 minutes of death (earlier the better), at least for the next 10 minutes (longer the better – upto 25 minutes), compress the centre of the chest of the victim effectively and continuously with a speed of 10×10 i.e. 100 per minutes”.

2. For patients whose blood pressure is not getting under control, new treatment is denervation of the nerves connected to the kidney.

3. For suspected rheumatic heart diseases, echo screening and not clinical screening is the answer.

4. Bypass surgery is better than drug quoted stents in patients with diabetes.

5. Pre-exposure prophylaxes with tenofvir and emtricitadine is now an established way of preventing HIV in high risk individuals.

6. New guidelines suggest that all patients of HIV+ should be treated regardless of CD4 T cells count.

7. Bacterial nasal sinusitis needs to be treated by anti-biotic and should be differentiated from viral nasal sinusitis.

8. In patients over the age of 70 years being treated with enema for constipation, one should use warm water enema rather than sodium phosphate enema.

9. In women of 65 years of age and older with a normal or slightly low bone mass at baseline measurement and with no risk factors of accelerated bone loss, follow-up bone densitometry should be done between 10-15 years.

10. Patients with high cholesterol on statin no more require monitoring of liver functions. They should be done only at baseline and not thereafter

11. Patients of depression on citalopriam should not be given a dose more than 40 mg and in 60+, it should not be more than 20mg.

12. Bio-absorbable polymers stent are now available inIndia.

13. Without surgery aortic valve replacement via catheter has now started inIndia.

14. Small intestinal transplant has been added to the list of transplant in the country.

15. Recently, a patient fromDelhiwho was brain dead donated his organs to 37 people.

16. A circular from Ministry of Health and Family Welfare has clarified that under the PNDT Act, medical practitioners with post graduation in gynecology and obstetrics are qualified to do obstetric ultrasound.

17. Suspect bacterial infection if:

a. Persistent symptoms or signs lasting more than 10 days with no improvement.

b. Onset with fever of more than 102 degree and purulent nasal discharge lasting three consecutive days.

c. Onset with worsening symptoms following a viral URI lasting 5-6 days which was initially improving.

Mr Gursharan Singh former Indian Cricketer was the special guest of the day.

The conference will be followed by ‘Doctor of the year’ awards and cultural evening.

National IMA (membership 2.2 lacs) and eMedinewS (readership 1 lac) recommendations to Justice Verma

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1. The word penis should not be used (use male sex organs) anywhere in the law

2. The work vagina, labia majora should not be used anywhere in the law (Female sex organs)

3. Under the influence of alcohol and drugs the punishment should be different and treatment added. For rarest of the rare case death sentence can be added. People with abnormal sexual urges should be treated.  

4. We must sensitize the parents, teachers and schools to identify red flag signals of an abnormal personality trait in children (present in up to 10% of children) so that they do not indulge in sexual offences later

5. Chemical castration is not acceptable to medical profession, is not safe, not health friendly is temporary and lead to corruption

6. Medical profession should help training all policemen in CPR and first aid

7. Every PCR van should be a mini ambulance also. One can post a paramedic in it for RTA and assault cases

8. Private hospital should be allowed to examine rape victims and guidelines should be pasted in every Emergency room

9. We need to define, issuing of medical bulletin, guidelines

10. Transfer to other country there should be a clear cut national policy and decide by a panel of treating doctors in consultation with Govt. health officials

 11. Sick RTA or assaulted patients should b shifted to a nearby hospital (govt. or private) so that medical services are available within ten minutes and stabilized within one hour.

12. Forensic examination lab should be strengthened and should give results in time bound manner.

13. Most sexual assault cases occur in slum areas. Efforts should be made to create awareness in these areas

14. All accused should be compulsorily be tested for sexually transmissible illnesses and victims be considered for STI, HIV and pregnancy prevention treatments

15. All health care professionals to have compulsorily short term training in counselling, empathy, communication, etiquette as part of medical education.

Drafted by Dr KK Aggarwal for National IMA and eMedinews based on proceedings of a seminar organised by IMA and inaugurated by National President IMA, Dr K Vijaykumar.




Do not ignore chronic constipation, especially in the elderly as it may be a sign of underlying cancer, said Padmashri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, Dr. Rajiv Khosla and Dr. Praveen Bhatia, in a joint statement.

They were participating in a seminar organized by Heart Care Foundation of India and eMedinewS at Constitution Club of India as part of 19th MTNL Perfect Health Mela celebrations. Over 200 doctors participated in the seminar which was supported by Win Medicare.

The doctors said that any abdominal pain associated with diarrhea should suspect one of inflammatory bowel disease but if the same appears for the first time in the elderly, one must conduct colonoscopy to rule out cancer of gut.

Constipation should not be treated with laxatives as they may be habit forming. Isabgol, triphala and poly ethylene glycol are the commonest medicines used to treat constipation. Isabgol is a bulk laxative. Presence of rectal bleeding, constipation and diarrhea, unexplained abdominal pain should warrant one to undergo colonoscopy.

Facts about chronic constipation
1. Constipation is the most common digestive complaint in the general population, and is associated with substantial economic costs
2. Infrequently, constipation is the first manifestation of metabolic (diabetes mellitus, hypothyroidism, hypercalcemia, heavy metal intoxication), neurologic, or obstructive intestinal disease; more often, it occurs as a side effect of commonly used drug
3. Constipation has been defined as a stool frequency of less than three per week
4. An international working committee recommended diagnostic criteria (Rome III) for functional constipation. The diagnosis should be based upon the presence of the following for at least three months (with symptom onset at least six months prior to diagnosis).
a. Must include two or more of the following:
 Straining during at least 25 percent of defecations
 Lumpy or hard stools in at least 25 percent of defecations
 Sensation of incomplete evacuation for at least 25 percent of defecations
 Sensation of anorectal obstruction/blockage for at least 25 percent of defecations
 Manual maneuvers to facilitate at least 25 percent of defecations (eg, digital evacuation, support of the pelvic floor)
 Fewer than three defecations per week
b. Loose stools are rarely present without the use of laxatives
c. There are insufficient criteria for IBS.
5. It often responds to dietary changes and various laxatives.
6. Idiopathic constipation is associated with normal or slow colonic transit, functional defecation disorder, or both.
7. Management of normal and slow transit chronic constipation includes patient education, behavior modification, dietary change, bulk forming laxatives, and the use of non-bulk forming laxatives or enemas
8. Initial management of idiopathic constipation involve dietary fiber and bulk forming laxatives such as psyllium ormethylcellulose, together with adequate fluids
9. For patients who do not tolerate bulk forming laxatives or respond poorly to fiber one should start with osmotic laxative
10. Other options include stool softeners or stimulant laxatives (bisacodyl, senna, and sodium picosulfate).
11. Management of severe constipation and functional defecation disorder may involve suppositories, biofeedback, botulinum toxin injections into the puborectalis muscle, or subtotal colectomy under specific circumstances.
12. Various pharmacologic therapies (lubiprostone, misoprostol, colchicine) have been used to treat severe constipation with limited success.
13. In patients over the age of 70 years warm water enemas rather than sodium phosphate enemas be used for the treatment of constipation
14. The use of sodium phosphate enemas in older adults has been associated with complications including hypotension and volume depletion, hyperphosphatemia, hypo- or hyperkalemia, metabolic acidosis, severe hypocalcemia, renal failure, and EKG changes (prolonged QT interval).