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Mixopathy will make patients suffer more: Medical experts

As IMA plans a non-cooperation movement to draw attention to the debate on ‘mixopathy’, medical experts explain why the matter is important for both doctors and patients, who will be the ‘ultimate sufferers’ of the practice.

Shalini Bhardwaj

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The Indian Medical Association (IMA) has been protesting continuously against the government encouraging ‘mixopathy’ in medical practice. After a 15-day relay hunger strike, the IMA is now planning a non-cooperation movement which can reach common people. In an interview with The Sunday Guardian, Dr Jayesh M. Lele, general secretary of the Indian Medical Association, Dr Harish Gupta, member of the National Medical Council and a former president of the Delhi Medical Association, and Dr Avinash Bhondwe, former president of the IMA, explain the matter of ‘mixopathy’ and why it needs to be discouraged.

Q: What does ‘mixopathy’ mean?

Dr Jayesh M Lele: Mixopathy refers to when a person who has learnt a particular kind of medicine, like Ayurveda, Unani or homeopathy, practices something other than that. Suppose if this person practices allopathic medicine, it will be called mixopathy. At this moment, these three kinds of doctors are prevalent in India, but they are keen on using the allopathic stream of medicine, and that is why they are using a mixture of streams. This is being called mixopathy or a crosspathy.

Q: How are other associations like the Delhi Medical Association supporting the IMA on this issue?

Dr Harish Gupta: Not only the Delhi Medical Association, but the entire medical fraternity is absolutely one on this issue. Recently, we have seen a notification by the CCIM by the Ayush Ministry that Ayurvedic doctors will be allowed to perform certain kinds of surgeries, whether related to ENT general surgery or others. That is absolutely unfair. The Honorable Supreme Court has clearly let us down. As Dr Lele just said, crosspathy should not be allowed and no streams of medicine can be mixed. If an Ayurvedic practitioner is going to do surgery, we have our objections to that, because they do not have drugs for anaesthesia. So, they will have to use allopathic drugs. They also do not have drugs for patients in ICUs, who need intensive care monitoring and antibiotics. So how can you mix two streams of medicine if they are not practising both? If I am a surgeon and somebody asks me to give them a homeopathic drug, I will never do that because I don’t know the ABCs of homeopathy. That is how it goes, and that is why the Delhi Medical Association is fully supporting this issue. I can assure you that we will do everything possible and we have already raised our voice and written to the government officers concerned. We have also raised the matter at the twelve branches of the Delhi Medical Association and reached the media. This issue is detrimental to the health of the nation and we are going to take it up at the highest level till this notification is withdrawn.

Q: How is mixopathy going to affect modern medicine?

Dr Harish Gupta: Surgery is not a simple thing which you can just read about and be able to practise. It’s a more delicate matter and also not something which can be learned in two or three years. When a student gets admission into an MBBS programme, in the first year, he learns about the anatomy. He learns each and every muscle, every vessel and bone and nerve. Along with that he learns how the body functions, how different things work. In the first year, he also learns the biochemistry, how all the chemicals in the body perform. Then, in the second year, he learns pathology, how a disease changes the organs of the body, how to cure the changes. He learns all this for three years, and then if he gets good marks, he has to go for a postgraduate programme, where he learns more under eminent surgeons or professors about techniques which he starts practicing after that. So, surgery is not about doing something that was done a thousand years ago, it keeps on updating and you have to learn it. And in case of unforeseen situations, a good surgeon has to know how to tackle it, cure the patient and save his life. All these things are important. But with mixopathy, these things will not be done because the basis of Ayurvedic education is totally different. The ultimate sufferer will be the patient.

Q: The Ministry of Ayush issued a clarification two months ago saying that general surgeries will not be included. What steps are you taking after this?

Dr Jayesh Lele: More clarification is needed. Whenever we have filed a red petition in the Supreme Court, all the previous judgements on crosspathy have come up as landmark judgements. We have written to all the possible government institutions like the AYUSH Ministry, CCIM, NITI Aayog, the PMO and the President’s office, but so far we have not had any response from their side. So when this issue was raised in November, we organized a one-day hunger strike. Subsequently, we talked and wrote letters to MPs. Next, a 14-day hunger strike was held across India. This time we wanted every one of the three and a half lakh doctors in the country to participate. Many other medical associations joined us at various other places. Now we are going to start the second phase of spreading public awareness with meetings. We have the first meeting in Delhi on 24 February. We are going to have doctors and senior MPs at the meeting. We are going to distribute banners and posters to every doctor’s clinic in India, where they will display them and talk to their patients and any senior leader who visits them. The most important step in Phase 2Two is the activation of leaders other than doctors. This includes lawyers, CAs, people from corporate sectors and the patients who are the ultimate sufferers. We are going to start immediately: we have issued the press release and I am already getting calls from the branches about the meeting. I have requested for a hybrid meeting so that our senior leaders can join along with local branches, leaders and businessmen.

Q: Do you think medical students will also protest against this?

Dr Avinash Bhondwe: Absolutely, medical students are already involved in this. Our student councils are already working on it. I want to make a few things very clear. We are not against Ayurveda. We respect Ayurveda but Ayurvedic doctors have their limitations. An MBBS doctor has his limitations too: he cannot perform all surgeries, a general surgeon cannot perform cardiovascular and neurosurgeries, etc. But, if Ayurveda has to prosper, Ayurvedic practitioners have to practise their speciality. Surgery is not their field. Secondly, we are not doing it for doctors. As Dr Lele said, the ultimate sufferer is the patient. If we perform a certain thing, it takes years of hard work, on the table training, and the person should be able to handle any unforeseen complications during surgery. We want to take it to the public at large, policy makers in the bureaucracy and others in politics.

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Medically Speaking

Learn CPR and Save Life- Must for every citizen

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We must have heard or seen situations like “A 50-year-old man jogging in the park. He suddenly collapses and people in the park surround him” Or “Oh ! he was well last night, I have talked to him, but expired suddenly in the early morning” And we keep wondering what could be the reason!!

Every year, about 4,280 out of one lakh victims of sudden cardiac arrest (SCA) die in India. Sudden cardiac arrest is a condition where the heart stops its function of pumping blood to the whole body leading to the cessation of heartbeat and breathing. The terms cardiac arrest and heart attack are often used interchangeably, but these are two different conditions. A heart attack occurs when an artery is blocked due to fat and cholesterol deposition and prevents blood from reaching the heart muscle causing severe chest pain and breathing difficulty. Whereas cardiac arrest often occurs suddenly without any warning due to disturbance in the electrical activity of the heart that causes an irregular heartbeat (arrhythmia) which disrupts the heart’s ability to pump blood to the brain, lungs, and other vital organs. Disturbance in the electrical activity of the heart leading to cardiac arrest can be due to any of the following reasons: diabetes, hypertension, lungs, liver and kidneys diseases, etc. However, it can happen to anybody at any point in time. Within few minutes of cardiac arrest, the victim becomes unconscious and death occurs within minutes if the victim didn’t receive treatment. It has been observed that “ Every minute’s delay in the resuscitation of the cardiac arrest victim reduces the chance of survival by 7-10%”. So a prompt action can save the person’s life with cardiac arrest.

India is a vast country with lots of diversity, differences in culture, language, religions, customs, atmosphere, socio-economic issues, and differences in terrain. The environment and the infrastructure for resuscitation of a person with sudden cardiac arrest vary from place to place. So there was a need for a structured guideline to be followed for resuscitation of cardiac arrested victims. Moreover, the approach should be such that it is applicable at all scenarios and remains scientifically valid. There is a large body of evidence to show that it is possible to save the victims of SCA with immediate high-quality bystander hands-only cardiopulmonary resuscitation (CPR) – Compression only life support (COLS)

Compression only life support (COLS) are the guidelines developed by the Indian Resuscitation Council for providing only chest compressions in a stepwise algorithmic approach by a layperson for the cardiac arrest victims till the time medical help arrives

The timely management of the victim with cardiopulmonary arrest is paramount. It may not be possible to provide immediate medical care by the trained person when the victim is outside the hospital. The inclusion of common man after their proper training would be beneficial to improve the outcome of the victim. However, the medical steps to be taught to a layperson should be kept simple and easy to follow, and yet evidence-based.

Learning the skill of saving one’s life is may not be easy. But it is equally not easy to ignore someone dying unattended. Let us all try and make a world where no one dies from cardiac arrest. The Compression only Life Support (COLS) provides an easy, algorithmic stepwise approach for resuscitation of the victim with cardiopulmonary arrest by the lay person. To save one’s life, you should know various steps of COLS-Compression Only Life Support.

  1. Ensure Scene safety
  2. Victim’s response check
  3. Call for help and emergency medical system
  4. Early and effective chest compression
  5. Transfer to the health facility

The main activity of Compression-Only Life Support (COLS) is effective chest compression which should be performed continuously till help arrives. The chest compressions are performed at the rate of 120 per minute and the depth of each chest compressions should be around 5-6 cms.

To enhance the outcomes in cardiac arrests we need high-quality adult resuscitation education and Hands-on Training to maximum citizens. To achieve this, we first need to create the awareness and creating confidence among laypersons, that their contribution is equally important for the survival of a sudden cardiac arrested victim outside the hospital.

The main motto of any project related to layperson training in CPR is to bring out wide popularity for resuscitation, impart training to as many laymen including school children so that every citizen becomes a lifesaver. The IRC aims to train at least one person in the family to save the life from sudden cardiac arrest.

So, remember, Each of one us can save a life. Your two hands can save a life. Your timely help with compression-only CPR (COLS), in this emergency, may save somebody’s life. This victim could be your family member, friend, or a stranger on the street! Let us take a pledge on this National CPR day to learn CPR.

About the authors: 

  • Mr Aditya Kumar is an Honorary Director Public Relations at Indian Resuscitation Council.
  • Dr Rakesh Garg  is an Honorary Scientific Director at Indian Resuscitation Council.

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The “well wishing” Aunties and Uncles of breastfeeding

Dr Emine A Rehman

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Aunty 1: The baby looks so thin, Baby needs cow’s milk, my dear. Me: Cow’s milk is for cow’s baby, my baby needs my milk.

Aunty 2: Oh God, such small breasts you have, how will your milk be enough? Me: My body has the capacity to create however much milk needed for my baby and you know it is the best food for her

Aunty 3: Don’t feed your baby so long, you are pampering him, he will never leave you. Me: How can you pamper your baby by nourishing him?

Aunty 4: Look at you, with the baby all the time, in our times we used to do all the household work and brought up so many kids as well. Me: bringing up a baby with love, care, and breastmilk is our choice as parents and we need all your help and support to successfully do it

Let’s ponder, how many of us have been the Aunty or ME in the above conversations in our lives? Almost all, right? Being a first-time mother at the age of 33 was not easy for me, to have a baby late was not a choice as well. Being a pediatrician was a privilege and personal life took a backseat in the pursuit of higher studies. I thought I knew the solutions to all the challenges of breastfeeding, but reality was far from different. As the saying goes “It takes a village to bring up a baby”, in the modern times “it takes an entire family to breastfeed a baby”. Urbanization, nuclear families and career goals have made the art of breastfeeding less familiar to many of the millennial to-be mothers. We want the best for our baby and we know that breastfeeding is the best path. However, many of us land up being a bundle of nerves when our babies arrive, not sure where to start and how to go about. Agreed that breastfeeding is natural both for mother and the baby, but we forget to warn the to-be mothers that it is a helluva painful, stressful and exhilarating ride. To top it all, mothers also have to deal with the benevolent, free-advice churning Aunties and Uncles in the midst of this roller-coaster. Many a time, the well-wisher could be our own father, mother or even husband. Equipped with knowledge and confidence, I could defend and retort to many of them. However, the dream is to equip every mother of our land with enough knowledge to be the ME in the above situations.

Adequate breastfeeding is a single practice that can prevent lakhs of children from dying, worldwide. World health organization and UNICEF recommends that breastfeeding is initiated within 1st hour of birth, baby be given nothing but mother’s milk till 6 months and breastfeeding to be continued till 2 years of age and beyond. The global rates for breastfeeding are 43%, 41%, and 45% at 1st hour, 6 months, and 2 years, respectively. So, it is not as universal as it has to be. Survey by POSHAN reported that in India, exclusive breastfeeding rate is 54.9%. Mothers face many a challenge like feeling of inadequate milk, household chores, expectations from workplace, pressure to supplement with formula etc. She needs the support of her near and dear ones as well as the community to overcome these hurdles. Currently, mothers can get guidance from ASHA/ anganawadi worker, and gain knowledge through materials circulated by Government of India via Radio and TV. She can also access various peer groups in social media as well as consult trained lactation counsellors. World Breastfeeding week celebration is celebrated every year in the 1st week of August and this year the theme is “Protect breastfeeding- a shared responsibility”. Breastfeeding no longer can be left as “ladies’ matter”. Confident, and knowledgeable mothers are the foundation of future generation. Hence, lets come together to support our mothers and become the true “well-wishing” Aunties and Uncles for our younger ones.

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REMOTELY SUPERVISED EXERCISE CLASSES ARE BEST OPTION DURING COVID

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The findings of a new study suggest that remotely supervised workout sessions are more effective than face-to-face exercise classes during the COVID-19 pandemic. The findings of the study appeared in the journal ‘Psychiatry Research’. Researchers at the University of Sao Paulo (USP) in Brazil investigated the effects of regular exercise on the physical and mental health of 344 volunteers during the pandemic.

The study compared the effectiveness of three techniques: sessions led in person by a fitness instructor, sessions featuring an online instructor but no supervision, and sessions supervised remotely by an instructor via video call. The two kinds of sessions with professional supervision had the strongest effects on physical and mental health. According to the researchers, this was due to the possibility of increasing the intensity of the exercises over time.

To their surprise, remotely supervised sessions were more effective than face-to-face sessions. Sedentary subjects served as controls. “The findings underscore the benefits of either approach, with the instructor online or physically present, compared with being sedentary. However, the physical and mental benefits have much to do with a secure and progressive increase in the intensity of the exercises, which occurred only when they were supervised by a professional. What’s interesting is that remote supervision by video call was more efficient. The difference was small but statistically significant,” Carla da Silva Batista, last author of the study, told Agencia FAPESP.

Batista is a researcher at the University of Sao Paulo’s School of Physical Education and Sports (EEFE-USP). The study was supported by FAPESP. Volunteers were selected from different age and income groups and came from different parts of Brazil. Some had symptoms of depression. The remotely supervised participants, who worked out using Pilates, Crossfit, yoga, dance and aerobics, exercised more intensely than those who lacked supervision.

“Increasing intensity in supervised online sessions was of paramount importance during the pandemic,” Batista said. “Around half the participants, or 55 per cent, performed high-intensity exercises before the pandemic, but the proportion fell to 30 per cent once lockdown began.” Other research shows intense exercise increases longevity, reduces the risk of developing Parkinson’s disease, and is associated with a reduced risk of 26 types of cancer.

“We don’t know exactly why working out with remote supervision by video call gets better results than when the instructor is physically present,” Batista said. “It’s probably that the participants felt the discomfort of wearing a mask hindered their performance during the pandemic.”

Other reasons could include the possibility that remotely supervised participants were more motivated. “They were doing exercises in safety and at home, but with supervision and without having to wear a mask. They didn’t have to worry about spreading the virus, so the instructor may have felt free to increase the intensity of the exercises safely, without risking injury or discomfort,” Batista said.To evaluate the participants’ physical and mental health, in July-August 2020 the researchers applied validated online questionnaires known as the International Physical Activity Questionnaire – Short Form (IPAQ-SF) and the Montgomery-Asberg Depression Rating Scale – Self-Rated (MADRS-S).

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Chemotherapy can induce mutations that lead to pediatric leukemia relapse

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A new study has found that a group of chemotherapy drugs can result in mutations that may trigger the relapse of blood cancer in children.Chemotherapy has helped make acute lymphoblastic leukemia (ALL) one of the most survivable childhood cancers. Now, researchers working in the US, Germany and China have shown how chemotherapy drugs called thiopurines can lead to mutations that set patients up for relapse. The findings of the study were published in the journal ‘Nature Cancer’.

The research provided the first direct genomic and experimental evidence in pediatric cancer that drug-resistant mutations can be induced by chemotherapy and are not always present at diagnosis. “The findings offer a paradigm shift in understanding how drug resistance develops,” said Jinghui Zhang, PhD, Department of Computational Biology chair at St. Jude Children’s Research Hospital.

“The results also suggest possible treatment strategies for ALL patients who relapse, including screening to identify those who should avoid additional thiopurine treatment,” added Zhang. Zhang is co-corresponding author of the study with Bin-Bing Zhou, Ph.D., of Shanghai Children’s Medical Center; and Renate Kirschner-Schwabe, M.D., of Charite-Universitaetsmedizin Berlin.

THE ROOTS OF RELAPSE

While 94 per cent of St. Jude patients with ALL become five-year survivors, relapse remains the leading cause of death worldwide for children and adolescents with ALL. This study involved ALL samples collected from relapsed pediatric ALL patients in the US, China and Germany. Researchers analysed more than 1,000 samples collected from the patients at different times in treatment, including samples from 181 patients collected at diagnosis, remission and relapse.Co-first author Samuel Brady, PhD, of St. Jude Computational Biology, identified a mutational signature that helped decipher the process. Mutational signatures reflect the history of genetic changes in cells.

Brady and his colleagues linked increased thiopurine-induced mutations to genes such as MSH2 that become mutated in leukemia. The mutations inactivated a DNA repair process called mismatch repair and rendered ALL resistant to thiopurines. The combination fueled a 10-fold increase in ALL mutations, including an alteration in the tumour suppressor gene TP53. The mutation, TP53 R248Q, promoted resistance to multiple chemotherapy drugs, including vincristine, daunorubicin and cytarabine.

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STUDY SUGGESTS EXCESS COFFEE CONSUMPTION COULD INCREASE RISK OF DEMENTIA

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It’s a favourite first-order for the day, but while a quick coffee may perk us up, new research from University of South Australia showed that too much could be dragging us down, especially when it comes to brain health.In the largest study of its kind, researchers have found that high coffee consumption is associated with smaller total brain volumes and an increased risk of dementia. The findings were published in the journal ‘Nutritional Neuroscience’.

Conducted at UniSA’s Australian Centre for Precision Health at SAHMRI and a team of researchers, the study assessed the effects of coffee on the brain among 17,702 UK Biobank participants, finding that those who drank more than six cups of coffee a day had a 53 per cent increased risk of dementia. Lead researcher and UniSA PhD candidate, Kitty Pham, said the research delivers important insights for public health. “Coffee is among the most popular drinks in the world. Yet with global consumption being more than nine billion kilograms a year, it’s critical that we understand any potential health implications,” Pham said.

“This is the most extensive investigation into the connections between coffee, brain volume measurements, the risks of dementia, and the risks of stroke – it’s also the largest study to consider volumetric brain imaging data and a wide range of confounding factors,” Pham added.

“Accounting for all possible permutations, we consistently found that higher coffee consumption was significantly associated with reduced brain volume – essentially, drinking more than six cups of coffee a day may be putting you at risk of brain diseases such as dementia and stroke,” Pham further said.Dementia is a degenerative brain condition that affects memory, thinking, behaviour and the ability to perform everyday tasks. About 50 million people are diagnosed with the syndrome worldwide. In Australia, dementia is the second leading cause of death, with an estimated 250 people diagnosed each day.

Stroke is a condition where the blood supply to the brain is disrupted, resulting in oxygen starvation, brain damage and loss of function. Globally, one in four adults over the age of 25 will have a stroke in their lifetime. Data suggests that 13.7 million people will have a stroke this year with 5.5 million dying as a result.Senior investigator and Director of UniSA’s Australian Centre for Precision Health, Professor Elina Hypponen, said while the news may be a bitter brew for coffee lovers, it’s all about finding a balance between what you drink and what’s good for your health.

“This research provides vital insights about heavy coffee consumption and brain health, but as with many things in life, moderation is the key,” Professor Hypponen said. “Together with other genetic evidence and a randomised controlled trial, these data strongly suggest that high coffee consumption can adversely affect brain health. While the exact mechanisms are not known, one simple thing we can do is to keep hydrated and remember to drink a bit of water alongside that cup of coffee,” Professor Hypponen added.

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A NEW STUDY FINDS COVID-19 PATIENTS WITH MALNUTRITION AT HIGHER RISK OF DEATH

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According to a new study, adults and children with COVID-19 who have a history of malnutrition may have an increased likelihood of death and the need for mechanical ventilation. The findings of the study appeared in the journal ‘Scientific Reports’. Malnutrition hampers the proper functioning of the immune system and is known to increase the risk of severe infections for other viruses, but the potential long-term effects of malnutrition on COVID-19 outcomes are less clear.

Louis Ehwerhemuepha and colleagues investigated associations between malnutrition diagnoses and subsequent COVID-19 severity, using medical records for 8,604 children and 94,495 adults (older than 18 years) who were hospitalised with COVID-19 in the United States between March and June 2020.Patients with a diagnosis of malnutrition between 2015 and 2019 were compared to patients without.

Of 520 (6 per cent) children with severe COVID-19, 39 (7.5 per cent) had a previous diagnosis of malnutrition, compared to 125 (1.5 per cent) of 7,959 (98.45 per cent) children with mild COVID-19. Of 11,423 (11 per cent) adults with severe COVID-19, 453 (4 per cent) had a previous diagnosis of malnutrition, compared to 1,557 (1.8 per cent) of 81,515 (98.13 per cent) adults with mild COVID-19.Children older than five and adults aged 18 to 78 years with previous diagnoses of malnutrition were found to have higher odds of severe COVID-19 than those with no history of malnutrition in the same age groups.

Children younger than five and adults aged 79 or above were found to have higher odds of severe COVID-19 if they were not malnourished compared to those of the same age who were malnourished. In children, this may be due to having less medical data for those under five, according to the authors. The risk of severe COVID-19 in adults with and without malnutrition continued to rise with age above 79 years.

The authors suggest that public health interventions for those at the highest risk of malnutrition may help mitigate the higher likelihood of severe COVID-19 in this group.

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