Dr K K Aggarwal

eMedinewS editorial

STOP PRESS

Dear Dr. K K Aggarwal :  This is to inform you that your name has been included in the name of the Central Council of IMA as per the Court Order dt. 25/6/2010 – CS (OS) No. 1275/2010.

With regards,

Dr. Dharam Prakash

Hony. Secretary General

New guideline helps determine brain death in adults

In an effort to create a uniform and accurate method for determining brain death, the American Academy of Neurology has issued an updated guideline that provides doctors with a step–by–step process for determining brain death in adults. The guideline is published in the June 8, 2010 issue of Neurology, the medical journal of the American Academy of Neurology.

The new AAN guideline is an improvement over the 1995 guideline and examines recent studies on clinical determination of brain death, said Dr Eelco Wijdicks, with the Mayo Clinic in Rochester, Minn. and Fellow of the American Academy of Neurology.

The diagnosis of brain death is made only after a comprehensive clinical evaluation and often involves more than 25 separate assessments. The new guideline includes a checklist that will help doctors with this diagnosis.

Brain death is the permanent loss of brain function and means that the person has died. The only way to keep the lifeless body working is through intensive care support. Brain death can result from severe traumatic brain injury, stroke or prolonged CPR after cardiac arrest. No further medical support is needed unless the person’s organs can be donated.

According to the guideline, there are three signs that a person’s brain has permanently stopped functioning.

1. The person is comatose, and the cause of the coma is known.
2. All brainstem reflexes have permanently stopped working.
3. Breathing has permanently stopped. A ventilator, or breathing machine, must be used to keep the body functioning.

The guideline describes several complex steps that doctors must follow to diagnose brain death. It carefully reviewed that the best way is to demonstrate absence of breathing. Laboratory tests such as EEG or cerebral flow studies are not needed to come to a diagnosis. The guideline also makes clear that this complex process must be completed by a doctor with considerable skill and experience in diagnosing brain death.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

eMedinewS Editorial

The Need Is To Unite And Not To Divide The Profession
High Court Appoints Justice S K Aggarwal as the IMA Elections Observer

Dear colleague,

You are all aware that I have devoted over 2 ½ decades of life for the profession. I at different points of time have also served the profession in responsible positions to the best of my ability. I have over the last many years actively contributed to the Indian Medical Association for the larger interest of the medical profession and the citizens of India. When I was awarded the Padmashri this year, I took it as recognition not for myself individually but for the entire medical profession. Over the past few years, I have held responsible positions at the national headquarters of India Medical Association including serving as the Chairman of IMA Academy, National Finance Secretary and the Director, IMA AKN Sinha Institute. At the state level, I had served as the President of Delhi Medical Association and tat of New Delhi Branch. My contributions to the profession in all these assignments is well known and something that I am proud of.

Few weeks back, I went to the Central Working Committee meeting of IMA organised in Gujarat. As an immediate Past Director of IMA AKM Sinha Institute and a recent recipient of Padmashri, I thought that I could contribute positively to chalk out proactive actions in the medical profession at an hour when the medical profession is passing through very troubled waters. This is a time when the entire profession should stand united to carve out a path of honesty, transparency and bold positive working. The image of the profession is at its lowest ebb. All of us owe it to our dear profession that we should take bold and honest stand so that the long tarnished image of medical profession could be improved. Also, our voice on pertinent and important issues should be heard with due respect.

However, I was surprised, stunned and demoralized to see that some WC members ensured a non-welcome approach towards my presence. Leave aside recognizing the fact that I was the only doctor present who was recently conferred the Padmashri, some vested interests were trying to give an impression that my presence at Central Working Committee was unwanted. It is clear and apparent that some individuals from Delhi who have been holding the office at IMA headquarters have always tried to ignore and shun other colleagues and the majority opinion of Delhi doctors. Probably, they felt that my presence could be a threat to their manipulative working. It is pertinent here to mention that while the majority leadership of Delhi Medical Association supported by few friends from Kerala and other States had openly opposed the BRMS (BRHC) issue, these very friends from Delhi had gone ahead to openly support it. What made them backtrack on their earlier stand of supporting it is well known to all. It is also well known that the clinical establishment bill about which some of these friends are now making noise was actually put forth with their approval. Today, they have decided to wake up from their slumber when major damage has already been done. Friends, it is issues like this clubbed with their manipulative actions to dissuade positive thinking, which made me return back to Delhi a saddened man.

As if that was not enough, I was aimed with another rude shock. In the list of Central Council of Members of this year was released (incidentally, they are the electoral college/ people who can contest the elections for this year IMA elections), I was shocked to see that my name was removed from the list. I am an elected Central Council representative from New Delhi branch and the results of the elections have been duly communicated to IMA headquarters and acknowledged by them. When I wrote to the Honorary Secretary General of IMA, for almost a week there was no response. When they responded (though late, by the time the case had gone to the court) they forwarded my csae to the election commision which is suppose to take over on 1st July after the elections are announced. The preperation of the list is the job of the office and not the election commission. I was convinced that the medical profession in general and that of Delhi in particular is again going to be subjected to manipulations in the coming elections. Emotionally, here again I had no option but to approach the Hon’ble High Court of Delhi seeking the relief.

I have pleasure in informing you that the Hon’ble High Court of Delhi, even during its vacation session, took up my application as an urgent application and granted hearing yesterday. The Hon’ble High Court has ensured that my name is included in the Central Council and voters cum contestants’ list. Also, to ensure that any manipulations are not carried out in the elections, as apprehended by most doctors in Delhi and across the country, the Hon’ble High Court has appointed Justice S.K. Aggarwal as the Court Observer to supervise and oversee the entire election process of IMA headquarters this year.

Friends, this is only the beginning of important my and your crusade for transparency, honesty and relentless fighting for the cause of the medical profession. I assure you of my total positive and proactive working and seem your active indulgence to see that the medical profession of the country this year election a team of dedicated office bearers to the IMA national headquarters who would be able to fearlessly, honestly and aggressively take up burning issues facing the profession and seek remedial measures. The profession needs today is that we shun divisive forces who work only for personal grandiose and with vested interests hidden agenda.

Let all of us honestly march forward to give the profession the dignity, the respect and the place in society we genuinely deserve.

With warm regards,

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

eMedinewS Editorial

Hypertension Strongest Predictor of Stroke

There are 10 factors that make up the vast majority of stroke risk, and half of those are modifiable. Hypertension is the strongest predictor of stroke, along with smoking, abdominal obesity, diet, and physical activity, according to Martin J. O’Donnell, MB, PhD, of McMaster University in Hamilton in Ontario, Canada.

The results are from the INTERSTROKE study, a large, multicenter, case–control study that included patients from low– and middle–income countries, published online June 18 in The Lancet. The same group of researchers had also conducted INTERHEART, which had concluded that there were nine risk factors for myocardial infarction: hypertension, smoking, abdominal obesity, diet, physical activity, diabetes, alcohol, psychosocial factors, and cholesterol.

The researchers found that a history of hypertension was the strongest risk factor for stroke, with nearly a threefold increased risk and the association was stronger for hemorrhagic stroke.

Atrial fibrillation was the most common cardiac source of thromboembolism in ischemic stroke, but overall there was a relatively low prevalence of cardiac causes of stroke –– especially in India and China.

Just five of these risk factors: hypertension, smoking, abdominal obesity, diet, and physical activity account for more than 80% of the overall risk of stroke. Adding the other five brings that figure to 90%.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor