Author: Dr Pankaj Kumar

I’m Dr Pankaj kumar, I entered medical school in 1984. postgraduate Int med 1994 and diploma Heath Management. presently a critical care specialist

  Pearl harbour Anaesthesia Tragedy- Historical Significance

Up to the end of World War II, less than 10% of the general anaesthetics administered were with intravenous barbiturates. The remaining 90% of anaesthetics given in the USA were with diethyl ether. In the United Kingdom and elsewhere, chloroform was also popular. Diethyl ether administration was a relatively safe and simple procedure, often delegated to nurses or junior doctors with little or no specific training in anaesthesia. During the Japanese attack on the US bases at Pearl Harbor, with reduced stocks of diethyl ether available, intravenous Sodium Pentothal(®), a most 'sophisticated and complex' drug, was used with devastating effects in many of those hypovolaemic, anaemic and septic patients. The hazards of spinal anaesthesia too were realised very quickly. These effects were compounded by the dearth of trained anaesthetists. The anaesthesia tragedies at Pearl Harbor, and the discovery in the next few years of many other superior drugs that caused medical and other health professionals to realise that anaesthesia needed to be a specialist medical discipline in its own right. Specialist recognition, aided by the foundation of the National Health Service in the UK, the establishment of Faculties of Anaesthesia and appropriate training in pharmacology, physiology and other sciences soon followed. Modern anaesthesiology, as we understand it today, was born and a century or more of ether anaesthesia finally ceased. It was estimated that the use of sodium thiopentone (Pentothal®) anaesthesia caused 1178 perioperative deaths in the hundreds of casualties who required emergency surgery in the 24 hours following the attack.

    Up to the end of World War II, less than 10% of the general anaesthetics administered were with intravenous barbiturates. The remaining 90% of anaesthetics given in the USA were with diethyl ether. In the United Kingdom and elsewhere, chloroform was also popular. Diethyl ether administration was a relatively safe and simple procedure, often delegated to nurses or junior doctors with little or no specific training in anaesthesia. During the Japanese attack on the US bases at Pearl Harbor, with reduced stocks of diethyl ether available, intravenous Sodium Pentothal(®), a most ‘sophisticated and complex’ drug, was used with devastating effects in many of those hypovolaemic, anaemic and septic patients. The hazards of spinal anaesthesia too were realised very quickly. These effects were compounded by the dearth of trained anaesthetists.  The anaesthesia tragedies at Pearl Harbor, and the discovery in the next few years of many other superior drugs that caused medical and other health professionals to realise that anaesthesia needed to be a specialist medical discipline in its own right. Specialist recognition, aided by the foundation of the National Health Service in the UK, the establishment of Faculties of Anaesthesia and appropriate training in pharmacology, physiology and other sciences soon followed. Modern anaesthesiology, as we understand it today, was born and a century or more of ether anaesthesia finally ceased.

It was estimated that the use of sodium thiopentone (Pentothal®) anaesthesia caused 1178 perioperative deaths in the hundreds of casualties who required emergency surgery in the 24 hours following the attack.

The  World War II  medical tragedies, especially those at Pearl Harbor, were a wake-up call for surgeons and the medical profession generally throughout the world. There was a realisation that it was no longer appropriate for any junior doctors or nurses to administer ‘sophisticated’ anaesthetic drugs for many types of surgeries and to critically ill patients. This had been known for many years in thoracic surgery and neurosurgery, but in the years after the war it was clear that appropriately trained anaesthetists were required, who had the knowledge and skills to use advanced drugs such as thiopentone and the new techniques and equipment which had rapidly developed in the 1940s.

The significance of the results of attempts of nurse and doctor anaesthetists to use thiopentone anaesthesia in military casualties who were hypovolaemic was very clear. Cardiovascular collapse and respiratory arrest with a lack of oxygen supplies, resuscitative skills and knowledge of thiopentone’s pharmacology and dosage, along with the insufficient numbers of skilled anaesthetists, clearly resulted in many tragedies. Some spinal anaesthetics also contributed to the perioperative mortality. So it was not too long during that fateful day in 1941 before surgeons and others reverted to using ‘drip ether’ as the principal anaesthetic technique and restricted the use of the available local anaesthetics, procaine and tetracaine, to infiltration only—mainly in burns patients. Exactly how many anaesthetic deaths resulted from intravenous thiopentone and hexobarbital will probably never be known as there were no defined classifications of such deaths as we have today.

In summary, the greatest significance of the anaesthetic events at Pearl Harbor, and more broadly throughout World War II, was that the surgeons, the medical profession generally  and health authorities recognised the need for appropriately trained and skilled specialist practitioners of anaesthesia. Modern anaesthesia, or anaesthesiology as I believe we should refer to it, was born soon after Pearl Harbor and World War II, and the ‘ether century’ began to expire, although ether continued to be used into the 1970s for many simpler surgeries in less developed centres.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Exorbitantly expensive medical education and lowered merit

0

Two siblings mauled by  stray dogs in Delhi; An urban jungle-where animals hunt humans

In an horrifying and frightening incident, mauled and hunted two siblings, aged 7 & 5, killed in stray dog attack in Delhi's Vasant Kunj NEW DELHI: Two siblings, aged seven and five, were killed allegedly in stray dog attack in two separate incidents in the Vasant Kunj area of Delhi. The police said that the 7-year-old boy went missing on March 10 and his body was recovered later with animal bite like injuries. They needed some shield to protect himself which society, government, courts and so called “dog-lovers” failed to provide. Courts have also upheld animal rights but failed to formulate and implement policies to ensure safety of humans from these violent strays. Government has not made out any policy to safeguard public from such attacks nor have courts come up with any solid guidelines, which can save public, children, women and older people from such bites. Danger of stray dogs is increasing every day around us. As the strays population in increasing, now they are grouped and see vulnerable humans as easy prey. Packs of dogs have become dangerous and difficult to control. Protected by Dog lovers and animal right laws, the danger to normal people of being hunted even around their homes is real. Human right of being in a safe environment is being ignored. Is it not hypocritical that you care for a violent stray that is a threat to the society? Problem is not about loving and feeding dogs, but simultaneous

In an  horrifying and frightening  incident,  mauled and   hunted  two siblings, aged 7 & 5, killed in stray dog attack in Delhi’s Vasant Kunj

NEW DELHI: Two siblings, aged seven and five, were killed allegedly in stray dog attack in two separate incidents in the Vasant Kunj area of Delhi. The police said that the 7-year-old boy went missing on March 10 and his body was recovered later with animal bite like injuries.

They  needed some shield to protect himself which society, government, courts and so called “dog-lovers” failed to provide. 

4-year-old mauled to death by stray dogs in Amberpet

An urban jungle-where animals hunt humans

Dog Lover but not for human child

        Courts have also upheld animal rights but failed to formulate and implement policies to ensure safety of humans from these violent strays. Government has not made out any policy to safeguard public from such attacks nor have courts come up with any solid guidelines, which can save public, children, women and older people from such bites.

 Danger of stray dogs is increasing every day around us. As the strays population in increasing, now they are grouped and see vulnerable humans as easy prey. Packs of dogs have become dangerous and difficult to control. Protected by Dog lovers and animal right laws, the danger to normal people of being hunted even around their homes is real. Human right of being in a safe environment is being ignored. Is it not hypocritical that you care for a violent stray that is a threat to the society? Problem is not about loving and feeding dogs, but simultaneous apathy towards safety of humans. Such dog lovers most of the time, totally ignore the fact that these dogs are a threat to children and older people. An immediate sense of hatred towards such dog lovers is a consequence and a natural thought.

Animal lovers while pretending of “dog love” have formed NGOs and have donations and accumulate money. But have failed to create shelters for stray dogs. Neither have any steps been taken to save people from dog bites. So consequently, people especially vulnerable are children and older people who are mauled and eaten alive by stray dogs. What responsibility and accountability these animal lovers and NGO bear towards such incidents? Why people who collect money in name of animals do not take care and form shelters for these strays? every single death from such preventable cause raise a question on this issue.

Apathy of these so called dog lovers towards humans is appalling.

SUGGESTION: the Government, NGOs and people who claim to be “animal lovers” should create shelters to save strays “as well as people”. It should be mandatory that all the dog and animal (stray or pet) droppings are properly collected and disposed off. This single step can do wonders as it will reduce infections, people’s suffering, save lives and eventually reduce use of antibiotics. A rationale mind will definitely appreciate the danger due to strays, and can initiate proper steps rather criticizing above said facts in the name of animal rights. An animal has no sense of responsibility, so rights should be limited accordingly.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Exorbitantly expensive medical education and lowered merit

1

What are Psychedelics? Ancient history and future possibilities

Psychedelics (serotonergic hallucinogens) are powerful psychoactive substances that alter perception and mood and affect numerous cognitive processes. They are generally considered physiologically safe and do not lead to dependence or addiction. Their origin predates written history, and they were employed by early cultures in many sociocultural and ritual contexts. After the virtually contemporaneous discovery of (5R,8R)-(+)-lysergic acid-N,N-diethylamide (LSD)-25 and the identification of serotonin in the brain, early research focused intensively on the possibility that LSD and other psychedelics had a serotonergic basis for their action. Psychedelics are a subclass of hallucinogenic drugs whose primary effect is to trigger non-ordinary mental states (known as psychedelic experiences or psychedelic "trips") and/or an apparent expansion

Psychedelics (serotonergic hallucinogens) are powerful psychoactive substances that alter perception and mood and affect numerous cognitive processes. They are generally considered physiologically safe and do not lead to dependence or addiction.

         Their origin predates written history, and they were employed by early cultures in many sociocultural and ritual contexts. After the virtually contemporaneous discovery of (5R,8R)-(+)-lysergic acid-N,N-diethylamide (LSD)-25 and the identification of serotonin in the brain, early research focused intensively on the possibility that LSD and other psychedelics had a serotonergic basis for their action.

Psychedelics are a subclass of hallucinogenic drugs whose primary effect is to trigger non-ordinary mental states (known as psychedelic experiences or psychedelic “trips”) and/or an apparent expansion of consciousness. Sometimes, they are called classic hallucinogens, serotonergic hallucinogens, or serotonergic psychedelics.   True psychedelics cause specific psychological, visual, and auditory changes, and oftentimes a substantially altered state of consciousness. The “classical” psychedelics, the psychedelics with the largest scientific and cultural influence, are

     Mescaline, 

     LSD, 

    Psilocybin,

    DMT. 

     LSD in particular has long been considered the paradigmatic psychedelic compound, to which all other psychedelics are often or usually compared.

Most psychedelic drugs fall into one of the three families of chemical compounds: tryptamines, phenethylamines, or Lysergamides  (LSD is considered both a tryptamine and lysergamide).

Many psychedelic drugs are illegal worldwide under the UN conventions, with occasional exceptions for religious use or research contexts. Despite these controls, recreational use of psychedelics is common. 

     Legal barriers have made the scientific study of psychedelics more difficult. Research has been conducted, however, and studies show that psychedelics are physiologically safe and rarely lead to addiction. Studies conducted using psilocybin in a psychotherapeutic setting reveal that psychedelic drugs may assist with treating depression, alcohol addiction, and nicotine addiction.  Although further research is needed.

List of psychedelic drugs

  • LSD (Lysergic acid diethylamide)
  • Psilocin (4-HO-DMT)
  • Mescaline (3,4,5-trimethoxyphenethylamine)
  • DMT (N,N-dimethyltryptamine) 
  •  2C-B (2,5-dimethoxy-4-bromophenethylamine) 

Uses 

Traditional

A number of frequently mentioned or traditional psychedelics such as     Ayauasca (which contains DMT), San Pedro, Peyote, and Peruvian torch (which all contain mescaline), Psilocybin mushrooms (which contain psilocin/psilocybin    all have a long and extensive history of spiritual, shamanic and traditional usage by indigenous peoples in various world regions, particularly in Latin America, but also Gabon, Africa in the case of iboga.  Different countries and/or regions have come to be associated with traditional or spiritual use of particular psychedelics, such as the ancient and entheogenic use of psilocybe mushrooms by the native Mazatec people of Oaxaca, Mexico or the use of the  Ayauasca   brew in the Amazon basin, particularly in Peru for spiritual and physical healing as well as for religious festivals. 

 Although people of western culture have tended to use psychedelics for either psychotherapeutic or recreational reasons, most indigenous cultures, particularly in South America have seemingly tended to use psychedelics for more supernatural reasons such as divination.

Psychedelic therapy

Psychedelic therapy (or psychedelic-assisted therapy) is the proposed use of psychedelic drugs to treat mental disorders. As of 2021, psychedelic drugs are controlled substances in most countries and psychedelic therapy is not legally available outside clinical trials, with some exceptions.

The procedure for psychedelic therapy differs from that of therapies using conventional psychiatric medications. While conventional medications are usually taken without supervision at least once daily, in contemporary psychedelic therapy the drug is administered in a single session (or sometimes up to three sessions) in a therapeutic context.

 As of 2022, the body of high-quality evidence on psychedelic therapy remains relatively small and more, larger studies are needed to reliably show the effectiveness and safety of psychedelic therapy’s various forms and applications.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Exorbitantly expensive medical education and lowered merit

0

Obesity-a growing epidemic & relation to climate

Twelve years from now, 4 billion people, or more than half the world’s population, will be overweight or obese, according to a recent report. While obesity is an issue more commonly associated with high-income countries, the World Obesity Federation (WOF) points out that lower income countries are facing rapid increases in its prevalence. The economic and environmental costs of obesity aside, there is also the impact on the climate to contend with in the battle of the bulge. A $4tn crisis The World Obesity Atlas 2023 says the cost of obesity-related issues would be more than $4 trillion globally by 2035. Apart from health, high BMI – obesity is defined as a Body Mass Index (BMI) equal to or more than 30 – also impacts economic productivity, including through premature retirement or death. The biggest presence of obese people will continue to be in high-income countries, the report says, but it is the low and lower middle income countries that are likely to

Twelve years from now, 4 billion people, or more than half the world’s population, will be overweight or obese, according to a recent report. While obesity is an issue more commonly associated with high-income countries, the World Obesity Federation (WOF) points out that lower income countries are facing rapid increases in its prevalence. The economic and environmental costs of obesity aside, there is also the impact on the climate to contend with in the battle of the bulge. A $4tn crisis

The World Obesity Atlas 2023 says the cost of obesity-related issues would be more than $4 trillion globally by 2035. Apart from health, high BMI – obesity is defined as a Body Mass Index (BMI) equal to or more than 30 – also impacts economic productivity, including through premature retirement or death. The biggest presence of obese people will continue to be in high-income countries, the report says, but it is the low and lower middle income countries that are likely to experience major increases in the prevalence of obesity by 2035. The total economic costs linked to a rise in obesity in these countries would be more than $350 billion but the burden for upper middle and high  income countries would be close to $4 trillion. The share of obese people in middle-income countries could jump to 66% among men and 70% for women even as the rate of increase in obesity prevalence appears to be slowing down in some rich countries. The chief reasons for rising obesity in poorer countries include a shift towards more highly processed foods and greater levels of sedentary behaviour.

 What climate change has to do with it.                        

                                                   

 Rising temperature and rainfall due to climate change could lead to higher obesity rates by hampering physical activity, studies say. The impact of extreme weather on fruit and vegetable production could also make it harder to maintain a healthy diet owing to rising prices. Higher prices could prompt a shift towards processed foods, which are linked to obesity. A 2019 Lancet report says severe food insecurity and hunger are associated with lower obesity prevalence, but mild to moderate food insecurity is “associated with higher obesity prevalence”. Another 2019 study says obesity is linked to about “20% greater GHG emissions compared with the normal weight state”. The total impact of obesity “may be extra emissions of (about) 700 megatons per year of CO2 equivalent. about 1. 6% of worldwide GHG emissions”.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Exorbitantly expensive medical education and lowered merit

0

All about Holi colours, Harms, Removal and Prevention

With the festival of colours just around the corner, we are all bound to be excited about having fun with family and friends. However, as Holi is played with lots of colours, it's important to keep safety in mind and take proper care to control the damaging effects of colours. HOLI COLOURS The market is flooded with a variety of colours – paste, dry and watercolours. Rather, industrial dyes being cheap and bright are widely used to make them. However, these can have detrimental effects on humans as they were never meant for playing Holi. Metallic pastes: These pastes are used for a silver, golden and/or black effect. While it's a very popular practice in youngsters, the use of metallic pastes during Holi is highly discouraged in view of the harmful effects. Dry colours: Commonly called as gulaal, dry colo

We all love playing with Holi colours, but do they leave any harmful side-effects?

With the festival of colours just around the corner, we are all bound to be excited about having fun with family and friends.

However, as Holi is played with lots of colours, it’s important to keep safety in mind and take proper care to control the damaging effects of colours.

 HOLI COLOURS

The market is flooded with a variety of colours – paste, dry and watercolours. Rather, industrial dyes being cheap and bright are widely used to make them. However, these can have detrimental effects on humans as they were never meant for playing Holi.

Metallic pastes: These pastes are used for a silver, golden and/or black effect. While it’s a very popular practice in youngsters, the use of metallic pastes during Holi is highly discouraged in view of the harmful effects.

Dry colours: Commonly called as gulaal, dry colours are a mix of toxic heavy metals like lead, chromium, cadmium, copper, mercury, nickel, and asbestos.

Water Colours: These colours commonly use gentian violet dye as colourant. Gentian violet is a hazardous chemical that can cause many serious health problems. The water colours used in Holi fare no better.

Harmful effects of colours

 All these are known to cause skin allergies, dermatitis and a host of other issues including problems with the scalp.

Metallic pastes- These colours can cause eye allergies, blindness, skin irritation, skin cancers, and even kidney failure.

The colored powders used during Holi can cause various respiratory problems when inhaled. This can lead to conditions such as bronchitis, asthma, and allergies.

Being exposed to these colors can cause irritation and inflammation of the eyes, nose, and throat, and can also trigger asthma attacks in people with pre-existing respiratory conditions.

Long-term exposure to these chemicals can lead to chronic respiratory problems such as bronchitis, emphysema, and lung cancer.

Other problems include conjunctivitis and hair loss.

Additionally, the colours, if inhaled can irritate the delicate tissues in the nose and throat, causing inflammation and discomfort.

If Holi is played out in the sun, it can further damage the skin, causing depletion of moisture and sun tan, leaving your skin dry and dull.

HOW TO PREVENT THE HARMFUL EFFECTS OF HOLI COLORS?

To apply sunscreen 20 minutes before going out in the sun. Make sure to use sunscreen for SPF 30 and above. Most sunscreens have built-in moisturizers. For the hair, apply a hair serum or leave-in conditioner.  Alternatively, you can use pure coconut oil and massage it lightly into the hair.

REMOVAL OF COLOURS

Appropriate removal of colours is equally important to get rid of the damaging effects of playing Holi. To begin with, rinse your face with plenty of water, followed by a cleansing cream or lotion, and lastly, wipe off with moist cotton wool. In case you experience itching, add two tablespoons of vinegar to a mug of water and use it as a last rinse.

Cleanse the area around the eyes. While bathing, gently scrub the body and apply a moisturiser on the face and body immediately after while the skin is still damp.

He said that if itching continues or you see a rash and redness, make sure to consult a doctor as there may be an allergic reaction to the colour. For the hair, use plenty of water to wash away the dry colours and tiny mica particles. Then use a mild shampoo and massage the scalp gently and rinse thoroughly with water again. Lastly, condition your hair with a mild conditioner.

Prevention

Instead, opt to use eco-friendly colours made of flower petals, herbs, vegetable extract, and turmeric.

Keep an eye out for any of these symptoms post your Holi party.

If you experience fever, nausea, vomiting, red eyes, difficulty seeing, skin eruptions, burning skin, dizziness, confusion, inability to concentrate, headaches, and/or blurred vision consult a doctor immediately.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Exorbitantly expensive medical education and lowered merit

0

How Heart (Cardiovascular) Disease in Women differs from that of Men #Sushmita-Sen-Angioplasty

A long-held belief has been that women are less prone to heart attacks, because of their so-called oestrogen advantage. Heart attacks in men is much higher than women. By classic teaching women have an advantage of 10 years in terms of getting cardiovascular disease (CVD), usually around the age of 55, compared to men who can get a CVD around the age of 45. That is partially correct as well, but one should be extra careful about the hugely increased vulnerability of post-menopausal women. More recent research findings that even younger #Sushmita Sen shared that she has had to undergo angioplasty, much public surprise centred on her age. As a Lancet global commission has emphasised, despite being responsible for causing 35% of deaths in women each year, their cardiovascular disease remains understudied, under-recognised, under-diagnosed, and under-treated, with women also under-represented in clinical trials. Heart disease may be considered by some to be more of a problem for men. Because some heart disease symptoms in women can differ from those in men, women may not know what to look for. The following discussion is about the differences in cardiovascular disease between men and women.

A long-held belief   has been that women are less prone to heart attacks, because of their so-called oestrogen advantage. Heart attacks in men is much higher than women.  By classic teaching women have an advantage of 10 years in terms of getting cardiovascular disease (CVD), usually around the age of 55, compared to men who can get a CVD around the age of 45.  That is partially correct as well, but one should be extra careful about  the hugely increased vulnerability of post-menopausal women.  More recent research findings that even younger  #Sushmita Sen shared that she has had to undergo angioplasty, much public surprise centred on her age.

As a Lancet global commission has emphasised, despite being responsible for causing 35% of deaths in women each year, their cardiovascular disease remains understudied, under-recognised, under-diagnosed, and under-treated, with women also under-represented in clinical trials.

                Heart disease may be considered by some to be more of a problem for men.  Because some heart disease symptoms in women can differ from those in men, women may not know what to look for. 

The following discussion is about the differences in cardiovascular  disease between  men and women.

How is the cardiovascular system different in women vs. men?

Researchers have found many sex-related differences in the cardiovascular system. These complex differences, often at a microscopic level, can affect how women and men experience heart disease. A few examples include:

  • Anatomy. Women have smaller blood vessels and heart chambers. The walls of their ventricles are also thinner.
  • Blood count. Women have fewer red blood cells. As a result, women can’t take in or carry as much oxygen at any given time.
  • Cardiovascular adaptations. Changes in altitude or body position (like quickly standing up after lying down) affect women more than men. Women are more likely to have sudden drops in blood pressure or faint.
  • Hormones. Estrogen and progesterone dominate in women and people AFAB, while testosterone dominates in men and people AMAB. These hormones can impact many aspects of heart health and overall health.

Heart attack symptoms for women

The most common heart attack symptom in women is the same as in men — some type of chest pain, pressure or discomfort that lasts more than a few minutes or comes and goes.

But chest pain is not always severe or even the most noticeable symptom, particularly in women. Women often describe heart attack pain as pressure or tightness. And it’s possible to have a heart attack without chest pain.

Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:

  • Neck, jaw, shoulder, upper back or upper belly (abdomen) discomfort
  • Shortness of breath
  • Pain in one or both arms
  • Nausea or vomiting
  • Sweating
  • Lightheadedness or dizziness
  • Unusual fatigue
  • Heartburn (indigestion)

These symptoms may be vague and not as noticeable as the crushing chest pain often associated with heart attacks. This might be because women tend to have blockages not only in their main arteries but also in the smaller ones that supply blood to the heart — a condition called small vessel heart disease or coronary microvascular disease.

Compared with men, women tend to have symptoms more often when resting, or even when asleep Emotional stress can play a role in triggering heart attack symptoms in women.

Because women’s heart attack symptoms can differ from men’s, women might be diagnosed less often with heart disease than are men. Women are more likely than men to have a heart attack with no severe blockage in an artery (nonobstructive coronary artery disease).

Heart disease risk factors for women

Several traditional risk factors for coronary artery disease — such as high cholesterol, high blood pressure and obesity — affect both women and men. But other factors may play a bigger role in the development of heart disease in women.

Heart disease risk factors for women include:

  • Diabetes. Women with diabetes are more likely to develop heart disease than are men with diabetes. Also, because diabetes can change the way women feel pain, there’s an increased risk of having a silent heart attack — without symptoms.
  • Emotional stress and depression. Stress and depression affect women’s hearts more than men’s. Depression may make it difficult to maintain a healthy lifestyle and follow recommended treatment for other health conditions.
  • Smoking. Smoking is a greater risk factor for heart disease in women than it is in men.
  • Inactivity. A lack of physical activity is a major risk factor for heart disease.
  • Menopause. Low levels of estrogen after menopause increase the risk of developing disease in smaller blood vessels.
  • Use of Contraceptives –  They do tend to increase a woman’s blood pressure. If a woman has other risk factors for heart disease, taking birth control pills can compound that risk of heart disease.
  • Pregnancy complications. High blood pressure or diabetes during pregnancy can increase the mother’s long-term risk of high blood pressure and diabetes. These conditions also make women more likely to get heart disease.
  • Family history of early heart disease. This appears to be a greater risk factor in women than in men.
  • Inflammatory diseases. Rheumatoid arthritis, lupus and other inflammatory conditions may increase the risk of heart disease in both men and women.

Women of all ages should take heart disease seriously. Women under age 65 — especially those with a family history of heart disease — also need to pay close attention to heart disease risk factors.

Lifestyle remedies

Living a healthy lifestyle can help reduce the risk of heart disease. Try these heart-healthy strategies:

  • Quit smoking. If you don’t smoke, don’t start. Try to avoid exposure to secondhand smoke, which also can damage blood vessels.
  • Eat a healthy diet. Opt for whole grains, fruits and vegetables, low-fat or fat-free dairy products, and lean meats. Avoid saturated or trans fats, added sugars, and high amounts of salt.
  • Exercise and maintain a healthy weight. If you’re overweight, losing even a few pounds can lower heart disease risks. Ask your health care provider what weight is best for you.
  • Manage stress. Stress can cause the arteries to tighten, which can increase the risk of heart disease, particularly coronary microvascular disease. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to tame stress.
  • Avoid or limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
  • Follow your treatment plan. Take medications as prescribed, such as blood pressure medications, blood thinners and aspirin.
  • Manage other health conditions. High blood pressure, high cholesterol and diabetes increase the risk of heart disease.

Exercise and heart health

Regular activity helps keep the heart healthy. In general, aim for at least 30 minutes of moderate exercise, such as walking at a brisk pace, on most days of the week. If that’s more than you can do, start slowly and build up. Even five minutes a day of exercise has health benefits.

For a bigger health boost, aim for about 60 minutes of moderate to vigorous exercise a day, five days a week. Also do strength training exercises two or more days a week.

It’s OK to break up your workouts into several 10-minute sessions during a day. You’ll still get the same heart-health benefits.

Interval training — which alternates short bursts of intense activity with intervals of lighter activity — is another way to maintain a healthy weight, improve blood pressure and keep the heart healthy. For example, include short bursts of jogging or fast walking into your regular walks.

You can also add exercise to your daily activities with these tips:

  • Take the stairs instead of an elevator.
  • Walk or ride your bike to work or to do errands.
  • March in place while watching television.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Exorbitantly expensive medical education and lowered merit

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Medical Education #NEET & Termite of Corruption, Legalities, Touts

Med admission season sees flood of legal cases Our society has failed itself to develop a robust system of choosing and nurturing good doctors and therefore itself responsible for decline in standards of medical profession. Therefore the quality of doctors who survive and flourish in such system will be a natural consequence of how society chooses and nurtures the best for themselves. A complicated admission process of NEET counselling has spawned a micro industry of medical education counsellors- nothing more than mediators and touts. Imagine, an opportunity is available to a patient, to decide the doctor as based on his route or marks for entry into medical college. Whether patient will like to get treated by a doctor, who secured 20% marks, 30 % marks or 60% marks or 80% marks for medical college. Even an illiterate person can answer that well. But strangely for selection of doctors, rules were framed so as to dilute the merit to the minimum possible. What is the need to dilute and shortlist around half a million for few thousand seats? Answer to that is simple. To select and find only those students from millions, who can pay millions to become doctors?

Our society has failed itself  to develop  a robust system of choosing and nurturing good doctors and therefore itself responsible for decline in standards of medical profession. Therefore the quality of doctors who survive and flourish in such system will be a natural consequence of how society chooses and nurtures the best for themselves.

     A  complicated admission process  of NEET counselling  has spawned a micro industry of medical education counsellors- nothing more than mediators and touts.

   Imagine, an opportunity is available to a patient, to decide the doctor as based on his route or marks for entry into medical college. Whether patient will like to get treated by a doctor, who   secured 20% marks, 30 % marks or 60% marks or 80% marks for medical college.  Even   an illiterate person can answer that well. But strangely for selection of doctors, rules were framed so as to dilute the merit to the minimum possible. What is the need to dilute and shortlist around half a million for few thousand seats? Answer to that is simple.  To select and find only those students from millions, who can pay millions to become doctors? 

Doctors are just as offshoots of a tree called as society. They essentially are the same as rest of the society. It is a specialized branch of tree which helps other offshoots of tree to save others. As part of same tree, they resemble the parent society, of which they are part. Society needs to choose and nurture a force of doctors carefully with an aim to combat for safety of its own people.

Exorbitantly expensive medical education and lowered merit has hollowed the quality of doctors  like  termite.  Aspiring doctors are now forced to pay exorbitant fee, in millions. Many go under heavy debt to pay medical colleges fee. Children with lower ranks in merit pay millions and can become doctors. The real problem here is that real deserving will be left out.

Medical students from the very onset,  are victims and witness to these practices and exploitation. They see their parents pay this unreasonable fee through their noses or take loans. Such blatant injustice will have an everlasting effect on the young impressionable minds.  

        The paradox- Society  and armchair preachers give doctors  lessons about  corruption and exploitation.

Medical admission season sees flood of legal cases

Mumbai TIMES OF INDIA: Chief Justice of India D Y Chandrachud, while speaking at a recent event in a Delhi hospital, called for reforms in medical education, referring to the sheer volume of cases that have made their way to the Supreme Court. It is no exaggeration, as the Directorate of General of Health Services’ Medical Counselling Committee (MCC), under the umbrella body of the union ministry of health and family welfare, alone has to deal with nearly 400 cases every year. From high courts to the apex court, the admission season is marred by litigation, from students aspiring to be doctors to doctors aspiring to be specialists and super-specialists. Sometimes, there are other stakeholders too and the stakes are indeed high. The National Eligibility and Entrance Test (NEET) for undergraduate courses, for instance. In the past four years, the number of MBBS aspirants registering for the test rose almost by 25%. Around 17.6 lakh students appeared for NEET-UG in 2022 —the highest for any competitive exam. On the contrary, the number of aspirants for engineering (registering for JEE-Main) dropped in the corresponding four years—from 11.5 lakh in 2019 to 9.05 lakh in 2022. If one takes into account the direct ratio of students to medical seats, 33 are vying for a single seat in a government college. It is further skewed if one considers the pool of seats in each category. The number of seats shrink at PG level. “The competition is fierce for students in the lower rank bracket. Eligibility issues are also a concern in lawsuits. There is a lot of emphasis on students bagging a PG degree, from parents, even colleges.

More students going for higher studies give colleges brownie points in the accreditation process. There is a general sense of feeling that only an MBBS degree is of no consequence. After all of it, if students lose their seat over a technical point, they will prefer moving court over losing a year, he said. Even as thousands of students appear for their NEET-PG today, courts saw several litigation seeking postponement of the exam till last week. “There is no uniformity in the schedule followed by different states, even as there is one central exam for all. Students have to mandatorily complete their internship to be eligible for a PG seat, but the internship deadline in states differ. What is the point of completing the exam in March and waiting till July for the counselling round? Such policy decisions are not student-friendly, and therefore are met with opposition,” said parent representative.  Former member (board of governor), erstwhile Medical Council of India and dean (projects) at Tata Memorial Hospital, Dr Kailash Sharma, said clarity from National Medical Commission, from MCC, government of India, is expected. “Similar cases in lower courts should be bundled and heard by the apex court that will also reduce time on each case,” said Sharma. Meanwhile, a complicated admission process has spawned a micro industry of medical education counsellors. The process is complicated for an 18-year old to manage on his own.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Exorbitantly expensive medical education and lowered merit

0

Unregulated Pharmaceuticals Industry’s Greed Pushing Drug Pricing- #Eli-Lilly cuts insulin prices 70%

Unregulated Pharmaceuticals Industry’s Greed Pushing Drug Pricing- #Eli-Lilly cuts insulin prices 70% "Look at the profit margins of these companies -- they’re hundreds of billions of dollars," Biden said. "It's not like they're getting hurt." The Indianapolis drugmaker's price cuts and discounts for insulin come as federal and state lawmakers and patient advocates pressure drug companies and health insurers to improve affordability for the lifesaving medication used by millions of Americans. The move follows criticism from federal lawmakers and advocacy groups. The noise level in the news regarding expensive medical costs is high. So who's to blame? Frequently buck stops at naming the doctors without really doing proper root cause analysis, not infrequently hiding the real culprits. It is easy to point the finger at calling the medical professionals greedy to keep the veil over mammoth medical and pharmaceutical industry. But there is a whole system of unregulated medical business associated with large and various health care industries: for example pharma industry, biomedical, equipment, consumables etc. These industries although play important part in medicine, cost, sale and purchase, but are largely remain unregulated and remain hidden to the patient. Pharmaceutical Companies associated with the production and pricing of the drugs have contributed to the problem and has negatively affected the patient’s expense, directly and indirectly.

“Look at the profit margins of these companies — they’re hundreds of billions of dollars,” Biden said. “It’s not like they’re getting hurt.”

The Indianapolis drugmaker’s price cuts and discounts for insulin come as federal and state lawmakers and patient advocates pressure drug companies and health insurers to improve affordability for the lifesaving medication used by millions of Americans. The move follows criticism from federal lawmakers and advocacy groups.

The noise level in the news regarding expensive medical costs is high. So who’s to blame?  Frequently buck stops at naming the doctors without really doing proper root cause analysis, not infrequently hiding the real culprits. It is easy to point the finger at  calling the medical professionals greedy  to keep the veil over  mammoth medical and pharmaceutical industry.   But there is a whole system of  unregulated medical  business  associated with large and various  health care industries: for example pharma industry,   biomedical, equipment, consumables etc. These industries  although play important part in medicine, cost, sale and purchase, but are largely remain unregulated and  remain hidden to the patient.

    Pharmaceutical Companies associated with the production and pricing of the drugs  have contributed to the problem and has negatively affected the patient’s expense, directly and indirectly.   

       When it comes to prescription drugs, rampant inflation has been the norm for decades. Drugmakers fearlessly increase prices on hundreds of medications every year because each of their products has no or few competitors. If the cost of a medication are kept high, that would increase directly influences the cost of health care for individuals.

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Eli Lilly cuts insulin prices up to 70% amid pressure to slash costs

Drug giant Eli Lilly said Wednesday it will slash the cost of its top-selling insulin drugs by 70% as Congress remains stalled on capping prices on the medication vital to millions of Americans who suffer from diabetes.

The Indianapolis-based drugmaker also will lower the price of its Lispro insulin injection to $25 a vial and expand its insulin value program so that an existing $35 cap on some insulins will now apply in about 85% of US pharmacies.

The move comes as President Biden has pushed to extend to most Americans the $35 cap on out-of-pocket insulin costs available to recipients of the government’s Medicare health program, a move some lawmakers have also said they would support with legislation.

“While we could wait for Congress to act or the healthcare system in general to apply that standard, we’re just applying it ourselves,” Chief Executive Dave Ricks told CNN in an interview.

The changes could help around 2 million people pay for the life-sustaining drug. Although many people, including some 3.3 million on Medicare, already pay $35 a month or less for insulin, about 1-in-5 with private insurance and the 17% of insulin users who are uninsured stand to benefit.

Eli Lilly, along with Sanofi and Novo Nordisk make up 90% of the US market for insulin. Lilly shares were up 1.3% at $315.30.

Some analysts have suggested the company was trying to get out ahead of lawmakers. “It certainly appears they were reacting to the growing chances that Congress is going to cap insulin prices,” said Brian Gardner, chief Washington policy strategist at Stifel investment firm.

The insulin products currently cost hundreds of dollars a month. Humalog reportedly has a list price of $530 for a five-pack of injection pens and $274 for a vial, though the company said it only costs less than $95 a month for patients with commercial insurance and Medicare. List prices for drugs often differ from what patients actually pay, including after insurance and other assistance programs.

While the $35 price is only available in pharmacies participating in the company’s insulin value program, Ricks said patients using other pharmacies can receive a rebate through the drugmaker’s website.

These price cuts “should be the new standard in America,” Ricks said, and he called on other companies and stakeholders “to meet us at this point.”

Around 8.4 million of the 37 million people in the United States with diabetes use insulin, according to the American Diabetes Association. Ricks said the company’s insulin price cuts had been planned for some time and were accounted for in Eli Lilly’s December financial forecast, which projected 2023 revenue of at least $30.3 billion.

Diabetes is the seventh leading cause of death in America. Those needed the medication spend an average of $16,752 a year, The Post reported.

In addition to substantial price reduction, Eli Lilly said it would launch on April 1 a new insulin product called Rezvoglar — a copycat version of Sanofi’s Lantus insulin. It will sell its version for $92 for a five-pack of injection pens, a 78% discount to the list price for Lantus.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

0

End of Life issues-  ‘Hold on’ or ‘Let go’ #Tom-Sizemore

The eternal human wish is to fight hard against age, illness, and death and holding on to life, to our loved ones, is indeed a basic human instinct. However, as an illness advances, “raging against the dying of the light” often begins to cause undue suffering, and “letting go” may instead feel like the next stage. Tom Sizemore has no hope of recovery after he suffered a brain aneurysm, his family has said, confirming they are making an end-of-life decision for the Saving Private Ryan actor. The 61-year-old has been in a coma in the intensive care unit of Providence Saint Joseph Medical Center in Los Angeles since he was hospitalised on 18 February. On Monday night, Sizemore’s representative, Charles Lago, issued a statement revealing that there was no chance for his recovery. “Today doctors informed his family that there is no further hope and have recommended end of life decision. The family is now deciding end of life matters and a further statement will be issued on Wednesday,” Lago said.

A difficult decision near death- try to ‘hold on’ or ‘let go’

The eternal human wish is to fight hard against age, illness, and death and holding on to life, to our loved ones, is indeed a basic human instinct. However, as an illness advances, “raging against the dying of the light” often begins to cause undue suffering, and “letting go” may instead feel like the next stage.

Tom Sizemore has no hope of recovery after he suffered a brain aneurysm, his family has said, confirming they are making an end-of-life decision for the Saving Private Ryan actor. The 61-year-old has been in a coma in the intensive care unit of Providence Saint Joseph Medical Center in Los Angeles since he was hospitalised on 18 February. On Monday night, Sizemore’s representative, Charles Lago, issued a statement revealing that there was no chance for his recovery. “Today doctors informed his family that there is no further hope and have recommended end of life decision. The family is now deciding end of life matters and a further statement will be issued on Wednesday,” Lago said.

      Humans have an instinctive desire to go on living. We experience this as desires for food, activity, learning, etc. We feel attachments to loved ones, such as family members and friends, and even to pets, and we do not want to leave them.

     When we realize that the end of life may be approaching, other thoughts and feelings arise. Fears arise, and may be so strong that they are hard to think about or even admit to: fear of change, of the dying process, of what happens after death, of losing control, of dependency and more. Both the person who is ill and the caregiver might also experience resentment, guilt, sadness, and anger at having to do what neither wants to do, namely face death and dying.

As death nears, many people feel a lessening of their desire to live longer. This is different from depression or thoughts of suicide. Instead, they sense it is time to let go.  They may reach a point where they feel they have struggled as much as they have been called upon to do and will struggle no more. Refusing to let go can prolong dying, but it cannot prevent it. Dying, thus prolonged, can become more a time of suffering than of living.

Family members and friends who love the dying person may learn to accept a life limiting illness, and then accept the possibility of a loved one dying. They may see that dying is the better of two choices and  accept the inevitability of death.

The dying may be cause distress and  grief for those who love them. If a stage  has reached when treatments are no longer working as well as before, and everyday life maintaining activities are becoming more and more burdensome. In a sense, life is disappearing. One has to look beyond the fears and wishes.  What is really best for the one who is dying, and for the others around? Given that death is unavoidable, what is the kindest thing to do? It might be holding on or it might be letting go.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

0

Medical CPA- Becoming Tool to extract money from Doctors- NCDRC penalizes patient

In a reverse trend and one of the rare instances where a patient asking for 25 lakhs of compensation was penalized by NCDRC for frivolous complaint. In present era, when patient is no more “patient” and defined as consumer, doctors’ status has been reduced to merely a service provider in lieu of little money. With Medical Consumer Protection Act has acquired roots, the whole system of medical delivery and healthcare has changed. Most striking is this entire fiasco is the “Us and Them” syndrome that seems to afflict all the stake holders. Doctors are pitted against every one- versus administrators, patients, managers, society and lawyers. There is no dearth of such patients, relatives and lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of huge money received in compensations. This encouragement and instigation of lawsuit against doctors has become a major disadvantage for medical profession. Zero fee advertisements and fixed commission ads on television by lawyers in health systems in certain developed countries is an example of instigation against medical profession. They lure patients to file law suits and promise them hefty reimbursements.

 In a reverse trend and one of the rare instances where a patient asking for 25 lakhs of compensation was penalized by NCDRC for frivolous complaint.  

In present era, when patient is no more “patient” and defined as consumer, doctors’ status has been reduced to merely a service provider in lieu of little money. With Medical Consumer Protection Act has acquired roots, the whole system of medical delivery and healthcare has changed. Most striking is this entire fiasco is the “Us and Them” syndrome that seems to afflict all the stake holders. Doctors are pitted against every one- versus administrators, patients, managers, society and lawyers. 

There is no dearth of such  patients,  relatives and  lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of  huge money received in compensations.  This encouragement and instigation of lawsuit against doctors has become a major disadvantage for medical profession.

Zero fee advertisements and fixed commission ads on television by lawyers in health systems in certain developed countries is an example of instigation against medical profession. They lure patients to file law suits and promise them hefty reimbursements.

        The patients’ right activists, media, administrators,  managers and lawyers have made their career and wealth out of it. Doctors know the truth that complications are not preventable beyond a point and are part and parcel of treatment.  The line separating errors or natural complications is really blurred and arbitrary. The doctors who work in life and death situation know it well that even natural poor prognosis can be labelled and proved as error by retrospective analysis and wisdom of hindsight and more certainly with luxury of time at disposal for lawyers and courts.

It becomes an unbalanced match specially when the amount of money which was paid to doctor to save a life was peanuts as compared to now being paid to punish him.

 Zero fee advertisements and fixed commission ads on television by lawyers in health systems in certain developed countries is an example of instigation against medical profession. They lure patients to file law suits and promise them hefty reimbursements.

  One of the  rare instances where a patient asking for 25 lakhs of compensation was penalized NCDRC10,000 rupees for frivolous  complaint

A mere perusal of the prayer clause of the Complaint shows that on the face of it itself an exaggerated claim was made without any justification given.

14.     The OP is a qualified Radiologist, having post graduate degree, MD (Radiology), and having extensive experience in performing USG of abdomen. There are certain limitations in USG. Sometimes the renal calculi are not visible due to intestinal gases shadows in the abdomen, sometimes stones even pass out through urine. Even the best of Radiologists cannot be better than the machine used for the USG, he cannot improve on the technical soundness or advancement of the machine available at his command. The more advanced a machine, the more precise is its report. However, not every hospital can afford the latest state of the art machines. And the Radiologist has to function with the machine available to him.  Pertinently, an advanced Apollo Diagnostic possesses USG 730 (GE) Machine having Advanced Live 4-D Voluson, which has more precision and accuracy, was used in the USG cited at (c) in para 11 above, in which left lower ureter stone was detected.

15.     The State Commission appears to have hastily arrived at its findings of medical negligence on the part of the OP, without examining to the requisite depth, the limitations and technicalities of USG, and without taking independent expert opinion on the subject where experts in the field could have thrown light from standard medical literature and brought forth limitations of the level of advancement of the machine used for imaging. As such its appraisal cannot sustain.

On the basis of the entire material on record and the critique made hereinabove no negligence is attributable to the OP Dr. Hulesh Mandle.

It is apparent that the instant Complaint was filed by the Complaint with wrong current address of the OP, beyond limitation, with highly inflated claim. The same, being bereft of any substance, being frivolous and vexatious, merits dismissal with cost of Rs. 10,000/- contemplated for such Complaints under Section 26 of the Act, 1986, to be deposited in the Consumer Legal Aid Account of the State Commission within six weeks from this Order. 

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

0

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