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cardiology

Jaslok Hospital in Mumbai has announced the beginning of a ‘heart transplant’ programme

by Medically Speaking November 30, 2021

written by Medically Speaking

Jaslok Hospital & Research Centre, one of Mumbai’s major hospitals, has announced the commencement of a ‘Heart transplant’ programme and division at its Mumbai location. The initiative will be directed by Dr. K R Balakrishnan, a famous cardiac surgeon and pioneer in the field of heart transplants in the nation. Jaslok Hospital will collaborate with MGM Hospital in Chennai to bring this concept to life in a first-of-its-kind cooperation. According to official data, the city has witnessed a total of 163 heart transplants in the previous five years.

Speaking on the occasion Jitendra Haryan, CEO Jaslok Hospital said, “We are thrilled to be expanding our transplant services and offerings to include heart transplants as well. Dr. K R Balakrishnan is a well-known cardiac surgeon in the country, and we are happy to bring his services and expertise to our patients in Mumbai and the larger western region. It is heartening to see the increase in the number of organ donations that happen in the city giving a new lease of life to many. ”

While the program will be led by Dr. K R Balakrishnan, he will be supported by the prestigious cardiac surgeons and cardiologists’ team at Jaslok Hospital. The programme will provide outstanding quality and outcome, comprehensive support services, easily accessible care, team consisting of transplant surgeons, critical care experts, infectious diseases Consultants, specially trained support nursing & other paramedical staff for ICU and wards, liaison officers, transplant coordinators, dedicated beds in ICU,cardiac rehab, and specialized post op care.

Dr. K R Balakrishnan is known as the pioneer of heart transplants in the country. A graduate of KEM Hospital, University of Bombay, he is one of the most awarded healthcare practitioners, who is known for his work in end-stage heart failure management, pediatric cardiac transplants and liver and heart transplants. In a career spanning more than 30 years, he has successfully performed over 329 transplants in the country.

MGM Healthcare CEO, Harish Manian said, “MGM Healthcare Chennai is very happy to associate with Jaslok Hospital Mumbai to provide Heart & Lung Transplant service under the leadership of Dr. K R Balakrishnan and team. The association with Jaslok is strategic in nature, which will help knowledge sharing and on-site transplant support from the team of experts from MGM Healthcare Chennai. Dr. K R Balakrishnan and team will be having a dedicated Heart Failure Clinic to evaluate the patients. This association also strengthens our relationship with Jaslok Hospital and enhances our commitment to get closer to our patients in Western India.”

As per recent estimates, heart disease is the number one cause of mortality and a silent epidemic among Indians. Data from Brihanmumbai Municipal Corporation (BMC) indicates that around 90 people die because of heart attacks every day in the city. All the speakers at the event stressed on the importance of organ donation to make any transplant programme successful and urged people to donate their organs.

The launch event was presided by dignitaries such as Dr. S K Mathur, President ZTCC, Dr. Suresh Rao, Cardiologist, MGM Hospital Chennai, Dr. A B Mehta, Director Cardiology Dr. Hemant Pathare, Additional Director of Heart & Lung transplant at Jaslok Hospital, along with others from the Jaslok Hospital team.

November 30, 2021 0 comment

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Researchers develop low-cost sensor that detects heart attack in less than 30 minutes

by Medically Speaking Team October 4, 2021

written by Medically Speaking Team

Researchers from the University of Notre Dame and the University of Florida have developed a sensor that could diagnose a heart attack in less than 30 minutes, according to a study published in Lab on a Chip.

Currently, it takes health care professionals hours to diagnose a heart attack. Initial results from an echocardiogram can quickly show indications of heart disease, but to confirm a patient is having a heart attack, a blood sample and analysis is required. Those results can take up to eight hours.

“The current methods used to diagnose a heart attack are not only time intensive, but they also have to be applied within a certain window of time to get accurate results,” said Pinar Zorlutuna, the Sheehan Family Collegiate Professor of Engineering at Notre Dame and lead author of the paper. “Because our sensor targets a combination of miRNA, it can quickly diagnose more than just heart attacks without the timeline limitation.”

By targeting three distinct types of microRNA or miRNA, the newly developed sensor can distinguish between an acute heart attack and a reperfusion — the restoration of blood flow, or reperfusion injury, and requires less blood than traditional diagnostic methods to do so. The ability to differentiate between someone with inadequate blood supply to an organ and someone with a reperfusion injury is an unmet, clinical need that this sensor addresses.

“The technology developed for this sensor showcases the advantage of using miRNA compared to protein-based biomarkers, the traditional diagnostic target,” said Hsueh-Chia Chang, the Bayer Professor of Chemical and Biomolecular Engineering at Notre Dame and co-author of the paper. “Additionally, the portability and cost efficiency of this device demonstrates the potential for it to improve how heart attacks and related issues are diagnosed in clinical settings and in developing countries.”

A patent application has been filed for the sensor and the researchers are working with Notre Dame’s IDEA Center to potentially establish a startup company that would manufacture the device.

Bioengineers Chang and Zorlutuna are both affiliated with Notre Dame’s Institute for Precision Health. Additional co-authors from Notre Dame are Stuart Ryan Blood, Cameron DeShetler, Bradley Ellis, Xiang Ren, George Ronan and Satyajyoti Senapati. Co-authors from the University of Florida are David Anderson, Eileen Handberg, Keith March and Carl Pepine. The study was funded by the National Institutes of Health National Heart, Lung, and Blood Institute.

Source:University of Notre Dame

October 4, 2021 0 comment

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Use Of Genetic Testing For Patients With Early-Onset Atrial Fibrillation supported by JAMA study

by Medically Speaking Team September 18, 2021

written by Medically Speaking Team

A new research published in JAMA Cardiology supports the use of genetic testing in individuals with early-onset atrial fibrillation (AF). Genetic testing in early AF finds pathogenic mutations associated to more significant hereditary cardiomyopathy and arrhythmia disorders, according to a study led by Zachary T. Yoneda of Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues.

In the research, disease-associated variants were discovered in 10% of individuals with early-onset AF utilising genetic testing (the percentage was higher if diagnosed before the age of 30 years and lower if diagnosed after the age of 60 years).
At this time, genetic testing for atrial fibrillation is not advised. Recent research has indicated that patients with early-onset AF have uncommon disease-associated variations. In addition, there are new case reports indicating that AF genetic testing has revolutionised clinical treatment.

Early-onset atrial fibrillation can signal a more significant underlying hereditary cardiomyopathy or arrhythmia syndrome.
In light of this, Yoneda and his colleagues wanted to look at the findings of genetic testing for early-onset AF and see how common disease-associated variations in susceptibility genes for hereditary cardiomyopathy and arrhythmia syndromes are in individuals diagnosed with AF before the age of 66.

Patients from an academic medical centre with AF diagnosed before the age of 66 were included in the prospective, observational cohort research, which included whole genome sequencing through the National Heart, Lung, and Blood Institute’s Trans-Omics for Precision Medicine programme.
Rare variations discovered in a panel of 145 genes included on cardiomyopathy and arrhythmia panels used by commercial clinical genetic testing facilities were among those exposed. The researchers evaluated sequencing data using an automated approach followed by a human examination by a team of independent, blinded reviewers.

The primary objective was the categorization of rare variations using criteria developed by the American College of Medical Genetics and Genomics: benign, likely benign, variant of unknown importance, likely pathogenic, or pathogenic.
Genetic testing found 131 individuals (10.1 percent) with a disease-associated variation, 812 (62.8 percent) with a variant of unknown relevance, 92 (7.1 percent) as heterozygous carriers for an autosomal recessive condition, and 258 (20.0 percent) with no susceptibility.

Key findings of the study include:

The likelihood of a disease-associated variant was highest in participants with AF diagnosed before the age of 30 years (20 of 119 [16.8%]) and lowest after the age of 60 years (8 of 112 [7.1%])
Disease-associated variants were more often associated with inherited cardiomyopathy syndromes compared with inherited arrhythmias.
The most common genes were TTN (n = 38), MYH7 (n = 18), MYH6 (n = 10), LMNA (n = 9), and KCNQ1 (n = 8).

The researchers concluded, “in our cohort study genetic testing identified a disease-associated variant in 10% of patients with early-onset AF (the percentage was higher if diagnosed before the age of 30 years and lower if diagnosed after the age of 60 years).” “Most pathogenic/likely pathogenic variants are in genes associated with cardiomyopathy. These results support the use of genetic testing in early-onset AF.

September 18, 2021 0 comment

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Apollo Hospitals Bangalore becomes the first hospital in the country to have completed 100 Robotic Cardiac Surgeries

by Medically Speaking September 6, 2021

written by Medically Speaking

Hyderabad, September 2021: Apollo Hospitals Bangalore announced the successful completion of 100 robotics cardiac surgeries at its dedicated Robot-Assisted Cardiac Surgery Unit; a milestone in the history of cardiovascular surgery in the country. The hospital also announced that the team had performed a Complex Mitral Valve surgery using robotic-assisted minimally invasive cardiac surgery with the da Vinci robotic system in under 70 minutes, a landmark achievement in interventional cardiology.

Dr. Sathyaki Nambala, Sr. Consultant, Cardiothoracic and Vascular Surgeon and HoD, Robotic Cardiac Surgery Unit said, “Cardiovascular diseases tend to affect patients in the most productive years of their lives result in catastrophic social and economic consequences. The establishment of a Robot-Assisted Cardiac Surgery program requires a tremendous amount of dedication and preparation, and we are proud to be India’s first hospital to complete 100 robotic cardiac surgeries since the program’s inception in late 2019. In comparison to traditional open-heart surgery, which involves opening up the chest by splitting the breastbone, the da Vinci Xi’s innovative technology allows for complex cardiovascular surgeries to be performed through smaller incisions and precise motion control.

“In addition, a high-definition camera provides a clear, 3D view of the chest to the surgeon on a console screen. With the help of the system, we were also successful in conducting the fastest Robotic Complex Mitral Valve repair in under 70 minutes as opposed to the global benchmarks. We hope to achieve more such milestones in the near future.”

Robotic cardiac surgery is a minimally invasive procedure that helps patients return to their everyday life much faster than open-heart surgeries. Surgeons use the da Vinci Surgical System to operate through 8 mm holes called ports and a magnified 3D high-definition vision as well as tiny wristed instruments that bend and rotate much more than the human hand aid in surgery. As a result, surgeons have better vision, precision, and control. Other benefits include decreased pain, fewer post-operative wound infections, less post-operative scarring, and improved breathing. Recovery is rapid, with lesser hospitalisation, faster mobilisation and rehabilitation. Reducing the chance of infection makes it an ideal procedure for people with diabetes and older patients.

Dr. Sangita Reddy, Joint Managing Director, Apollo Group of Hospitals said, ” Our goal has always been to bring the most cutting-edge medical technology to India for the benefit of our patients. We want more patients to benefit from the most advanced surgical and medical care available at our hospital. The da Vinci Surgical System has assisted us in providing the best possible surgical outcomes, and the completion of more than 100 successful robotic cardiac surgeries attests to our commitment to providing the most recent and highest quality of care. The patient is at the heart of all our efforts at Apollo Hospitals to provide accessible and affordable world-class treatment, and the addition of the da Vinci Xi robotic surgical system is a step toward that goal. We are confident that by achieving the two milestones of 100 surgeries and performing the robotic complex mitral valve repair in under 70 minutes, we will change the lives of many more patients who cannot undergo conventional cardiac surgery.”

Commenting on this, Mandeep Singh Kumar, VP and General Manager, Intuitive India, said, “It gives us great pleasure to be part of this exemplary milestone of 100 successful robotic-assisted cardiac surgeries. At Intuitive, we believe technology should enhance a surgeon’s ability to perform complex procedures with ease and help improve clinical outcomes. Surgeons today are increasingly vouching for robotic-assisted surgery and the da Vinci system for its potential to enhance precision, improve visualisation, flexibility, and its potential to improve clinical outcomes. The dedicated Robotic Cardiac Unit at Apollo (Bengaluru) is one amongst the very few such centres globally that provide robotic cardiac surgery as a treatment option. That coupled with Dr. Sathyaki’s expertise in minimally invasive cardiac surgery is a true testament to the world-class standards set by the organisation and its care teams. It also speaks highly of Apollo’s ongoing commitment to leveraging the power of technology towards providing quality care. We are proud of our association with the Apollo Group of Hospitals towards making robotic-assisted surgery accessible to the greater patient community.”

Cardiovascular diseases (CVDs) have overtaken cancer as the leading cause of death in India. This epidemiological shift is primarily due to an increase in the prevalence of cardiovascular diseases (CVDs) and cardiovascular risk factors in India. According to studies, the estimated prevalence of CVDs in India in 2016 was approximately 54.5 million, with 1 in 4 deaths in India being caused by CVDs, with ischemic heart disease and stroke accounting for more than 80% of this burden.

According to a study published in The Lancet Global Health, Indians now have one of the highest rates of mortality after a heart failure diagnosis, higher than people in several developing countries around the world. According to the study, heart failure patients in India had one of the highest mortality rates after one year of diagnosis, at 23%. This was higher than the mortality rates in Southeast Asia (15%), China (7%), South America (9%), and West Asia (3%). (9 percent). The study also found that heart failure patients in India, Africa, and Southeast Asia were about ten years younger than patients in developed countries like the United States and Europe.

The Robot-Assisted Cardiac Surgery Unit at Apollo provides patients with complex cardiac disease with access to the best cardiac care available. Dr. Sathyaki P Nambala, Senior Consultant, Cardio-thoracic and Vascular Surgeon and Head of the Department, Robotic Cardiac Surgery Unit, leads the Robot-Assisted Cardiac Surgery Unit, which is equipped with the advanced fourth-generation versatile ‘da Vinci Xi’ robotic surgical system and a dedicated team.

September 6, 2021 0 comment

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Eating more plant foods may lower heart disease risk in young adults, older women

by Medically Speaking Team September 5, 2021

written by Medically Speaking Team

In two separate studies analyzing different measures of healthy plant food consumption, researchers found that both young adults and postmenopausal women had fewer heart attacks and were less likely to develop cardiovascular disease when they ate more healthy plant foods.

The American Heart Association Diet and Lifestyle Recommendations suggest an overall healthy dietary pattern that emphasizes a variety of fruits and vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes and non-tropical vegetable oils. It also advises limited consumption of saturated fat, trans fat, sodium, red meat, sweets and sugary drinks.

One study, titled “A Plant-Centered Diet and Risk of Incident Cardiovascular Disease during Young to Middle Adulthood,” evaluated whether long-term consumption of a plant-centered diet and a shift toward a plant-centered diet starting in young adulthood are associated with a lower risk of cardiovascular disease in midlife.

“Earlier research was focused on single nutrients or single foods, yet there is little data about a plant-centered diet and the long-term risk of cardiovascular disease,” said Yuni Choi, Ph.D., lead author of the young adult study and a postdoctoral researcher in the division of epidemiology and community health at the University of Minnesota School of Public Health in Minneapolis.

Choi and colleagues examined diet and the occurrence of heart disease in 4,946 adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants were 18- to 30-years-old at the time of enrollment (1985-1986) in this study and were free of cardiovascular disease at that time. Participants included 2,509 Black adults and 2,437 white adults (54.9% women overall) who were also analyzed by education level (equivalent to more than high school vs. high school or less). Participants had eight follow-up exams from 1987-88 to 2015-16 that included lab tests, physical measurements, medical histories and assessment of lifestyle factors. Unlike randomized controlled trials, participants were not instructed to eat certain things and were not told their scores on the diet measures, so the researchers could collect unbiased, long-term habitual diet data.

After detailed diet history interviews, the quality of the participants diets was scored based on the A Priori Diet Quality Score (APDQS) composed of 46 food groups at years 0, 7 and 20 of the study. The food groups were classified into beneficial foods (such as fruits, vegetables, beans, nuts and whole grains); adverse foods (such as fried potatoes, high-fat red meat, salty snacks, pastries and soft drinks); and neutral foods (such as potatoes, refined grains, lean meats and shellfish) based on their known association with cardiovascular disease.

Participants who received higher scores ate a variety of beneficial foods, while people who had lower scores ate more adverse foods. Overall, higher values correspond to a nutritionally rich, plant-centered diet.

“As opposed to existing diet quality scores that are usually based on small numbers of food groups, APDQS is explicit in capturing the overall quality of diet using 46 individual food groups, describing the whole diet that the general population commonly consumes. Our scoring is very comprehensive, and it has many similarities with diets like the Dietary Guidelines for Americans Healthy Eating Index (from the U.S. Department of Agriculture’s Food and Nutrition Service), the DASH (Dietary Approaches to Stop Hypertension) diet and the Mediterranean diet,” said David E. Jacobs Jr., Ph.D., senior author of the study and Mayo Professor of Public Health in the division of epidemiology and community health at the University of Minnesota School of Public Health in Minneapolis.

Researchers found:

During 32 years of follow-up, 289 of the participants developed cardiovascular disease (including heart attack, stroke, heart failure, heart-related chest pain or clogged arteries anywhere in the body).
People who scored in the top 20% on the long-term diet quality score (meaning they ate the most nutritionally rich plant foods and fewer adversely rated animal products) were 52% less likely to develop cardiovascular disease, after considering several factors (including age, sex, race, average caloric consumption, education, parental history of heart disease, smoking and average physical activity).
In addition, between year 7 and 20 of the study when participants ages ranged from 25 to 50, those who improved their diet quality the most (eating more beneficial plant foods and fewer adversely rated animal products) were 61% less likely to develop subsequent cardiovascular disease, in comparison to the participants whose diet quality declined the most during that time.
There were few vegetarians among the participants, so the study was not able to assess the possible benefits of a strict vegetarian diet, which excludes all animal products, including meat, dairy and eggs.

“A nutritionally rich, plant-centered diet is beneficial for cardiovascular health. A plant-centered diet is not necessarily vegetarian,” Choi said. “People can choose among plant foods that are as close to natural as possible, not highly processed. We think that individuals can include animal products in moderation from time to time, such as non-fried poultry, non-fried fish, eggs and low-fat dairy.”

Because this study is observational, it cannot prove a cause-and-effect relationship between diet and heart disease.

In another study, “Relationship Between a Plant-Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings from the Women’s Health Initiative (WHI) Prospective Cohort Study,” researchers, in collaboration with WHI investigators led by Simin Liu, M.D., Ph.D., at Brown University, evaluated whether or not diets that included a dietary portfolio of plant-based foods with U.S. Food and Drug Administration-approved health claims for lowering “bad” cholesterol levels (known as the “Portfolio Diet”) were associated with fewer cardiovascular disease events in a large group of postmenopausal women.

The “Portfolio Diet” includes nuts; plant protein from soy, beans or tofu; viscous soluble fiber from oats, barley, okra, eggplant, oranges, apples and berries; plant sterols from enriched foods and monounsaturated fats found in olive and canola oil and avocadoes; along with limited consumption of saturated fats and dietary cholesterol. Previously, two randomized trials demonstrated that reaching high target levels of foods included in the Portfolio Diet resulted in significant lowering of “bad” cholesterol or low-density lipoprotein cholesterol (LDL-C), more so than a traditional low-saturated-fat National Cholesterol and Education Program diet in one study and on par with taking a cholesterol-lowering statin medication in another.

The study analyzed whether postmenopausal women who followed the Portfolio Diet experienced fewer heart disease events. The study included 123,330 women in the U.S. who participated in the Women’s Health Initiative, a long-term national study looking at risk factors, prevention and early detection of serious health conditions in postmenopausal women. When the women in this analysis enrolled in the study between 1993 and 1998, they were between 50-79 years old (average age of 62) and did not have cardiovascular disease. The study group was followed until 2017 (average follow-up time of 15.3 years). Researchers used self-reported food-frequency questionnaires data to score each woman on adherence to the Portfolio Diet.

The researchers found:

Compared to women who followed the Portfolio Diet less frequently, those with the closest alignment were 11% less likely to develop any type of cardiovascular disease, 14% less likely to develop coronary heart disease and 17% less likely to develop heart failure.
There was no association between following the Portfolio Diet more closely and the occurrence of stroke or atrial fibrillation.

“These results present an important opportunity, as there is still room for people to incorporate more cholesterol-lowering plant foods into their diets. With even greater adherence to the Portfolio dietary pattern, one would expect an association with even less cardiovascular events, perhaps as much as cholesterol-lowering medications. Still, an 11% reduction is clinically meaningful and would meet anyone’s minimum threshold for a benefit. The results indicate the Portfolio Diet yields heart-health benefits,” said John Sievenpiper, M.D., Ph.D., senior author of the study at St. Michael’s Hospital, a site of Unity Health Toronto in Ontario, Canada, and associate professor of nutritional sciences and medicine at the University of Toronto.

The researchers believe the results highlight possible opportunities to lower heart disease by encouraging people to consume more foods in the Portfolio Diet.

“We also found a dose response in our study, meaning that you can start small, adding one component of the Portfolio Diet at a time, and gain more heart-health benefits as you add more components,” said Andrea J. Glenn, M.Sc., R.D., lead author of the study and a doctoral student at St. Michael’s Hospital in Toronto and in nutritional sciences at the University of Toronto.

Although the study was observational and cannot directly establish a cause-and-effect relation between diet and cardiovascular events, researchers feel it provides a most reliable estimate for the diet-heart relation to-date due to its study design (included well-validated food frequency questionnaires administered at baseline and year three in a large population of highly dedicated participants). Nevertheless, the investigators report that these findings need to be further investigated in additional populations of men or younger women.

Source: American Heart Association

September 5, 2021 0 comment

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Why are so many young Indians dying of heart attacks? A doctor from AIIMS explains

by Medically Speaking September 3, 2021

written by Medically Speaking

Many people were taken aback by the death of Siddharth Shukla, 40. On Thursday, the actor and Big Boss Season-13 winner died, with initial reports indicating a heart attack as the reason of death.

Heart problems among young Indians have recently become a source of worry for health professionals. The reason for the increase in heart attack incidence in comparatively younger age groups in India is being discussed.

Dr. Ambuj Roy, professor of cardiology at the All India Institute of Medical Sciences (AIIMS) in New Delhi, outlined in detail the major causes for the surge in heart attack and cardiac arrest cases among the younger generation in an exclusive interview with India Today.

Dr Roy emphasised that mental stress, physical health and other reasons were linked to rising cases of heart disorders among young Indians. Excerpts:

IT: Why are these deaths happening in people who exercise and eat healthy too?

Dr Roy: Exercising is not the only thing. Stress is driving more and more people into alcohol and drugs. People exercise but to release stress, they end up smoking and drugs abuse. The hormone changes happening in the body due to these are directly linked to heart disorders.

IT: How much of a role do stress and mental health play when we speak of heart attacks?

Dr Roy: Mental health is equally important. We are so driven in our lives and jobs and in general. Our lifestyle is very stressful.

Many people are working long hours around the clock without realising that they have not given time to their own physical and mental health.

It is the pressure to prove oneself in the professional life that is also leading to this high-voltage lifestyle where little time is given to personal health.

IT: Is genetic predisposition or family history also a factor?

Dr Roy: Asians are more predisposed to having cardiac disorders due to our genes. And, there is nothing we can do about it. One of the reasons is the genetic formation. Hence, young people in our country are facing heart attacks more than our western counterparts.

IT: What can people do to prevent these disorders?

Dr Roy: Get regular health check-ups. Avoid smoking to release stress. Avoid drugs abuse. Take care of mental health through meditation and yoga. One needs to ‘slow down’ to check our lifestyle habits.

September 3, 2021 0 comment

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MitraClip implant at Apollo Hospitals saves 41-year-old farmer who waited 91 days for a heart transplant!

by Medically Speaking Team August 4, 2021

written by Medically Speaking Team

Apollo Hospitals, Asia’s foremost and most trusted healthcare group, today announced a successful MitraClip implant on a 41-year-old male farmer who had waited for over three months in different hospitals for a heart transplant. The patient was back on his feet within a few days after the procedure, and might not even need a heart transplant.

Ms. Preetha Reddy, Executive Vice Chairperson, Apollo Hospitals Group said, “As one of the few hospitals in India accredited to perform the MitraClip procedure, being able to save the life of a patient waiting for a heart transplant gives us the ability to offer hope to many others. Patients with severe/end-stage heart failure comprise up to 10% of patients suffering from heart disease. Research has shown that using MitraClip as a bridge to heart transplantation is safe and may even lead to functional improvements that permit patients to be removed from the transplant list. We are proud to have demonstrated this at Apollo Hospitals through the case of a 41 year old male patient who was waiting for a heart transplant for over three months. The success of this case has renewed our commitment to taking this cutting edge and revolutionary medical innovation to the people who need it the most. Also a vast majority of these cases were performed during the worst months of the second wave and this was possible only because of the stringent infection control protocol and the iron curtain that separates COVID and non-COVID patients in the hospital.”

Data from 119 patients in the International MitraBridge Registry on critically ill patients on a transplant list showed procedural success was achieved in 87.5% of cases, and 30-day survival was 100%.

Dr Preeta Reddy, Vice Chairperson Apollo Hospitals Group, with Dr Sai Satish, Sr Interventional Cardiologist along with a 41 year old farmer who got MitraClip procedure done.

Dr. Sai Satish, Senior Interventional Cardiologist, Apollo Hospitals said, “The MitraClip is a small metal clip with a polyester fabric that is inserted in place to fix the leaky mitral valve thereby ensuring that the blood flow is in the right direction. It is a globally accepted procedure for patients with heart failure. Patients with moderate to severe or severe primary and secondary mitral regurgitation who are not improving on medical treatment can opt for this minimally invasive solution that offers them a vastly improved quality of life and health.”

“For three years now we have been performing this procedure on patients we think are suitable candidates and we have seen incredible results in the quality of life they are able to return to, post procedure. Our experience in this domain has enabled us to achieve many milestones including back-to-back MitraClip implants in four very sick patients in just one day earlier this year, at the height of the second wave of the pandemic. Today, we are at pole position; 70% of all MitraClips in India to date have been performed at Apollo Hospitals and we are only looking at bigger and more remarkable milestones in the journey ahead,” added Dr. Sai Satish.

MitraClip was introduced in India just three years ago. The first MitraClip was implanted in 2003 in a patient in the US. It was a game-changing procedure and was made commercially available in Europe in 2008 and in the US in 2013. Today over 100,000 patients in more than 50 countries have undergone the MitraClip procedure.

MitraClip implants give a new lease of life for frail and elderly patients who cannot go in for conventional open-heart surgery. The minimally invasive MitraClip procedure is effective in both functional and degenerative mitral regurgitation. The procedure is performed percutaneously in a cath lab and the device is removable and repositionable. These important attributes contribute to the safety of this procedure. Diligent patient selection is an important element to ensure success.

Repeat hospitalisations are avoided after the MitraClip procedure as compared to conventional surgery, making it economical in the long run and patients are able to recover and resume life in a very short span of time.”

India’s first two scientific papers on MitraClip have both been published from Apollo Hopsitals, one on the first case and the second paper on the first seven cases with a year’s follow-up showing excellent outcomes. Dr. Sai Satish of Apollo Hospitals is the only Indian author involved in the authorship of the APAC guidelines for MitraClip implants. Asia’s first MitraClip training programme that included theory and four cases over two days was also conducted at Apollo Hospitals, cementing its position as a Centre of Excellence in Interventional Cardiology.

August 4, 2021 0 comment

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Metabolic Syndrome Is Associated With An Increased Risk Of Second Stroke And Death: A Study

by Medically Speaking July 30, 2021

written by Medically Speaking

According to a meta-analysis, people with larger waistlines, high blood pressure, and other risk factors associated with metabolic syndrome may be more likely to have a second stroke and even die than people who do not have metabolic syndrome.

The study’s findings were published online in Neurology, the medical journal of the American Academy of Neurology.

Excess belly fat plus two or more of the following risk factors was defined as metabolic syndrome: high blood pressure, higher than normal triglycerides (a type of fat found in the blood), high blood sugar, and low high-density lipoprotein (HDL) cholesterol.

“Studies have shown conflicting results on whether metabolic syndrome, which has been linked to an increased risk of a first stroke, also increases the risk of a second stroke and death,” said study author Tian Li, MD, of the Fourth Military Medical University in Xi’an, China.

“Studies have shown conflicting results on whether metabolic syndrome, which has been tied to an increased risk of a first stroke, also increases the risk of a second stroke and death, so we wanted to analyze all of the research available,” said study author Tian Li, MD, of Fourth Military Medical University in Xi’an, China.

“These findings will help people with metabolic syndrome and their health care providers know that they should be screened for risk of recurrent stroke and given preventative treatments,” added Li.

For the risk of stroke recurrence, the meta-analysis combined results from six studies with 11,000 participants who were followed for up to five years. During that time, 1,250 people had a second stroke.

The analysis found that people with metabolic syndrome were 46 per cent more likely to have a second stroke than people who did not have the syndrome.

Looking at each component of metabolic syndrome, researchers found that having a low level of good cholesterol and having two or more components of the syndrome were associated independently with an increased risk of a second stroke.

Having excess belly fat, high blood sugar and high blood pressure were not associated with increased risk of the second stroke on their own.

For the risk of death from any cause, the meta-analysis combined eight studies with 51,613 people who were followed for up to five years. During that time, 4,210 people died.

People with metabolic syndrome were 27 per cent more likely to die during the study than people without the syndrome. None of the individual components of the syndrome was independently associated with an increased risk of death.

“These results add to the evidence that people with metabolic syndrome should take steps to modify their risk of second stroke and even death where possible, through medication, diet, exercise and other recommended lifestyle changes such as stopping smoking,” Li said.

July 30, 2021 0 comment

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Sudden Cardiac Arrest, a leading cause of Preventable Deaths

by Dr Siddha SC Chakra Rao July 28, 2021

written by Dr Siddha SC Chakra Rao

Sudden Cardiac Arrest is the most leading cause of preventable deaths in India. It can occur to any person rich or poor, anywhere, even without any pre-existing cardiac diseases. Many important dignitaries of the Nation have succumbed sudden Cardiac Arrest. The incidence is more than covid-19.

Less than 2% of the population in India are aware of CPR. Most of the victims unattended or treated by local methods of superstitions. About 4280 people per one lakh population are prone to Sudden Cardiac Arrest every year and nearly 90% succumbed to death. The Sudden Cardiac Arrest the cause for 59,064,000 preventable deaths in a year in India. And 161,819 per day, ie 6742people get Sudden Cardiac Arrest in an hour. India is a poor country with very meager per capita income and can’t afford an expensive training.

1.38 billion population in India. A sort of Indian guidelines and trainings is a must. Indian Resuscitation Guidelines will give confidence in all medical fraternity and among people, will save life’s, bring unity among organization. They need training in the local languages.

Indian Society of Anaesthesiologists has convened a meeting on 16^th April 2017 at Hyderabad inviting many people involved in CPR in India. Indian Society of Anaesthesiologists, Indian society to study pain, Research society of Anaesthesiology and clinical pharmacology, Indian association of Cardiothoracic Anaesthesiologists, Indian Medical Association, Dr. NTR University of Heath Sciences, Indian Society of Critical Care Medicine, Association of Obstetric Anesthesia, UP Rural Institute of Medical University, Indian Association of Pediatric anesthesia , GVK EMRI, 108, Indian society of perinatology and reproductive biology, Indian College of Anaesthesiologists, and some members of Emergency medicine from different cities. It is resolved that India should have its own guidelines of resuscitation, as we do not have proper emergency medical system, equipped Ambulances, AEDs. We have different cultures, languages, customs, religions, inaccessible areas and superstitions. We studied the available literature available on similar circumstances around the world, less effluent countries and brought out the guidelines, and published in a PubMed Indexed journal after peer reviewing. Thus, a MAKE IN INDIA guidelines prepared to serve Indians.

Ahmed SM, Garg R, Divatia JV, Rao SC, Mishra BB, Kalandoor M V, Kapoor MC, Singh B. Compression-only life support (COLS) for cardiopulmonary resuscitation by layperson outside the hospital. Indian J Anaesth [serial online] 2017 [cited 2021 Jul 12];61:867-73. Available from: https://www.ijaweb.org/text.asp?2017/61/11/867/218099

Garg R, Ahmed SM, Kapoor MC, Mishra BB, Rao SC, Kalandoor M V, Divatia JV, Singh B. Basic cardiopulmonary life support (BCLS) for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital. Indian J Anaesth [serial online] 2017 [cited 2021 Jul 12];61:874-82. Available from: https://www.ijaweb.org/text.asp?2017/61/11/874/218100

Garg R, Ahmed SM, Kapoor MC, Rao SC, Mishra BB, Kalandoor M V, Singh B, Divatia JV. Comprehensive cardiopulmonary life support (CCLS) for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital. Indian J Anaesth [serial online] 2017 [cited 2021 Jul 12];61:883-94. Available from: https://www.ijaweb.org/text.asp?2017/61/11/883/218102

Singh B, Garg R, Chakra Rao S S, Ahmed SM, Divatia J V, Ramakrishnan T V, Mehdiratta L, Joshi M, Malhotra N, Bajwa SJ. Indian resuscitation council (IRC) suggested guidelines for comprehensive cardiopulmonary life support (CCLS) for suspected or confirmed coronavirus disease (COVID-19) patient. Indian J Anaesth [serial online] 2020 [cited 2021 Jul 12];64, Suppl S2:91-6. Available from: https://www.ijaweb.org/text.asp?2020/64/14/91/284914

The motto od Indian Resuscitation council is to make Every Citizen a Life saver

Train your neighbors and save yourself

Your two hands can save lives

We postulated the technic of Compression only Life Support (COLS) where a layperson can perform Cardiopulmonary resuscitation with his two hands outside the hospital and even useful for the Army personal.

We have many challenges ahead, to make Every Citizen A LifeSaver

13 million school children every year need to training Basic cardiopulmonary life support (BCLS)

83,000 medical students need mandatory certificate in Basic Cardiopulmonary life support and Comprehensive cardiac life support (CCLS)

200,000 nurses need of certify every year in BCLS and CCLS across nation

Only 1 % out of cardiac arrest attempt was done in India vs 40% in western countries.

We Indian Resuscitation Council established in 2017 participated in WRAH Day and trained school children and laymen.

Over 675,000 lay people trained in

cardiopulmonary resuscitation

worldwide — The “World Restart a Heart

(WRAH)” initiative 2018

Available online at www.sciencedirect.com

Resuscitation

journal homepage: www.elsevier.com/locate/resuscitation

The Indian Resuscitation Council, members of the Indian Society of Anaesthesiologists, and other professional, societies performed nationwide CPR training of laypeople in high schools, colleges, bus stations, railway stations, police stations, company offices, and other public places. At least 30 federal states of India participated and many

Chief Ministers and Health Ministers were actively involved. Overall, 225,000 people were trained in India for WRAH 2018.

Up to 206 million People Reached and Over 5.4 million Trained in Cardiopulmonary Resuscitation Worldwide: The 2019 International Liaison Committee on Resuscitation World Restart a Heart Initiative

INDIA IRC/ ISA : No trained in COLS are 500,268 , in 2019,

Vice President of India Sri Venkaiah Naidu released in BCLS manual in November 2018.

Vice President of India Sri Venkaiah Naidu released the CCLS manual in July 2019.

2020 March Covid19 has slowed down our progress.

Since 2018, IRC is attending all the bimonthly meetings of WRAH Day. Demonstrated CPR in Heritage sites, prepared songs, skits on CPR, in different languages including Urdu and Kashmiri.

Released 1^st day envelop and stamp on the occasion of WEAH Day on 16^th October 2020, by the Andhra Pradesh State Minister, Member of the Parliament and the Member of Legislative Assembly, in the virtual presence of WRAH Day, AAPI and ISA dignitaries.

COLS basic CPR guidelines are included in 12^th grade nationwide school’s syllabus in July 2021

-Mandatory Certification of Basic cardiopulmonary life support before graduation in state of Andhra Pradesh by Dr NTR University of Health Sciences, Andhra Pradesh of 50 million population,6000 medical student graduated,

National Medical commission has introduced a foundation course for the newly admitted students of MBBS and they have incorporated BCLS for them

Establishing IRC Resuscitation Training centers in medical colleges across country

Training of trainers (TOT) across country is going on every two months. A separate dedicated training started for all the hospital staff with National Accreditation Board for Hospitals and Health care providers (NABH) (like joint council of hospitals). NABH certifying body of 30,000 private and thousands of govt hospital, who has mandatory certification for BCLS to all Doctors, nurse and paramedics working from front office to the high dependency areas

Providing affordable courses through IRC part of ILCOR will have more support and on international platform as health is global.

July 28, 2021 0 comment

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Learn CPR and Save Life- Must for every citizen

by Medically Speaking Team July 27, 2021

written by Medically Speaking Team

Feature by:

Mr Aditya Kumar, Honorary Director Public Relations, Indian Resuscitation Council.
Dr Rakesh Garg Honorary Scientific Director, Indian Resuscitation Council.

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.

CPR 2

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. 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, we should know various steps of COLS-Compression Only Life Support.

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

CPR

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.

July 27, 2021 0 comment

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