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Archive for the ‘Public health issues’ Category

Thousands of delegates* converge annually in glittering convention centers on a regular basis to present high quality research. It’s all about overflowing seminar halls, stunning speeches , Intense questions , adoring debates , cozy discussions in grand dinner nights . The meet continues further, as news breaks in global TV shows, spreads in non-stop handles of twitter after igniting the face books.

Finally , it ends over the week-end ! (It has to you know ! ) . . . Every one flies back, only to come back next year to ponder “almost the same issue”  all over again. (Some times the questions are left unanswered for decades ! Not getting an answer is okay , after all research is a  journey towards  truth   but sustaining a confusion or creating new one has been a norm in recent times.)

*Sorry , If am provocative , I need to be genuine in my expression.

Coming to the topic, Aspirin is one wonder drug which made a big impact on CAD risk . We know there is something great with this cheapest and humble Dual COX  blocker.The only weak point is ,it lacks the glamor quotient like that of newer antiplatelets, NOACs  and their clones.

Its my perception ,big breaking research has tried to ditch this drug for quiet a while .But ,it was all too difficult to go for the kill.So these studies circumnavigate the real issue. and end up with  suspicious conclusions  (or Inconclusions !) always trying to hide behind sinister statistics of course with a questionable caveat !

What’s new in the topic of Primary prevention of CAD ?

Two major studies were released recently in August 2018

Both studies suggest caution for Aspirin. If Aspirin is really  bad it would (and should) have buried long ago. We should be thankful even in these testing times for truth ,this humble drug is fighting  back and forth .(Digoxin is another close  cousin of Aspirin fighting for the existence  crisis in cardiology  ! ) 

So what is the role of Aspirin in primary prevention of CAD ?

This question doesn’t make sense in many clinical situations.

Primary and secondary prevention are defined with reference to manifest vascular event. We will not know how much of silent CAD exist in asymptomatic persons.Primary prevention of CAD itself could be a misnomer as most elderly do carry at-least some form of CVD. For example, If a patient with manifest peripheral arterial disease (PAD) and takes Aspirin , its  secondary prevention for PAD but becomes primary prevention for CAD . . . isn’t  ?

Final message

We know Aspirin  continues to be the flag bearer of  all DAPT regimen.I wish it remains a star in primary prevention as well. It looks like(for me)  these studies  are another attempt to pull down Aspirin in primary prevention .I think ARRIVE failed to reach the desired conclusion. Aspirin is a warrior and it will never allow that to happen and ASCEND to glory again !

Postamble

Modern drug research appears to pursue a study till the desired conclusion is reached. We need important  drugs in many vital areas of cardiology .Our energy should be focused to find new molecules. It is worrying trend(if its true !) if efforts are wasted to finish off humble generic drugs with proven worthiness. Doing research in established concepts is the most silly thing to do. Its duplication of knowledge.

Counterpoint

It’s scientific blasphemy to criticise  studies without analysing it in a professional manner.It appears all too brutal to take a biased view and questioning the motive of researchers. Yes agreed , I may be prejudiced , . . but , why a doctor of this caliber make a statement of this sort ?

Its a fact  , there are so many true scientist doing their job right, my query is simple why we are not getting clear answer in many common issues In spite of great research ?

Is it the limitation of science or vagaries of research ? I think it’s more of a  Intellectual insufficiency  aided by  malfunctioning regulators !

 

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I got this alert from World health organisation  yesterday .Click over the image to read more .

dr s venkatesan who sucide alert cardiology heart transplantation

Why should  a cardiologist   affected about this ?

When we are fighting in cath lab day in night day out  to  extinguish the  myocardial fire set by  coronary thrombosis and the resultant STEMI  . . . the  solemn attempt to  salvage  whatever myocardial cells we can !

See . . . what is happening elsewhere  every 40 seconds a healthy heart  in toto  is executed by weak minds !

What should the WHO do ?

Just publish these data and forget . No,they should organise the world leaders to take a resolve !

Either , we should prevent these unnatural deaths or else we should  have world organ net work. Why can’t we use these weak hearts  for those courageous  men and women  who lose their life daily with end stage  cardiomyopathy  who  long for living !

Is this  possible ?

Why not ?  Ain’t  the world leaders group  together periodically  to impose a sanction or bomb other countries  for personal reasons !

 

WHO sucide prevention

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I stumbled upon a TV reality show where a mother of a child  was crying inconsolably ,whom she lost when it fell  into a open  bore-well pit .She was blaming it as her fate and the hole was sent by Lord Yama (God of death )

I  just got  curious ! This article was written  in a flash.

I used to get questions from anxious parents  of  children with holes in the heart .(Asymptomatic small VSDs or ASDs  who come for  periodic echo-cardiograms) .I reassure and  convey  the message , most of these  holes are tiny and will close automatically and they need not worry.Even if it doesn’t, it poses little problem.

 

asd clsoure

But .after watching  that haunting TV show, I have started to warn  the parents  that  holes in the heart may not be that dangerous  but  be wary of  holes in the roads  and unclosed bore wells  in our country !

Every single parent was amused  with  my statement  ! Some how it appeared sense to me !

I made a mini google research. It is estimated thousands of bore-wells are dug every day and kept open in allover the country side .It is like live land mines .  Some press reports  suggest at least one child dies in India every day due to uncovered bore-wells and man holes ! (May be really true !)

The following are  some of the  samples.

One

borewell deaths 4

One more

borewell deaths  3

Two

You can understand the gravity of the problem , one engineer has devised a special  child retrieval Robot for such accidents.

baby snare bore well cath lab snares asd vsd device av loop how to snare a device

Three

A news report  in Times of India  .What shall we do about these ?

asd vsd borewells pits holes in the heart

It is a horrific truth in this  civilised world .Nature creates  holes  in the heart due to defective gene in some . It appears  less dangerous to me. After all a hole in the heart  threatens only one life,while  a hole in the road  kills many people.

As a cardiologist  , I am saying  this with anguish as our  team  along with  surgeons  work  over time to close intra-cardiac  holes  with device ,  the  holes in the road are often  callously  kept open   forming   death traps  for our children .The men responsible for such things deserves no  pardon.

The story is never ending . . .

borewell deaths 2

Post-amble:
Doctors are not just the  noble professional who provide relief  from  illness . They  have  other social responsibilities  too !
I believe ,  as physicians bound by Hippocratic  oath , we should  help tackle issues that threaten  our pubic health  system , especially in this case were the victims are  vulnerable children !
In fact ,  pediatricians should come forward to work with Govt to  improve safety  issues for children  and  orthopedicians  should help  prevent road traffic accident while  cardiologists  shall  work with the Govt to prevent  heart disease . . .  etc etc .
Though  bore-well deaths are  a pan India  phenomenon , One state in India ( TN)   has taken a   new initiative recently  and has  banned digging  bore-wells without prior permission and stipulated strict guidelines .Others can take a cue from here !

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