November 1   2015, Sunday
Dr KK AggarwalDr KK Aggarwal
Social determinants of health

There are a series of factors that determine our health; access to social and economic facilities being the most prominent of all. For instance, factors like the conditions in which people are born and the conditions in which they live, work and grow old can impact an individual’s health to a greater extent. These factors directly influence the quality and length of life along with impacting the possibilities of disability-free life.

In most of the cases, medical professionals only evaluate the proximate causes of diseases like smoking, obesity, disrupted lifestyle and alcohol. But the real “causes of causes” are often ignored, which make up for the root of all the medical ills prevailing in the society. However, the effective social determinants approach goes beyond just focusing on proximate causes and seeks to address what actually aggravates premature ill health and the contributing factors.

For instance, the lower people are in the socioeconomic hierarchy, the more they smoke, the more incomplete their diet, and the less physical activity they engage in. Education dominates all the other factors like excessive alcohol consumption, taxation, price and availability, bans on advertising, smoking in public places and tobacco consumption.

Examples of social determinants include:

• Accessibility and availability of resources to fulfill daily requirements like shelter, food, cloth and much more

• Access to educational institutions, medical establishments, economic opportunities like a job or any other source of earnings

• Access to quality medical facilities and healthcare services

• Quality education, learning and knowledge

• Availability of community-based resources like recreational and leisure-time activities

• Daily-life facilities like transportation and public safety options

• Society’s attitude towards a person; it includes discrimination, racism or any other kind of bias

• Prevailing conditions like crime, violence, lack of cooperation in a community and social disorder

• Socioeconomic conditions like concentrated poverty and other stressful conditions

• Literacy and culture

• Access to mass media and emerging technologies like cell phones, the Internet, and social media

The world is witnessing a universal movement that seeks to address gross inequalities in health and length of life through action on the social determinants of health. This movement has involved the World Health Organisation, several national governments, civil society organization, and academics. Solutions are being sought and learnings shared.

WMA insists that doctors should be well-informed participants in this debate. The medical professionals can be advocates for action on those social conditions that have important effects on health. In addition to this, WMA has agreed to add significant value to the necessary actions being taken:

• By helping doctors, other health professionals and National Medical Associations understand what the emerging evidence shows and what works, in different circumstances

• By helping doctors to lobby more effectively within their countries and across international borders, and ensure that medical knowledge and skills are shared

• Gathering data of examples that are working, and help to engage doctors and other health professionals in trying new and innovative solutions

• Educating and inform their members and put pressure on national governments to take the appropriate steps to try to minimise these root causes of premature ill health

• Drawing up new action plans of action, which include general practice that works across sectors to improve the quality of people's lives and hence reduce health inequalities

• Gathering examples of good practice from its members and promoting further work in this area
Breaking news
FDA Clears New Combo Inhaler, Utibron Neohaler, for COPD

The US Food and Drug Administration (FDA) has approved a new inhaled combination bronchodilator for long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), according to a company news release. Utibron Neohaler, from Novartis, combines the long-acting beta2-adrenergic agonist indacaterol (27.5 μg) and the long-acting muscarinic antagonist glycopyrrolate (15.6 μg). (Medscape)
Dr Good Dr Bad
Specialty Updates
• The increase in pregnancy and prenatal complications seen in women who undergo fertility treatments is likely related to maternal issues, not fertility drugs or assisted reproductive technology, according to a new study presented at the American Society for Reproductive Medicine (ASRM) 2015 Annual Meeting.

• G. Saccone, PhD, from the Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II in Italy, and colleagues report in BJOG that cervical length is moderately able to predict when labor will begin for pregnant women who are at 38 or 39 weeks' gestation.

• Passive surveillance for legionellosis showed a 249% increase in crude incidence in the United States between 2000 and 2011, according to a report from the Centers for Disease Control and Prevention (CDC) published in the October 30 issue of the Morbidity and Mortality Weekly Report.

• The Centers for Disease Control and Prevention (CDC) has issued an update on outcomes from 2012 to 2014 of the unprecedented multistate outbreak of fungal meningitis and other infections associated with contaminated methylprednisolone acetate injection solution. The Mycoses Study Group Education and Research Consortium is conducting a long-term follow-up study and warns clinicians that infections may recur.

• More than one in five cases of anaphylaxis that occur in schools happen in people with no known allergies, and school staff are not always properly trained to handle them, as per a new study presented at the American Academy of Pediatrics (AAP) 2015 National Conference.

• Prior to initiating isotretinoin therapy, the majority of young adult patients with severe acne were associated with a much longer course of antibiotics than currently recommended, according to a small retrospective chart review in one New York City hospital. The results, published in The Journal of the American Academy of Dermatology, found that the average duration of antibiotic use was 11 months, or 331.3 days (range 37-1,501 days), with a median of 238 days.

• Presenting the results at the 2015 Canadian Cardiovascular Congress (CCC), investigators, including senior researcher Dr Paul Poirier (Université Laval, Quebec City, QC), report that diabetic patients who engaged in "burst exercise" (short bursts of high-intensity exercise) had significantly larger reductions in HbA1c, LDL cholesterol, and triglyceride levels, as well as larger increases in HDL cholesterol, compared with those who participated in a sustained-exercise program.

• Patients with supraventricular tachycardia (SVT) treated with a modified Valsalva maneuver are nearly four times more likely to return to normal sinus rhythm than individuals treated with the standard semirecumbent Valsalva maneuver. In the study, published in the Lancet, lead investigator Dr Andrew Appelboam (Royal Devon and Exeter Hospital NHS Foundation Trust, UK) and colleagues explain that the modified Valsalva is performed in the same semirecumbent manner as a standardized procedure, except patients lie flat immediately at the end of the Valsalva strain and have their legs lifted by a staff member to 45 degrees for 15 sec. The patient then returns to the semirecumbent position for 45 seconds before cardiac rhythm is reassessed.

• The combination of grazoprevir and elbasvir is effective for treating hepatitis C virus (HCV) genotype 1 infection in patients with stage 4-5 chronic kidney disease (CKD), according to the C-SURFER trial.

• Single-dose oral dexamethasone is as effective as multidose prednisolone for treating acute exacerbations of asthma in children presenting to the emergency department, researchers from Ireland report in the Annals of Emergency Medicine.
Think differently in mythology
• Lord Ganesha’s elephant head depicts that one should use his/her wisdom before taking any decision.

• Vishnu’s first incarnation, fish, symbolizes need to learn to swim in the opposite direction.

• Brahma’s five heads mean to use all five senses before taking any decision.

• Shiva’s third eye means to think differently in difficulties.

• Ravan’s 10 heads mean using your ten senses before taking any decision (but he used them for negative forces).

• Maha Mrityunjaya mantra starts with saying that we worship the three eyed Shiva.

• Gayatri manta means that one should ask the heart to direct the intellect to take the right decision

The 3H philosophy is linked to the same. Where first H is ask the head for options; second H is to ask the heart to choose one of the options and the third H means to order the hand to do the action
The proposed ART Regulation Bill: Some suggestions

I agree with the remarks of Dr Kaberi Banerjee (published in earlier edition of eMedinewS). A single woman can make some living by surrogacy. There is nothing wrong as it is her legal right. Such draconian laws will not benefit the poor and destitute women, and it is beyond any country to make such poor women live an honest living. No Government can look after or nourish all poor in the country. Dr KS Ananda Kumar
Legal Quote
Jacob Mathew vs State of Punjab and Anr: 5th day of August 2005: 334/2005/SCI/ 144-145 of 2004

“The jurisprudential concept of negligence differs in civil and criminal law. What may be negligence in civil law may not necessarily be negligence in criminal law. For negligence to amount to an offence, the element of mens rea must be shown to exist. For an act to amount to criminal negligence, the degree of negligence should be much higher i.e. gross or of a very high degree. Negligence which is neither gross nor of a higher degree may provide a ground for action in civil law but cannot form the basis for prosecution.”
Estate planning: Wills

There may be minor children in the family whom one may want to pass on some property through will. In these circumstances, it would be best to assign guardians to those minor children and specify clearly the terms in the

(Source: IJCP)
Industry News
Easier Sebi rules fail to lure start-ups to launch IPOs: Mumbai: Four months after the capital markets regulator made it easier for start-ups to raise money and trade on Indian stock exchanges, no entrepreneur has moved to seek a local listing, preferring instead to raise funds from venture capital (VC) and private equity (PE) firms or individual angel investors. Tough promoter holding norms set by the Securities and Exchange Board of India (Sebi), uncertainties about the valuations start-ups can attract and doubts over how liquid stocks would be after a listing are deterring start-ups from raising money through initial public offerings (IPOs), market participants say. (Mint- Anirudh Laskar)

Insurance Tips for Entrepreneurs and Startups: Being an entrepreneur does sound exciting but his life is not that easy as it seems. The day he begins to carve the business plan, he knows he will have to go through many hardships. Most of the startups are delayed just because it is a well-known fact that there is no guarantee of making profits or earning something to even cover up the expenses. That is the most-known risk when it comes to entrepreneurship. Well, it really takes strong heart to become an entrepreneur and soar high in the mid of daunting ups and down and unending risks but it is not an impossible thing to achieve. ( Guest Column)

India's thriving start-ups do not have enough angel investors: New Delhi: Unlike the west, India does not have enough number of angel investors who can fuel the growth of the country's thriving start-up ecosystem, industry body Nasscom has said. "For a successful start-up ecosystem there is need for enough angel investors who can support the budding entrepreneurs from early stage. But this is not happening in India and there is a serious lack of it," Nasscom Vice-President Rajat Tandon told PTI. "High net-worth individuals and corporate executives among others should come forward and participate in this growth story," he said. A recent report by Nasscom had said that India ranks third among global startup ecosystems with more than 4,200 new-age companies. (Firstpost)

Eight critical factors to consider before investing in a mobile App: Thinking of building a mobile app for your business? With an increasing percentage of smartphone users opting to conduct business transactions on their mobile devices, a mobile app seems like a natural progression that will offer your customers a unique experience in an easy-to-use interface. But considering whether a mobile app is the right move for your business — and how your plan will be carried out if so — is critical. (Forbes)
Eight more birds from India added to international list of threatened species

Eight more birds from India have been added to the International Union for Conservation of Nature’s (IUCN) Red List of threatened species for 2015 indicating increased threat to avian habitats like grasslands and wetlands. With the additions in the latest Red List of birds released by the IUCN, an international environmental NGO, the total number of birds’ species whose population in India is threatened has reached 180 from 173 last year. One species was moved out of last year’s Red List while eight were added. Worldwide 40 bird species have now been added in the Red List while 23 species were downlisted to lower threat categories.
Inspirational Story
The history of ‘APRONS’

I don’t think our kids today know what an apron is. The principal use of Grandma’s apron was to protect the dress underneath because she only had a few. It was also because it was easier to wash aprons than dresses and aprons used less material.

But along with that, it served as a potholder for removing hot pans from the oven. It was wonderful for drying children’s tears, and on occasion was even used for cleaning out dirty ears. From the chicken coop, the apron was used for carrying eggs, fussy chicks, and sometimes half–hatched eggs to be finished in the warming oven.

When company came, those aprons were ideal hiding places for shy kids. And when the weather was cold Grandma wrapped it around her arms. Those big old aprons wiped many a perspiring brow, bent over the hot wood stove. Chips and kindling wood were brought into the kitchen in that apron. From the garden, it carried all sorts of vegetables. After the peas had been shelled, it carried out the shells.

In the autumn, the apron was used to bring in apples that had fallen from the trees. When unexpected company drove up the road, it was surprising how much furniture that old apron could dust in a matter of seconds. When dinner was ready, Grandma walked out onto the porch, waved her apron, and the men folk knew it was time to come in from the fields to dinner.

It will be a long time before someone invents something that will replace that ‘old–time apron’ that served so many purposes.

Remember: Grandma used to set her hot baked apple pies on the window sill to cool. Her granddaughters set theirs on the window sill to thaw. They would go crazy now trying to figure out how many germs were on that apron. I don’t think I ever caught anything from an apron – but love…
Warning signs of worsening heart failure If you have heart failure, call your doctor if you notice any of these signs:

• Sudden weight gain (2–3 pounds in one day or 5 or more pounds in one week)
• Extra swelling in the feet or ankles
• Swelling or pain in the abdomen
• Shortness of breath not related to exercise
• Discomfort or trouble breathing when lying flat
• Waking up feeling short of breath
• Coughing or wheezing
• Increased fatigue
• Mental confusion
• Loss of appetite
Cardiology - Yesterday, Today & Tomorrow - A CME was organized by IMA HQs on World Heart Day at IMA House, New Delhi
A 64-year-old hypertensive obese female was undergoing surgery for fracture femur under general anaesthesia. Intra operatively her end-tidal carbon-dioxide decreased to 20 from 40mm of Hg. followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1. Fat embolism.
2. Hypovolemia.
3. Bronchospasm.
4. Myocardial infarction.

Yesterday’s Mind Teaser: At the end of a balanced anaesthesia technique with non-depolarizing muscle relaxant, a patient recovered spontaneously from the effect of muscle relaxant without any reversal. Which is the most probable relaxant the patient had received?

1. Pancuronium.
2. Gallamine.
3. Atracurium.
4. Vecuronium.

Answer for Yesterday’s Mind Teaser: 3. Atracurium.

Answers received from: Dr Rajesh S. Joshi, Dr Poonam Chablani, Dr.K.Raju, Raghavendra Chakurkar, Dr.K.V.Sarma, Daivadheenam Jella, Dr Avtar Krishan

Answer for 30th October Mind Teaser: 4. Oxygen affinity of hemoglobin.

Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Daivadheenam Jella, Raghavendra Chakurkar, Dr.K.Raju, Dr Avtar Krishan
MTNL Perfect Health Mela 2015.
Pls click here for details
IMA Digital TV
A man and his wife were having an argument about who should brew the coffee each morning.

The wife said, "You should do it, because you get up first, and then we don’t have to wait as long to get our coffee".

The husband said, "You are in charge of the cooking around here and you should do it, because that is your job, and I can just wait for my coffee."

Wife replies, "No you should do it, and besides it is in the Bible that the man should do the coffee."

Husband replies, "I can’t believe that, show me."

So she fetched the Bible, and opened the New Testament and shows him at the top of several pages, that it indeed says:

Defensive Medicine

Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital,
New Delhi

The rate of cesarean section deliveries is growing all over the country. Obstetricians are often accused of using cesarean section to increase their income. On the other hand, issues such as increasing maternal age, precious babies, mothers’ insistence, safety and ease, parents’ schedule preferences, and preferences for doctor’s and hospital’s office hour delivery all result in increasing operative deliveries. However all doctors believe that ‘natural is the way to go’ in pregnancy. Yet operative deliveries are undertaken to avoid the smallest risk to mother or child. What do you think?

a. Is caesarean section a part of defensive medicine?

b. Do you agree to cesarean section deliveries in general?

c. Can such sections lead to complications for the baby such as prematurity and therefore, should they be always avoided?

d. If no to cesarean section, then what is the alternative?

e. Should there be definite essential requirements for cesarean section?

Adapted and shortened from: UNESCO, 2011. Casebook on Human Dignity and Human Rights, Bioethics Core Curriculum Casebook Series, No. 1, UNESCO: Paris, 144 pp.

Do write in with views and your solutions!
Breaking news
WHO is not telling people to stop eating bacon after cancer report

WHO has clarified that it is not telling people to stop eating bacon and other processed meats after a report claimed they could increase the risk of cancer. International Agency for Research on Cancer (IARC) put ham and sausages in the ominous-sounding “group one” of carcinogens, which includes formaldehyde, gamma radiation and cigarettes. Eating just a 50g portion of processed meat – or two rashers of bacon - a day increases the risk of bowel cancer by 18 per cent, as per the report. But the WHO has sought to ease panic by emphasizing that the findings only confirmed recommendations made back in 2002, which advised people to moderate their consumption to reduce the risk of cancer. The latest IARC review does not ask people to stop eating processed meats but indicates that reducing consumption of these products can reduce the risk of colorectal cancer.
Indian Medical Association National Satyagraha for a Healthy India
IMA Digital TV
IMA Satyagraha, suggested slogans
• Writing prescription drugs by a non-MBBS is injurious to health of the community.
• Writing prescription drugs by unqualified people can be dangerous.
• Allow doctors to treat patients irrespective of patients’ income. (If compensation is not capped, we can't do this)
• When there is capping of Rs 2 lakh for a sterilization death, why not for other procedures?
• When there is a compensation of Rs 30,000/- for a sterilization failure, why not for other procedures?
• Allow us to treat poor and rich equally.
• Non pelvic ultrasound providers should be out of PCPNDT Act.
• Unless caught doing sex determination, no criminal offence shall be registered.
• If any prospective parent asks for sex determination, they should be booked under a non bailable offense.
• More patients will die if doctors are not provided protection during duty hours.
• Death does not mean negligence.
• Money spent does not mean you will get a cure.
• Including single clinic and small establishments under Clinical Establishment Act will make treatment costly.
• How can we treat patients using outdated standard treatment guidelines made by government?
• How can government decide the charges of a clinical establishment?
The IMA standing committees are now active. Each one will be posting one position statement for discussion, changes and later adoption in the central council. Kindly suggest changes

IMA Position Statement on Prevention of Heart Disease

India is going through an epidemic of coronary artery disease. Not only the prevalence is high, Indians suffer from heart attack about ten years before rest of the world. Every 30 seconds one death occurs due to heart attack. Following preventive measures have been suggested:

• Aerobic exercise should be done for 30 to 40 minutes per day at least 5 days a week. People not able to spare time should try to create work place gymnasium a new emerging concept in corporate and government office.

• One should use cooking medium which is liquid at room temperature. The diet should be free of trans fats as far as possible
• One should avoid red meat (especially processed). Sea foods may not be harmful for the heart
• One should avoid nicotine intake in any form. Smoking active or passive both are dangerous.
• One should avoid undue stress. One should leave the workplace in office once at home.
• There are few risk factors which cannot be prevented like genetic predisposition. Get yourself checked up if you have a family history
• Two emerging risk factors are environmental pollution (PM 2.5) and rising addiction in young generation

Dr Niraj Prasad, Chief Cardiologist Medanta Ranchi, Jharkhand & Dr Ajoy Kumar Singh, Chairperson, IMA Standing Committee on National Plans

Control of cardiovascular diseases revolves around 3 As: Awareness, Accessibility and Affordability

Awareness about the fact that they are preventable or at least can be delayed. Billboards in cities and villages can display the importance of life style management like need for exercise and healthy diet and the ways to combat stress. Awareness should also be created about when to suspect a C V disease and report to your doctor. And also the importance of initiating treatment within 4 hours of chest pain.

Accessibility involves training doctors in PHCs to recognise a cardiac event on ECG and availability of Trop T testing which does not require any equipment.

Thrombolytic agents can be given at PHC level also, which will save lot of lives. Training the doctors in line with and with same outreach as the family planning training programme will be extremely helpful. All B grade cities should be equipped with a cath lab that should be connected to a higher centre through telemedicine. These centres should be equipped and staffed to perform primary angioplasty and thrombosuction.

The biggest problem in a country like ours is of affordability. To achieve this, we have to reduce the cost by producing good quality implants at a much cheaper rate than now. We will have to cover every citizen of India under health insurance scheme. Public sector banks, undertakings and the corporates will have to play a big role in this. EMI schemes in hospitals can also help a lot of patients.

Dr H D Sharan
WMA News
Imprisonment of two young doctors condemned by WMA

The World Medical Association has condemned the decision of a Turkish court to imprison two young doctors for giving first aid to people injured during the Gezi Park demonstrations in Istanbul two years ago. The two doctors were sentenced last week to 10 months imprisonment. Their crime was to give first aid to demonstrators who had taken refuge in an Istanbul mosque. They were charged with ‘fouling a temple' while delivering health care services and were included in an action brought against more than 250 people for ‘taking sides with offenders by extending first aid to demonstrators'.

WMA President Sir Michael Marmot said: ‘As members of the international medical community, we are gravely concerned at the punitive sentences that have been imposed on these two doctors. Physicians should never be punished for following their professional duty of providing care without discrimination to those in need. We have repeatedly urged the Turkish authorities to bring a halt to this inhumane situation of arresting and imprisoning health professionals who care for the sick and wounded.

‘The Turkish authorities have an obligation to respect the sacred duty of physicians to care for those in need and uphold people's right to health at all times. These young doctors were simply following international standards of medical ethics by providing emergency medical care to those who needed it.' ‘Physicians must be able to practise their profession without any fear or intimidation in Turkey and in all other parts of the world. They should be able to help anybody anywhere without any distinction. These doctors followed their belief that their first principle must be the provision of medical care and the saving of life. We urge the relevant Turkish authorities to respect these principles and reconsider these sentences.'
Shri Nadda reaffirms India’s commitment to support Africa in its fight to “End AIDS Epidemic by 2030”

India stands committed to the world in its fight against HIV and AIDS, and particularly to the African nations, in the combined resolve to end the AIDS epidemic by 2030. India will extend all support and cooperation in sharing its knowledge and expertise in developing shared frameworks of cooperation and means of implementation towards meeting this goal. This was stated by the Union Minister for Health & Family Welfare, Shri J P Nadda at the India-Africa Forum Summit to “End AIDS Epidemic by 2030”.

Complementing the African nations in their resolve to end the AIDS epidemic and the significant reductions in the number of new AIDS infections in several countries in Africa as a result of their sustained collective efforts, the Health Minister stated that “India learnt from Africa’s early experience in responding to AIDS in increasing awareness and providing services to key populations, and in expanding access to treatment. Today also we are applying Malawi’s B+ strategy in India to ensure that no child is born with HIV and all children have access to treatment. The learning from these exchanges helped India to formulate its successful strategies for combating AIDS”. (PIB)
World Antibiotic Awareness Week 16-22 November 2015

World Antibiotic Awareness Week (aims to increase awareness of global antibiotic resistance and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of antibiotic resistance. A global action plan to tackle the growing problem of resistance to antibiotics and other antimicrobial medicines was endorsed at the Sixty-eighth World Health Assembly in May 2015. One of the key objectives of the plan is to improve awareness and understanding of antimicrobial resistance through effective communication, education and training.

The theme of the campaign, Antibiotics: Handle with Care, reflects the overarching message that antibiotics are a precious resource and should be preserved. They should be used to treat bacterial infections, only when prescribed by a certified health professional. Antibiotics should never be shared and the full course of treatment should be completed – not saved for the future. WHO is encouraging all Member States and health partners to join this campaign and help raise awareness of this issue. A variety of resources will be made available to support local campaigns including factsheets, infographics, posters and multi-media materials. (WHO)
The Bombay High Court on Thursday directed the state government to consider taking steps in law to regulate the sale of medicines through websites, until a proper law is enforced. As of now, the state government has constituted a committee, with terms of reference for sale and regulation of medicines through online websites. The committee has called for suggestions from the public, NGOs and other organisations, after which it will issue recommendations to carry out the necessary amendments in the Drugs and Cosmetics Act. The suggestions will be received till October 30. A division bench of justices Naresh Patil and S B Shukhre asked the committee to also study laws of developed countries such as the US, the UK and Norway, where online sale of medicines is allowed, and of countries such as Turkey, Thailand and Korea, where it is not allowed. (DNA)
IMA Digital TV
GP Tip: Occult wheezing

When evaluating a cough, ask the patient to perform a forced expiration, which often reveals occult end-expiratory wheezing. In small children ask them to blow as if they are trying to extinguish the candles on their birthday cake

(Source: IJCP)
Readers column
Dear Sir, Thanks for the updates. Regards: Dr Kartik
IMA Digital TV
Over 50 doctors attended the IMA Rise & Shine CME on Vitamin D deficiency in Vashi

Press Release
Keep your heart safe this winter

Awareness must be generated about how the sudden change in weather can cause health complications for the elderly, children and people with existing lifestyle diseases

While the sudden change in weather comes as a sign of relief for many; it also brings with it health implications especially for those suffering from pre-existing lifestyle diseases, the elderly and young children. It is essential that special care is taken during this time to be able to enjoy properly the winter season.

Given that the lack of preventive awareness that exists amongst the masses, special workshops and lectures on winter preparedness will be organized during Heart Care Foundation of India (HCFI)’s annual flagship event, the upcoming 22nd MTNL Perfect Health Mela scheduled to be held from Nov 4-8 at the Talkatora Stadium in Delhi.

It is a known fact that the number of deaths due to heart attacks, cardiac arrests and strokes increase during the winters. There are several reasons for this; firstly the reduction in the daylight hours affects the hormonal balance of the body and causes Vitamin D deficiency a common trigger for heart attacks. Additionally, cold temperatures cause the heart arteries to condense thereby restricting the blood and oxygen flow to the heart. This often causes a rise in the blood pressure.

The cold weather also triggers bouts of depression especially amongst the elderly population causing an increase in stress levels and hypertension. People suffering from winter depression are also seen indulging in high sugar, trans fat and sodium comfort food, which can be extremely dangerous for the diabetic and hypertensive population. The temperature drop also increases the chances of blood clot formation, since blood platelets are more active and stickier.

Speaking about this, Padma Shri Awardee, Dr. K K Aggarwal, President HCFi and Honorary Secretary General IMA said, “The risks of developing serious cardiovascular concerns during winter months can be prevented and easily managed by making some habitual changes to one’s lifestyle. It is advised that heart patients shouldn’t consume alcohol quantities during in winter months as it can cause atrial fibrillation. A heart healthy diet must be followed, and binge eating should be avoided. Eating small and frequent meals is recommended as it helps eradicate overeating and excess pressure on the heart”.

A few tips on how to stay healthy during the winter months include:

• Don’t stress your heart, regularly step out in sunlight and adequate amounts of aerobic exercise
• Don’t indulge in high-intensity workouts excessive exhaustion can overstress your heart. Take rest breaks so that you don’t feel too tired suddenly while walking
• Don’t go for a walk in extreme chilly mornings, instead go out when the sun is out
• Ask your doctor to adjust the dosage of your routine medicines
• Keep a close tab on your cholesterol levels, as they can fluctuate in the winters. Immediately consult your doctor in case you notice something unusual, borderline high cholesterol levels can put you at an increased risk of a heart attack
• Hypothermia is one such problem that majority of heart patients encounter during winters. To keep the risk of hypothermia away, it is suggested that you stay warmly clad
• Don’t ignore any unusual symptoms like slight discomfort in the chest, sweating, pain in jaw and shoulders, pain in neck and arms and shortness of breath. Immediately, reach out for medical assistance in case you suffer from any of these symptoms

Prevention is always better than cure. A little extra care can help make the holiday months, more enjoyable and heart healthy.
Digital IMA