December 4   2015, Friday
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EDITORIAL
Dr KK AggarwalDr KK Aggarwal New treatment of heart failure with reduced ejection fraction

Millions suffer from heart failure. New research suggests that a new medication, sacubitril-valsartan, might help these patients live longer.

In a study published in the Dec. 3 issue of the New England Journal of Medicine, researchers analysed data from nearly 8,400 heart failure patients with reduced ejection fraction. A team led by Dr Scott Solomon, director of non-invasive cardiology at Brigham and Women’s Hospital in Boston, estimated the patients’ survival time if they took sacubitril-valsartan or enalapril. Patients who took sacubitril-valsartan were projected to live 1.5 to two years longer than those who took enalapril.

Another randomized double-blind trial (PARADIGM-HF) in patients with HFrEF (heart failure with reduced ejection fraction ) found that sacubitril-valsartan reduced cardiovascular mortality and hospitalization for HF as well as all-cause mortality compared to a proven dose of the ACE inhibitor enalapril.

An analysis of nonfatal clinical deterioration among patients enrolled in the PARADIGM-HF trial found that patients treated with sacubitrial-valsartan reduced the combined end-point (intensification of medical treatment for HF, emergency department visits for worsening HF, hospitalization for HF, and need for intensive care) more effectively than ACE inhibitor therapy.

Treatment of heart failure

• In patients with heart failure with reduced ejection fraction (HFrEF), angiotensin II receptor blocker treatment reduces hospitalizations for HF.

• For patients with HFrEF who are intolerant of angiotensin-converting enzyme inhibitor (ACEI) due to cough, give an angiotensin receptor blocker (ARB) (candesartan or valsartan). But if ACEI intolerance is in the form of hyperkalemia or renal insufficiency, then the same risks would apply to an ARB and hence, this recommendation is not applicable in such a situation.

• If a patient has developed angioedema on ACEI, exercise caution in giving an ARB as angioedema has been infrequently reported with ARB therapy.

• When an ARB is indicated, give candesartan or valsartan

• Avoid using an ARB, an ACEI and a mineralocorticoid receptor antagonist all at the same time.

• Adverse effects of ARBs include hypotension, dizziness, worsening renal function and hyperkalemia.

• In a randomized double-blind trial in patients with HF with left ventricular ejection fraction (LVEF) =40%, sacubitril-valsartan, an angiotensin receptor-neprilysin inhibitor, reduced mortality and morbidity vs ACEI therapy when used in combination with other standard HF therapies.

• For patients with new diagnosis of NYHA class II to IV HFrEF (LVEF =40%), give ACEI (or single agent ARB) rather than sacubitril-valsartan as a component of initial medical therapy. Use of sacubitril-valsartan routinely as a component of initial therapy in such patients has been recommended by some.

• For patients with stable mild to moderate HFrEF (LVEF =40%), an elevated natriuretic peptide level or hospitalization for HF in the past 12 months, a systolic BP = 100 mm Hg and eGFR = 30 mL and who have tolerated high-doses of ACEI or ARB therapy (equivalent to at least enalapril 10 mg twice daily) for =4 weeks, start sacubitril-valsartan in place of the ACEI (or single agent ARB) component of therapy.

• Factors that impact the decision to switch to sacubitril-valsartan in place of ACEI (or single agent ARB) include patient acceptance/tolerance of drug changes (including need for a 36-hour ACE inhibitor washout period prior to starting sacubitril-valsartan), lack of data on the long-term effects of sacubitril-valsartan, and cost.

• When sacubitril-valsartan is used in patients with HFrEF, it is used in place of ACEI (or single-agent ARB). Sacubitril-valsartan should not be used in combination with an ACEI (or single-agent ARB).
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Amit Sharma and Nilesh Aggarwal

We are extremely happy to have been part of IMA Satyagraha campaign and would like to congratulate the Indian doctor community as a whole. We are aiming to be a digital voice of all Indian doctors and will continue to work towards raising such important issues. Currently, we are in our Beta phase and we will soon be introducing features such as interesting cases, online CME's, conference updates etc. Please do register and read eMediNews, eIMANews as well as other engaging content on the website/app. You can also add other doctors to your network, find long lost alumni, chat and discuss cases, post questions for the medical fraternity, create your detailed medical resume and lots more.
Breaking News
About 415 million adults worldwide have diabetes

An estimated 415 million adults have diabetes worldwide, or about one in every 11, according to the newly-released Diabetes Atlas, 7th edition, from the International Diabetes Federation (IDF). The new estimate, which combines the diabetes types reflects an increase of 31 million adults living with diabetes worldwide since the last atlas, published in 2013… (Medscape)

Health ministry to launch injectable contraceptive in public health system under NFPP

The Drugs Technical Advisory Board (DTAB) has given its approval to the injectable contraceptive depot medroxyprogesterone acetate (DMPA). The Union health ministry will soon introduce this injectable contraceptive in the public health system under the National Family Planning Programme (NFPP)... (Pharmabiz – Ramesh Shankar)
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Specialty Updates
• New analysis from the Coronary Artery Risk Development in Young Adults (CARDIA) study revealed that the level of cardiorespiratory fitness (CRF) at an early age may predict long-term cardiac outcomes. Researchers noted that participants who had higher treadmill exercise testing scores at baseline, when they were 18 to 30 years of age, had significantly lower LV mass index and better "global longitudinal strain" 25 years later. The findings were published online in JAMA Internal Medicine.

• A new study, published in JAMA Psychiatry, found that low levels of physical activity and high levels of television viewing during young to mid-adulthood were associated with worse cognitive performance in midlife.

• Atopic disease increases the risk of anemia in children and adolescents, suggested data from two large population-based surveys published in JAMA Pediatrics.

• Maternal malabsorptive bariatric surgery may be associated with fetal growth restriction, suggested a study published online in the American Journal of Obstetrics and Gynecology.

• Eating a handful of walnuts each day may be particularly good for people at risk of developing diabetes, suggests a study published in BMJ Open Diabetes Research and Care. Adding walnuts to the diet led to improvements in blood vessel function and reductions in LDL cholesterol.

• Prior research has shown an association between breast density and breast cancer. However, a new study presented at the annual meeting of the Radiological Society of North America (RSNA) revealed that breast density may not be a strong independent factor for breast cancer risk.

• A new software algorithm automatically measures ptosis from facial photographs, suggests new research published online in JAMA Ophthalmology. Researchers developed a software algorithm that can identify the corneal light reflex and eyelid margins in frontal photographs of human faces and automatically calculate margin reflex distance 1 (MRD1) and MRD2.

• The International Osteoporosis Foundation (IOF) Bone and Diabetes Scientific Working Group has published a review in the European Journal of Endocrinology which provides valuable information in regard to fracture risk in type 1 diabetes patients. The review calls for regular evaluation of fracture risk as well as more research into the role of osteoporosis drugs in diabetic patients.
eSpiritual
Signs of Spiritual Awakening

• More experiences of telepathy
• More experiences of reverse telepathy
• More spontaneous fulfillment of desires
• Increased tendency to let things happen rather than make them happen. Work done with the least effort.
• Change in the nature, more smiling, laughter and thankful nature.
• Feelings of being connected with others and nature.
• Frequent overwhelming episodes of appreciation.
• Tendency to think and act spontaneously rather than from fears based on past experience.
• Ability to enjoy each moment.
• Living in the present.
• Loss of worry.
• A loss of interest in conflict.
• A loss of interest in interpreting the actions of others.
• A loss of interest in judging others.
• A loss of interest in judging self.
• Gaining the ability to love without expecting anything in return.
• Quality of converting an adversity into opportunity.
• Dislike for drugs, smoke and excess of alcohol.
• Happiness in doing random acts of kindness.
• Looking for good in every one.
Legal Quote
V. Kishan Rao vs Nikhil Super Speciality Hospital on 8 March, 2010 Civil Appeal No. 2641 / 2010

“When the Fora finds that expert evidence is required, the Fora must keep in mind that an expert witness in a given case normally discharges two functions.

1. The first duty of the expert is to explain the technical issues as clearly as possible so that it can be understood by a common man.

2. The other function is to assist the Fora in deciding whether the acts or omissions of the medical practitioners or the hospital constitute negligence.”
Medical Breakthroughs that were initially ridiculed or rejected
Viruses and Cancer

When Peyton Rous demonstrated the viral transmission of cancer in 1911, it was received with severe criticism. Consequently, he quit working with the retrovirus that now bears his name, the Rous sarcoma virus and abandoned his cancer research for the next 2 decades. At the time, viruses were not well understood and beyond the reach of contemporary microscopy; critics contended that the tumor caused by Rous's virus was not a true neoplasm but rather a reaction to the virus more akin to inflammation, such as a granuloma. Six decades later, American biologists Peter Duesberg and Peter Vogt validated Rous’ work by the discovery of the gene responsible for the tumorigenic activity of the virus, the first viral oncogene v-src. J Michael Bishop and Harold Varmus won a Nobel Prize for extending this work yet further to discover the first proto-oncogene, suggesting that tumors may arise from defects in normal cellular genes in 1989. Fifty-five years after his discovery, Rous himself was awarded the Nobel Prize In 1966, the longest "incubation period" in the history of the Nobel Prizes in Physiology or Medicine. (Medscape)
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IMA National Health Scheme (Contd.)

Member’s Disqualification

a. If a member/beneficiary member fails to pay the Financial Assistance Contribution (AFAC) within 30 days of the demand notice sent by the office, he/she shall be treated as a defaulter and he/she shall pay fine of Rs 50/- per month or part thereof. If the default continues beyond the period of 60 days, then a notice by registered post with acknowledgement shall be issued to such a member at his/her expense and if such member does not pay the dues within 30 days of the receipt of such a notice, membership shall be terminated forthwith.

b. If a member furnishes any wrongful information in his/ her application form or any provisions of this scheme and he/she tries to obtain any wrongful benefit under the scheme ,after giving him/her an opportunity of being heard before the managing committee ,and if his/her explanation is not found satisfactory. The managing committee of the scheme shall have the right to terminate the membership of the member concerned without any benefit. He/She shall not be eligible for any further enrollment in the scheme and all amount paid by him/her will be forfeited

Benefits of the Scheme: (a). This scheme is entitled to be helpful to the members/beneficiary members to meet the heavy expenses for the management of coronary heart disease and surgical management of valvular heart diseases, management of Renal failure, management of Cancer, Brain tumours involving surgical treatment and joint replacement surgery for hip and knee joints, spinal surgery, Trauma and diseases requiring admission causing expenditure above Rs. 5000.00.

1. Coronary Heart Disease: Bypass surgery and angioplasty required for the treatment of coronary heart disease and valvular heart disease surgery will be covered under this scheme. Upper limit will be Rs 2 Lakhs/year.

2. Renal Failure: Regular haemodialysis or renal transplantation required in the management of chronic irreversible failure of both the kidneys will be covered under the scheme. Upper limit is Rs 2 lakhs/year.

3. Cancer: Surgery, Radiotherapy and chemotherapy required for the treatment of all cancers will be covered under the scheme. Upper limit will be Rs 2 Lakhs/year.

4. Management of Brain Tumour: Surgery, radiotherapy and chemotherapy required for the treatment of brain tumors will be covered under the scheme. Upper limit will be Rs 2 Lakhs/year.

5. Major Surgeries: Surgery for knee and hip joints, spinal stenosis and disc surgery, or other major surgeries will be covered by the scheme with an upper limit of Rs one lakhs/year.

6. Other diseases: Any serious diseases requiring hospitalization will be covered with an upper limit of Rs 50,000/- per year.

Accounts

The funds of the Scheme shall be deposited in the name of the scheme in a nationalized bank. Such accounts should be operated jointly by two among the Hon. Secretary/ or the Joint Secretary and the Treasurer. Accounting year will be that of the Indian Medical Association. Annual Audited accounts should be presented in the Annual Central Council meeting of the IMA. The report and accounts of the scheme will be presented in every CWC meeting.

(To be contd.)
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22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
Final report on national drugs survey likely to come by April 2016

The final report of field data involving 47,000 samples as part of national drugs survey is likely to be released by April next year. These samples have been sent to 10 drug testing labs across the country, which is likely to conclude by end of December this year. These samples were collected from all retail drug stores including government medical stores, CHCs and PHCs as part of the pan-India survey. Central Drug Testing Labs (CDTL) in Chandigarh, Mumbai, Hyderabad, Chennai, Kolkata and Guwahati, state drugs testing labs at Gujarat, Karnataka Maharashtra and a lab at Indian Pharmacopoeia Commission (IPC), Ghaziabad are part of testing and analysis. This pan India survey assumes significance as for the first time, complete testing of not-of-standard quality (NSQ) drugs would be done as per Indian pharmacopoeia and other pharmacopoeias. All previous studies were done only for spurious drugs… (Pharmabiz - Shardul Nautiyal)
Flavored TB drugs for kids

The World Health Organisation (WHO) launched strawberry- and raspberry-flavored medicines customized for children, at a conference on lung health in Cape Town, South Africa. This is the first time that a fixed dose has been customized for children who were so far given regular TB pills in halves or crushed manner. Significantly, the innovation has a Mumbai angle: Andheri-based Macleods Pharmaceuticals Ltd has been roped in by the WHO and TB Alliance to manufacture the new fixed dose combination for children. Mumbai is believed to be the TB capital of the world with over 30,000 new patients diagnosed every year. Of these, around 7% to 9% are under 14 years of age. (Times of India – Malathy Iyer)
Letter to Editor

Dear sir

This is with reference to interministerial committee meeting to be held on 8th of this month. First of all I congratulate you and your team for a successful initiative to look into the problems of all IMA members. I am a radiologist by profession and here is a suggestion related with PCPNDT Act. Apart from the harsh punishment for clerical mistake, another thing we are bothered about is the sealing of ultrasound machine. The machine is sealed on any minor ground or the authorities threaten us to do so. Once done, the machine can be realized only by the High Court, and it takes months to do so. Sealing of the machine should be the last resort. However, the authorities use it as the first and only weapon against us. There should be some strict criteria for sealing the machine. Also, the procedure to deseal the machine should be simplified. I hope you will raise the issue at an appropriate platform.

Dr Sanjay Kedia
Akola, Maharashtra
High computer use affects patient's perception of care

A research letter published online November 30 in JAMA Internal Medicine observes that physicians in safety net hospitals who were assessed as high computer users during clinical encounters fared significantly worse than their low-computer-use counterparts in measures of patient experience. Neda Ratanawongsa, MD, MPH, from the Division of General Internal Medicine, University of California, San Francisco, and colleagues reported that 48% of the patients of physicians with heavy computer use during clinical encounters rated the care they received as excellent on patient experience surveys, whereas 83% of patients whose physicians were less engaged with their computers during the encounter felt the care they received was excellent. High computer use was also associated with observable communication differences … (Medscape)
Major policy decisions announced in fight against HIV-AIDS

“Reaffirm India’s commitment in ending epidemic by 2030”

On World AIDS Day this year, Shri J P Nadda, Union Minister of Health and Family Welfare announced major policy decisions in the fight against HIV-AIDS. The Health Minister also released the “India HIV Estimations 2015-Technical Report” and launched Distance Learning Programme on Opioid Substitution Therapy (OST), Integrated HIV TB e-learning module, PPTCT ART Linkage Software (PALS) and HIV Sensitive Social Protection Portal on this occasion. The National AIDS Control Programme will continue as a Central Sector Scheme… (PIB)
Significant decline in Hospital-Acquired Conditions in the US

The rate of hospital-acquired conditions (HACs) has dropped by 17% over a 4-year period, as reported by the Dept. of Health and Human Services (HHS). The rate of HACs dropped from 145 per 1,000 discharges in 2010 to 121 per 1,000 discharges in 2014. The report was issued by the Agency for Healthcare Research and Quality (AHRQ). Over a 4-year period starting in 2011, "a cumulative total of 2.1 million fewer HACs were experienced by hospital patients ... relative to the number of HACs that would have occurred if rates had remained steady at the 2010 level. Approximately 87,000 fewer patients died in the hospital as a result of the reduction in HACs, and approximately $19.8 billion in health care costs were saved from 2010 to 2014… (Medpage Today)
Pollution in Delhi

At least one European country is considering classifying New Delhi as a “hardship” posting on account of the increasing air-pollution level in the city, reports The Hindu. The Norwegian embassy is considering a hardship allowance for those posted in Delhi, due to the air pollution. Similarly, an international school in the city have cancelled outdoor activities for students as the city gasps for breath… (The Hindu - Vidya Krishnan)
eWellness
Prevention strategy relies on lifestyle

Stenting may not always be the answer to treating heart disease with stable coronary artery disease. A German study has shown that patients with stable coronary artery disease who were put on an exercise regimen had significantly higher rates of event-free survival than those who had undergone percutaneous coronary intervention (PCI). In the study, 70% of patients in the exercise program had event-free survival -- no stroke, heart attack, or death -- compared with 50% of stented patients after four years. Exercise is an important part of any type of prevention, and it should be instituted for "anyone with stable coronary heart disease."

The study on stenting versus exercise come was a continuation of a pilot study first reported in 2004 in the journal Circulation. That study of 101 male patients found that after one year, 88% of patients who exercised had event-free survival compared with 70% of stented patients. The updated data reflect an additional 100 patients, who performed moderate intensity exercise for two weeks under hospital supervision, and then were given an exercise bike to continue their regimen at home. Patients with stable angina exercised at 80% of their threshold, and that after four weeks of exercising, their angina threshold increased.

The clear message for patients is to get 30 to 60 min of moderate-intensity aerobic activity every day, noting that 30% of heart disease could be prevented by 2.5 hours of walking per week.
IMA JIMA

http://module.ima-india.org/ima/jima/2015/September/
WP(C) No.8706/2015 titled “Indian Medical Association Vs. Union of India & Anr (NCERT)” Delhi High Court, New Delhi

Click here to read the proposed changes
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Bioethical issues in medical practice
Duty as a parent

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

Rina is mother to Chini, an 11 year old girl with mental retardation. Chini can barely look after herself. Her mother is constantly worried as to how she will look after herself when her periods start. At present Chini has barely learnt to bather herself, speak intelligible sentences and move around by herself. However Chini has no idea about her own disability and loves watching romantic scenes on TV. Rina is worried that in these insecure times, Chini may end up being abused or taken advantage of due to her lack of understating. They approach you as a doctor to provide a certificate so that the parents can ask for a hysterectomy. You tell them that this is against human rights and in fact, there is a court judgment against this practice but they keep insisting, because they see you both as a doctor as well as a friend. What should you do?

a) Go all out to help them for the operation because you feel that times are actually bad and chances of (possible) rape and pregnancy are high?
b) Go by the book and say there is nothing you can do?
c) Suggest alternative treatments?

Any other suggestions and solutions? Do write in!

Responses received

It is the responsibility of the mother to protect her from sexual abuses and subsequent pregnancy as she cannot take care of herself. The best course would be to get a certificate from psychologist that she is mentally unfit and cannot take care of herself. Then she should get her operated for tubectomy to save her from subsequent pregnancy and then get her treated by some psychologist for her mental illness. If she recovers and becomes mentally fit she may get her operated for reversal of procedure, reuniting the tubes. This will give her a chance of getting pregnant which is very important factor for any lady. Hysterectomy will be a permanent failure to get the child of her own, which becomes unethical. Dr BR Bhatnagar
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Inspirational Story
Live and Work

Father was a hardworking man who delivered bread as a living to support his wife and three children. He spent all his evenings after work attending classes, hoping to improve himself so that he could one day find a better paying job. Except for Sundays, Father hardly ate a meal together with his family. He worked and studied very hard because he wanted to provide his family with the best money could buy.

Whenever the family complained that he was not spending enough time with them, he reasoned that he was doing all this for them. But he often yearned to spend more time with his family. The day came when the examination results were announced. To his joy, Father passed, and with distinctions too! Soon after, he was offered a good job as a senior supervisor which paid handsomely.

Like a dream come true, Father could now afford to provide his family with life’s little luxuries like nice clothing, fine food and vacation abroad. However, the family still did not get to see father for most of the week. He continued to work very hard, hoping to be promoted to the position of manager. In fact, to make himself a worthily candidate for the promotion, he enrolled for another course in the Open University.

Again, whenever the family complained that he was not spending enough time with them, he reasoned that he was doing all this for them. But he often yearned to spend more time with his family.

Father’s hard work paid off and he was promoted. Jubilantly, he decided to hire a maid to relieve his wife from her domestic tasks. He also felt that their three-room flat was no longer big enough, it would be nice for his family to be able to enjoy the facilities and comfort of a condominium. Having experienced the rewards of his hard work many times before, Father resolved to further his studies and work at being promoted again. The family still did not get to see much of him. In fact, sometimes Father had to work on Sundays entertaining clients. Again, whenever the family complained that he was not spending enough time with them, he reasoned that he was doing all this for them. But he often yearned to spend more time with his family.

As expected, Father’s hard work paid off again and he bought a beautiful condominium overlooking the coast of Singapore. On the first Sunday evening at their new home, Father declared to his family that he decided not to take anymore courses or pursue any more promotions. From then on he was going to devote more time to his family.

Father did not wake up the next day.
Over 50 doctors attended the IMA Rise & Shine CME on Vitamin D deficiency in Nippani
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Over 60 doctors attended the IMA Rise & Shine CME on Vitamin D deficiency in Siliguri
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eMedi Quiz
Asymptomatic H1N1 infection is seen in

1. 9% cases
2. 20% cases
3. 30% cases
4. 40% cases

Yesterday’s Mind Teaser: Which of the following is true about restless leg syndrome?

1. RLS also occurs at rest
2. RLS is predominantly in the evening or at night
3. RLS is sometimes painful.
4. All of the above

Answer for Yesterday’s Mind Teaser: 4. All of the above

Answers received from: Dr Rajesh S Joshi, Dr Shangarpawar, Dr K Raju, Daivadheenam Jella, Dr Bitaan Sen & Dr Jayashree Sen, Dr Avtar Krishan.

Answer for 2nd December Mind Teaser: TRUE

Answers received from: Dr Kailash Chandra Sharma, Dr Praneet Telukunta, Dr Jainendra Upadhyay, Daivadheenam Jella, Dr K V Sarma, Dr Avtar Krishan.
Humor
Blonde Stop

A police car pulled alongside a speeding car on the motorway. Glancing at the car he was astonished to see that the blond behind the wheel was knitting! Realizing that she was oblivious to his flashing lights and siren, the cop rolled down his window and shouted "Pullover!" The blonde rolled down her window and yelled back "No, it's a scarf!"
Readers column
Sir, very informative news. May God bless all. Kuldeep
Press Release
Cardiovascular diseases, stroke and diabetes are also causes of disability

• There are over 120 million people in India who live with some disability or the other
• Over 41% of these are physically disabled


On the occasion of World Disability Day, the Indian Medical Association raised awareness about the need to create awareness about the prevention of lifestyle diseases like diabetes, hypertension, and cardiovascular ailments, which are also causes of disability in our country.

They also stressed the need for stricter laws when it comes to the availability of disability services in India. There still exists a social taboo towards people living with a disability. They are often not preferred as employees; several buses, malls, and other public places are not disability friendly, and they are often deprived quality educations. This is a major point of concern for the Indian society. What graves the medical community is the lack of emotional and healthcare support for such people. A large section of the disabled population resides in rural areas where accessibility to healthcare and affordability become major issues.

India is home to 120 million people who suffer from some disability or the other. Over 41% of these suffer from a physical disability. This vast number is a shocking reality, and it continues to grow. The increasing prevalence of lifestyle diseases in the present century further adds to this problem. In fact people suffering from severe cardiovascular diseases should also be taken under the classification of disability.

Speaking about this, Padma Shri Awardee Dr. A Marthanda Pillai – National President IMA and Padma Shri Awardee, Dr. KK Aggarwal – Honorary Secretary General IMA and President HCFI said, “Chronic diseases and conditions such as heart disease, cancer, obesity, diabetes, stroke, and arthritis are among the preventable causes of disability in our country. With the unhealthy and rather sedentary lives lived by our population today, the prevalence of disability continues to grow. It is extremely important that this trend is reversed. We urge people to consume a healthy and balanced diet, get adequate exercise, sleep, and sunlight, engage in outdoor activities more and find holistic ways of managing stress. Awareness must also be raised about timely intervention in stroke patients which is a direct cause of disability."

A few ways in which people can prevent most lifestyle diseases are

Exercise Regularly – A recent study has revealed that lack of physical activities along with the changing lifestyle patterns has put 74 percent urban Indians at risk of suffering from cardiovascular diseases (CVD). Thus, exercising regularly is highly recommended as it helps increase the immunity of a person, regulates their blood pressure and keeps cholesterol and obesity under check. It is also a good way of eliminating the stresses of day-to-day urban living.

Quit smoking – Currently tobacco intake is responsible for one million deaths in India. As soon as one smokes, more than 400 toxic byproducts are released in their blood. These damage the lining of the arteries and also narrow them due to a build-up of fatty material (plaque). This in turn can lead to stroke, angina or a heart attack. To beat tobacco cravings, one can chew gums, eat celery sticks, and mint leaves. Forming a core support group and sharing each other’s experiences can also prove to be beneficial.

Consume a heart-healthy diet - A healthy and balanced diet is key to a healthy life. Consuming food that has excessive amounts of trans fatty acids, dietary cholesterol and saturated fats leads to obesity, high cholesterol levels, hypertension and diabetes, all key risk factors for heart disease. Eating ample amounts of green and leafy vegetables, fresh fruits, whole grains, beans, dietary fiber, nuts, and fish are highly recommended for good health.

Reducing stress the healthy way – Modern day lifestyle induced stress is another major contributor to the increasing incidence of all lifestyle diseases. Many a times stress takes the manifestation of a depressive disorder. People often resort to evils such as smoking, drinking and eating unhealthy food to deal with stress. All these increase the risk of lifestyle diseases. Relaxation and calming methods such as meditation, breathing exercises, and yoga, can be very useful in lowering stress levels.

Regular health check-ups - Since these days majority of the population follows a very unhealthy lifestyle, health check-ups are extremely necessary especially if there exists a family history of lifestyle diseases. Early detection and treatment can help eliminate a majority of fatalities