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Editorial (Dr K K Aggarwal)                                                                                       (Dr RN Tandon)
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9th October, 2017
 One in four people leave work a year after a heart attack
Dr KK Aggarwal
Most people leave their job within a year of returning to work after having a heart attack, says a study reported in the Journal of the American Heart Association. Patients aged between 30 and 39 years and those between 60 and 65 years reported the highest rate of work dropout after return to work.
About 91% of the 22,394 heart attack patients who were employed before hospitalization for a first-time heart attack, returned to work within a year of the episode. But, within a year of resuming work, 24.2% of them left their jobs and were supported by social benefits.
Comorbid heart failure, arrhythmia, and depression, diabetes were found to be the clinical risk factors for unemployment. Patients with high income and high education level were more likely to remain employed, compared with those with lower educational and income levels.
Several factors - medical, economic, psychosocial - influence return to work following a heart attack. As doctors we take care of the medical factors, drug therapy, managing complications and secondary prevention. But, being part of the multidisciplinary cardiac rehabilitation team, it is equally important to take care of psychosocial factors that may affect recovery of a patient.
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Top News
WHO recommends large-scale deworming to improve children's health and nutrition
Periodic deworming programmes with a single-tablet treatment can drastically reduce the suffering of those infected with parasitic intestinal worms and protect the 1.5 billion people currently estimated to be at risk. Four main species of intestinal worms (also known as soil-transmitted helminths) affect almost a quarter of the world's poorest and mostly marginalized people. They are a major public health problem because the worms disrupt people's ability to absorb nutrients, impeding the growth and physical development of millions of children.
WHO's guideline "Preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups" confirms that deworming improves the health and nutrient uptake of heavily infected children. "There is now global evidence-based consensus that periodic, large-scale deworming is the best way to reduce the suffering caused by intestinal worms," says Dr Dirk Engels, Director of WHO's Neglected Tropical Diseases Department... (WHO, September 29, 2017).
Practice Updates
Study shows association between asthma and periodontitis
A systematic review and meta-analysis published online September 5, 2017 in the Journal of Periodontology has shown an association of asthma with periodontal disease. Significant differences were observed for gingival bleeding, plaque index, and gingival index in the study participants who had asthma.

Better outcomes with FFR-PCI vs angiography-guided PCI
Fractional flow reserve (FFR)- percutaneous coronary intervention (PCI) as compared to angiography-guided PCI is associated with lower in-hospital and follow-up myocardial infarction and major adverse cardiovascular events rates. FFR-PCI was also associated with less PCI and lower procedure costs with no effect on procedure time, contrast volume or fluoroscopy time. These findings were published online October 5, 2017 in the journal Catheterization and Cardiovascular Interventions.

Liver fibrosis increases risk of albuminuria in patients with type 2 diabetes and NAFLD
Advanced liver fibrosis, a severe form of NAFLD, but not steatosis is independently associated with increased risk of albuminuria in patients with type 2 diabetes, says a study from China published online October 6, 2017 in the Journal of Hepatology. The risk of albuminuria increased with greater severity of liver fibrosis.

Women with rheumatoid arthritis at risk of developing COPD
Rheumatoid arthritis was associated with increased risk for incident chronic obstructive pulmonary disease (COPD), independent of lifestyle confounders and mediators after diagnosis, including smoking according to analysis of data from the prospective Nurses' Health Study (NHS) published online September 15, 2017 in the Seminars in Arthritis & Rheumatism.

Secukinumab improves signs and symptoms of psoriatic arthritis
Two-year results from the phase 3 FUTURE 2 study published online August 16, 2017 in the journal Rheumatology (Oxford), secukinumab was well tolerated and led to sustained improvements in signs and symptoms and multiple clinical domains in patients of active psoriatic arthritis for the study duration. 
eMedi Humor
Doctor complaining to mechanic
A doctor is taking to a car mechanic, "your fee is several times more per hour then we get paid for medical care."
'Yeah, but you see, doc, you have always the same model! It hasn't changed since Adam; but we have to keep up to date with new models coming every month"
Medicolegal Corner
Can a doctor who is preparing for MCh suffix 'MCh' degree after his name?
Section 1.4.2 of the Indian Medical Council Act clarifies that no doctor should suffix any degree after the name unless they have cleared the exam for the said degree. Preparing for a degree e.g. MCh does not mean that one can add MCh to your qualifications.

1.4.2 Physicians shall display as suffix to their names only recognized medical degrees or such certificates/diplomas and memberships/honours which confer professional knowledge or recognizes any exemplary qualification/achievements.
eMedi Quiz
The parameters of sensitivity and specificity are used for assessing:
1. Criterion validity.
2. Construct validity.
3. Discriminant validity.
4. Content validity.
Lifestyle Updates
eWellness: Lifestyle tips
  • Set goals: For example, to add one fruit serving in a meal every day
  • Measure progress: Count the distance traveled in 6 minutes every day. An improvement of 30 meters in distance walked is significant.
  • Make goals that are achievable. For example, don't set a goal of a daily 5 mile run if you're out of shape.
  • Make realistic goals: Quitting smoking or losing weight without a doctor's help may not be realistic but an additional fruit serving a day is a small, manageable step toward better health.
  • Set time commitments: Pick a date and time to start.

ESpiritual: Meaningful Coincidences: Synchronicity
If you meet someone you haven't met for a long time, stop and talk to him or her. Remain aware of a message from the Universe that they might be carrying for you.
Follow the coincidence through, and you'll be amazed to find where it takes you.
Time and again, we all experience coincidences that have some special meaning or significance, and that appear to defy the laws of probability. Most of us tend to ignore them as something amusing or insignificant.
(Disclaimer: The views expressed in this write up are my own).
Inspirational: The seed
Once upon a time, there was a seed and because it was only a seed, nobody cared to notice it. Thus, gripped by a sense of inferiority, the seed gave no importance to his existence. Then one day, a wind picked him up - randomly or otherwise he didn't know - and threw him mercilessly on an open field under the sweltering sun. He was confused. Why would anything do such a thing? But instead of any copasetic answers, he was provided with rain (in addition to sunlight); sometimes in drizzles and sometimes in torrents. Meanwhile time flew and years later he saw a traveler sitting by his side. "Thank you God for this.
I really needed some rest," he heard the traveler say. "What are you talking about?" The seed promptly asked. He thought the man was making fun of him. Sure, he had witnessed many people sitting by his side - more so in recent years - but no one ever spoke to him like that. "Who is this?" The man was startled. "This is me. The seed." "The seed?" The man looked at the giant tree. "Are you kidding me? You are no seed. You are a tree. A goliath of a tree!" "Really?" "Yes! Why else do you think people come here?" "What do they come here for anyways?" "To feel your shade! Don't tell me you didn't know you had grown over time."
A moment passed before the traveler's words struck the chord of realization within him. The seed, now a prolix tree, thought and smiled for the first time in his life. The years of relentless tortures by the sun and the rain finally made sense to him. "Oh! That means I'm not a tiny-flimsy seed anymore! I wasn't destined to die unnoticed but was actually born to strip people of their lassitude. Wow! Now that's a life worth a thousand gems!"
The 24th HCFI MTNL Perfect Health Mela concludes with stellar performances and successful mass health awareness initiatives

New Delhi,08 October 2017: Heart Care Foundation of India (HCFI), a leading national non-profit organization committed to making India a healthier and disease-free nation concluded its annual flagship event - the 24th MTNL Perfect Health Mela today.The five-day event was organized jointly with the Health and Family Welfare Dept. NCT Delhi, MTNL, NDMC, and other central and Delhi state government departments. The IMA was the knowledge partner for the event. The theme for this year's event was 'Digital Health', a concept which talks about how technology can help in preventive health and creating mass health awareness. Experts at the Mela deliberated and debated on strategies for preventive health and health management.
The Health Mela is a confluence of tradition and modernity and has successfully since the past two and a half decades been working towards creating mass awareness on all aspects of health; using a consumer-driven model as the medium. It began with much fanfare and a grand inauguration by the Hon'ble Chief Minister of Delhi, Shri Arvind Kejriwal on the 4th of October 2017.
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