Dr KK AggarwalDr KK Aggarwal AHA/ACC Guidelines okay more sports for athletes with long QT and other CV disorders

The American Heart Association (AHA) and American College of Cardiology (ACC) have updated the guidelines and recommendations establishing eligibility and disqualification criteria for competitive athletes with cardiovascular disease. These guidelines ‘Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities’ are published in the journal Circulation.

Individuals with long QT syndrome (LQTS) had been excluded from all competitive sports since 2005. But, the new guidelines say that “it is reasonable” for asymptomatic LQTS individuals to participate in all competitive sports as long as they take certain precautionary measures, such as avoiding QT-prolonging drugs and acquiring a personal AED as part of their personal sports gear, among other measures. In addition, the school or team officials must have an appropriate action plan in place for the student.

The LQTS recommendation, which also holds for those with catecholaminergic polymorphic ventricular tachycardia (CPVT), Brugada syndrome, early repolarization syndrome, idiopathic ventricular fibrillation, or short-QT syndrome, is a class IIa recommendation (level of evidence C).

These guidelines took two years to develop and consist of documents written by 15 task forces and the scientific statement covers everything from preparticipation screening for cardiovascular disease in competitive athletes to eligibility and disqualification recommendations for athletes with hypertrophic cardiomyopathy, congenital heart disease, valvular heart disease, aortic disease, hypertension, coronary disease, arrhythmias and conduction defects, and channelopathies, among others.

There are also statements from the task force on drugs/performance-enhancing substances and the establishment of emergency action plans involving cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs).

In the final document, the task force also addresses some of the legal aspects of medical eligibility and disqualification criteria.
Breaking News
Intensive BP lowering improves outcomes
Results of a new systemic review and meta-analysis, of 19 trials involving nearly 45,000 participants, issued ahead of the AHA meeting suggest that intensive blood-pressure reduction below currently recommended targets provides greater vascular protection, particularly for people at high risk for cardiovascular outcomes. The findings were published online November 6 in the Lancet by Dr Xinfang Xie, of the renal division, department of medicine, Peking University First Hospital, Beijing, China, and colleagues. In the study, intensive blood-pressure lowering achieved in the trials significantly reduced major cardiovascular events (composite), stroke, myocardial infarction (MI), albuminuria, and retinopathy progression, but did not impact heart failure, cardiovascular death, total mortality, or end-stage kidney disease compared with less intensive regimens. According to the authors, the new data call into question the recent loosening of blood-pressure targets for some high-risk populations in recent guidelines from the Eighth Joint National Committee (JNC8) and the European Society of Cardiology/European Society of Hypertension among others … (Medscape)

Unique code to define patient's medical history in pipeline

Kolkata: The Union Ministry of Health & Family Welfare has included Systematised Nomenclature of Medicine- Clinical Terms (SNOMED CT) as the standard for clinical vocabulary for use in medical records.
SNOMED CT is a popular coding standard in the Health IT industry. It is a comprehensive clinical terminology, originally created by the College of American Pathologists and, as of April, 2007, owned, maintained, and distributed by the International Health Terminology Standards Development Organisation (IHTSDO). At the moment, 28 countries are members of the IHTSDO.

This comprehensive, multilingual clinical healthcare terminology, used across the globe enables standardisation of clinical vocabulary for use in Electronic Medical Records/ Electronic Health Records (EHR) by hospitals and healthcare providers, besides aiding in generation of unique EHR for each individual. Incorporation of such a comprehensive terminology in the EHR requires understanding of the underlying concept model, various levels at which clinical information can be effectively represented, and cross-mapping to other international vocabulary standards. The Union Health Ministry has designated the Centre for Development of Advanced Computing (C-DAC), Pune, to run the National Release Centre, for distribution and management of SNOMED CT within India… (ET Healthworld - PTI)
Indian Medical Association National Satyagraha for a Healthy India
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Specialty Updates
•Bazedoxifene, a drug approved for the prevention of osteoporosis, suppressed the growth of pancreatic tumors by inhibiting the IL-6/STAT3 signaling pathway used by cancer cells to survive and multiply, reported preclinical data presented at the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics.

• Fecal calprotectin levels suggest mucosal healing in patients with ulcerative colitis, but are too variable to replace endoscopy and biopsy, suggested a report published in the November issue of Clinical Gastroenterology and Hepatology.

• When acute kidney injury (AKI) occurs in people with diabetes, the rate of renal function loss is twice that of their non-AKI counterparts, suggests new research presented at the American Society of Nephrology's Kidney Week.

• If one child in a family has a food allergy, chances are good that siblings might also have food allergies. However, new research suggests that 53% of siblings of children with food allergies had a food sensitivity, but only 13% had actual food allergy. The findings were presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting.

• The absence of pejvakin, a molecule that plays a vital role in the hearing system, appears to be responsible for noise-induced hearing loss, one of the most common causes of deafness, suggested new research published November 5 in the journal Cell.

• A new study published in the journal Blood reveals that it may be difficult for the body to absorb iron in quantities that are necessary and desirable when the supplement doses are administered in 24-hour intervals.

• A large-scale study with nearly 16,000 specimens from small mammals across various continents suggests that the hepatitis A virus - like HIV or Ebola - is of likely animal origin, though previously considered to be a purely human pathogen. The results appear in the journal Proceedings of the National Academy of Sciences of the United States of America (PNAS).

• New research, published in the journal Brain, suggests that the right side of the brain increases growth of gray matter to compensate for loss of gray matter in speech-related areas in the left side due to stroke, thus assisting in speech recovery.

• Bariatric surgery can be considered a relatively safe option for managing type 2 diabetes in patients with mild obesity, suggested a new study presented at the annual Obesity Week conference.

• Intravenous immunoglobulin (IVIg) has clinical benefit as an adjunctive therapy in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV), a French nationwide study reported in Arthritis & Rheumatology has found, and findings support its use in AAV, particularly in relapsing or refractory disease.
Three great sentences of importance apart from mahavakyas
Brahma Satyam Jagan Mithya Jivo Brahmaiva Na Aparah. Brahman only exists truly, the world is false, and the individual soul is Brahman only and no other.

Ekam Evadvitiyam Brahma. Brahman is one, without a second (There is one absolute reality, without any secondary parts)

Sarvam Khalvidam Brahma. All of this is Brahman
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Legal Quote
Martin F. D’Souza vs Mohd. Ishfaq SCI: 3541 of 2002, dated 17.02.2009

” A doctor should not merely go by the version of the patient regarding his symptoms, but should also make his own analysis including tests and investigations where necessary.”
Benefits of Estate Planning

Controlled estate planning will help you plan against:

• Inadequate income if disability occurs: Electing the maximum benefits from your employer sponsored plans, and filling in the gaps with personal disability coverage and insurance waivers of premium.

• Inadequate income for his family at his death: To maintain the same standard of living, the family will typically need 80% of the present gross income. This must be adjusted periodically for inflation, additional debts incurred, education funding needs and special family circumstances.

(Source: IJCP)
Industry News

States plan incentives to serenade startups: New Delhi: Even as the Centre is working on its own national-level policy to boost the startup ecosystem, over half-a-dozen state governments are scrambling to come up with their own sets of incentives to lure these new businesses into making regional centres their hubs. While Karnataka - the hub of technology and new-age businesses - is about to release its policy over the next month or so; and Andhra Pradesh and Rajasthan have been the first states to unveil their policy statements, Uttar Pradesh, Telangana, Tamil Nadu and West Bengal are the latest to join the bandwagon. According to officials in the know, states have reached out to stakeholders for inputs and have started conversations to draft policies… (The Economic Times- Surabhi Agarwal)

Healthcare startups on biotech, stem cell research and diagnosis to lead innovation: Ratan Tata, chairman emeritus of Tata Sons said, “Healthcare startups focused on biotechnology, stem cell research and diagnosis will be at the forefront of the next wave of innovation. Going ahead, cancer research, medical breakthrough and startups which deal with imaging and analysis will be the next big wave.” He was speaking at the inauguration of the Telangana government-run incubator, T Hub, on Thursday. The incubator, established at Rs. 40 crore, will have a cost of corpus of Rs 10 crore… (The Economic Times- Payal Ganguly)

Microsoft launches initiative to help startups working on smart city solutions: Microsoft’s CEO Satya Nadella announced an initiative to help local startups working on solutions for smart cities, at the American technology company’s ‘Future Unleashed’ event in Mumbai. Towards this initiative, Microsoft will provide $120,000 worth of Azure credits-Microsoft’s public cloud platform to startups working on solving urban issues like education, logistics and services… (Inc42.com- Shweta Modgil)

IT investment transforming healthcare industry: In today’s highly connected world, Information Technology (IT) is transforming the healthcare sector like any other verticals. IT market research agency IDC believes IoT will become a big part of the next wave of technology in healthcare, and 3rd-Platform technologies such as cloud, Big Data, mobile, and social media will play a central role in this transformation. Healthcare investment forecasts from research agencies underscore IDC’s observation. Technavio’s report says global healthcare IT spending is expected to grow at a CAGR of more than 7 percent from 2015-2019. (Infotechlead.com)
Digital IMA
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22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
IMA Satyagraha
IMA Satyagraha, suggested slogans

• Allow doctors to treat patients irrespective of patients’ income - If compensation is not capped, we can't do this.

• Writing prescription drugs by anyone other than with an MBBS degree is injurious to peoples’ health.

• Please allow Doctors to treat poor and rich equally.

• More patients will die if doctors are not provided protection during duty hours.

• Death does not mean negligence.

• Save single clinic and small establishments - Exclude them from Clinical Establishment Act

• PCPNDT Act needs graded punishments

View Video: https://www.youtube.com/watch?v=UV1zCH33BlU
• My view is Telemedicine consultation retains legal liability of both the consulting physicians, the one in India and the one in US. Indian courts still need to decide on such issues. Dr Neeraj Nagpal

• Please guide whether same memorandum is to be used by local branches to submit to PM via DM. Or some other matter will be provided. Dr Sanjay Jain

• We had a meeting yesterday for planning the modalities of November 16 Satyagraha. Please mail me a copy of draft memorandum to be submitted on that day. Dr Amandeep Aggarwal, CWC member, IMA.
Make Sure
Situation: A patient with hiatus hernia developed severe symptoms after eating a ‘Paan’.
Reaction: Oh my God! Why was he given a peppermint?
Lesson: Make sure patients with reflex esophagitis are not given any food which can relax GI sphincter.
Indian Medical Association National Satyagraha for a Healthy India
HvPI adds 29 more centers for reporting blood transfusion-related adverse reactions
In order to generate evidence based recommendations for safety related regulatory decisions in blood safety, Haemovigilance Programme of India (HvPI) has broadened its scope and reach by adding 29 more centres under it. HvPI is aimed at raising awareness of transfusion hazards and giving an early warning of new complications to improve safety of blood transfusion for patients. Launched on December 10, 2012 by National Institute of Biologicals (NIB), HvPI earlier had 207 centres covering blood banks, medical colleges, government and private hospitals across the country. With this, the HvPI programme has also been able to generate 2900 blood transfusion related adverse reaction reports till date through its 236 centres across the country. NIB is an autonomous institution under the Union health ministry which ensures quality of biologicals and vaccines in the country available through domestic manufacturers or imports. As a part of the programme, data in transfusion reaction reporting form (TRRF) from various centres is being collected through a software, Haemo-Vigil indigenously developed by IT division of NIB. Through this reporting system, HvPI will help in identifying trends in adverse reactions and events, thereby to also form transfusion policy... (Pharmabiz - Shardul Nautiyal)
Digital Literacy Mission is a key component of Digital India initiative
Union Minister for Communication & Information Technology, Mr Ravi Shankar Prasad today articulated the 'Digital India' initiative of the government to transform India into a digitally empowered society. Speaking at the 'Future Unleashed' Technology Conference organized by Microsoft to commemorate its 25 years of operations in India, Mr. Prasad said the government was working towards connecting all the 2.5 lakh gram panchayats through Bharat Net optic fibre network. He also said nearly 1.25 lakh post offices will be digitized. Outlining the efforts undertaken by the government, he said the 'Digital Saksharata Abhiyan' was geared towards making at least one person in every household digitally literate. Mr Prasad reiterated Prime Minister's digital equation that IT (Information Technology) + IT (Indian Talent) = IT (India's Tomorrow)

Mr. Ravi Shankar Prasad said that support for regional languages was imperative to take the whole of India to the digital age. He said a country as diverse as India with 22 official languages would require some efforts in localization of contents. Mr. Prasad appealed to Microsoft to develop software in regional languages to promote digital inclusiveness… (Business Standard)
Hepatitis A virus likely of animal origin
A large-scale study published in the journal Proceedings of the National Academy of Sciences (PNAS), looking into the evolutionary origins of the global pathogen has found that similar to the HIV and Ebola viruses, the hepatitis A virus is of likely animal origin. The virus, which is found worldwide, has previously been considered to be a purely human pathogen which at most is found in isolated cases in non-human primates. Virologists from University of Bonn Hospital, together with their colleagues from several German and international research institutes worldwide searched for viruses related to the hepatitis A virus and investigated a total of 15,987 specimens from 209 different species of small mammals -- from rodents to shrews and bats to hedgehogs. Viruses from these mammals are very similar to the human hepatitis A virus with regard to their genetic properties, protein structures, immune response and patterns of infection. "The seemingly purely human virus is thus most likely of animal origin," Drexler pointed out… (The Pioneer – IANS)
CDC’s HA-VTE Prevention Challenge
The Centers for Disease Control and Prevention (CDC) has launched a challenge designed to find, honor and recognize hospitals, multi-hospital systems, hospital networks, and managed care organizations that have implemented innovative and effective prevention strategies or interventions to identify best practices and to increase use of strategies to prevent healthcare-associated blood clots. “Doctors and nurses in hospitals and other healthcare settings can save lives by implementing the best practices discovered through this challenge,” said CDC Director Tom Frieden, M.D., M.P.H. “‎Tell us about what you are doing and what’s helping prevent blood clots, so we can advance science and save lives together.” CDC’s HA-VTE Prevention Challenge encourages health care systems across the country and internationally to submit evidence of demonstrated successful use of prevention strategies and interventions such as:

• Implementation of protocols

• Risk assessments

• Use of health information technology (for example, electronic reminders)

• Clinical decision support tools

• Education of providers, patients and families

• Post-discharge follow-up
(Source: CDC)
WHO to declare end of Ebola in Sierra Leone
The World Health Organization is set to announce Saturday that Ebola-ravaged Sierra Leone has beaten an epidemic that killed almost 4,000 of its people and plunged the economy into recession. The country recorded around half of the cases in an outbreak that has infected 28,600 people across the three hardest-hit west African nations and claimed 11,300 lives since December 2013. A country is considered free of human-to-human transmission once two 21-day incubation periods have passed since the last known case tested negative for a second time. After several false-starts, Sierra Leone's countdown finally began on September 25, three weeks after the WHO had declared neighbouring Liberia Ebola-free following 4,800 deaths there… (ET Healthworld)
Online shopping prevents hypertension, depression
Findings of a survey conducted across major cities including Mumbai, Chennai, Delhi and Pune have revealed that online shopping prevents work-related stress and several types of health issues caused by it like hypertension and depression. The study, conducted over a period of six months, has also showed that over 40 percent of professionals worldwide consider online shopping as solution for their stress and depression caused due to their work. Most of the people found that online shopping was an easier way to lower stress as it needed less efforts.

The study, conducted by leading web portal Shop Pirate, revealed that 45 percent of the people in India voted online shopping to be the best way to ensure temporary distraction from anxieties caused by the work. “While shopping, their level of oxytocin, hormone of love and happiness, increases due to excitement. It's like when we kiss or hug our loved one, we feel this hormone and our happiness grew. This helps in decreasing stress level and relieving shoppers who gets feeling of achievement," Kulpreet Kaur, co-founder of Shoppirate.in, said in a statement… (The Pioneer – IANS)
GP Tip
Formula of 10 for CPR

Within 10 minutes of death (earlier the better), at least for the next 10 minutes (longer the better, up to 25 minutes), compress the center of the chest of the victim with a speed of 10×10 i.e. 100 per minute.
All diabetics must have an eye check up done

The vast majority of diabetic patients who develop diabetic retinopathy (eye involvement) have no symptoms until the very late stages (by which time it may be too late for effective treatment). Because the rate of progression may be rapid, therapy can be beneficial for both symptom amelioration as well as reduction in the rate of disease progression, it is important to screen patients with diabetes regularly for the development of retinal disease. The eyes carry important early clues to heart disease, signaling damage to tiny blood vessels long before symptoms start to show elsewhere. Diabetic people with retinopathy are more likely to die of heart disease over the next 12 years than those without it. As per a study from the University of Sydney and the University of Melbourne in Australia and the National University of Singapore, people with retinopathy are nearly twice as likely to die of heart disease as people without it.

People with these changes in the eyes may be getting a first warning that damage is occurring in their arteries, and work to lower cholesterol and blood pressure. Patients with retinopathy have a greater risk of incident cardiovascular disease (CVD) events, including heart attack, stroke, revascularization, and CVD death, compared with those without retinopathy.
Bioethical issues in medical practice
Rights and duties of a parent

Smita N Deshpande

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

A girl suffering from intellectual disability, serious enough so that she could not take care of herself became pregnant at the care home. By the time the pregnancy was discovered she was pregnant for over four months. The girl was admitted to a government hospital and assessed for MTP. The girl insisted- from the point of view of her limited understanding of the matter- that she wanted to keep the child and bring it up herself. Doctors at the hospital where she was admitted after the pregnancy was discovered were of the opinion that she was intellectually unfit to look after herself, what to say of a child. What should the doctors do?

a) Carry out MTP regardless of the girl’s wishes

b) Allow the pregnancy to continue possibly to the future detriment of the unborn baby.

c) Any other recourse such as going to court – but what if the court orders continuance of the pregnancy? Who will look after the baby?

Do write in with views and your solutions!
Inspirational Story
The Three Dolls

A sage presented a prince with a set of three small dolls. The prince was not amused. “Am I a girl that you give me dolls?” He asked. “This is a gift for a future king,” Said the sage. “If you look carefully, you’ll see a hole in the ear of each doll.” The sage handed him a piece of string. “Pass it through each doll.” He said.

Intrigued, the prince picked up the first doll and put the string into the ear. It came out from the other ear. “This is one type of person,” said the sage, “whatever you tell him, comes out from the other ear. He doesn’t retain anything.”

The prince put the string into the second doll. It came out from the mouth. “This is the second type of person,” said the sage, “whatever you tell him, he tells everybody else.”

The prince picked up the third doll and repeated the process. The string did not come out. “This is the third type of person,” said the sage, “whatever you tell him is locked up within him. It never comes out.”

“What is the best type of person?” Asked the prince. The sage handed him a fourth doll, in answer. When the prince put the string into the doll, it came out from the other ear. “Do it again.” Said the sage. The prince repeated the process. This time the string came out from the mouth. When he put the string in a third time, it did not come out at all.

“This is the best type of person,” said the sage. “To be trustworthy, a man must know when not to listen, when to remain silent and when to speak out.”
eMedi Quiz
The buffering capacity of a buffer is maximum at pH equal to:
1. 0.5pKa.
2. pKa
3. pKa+1
4. 2pKa

Yesterday’s Mind Teaser:  In a patient with a tumor in Superior medistinum compressing the superior vena cava, all the following veins would serve as alternate pathways for the blood to return to the right atrium, except:

1.Lateral thoracic vein.
2.Internal thoracic vein.
3.Hemiazygos vein.
4.Vertebral venous plexus.

Answer for Yesterday’s Mind Teaser: 4. Vertebral venous plexus.
Answers received from: Answer for 7th November Mind Teaser: 2. Propionyl CoA.
Answers received from: Dr.Bitaan Sen & Dr.Jayashree Sen, Dr.K.V.Sarma, Dr Poonam Chablani, Dr.K.Raju, Dr Jainendra Upadhyay, Raghavendra Chakurkar, Daivadheenam Jella,
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Readers column
Dear Sir, reading emedinews is very informative to us. Regards: Dr Jyoti
Press Release
HCFI’s annual flagship event, the 22nd MTNL Perfect Health Mela comes to a power-packed end Key events of Day 5 included a discussion on tolerance and non-violence with nine religious gurus,inter-medical college competitions, and an appeal to have a safe and healthy Diwali

New Delhi 8th November 2015- Heart Care Foundation of India (HCFI)’s annual flagship event, the 22nd MTNL Perfect Health Mela concluded this evening. Speaking at the valedictory, Padma Shri Awardee Dr. KK Aggarwal, President HCFI &Honorary Secretary General IMA urged everyone to have a healthy Diwali and to take necessary precautions to protect oneself and others from injury and harm.

According to him, "There is a sudden spike in the number of hospital admissions during the Diwali season. The reasons for this include respiratory ailments and allergies triggered due to the high levels of smog caused by the firecracker and vehicular pollution, complications suffered by heart patients due to the increased decibel levels and the consumption of an unhealthy diet; and burn and accidental injuries. Road accidents are also extremely common during the season due to an increased practice of drinking and driving. It is necessary to take precautions to ensure a safe and healthy Diwali. We thank all our sponsors and partners for helping make the 22nd MTNL Perfect Health Mela such a grand success. We will be back again next year, on a bigger and grander scale.”

In its 22nd edition, the event was organized at the Talkatora Indoor Stadium, New Delhi from 4 – 8th November inassociation with the IMA, MTNL, Coke, MCD, NDMC, Ministry of Science & Technology, Earth Sciences, Textile, and AYUSH – Government of India.None other than Shri Satyendar Jain – Hon’ble Minister of Health & Family Welfare, Govt. of NCT of Delhi and Padma Vibhushan Awardee Dr. Sonal Mansingh, inaugurated the event.

The five-day event served as a podium for over 50 on the spot competitions like a fashion show, classical and western dance and rock band performances. The Mela drew over 20,000 visitors daily including 500 doctors, 5000school students and 2500 nurseswho participated in a variety of cultural events.The purpose of inculcating all these cultural activities was to useinfotainment as a way of creating mass health education.

As we all know that present day, India suffers from a plethora of modern day epidemics like Dengue, Swine Flu, and Diarrhea. A special focus was given during the event to educate the public about essential prevention measures and the need to maintain cleanliness and hygiene. Medanta – the Medicity in association with MTNL also provided live-telemedicine facilities to all visitors.

UNESCO and the Indian Medical Association also organized a first of its kind discussion on the Bioethics charter. The panelists including Dr. Susan Vize, Advisor - UNESCO, Prof Kalra - Vice Chancellor, University of Health Sciences and Patron of the UNESCO Charter, IMA’s & Honorary Secretary General Dr. KK Aggarwal andeight Vice-Chancellors from medical universities across the countrystressed the urgency to include ethics as a part of the medical curriculum across the country.

A one of its kind inter-religious meet was also organized on the last day of the Mela. The panel constituted eminent Dharma gurus like Mr. Ven. Sumithananda Thero, Secretary Mahabodhi Society Centre, Delhi, Fr. (Dr.) M D Thomas, Christian Scholar, Founder Director, Institute of Harmony and Peace Studies, Dr. Hanif Md. Khan Shastri, Muslim and Hindu Scholar, Dr. Amrit Kaur Basra, Lecturer at College and Sikh Scholar, Rabbio Ezekiel I. Malekar, Jewish Community Secretary, Delhi, Acharya Vivek Mun, Jain Monk, Acharya Sushil Muni Ashram, Dr. A K Merchant Natonal Trustee, Lotus Temple and Baha’I Community of India, Mr M Ananda and Dr S Mohinder Singh, Executive Director, Bhai Vir Singh Sahitya Sadan, New Delhi. The discussion ended with a conclusion that "everyone should learn how to tolerate each other in order to maintain peace and harmony and to avoid any disruptions and violence."

Speaking at the valedictory, Dr. Vinay Aggarwal, Dr. D L Rai, Dr. Narendra Saini, Dr. Anil Goel, Dr. Pawan Gupta and Dr. Ajay Lekhi said, "We all thank everyone who came and attended the 22nd Perfect Health Mela and made it such a success. We encourage everyone to inculcate healthy habits in their everyday lives and live diseases-free.”

Heart disease patients belonging to the economically weaker section in need of surgical intervention were also provided financial and technical assistance by the Sameer Malik Heart Care Foundation Fund another project of HCFI. All visitors were also trained in the life-saving technique of Hands only CPR 10.