Weather and Elevated Heart Attack Risk

Freezing outdoor temperatures is associated with an elevated risk for heart attack but weather conditions independent of the cold can also be triggers, suggests a cohort study from across Sweden.
 

For STEMI and NSTEMI combined, lower daily air temperature, lower atmospheric air pressure, higher wind velocity, and shorter duration of sunshine appeared to be independent triggers among the 274,029 patients in the SWEDEHEART registry cohort.

The strongest association was observed for air temperature, with a higher incidence of MI on days with air temperatures less than 0°C, with rates of MI declining when temperatures rose to greater than 3°C to 4°C,"  (October 24 in JAMA Cardiology)

In the analysis, a one-standard-deviation rise in air temperature that is by 7.4°C, corresponded to a 2.8% reduction in risk for MI.

Pollution and Heart Attack

Every 10 mcg/m3 increase in pollution there is significant increases in the risk of a cardiovascular event,  (hazard ratio 1.24), death from heart disease (HR 1.76), and stroke (HR 1.35). (N Engl J Med 2007; 356:447). PM2.5 concentration is associated with the risk of cardiac death (relative risk 1.2). (N Engl J Med 2009; 360:1085).

CO, NO2, SO2 and PM 2.5 are also linked to an increased risk of acute heart attack with risk ranging from 1 to 5 percent (JAMA 2012; 307:713).

PM < 10 increases the risk by raising the blood pressure through an increase in sympathetic tone (Circulation 2002; 105:1534), transient increases in plasma viscosity and impaired endothelial dysfunction (Circulation 2002; 106:933.) and the initiation of atherosclerosis (Circulation 2010; 121:2755, J Am Coll Cardiol 2010; 56:1803)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Oxygen supplementation should be used conservatively

Supplemental oxygen is not always indicated for acutely ill patients and giving extra oxygen to hospital patients with normal oxygen levels increases mortality, according to new recommendations published online October 24, 2018 in the BMJ, which recommends conservative use of oxygen supplementation.

·         The expert panel makes a strong recommendation that if supplemental oxygen is administered, a maximum SpO2 of 96% should be ensured. Oxygen therapy should be stopped y in acutely ill medical and surgical patients already receiving oxygen therapy, with a saturation of 96% or higher.

·         For patients with acute stroke or myocardial infarction, the guidelines recommend against starting oxygen therapy when levels are between 90% and 92% saturation.

·         Oxygen therapy should not be started when levels are at or above 93% saturation.

·         For most patients, a target of 90-94% saturation is reasonable and is low enough to avoid harm.

·         The ideal oxygen saturation at which to start oxygen therapy is uncertain, but is probably 90% or lower.

·         A lower target (such as SpO2 88-92%) may be useful in patients at risk of hypercapnic respiratory failure e.g. Chronic obstructive pulmonary disease (COPD), obesity hypoventilation, neuromuscular respiratory diseases, obstructive sleep apnea (OSA), decreased central respiratory drive such as sedative overdose, stroke, encephalitis.

·         A higher target such as SpO2 approaching 100% may help patients with carbon monoxide poisoning, cluster headaches, sickle cell crisis, pneumothorax

·         In all cases, the minimum amount of oxygen necessary is recommended.

·         Clearer information may reduce anxiety and improve patient satisfaction in patients where oxygen is needed.

(Source: BMJ, Eurekalert)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

The 25th MTNL Perfect Health Mela closed with the HCFI CSR Awards

The curtains came down on the Silver Jubileecelebrationsofthe MTNL Perfect Health Mela on Saturday with the valedictory ceremony.

The 5-day celebrations, which began on the 23rdculminated with the HCFI CSR awards followed by a scintillating performance by singer Shibani Kashyap and a fascinating illusion act by Mr Rahul Kharbanda.

The HCFI CSR Awards were presented to 10 corporate organizations in recognition of their contributions towards access to affordable healthcare.Two other awards presented during the valedictory ceremony were the HCFI Awards and the IMA NDB Doctor Awards in appreciation of the contributions of the medical fraternity.

This year the Mela focused on a very relevant theme “affordable healthcare” given the wide gap between the need and availability of efficient and cost-effective healthcare services in the country. Though paradoxically, India is fast becoming the hub of medical tourism ande-commerce.

The Mela was inaugurated by Shri Satyendra Jain, the Hon’ble Health minister, Govt. of Delhi at the Talkatora Indoor Stadium, New Delhi. A vocal performance by Padma Bhushan Pandit Chhannulal Mishra left all spellbound.

A National Campaign on Hands-only CPR10 was launched on the inaugural day in collaboration with Ministry of Youth Affairs, Government of India.

Insightful discussions were held in the Evening Conclaves on antimicrobial resistance, IVF, indoor pollution, safe water and air, harm reduction and non-communicable diseases.

Aone-of-its-kindSpiritual Inter-Faith Conferenceon air, sanitation and antimicrobial resistancewas also organized by HCFI along with the World Fellowship of Religions, in which eminent dharma Gurus of all religions participated as speakers. They took a pledge to spread the message about misuse of antibiotics “Saying no to self-antibiotics”and“To take antibiotics only when prescribed by the doctor” among their disciples.

There were lifestyle exhibitions, free health check-ups and consultations with all pathies under one roof, lectures, workshops and competitions ‘Harmony and EcoFest’ (inter-school competitions), National Youth Fest (inter-college competitions) and Anmol (for specially-abled children) all focusing on preventive health.

More than 7000 children from various schools and colleges participated enthusiastically in various on-the-spot competitions like Mehendi art, collage making, painting, and slogan writing.

Thefive-day event was organized jointly with the Health and Family Welfare Dept. NCT Delhi, MTNL, NDMC, MCD and other central and Delhi state government departments.

Dr Tusker, the friendly elephant was the mascot for the Mela.

In its long journey of 25 years, the Perfect Health Mela has been working towards its commitment of making India a healthier nation by creating mass awareness on all aspects of health among people from all walks of life using infotainment as a low-cost health education module.

I am extremely happy at the successful conclusion of the event and the huge participation.

I also take this opportunity to thank all who have been associated with us on this long journey and made it a fruitful one.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Homosexuals in a live-in relationship is not a crime, rules Kerala High Court

Advocate Ira Gupta & Dr KK Aggarwal

In a string of progressive judgments being passed by the Indian Judiciary, the High Court of Kerala in this recent case has allowed lesbian couple to lead a live-in relationship noting that the same is not a crime or contrary to any Indian law.

In the case titled as “Sreeja S. versus The Commissioner of Police”, the seminal and intriguing issue that fell for consideration before the High Court of Kerala was “whether persons of same gender are entitled to lead a ‘live-in relationship’?

The petitioner, a lady, alleged that her ‘lesbian partner’, ‘A’, years is under illegal of her parents, against her free will. Accordingly, the Petitioner in the case prayed production of the corpus of the alleged detenue and to set her at liberty.

The High Court in view of the facts of the case noted that the larger issue in the case was whether detenu can be permitted to go along with the petitioner to lead a ‘live-in relationship’, because both of them belong to the same gender, and could not solemnize a valid marriage between them?

While arriving at its decision in favour of the Petitioner, the High Court made reference to recent string of cases highlighting the freedom of choice of an individual and the validity of adults to have a live-in relationship.

With respect to permitting of ‘live-in relationship’ the High Court made reference to the recent case of Nandakumar and another V. State of Kerala and others, whereby the Supreme Court noted that, even if the parties are not competent to enter into the wedlock, they have the right to live together even outside the wedlock. The Court also observed that ‘live-in relationship’ was now recognized by the Legislature itself which has found its place under the provisions of the Protection of Women from Domestic Violence Act, 2005.

Reference was also made to the famous case of Shafin Jahan V. Asokan, wherein it was held by the Apex Court that the social values and morals have their space, but they are not above the constitutionally guaranteed freedom. Reference was also made to the landmark verdict in case of Navtej Singh Johar V. Union of India.

Finally, the High Court in the present case observed that the ‘live-in relationship’ between the petitioner and the alleged detenue will in no manner offend any provisions of law or it will become a crime in any manner and the Court directed to set the alleged detenue at liberty to go along with the petitioner, as desired by her.

(Source: Vakilno1)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Only crackers with reduced emission (improved crackers) and green crackers are allowed by Hon’ble Supreme Court

Advocate Ira Gupta & Dr KK Aggarwal

Vide judgment dated 23.10.2018 the Hon’ble Supreme Court of India in the matter titled as “Arjun Gopal & others versus Union of India & Others” has permitted the crackers with reduced emission (improved crackers) and green crackers to be manufactured and sold. The manufacture, sale and use of joined firecrackers (series crackers or laris) has been banned by the Hon’ble Apex Court as the same causes huge air, noise and solid waste problems.

The following are the specific directions as laid down by the Hon’ble Supreme Court:

(i) The crackers with reduced emission (improved crackers) and green crackers, as mentioned in Suggestion Nos. II and III above only would be permitted to be manufactured and sold

(ii) As a consequence, production and sale of crackers other than those mentioned in Suggestion Nos. II and III is hereby banned.

(iii) The manufacture, sale and use of joined firecrackers (series crackers or laris) is hereby banned as the same causes huge air, noise and solid waste problems.

(iv) The sale shall only be through licensed traders and it shall be ensured that these licensed traders are selling those firecrackers which are permitted by this order.

(v) No e-commerce websites, including Flipkart, Amazon etc., shall accept any online orders and effect online sales. Any such e-commerce companies found selling crackers online will be hauled up for contempt of court and the Court may also pass, in that eventuality, orders of monetary penalties as well.

(vi) Barium salts in the fireworks is also hereby banned.

(vii) PESO is directed to review the clinical composition of fireworks, particularly reducing Aluminum content, and shall submit its report in respect thereof within a period of two weeks from today. For undertaking this exercise, PESO would also associate FRDC.

(viii) Even those crackers which have already been produced and they do not fulfill the conditions mentioned in Suggestion Nos. II and III above will not be allowed to be sold in Delhi and NCR.

(ix) PESO will ensure fireworks with permitted chemicals only to be purchased/possessed/sold/used during Diwali and all other religious festivals, of any religion whatsoever, and other occasions like marriages, etc. It shall test and check for the presence of banned chemicals like Lithium/Arsenic/ Antimony/Lead/Mercury.

(x) PESO will ensure suspension of the licenses of manufacturers of such fireworks items and appropriate disposal of such stock.

(xi) PESO will ensure that only those crackers whose decibel (sound) level are within the limits are allowed in the market and will ensure to take action by suspending the licenses of the manufacturers on such violations and disposal of such lots. To add to it, as mentioned in the order dated September 12, 2017, the directions issued and restrictions imposed in the order passed by this Court on July 18, 2005 in Noise Pollution (V) shall continue to be in force.

(xii) Direction Nos. 4 to 9 and 11 contained in the order dated September 12, 2017 shall continue to operate and are reiterated again.

(xiii) Extensive public awareness campaigns shall be taken up by the Central Government/State Governments/Schools/ Colleges informing the public about the harmful effects of firecrackers.

(xiv) On Diwali days or on any other festivals like Gurpurab etc., when such fireworks generally take place, it would strictly be from 8:00 p.m. till 10:00 p.m. only. On Christmas eve and New Year eve, when such fireworks start around midnight, i.e. 12:00 a.m., it would be from 11:55 p.m. till 12:30 a.m. only.

(xv) The Union of India, Government of NCT of Delhi and the State Governments of the NCR would permit community firecracking only (for Diwali and other festivals etc. as mentioned above), wherever it can be done. For this purpose, particular area/fields would be pre-identified and predesignated by the concerned authorities. This exercise shall be completed within a period of one week from today so that the public at large is informed about the designated places one week before Diwali. The areas designated now for the purpose of Diwali shall be valid for community firecracking on other occasions/festivals as well, as mentioned above. Even for marriages and other occasions, sale of improved crackers and green crackers is only permitted. Insofar as other States are concerned, an endeavour shall be made by them also to explore the feasibility of community firecracking. However, it is made clear that Direction No. (xiv) pertaining to the duration within which fireworks can take place on all such occasions would be applicable throughout India. Similarly, Direction No. (xiii) for extensive public awareness campaigns is also a pan India direction.

(xvi) All the official respondents, and particularly the Police, shall ensure that fireworks take place only during the designated time and at designated places, as mentioned above. They shall also ensure that there is no sale of banned firecrackers. In case any violation is found, the Station House Officer (SHO) of the concerned Police Station of the area shall be held personally liable for such violation and this would amount to committing contempt of the Court, for which such SHO(s) would be proceeded against.

(xvii) CPCB and respective State Pollution Control Boards/ Pollution Control Committees (SPCBs/PCCs) of the States and Union Territories shall carry out short-term monitoring in their cities for 14 days (commencing from 7 days prior to Diwali and ending 7 days after Diwali) for the parameters namely, Aluminum, Barium, Iron apart from the regulatory parameters against the short-term Ambient Air Quality Criteria Values (AAQCVs) proposed by CPCB with regard to bursting of firecrackers. This will help in generation of data on pollution caused by the bursting of firecrackers and would be helpful for regulation and control quantity of Aluminum, Barium and Iron used in the manufacture of firecrackers.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Information available with another public authority is not a ground to deny information

Advocate Ira Gupta & Dr KK Aggarwal

In the matter titled as “Public information Officer versus V. Chaudhary”, W.P.(C) 2025/2014, vide judgment dated 08.10.2018 the Hon’ble High Court of Delhi has held that whether authentic information is available with another public authority is not a ground to deny the information sought from a public authority.

“19. In terms of the RTI Act, all information as available with the public authority is required to be provided to the citizen unless it is exempt from disclosure under Section 8 of the RTI Act or otherwise pertains to the organizations that are excluded from the purview of the RTI Act. Thus, the question whether authentic information is available with another public authority is not a ground to deny the information as sought from a public authority. In this case, the petitioner had sought the status of the properties against which complaints had been sent to MCD. It was his suggestion (although couched as a query) that even though police authorities inform MCD regarding unauthorized construction, they do not take steps to stop the same by accepting illegal gratification.

20. The petitioner had duly informed the respondent that a total number of 5313 forms had been sent to the concerned Municipal Corporation. However, the balance information was denied on the ground that it cannot be provided under Section 11 of the Act.

21. It is apparent from the above that the petitioner diad have the information as sought by the respondent. However, the same was denied to the respondent by referring Section 11 of the RTI Act. A plain reading of Section 11 of the RTI Act indicates that the same does not proscribe furnishing of information. In terms of Section 11(1) of the RTI Act, in cases where the public information officers (PIOs) intend to disclose the information, which relates to or has been supplied by a third party and has been treated as confidential by a third party, it would be necessary for the concerned PIO to give a written notice to the third party. The concerned third party has a right to make a submission either in writing or orally and the concerned PIO is required to keep the same in view while taking a decision regarding disclosure of such information. Thus, Section 11 of the RTI Act cannot be read as a provision proscribing disclosure of information; it is a provision to enable disclosure of third party information subject to certain safeguards. In this view, the decision of the CPIO denying the information by referring Section 11 of the RTI Act is wholly unsustainable.

22. The contention of the petitioner that the information as sought by the respondent was third party information, is also unpersuasive. The information as sought by the respondent pertains to unauthorized construction noticed by the police authorities, and in respect of which information had been forwarded to the concerned Municipal Corporation. Such information has neither been provided by any third party nor has been treated as confidential. Undisputedly, the information may relate to third parties inasmuch as it relates to the property of those third parties. However, the information as to unauthorized construction observed by the police authorities cannot be construed as one, which is to be kept confidential in terms of Section 11 of the RTI Act. Subject information that is sought by the respondent is gathered by the police authorities in discharge of their functions and this Court finds no infirmity with the decision of the CIC in directing that the same be provided to the respondent.”

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

 

Safe water to drink and safe air to breathe is our right

Today is the third day of the ongoing 25th MTNL Perfect Health Mela. And, we have a series of “infotainment” activities lined up for you.

Clean water and air are essential to life. But, with rising pollution, these basic necessities can no longer be taken for granted.

Air pollution has become a much-talked about topic these days. World Health Organization (WHO) estimates that 9 out of 10 people breathe air containing high levels of pollutants reiterating the need for urgent action to check the dangerously high levels of pollution. What should worry us all is that 14 cities in India, along with our national capital Delhi, are among the 20 most polluted cities in the world with regard to PM2.5 levels in 2016. For PM10 levels also, 13 Indian cities are included among the 20 most-polluted cities of the world in 2016.

Besides air pollution, water pollution is another very important public health concern. Water pollution affects drinking water, rivers, lakes, oceans and water bodies. Industrial waste, microbial pollutants from sewage, waste water, chemical fertilizers and pesticides, leakage from landfills are some of the common sources of water pollution. Polluted water is harmful to the health of humans and animals and also adversely affects the environment.

Given their significance, safe water and air have also been included in the Sustainable Development Goals “Clean water and sanitation” (SDG 6) and “Sustainable cities and communities” (SDG 11).

Day three will focus on two conclaves.

The “Puricare” Conclave on right to safe water and air will discuss this very crucial environmental issue.

The second conclave today on Fertility will be moderated by Dr Kaberi Banerjee, Clinical Director, Advanced Fertility & Gynaecology Center, New Delhi.

The Panelists include Mr AR Kohli, Former Governor of Mizoram; Mr Amit Gujral, Head Corporate Marketing LG, Mr JK Jain, Chairman DASNAC; Ms Anita Singh Member Executive Committee, INTACH; Ms Pinky Anand Additional Solicitor General of India and Ms Shobha Mishra Ghosh, Assistant Secretary General FICCI.

These conclaves will be followed by a Qawwali performance by the renowned Warsi Brothers.

The theme for the Mini Mela today (9 am to 1 pm) is Adolescent Girls Health Mela by Maharaja Agrasen Adarsh Public School, Pitampura

The highlight of the day is “Anmol”, competition for the specially-abled, who will participate in activities like Yoga, painting, singing, dance and diya decoration.

The National Youth Fest, Harmony & Eco Fest will continue today and will feature Folk dance, Aerobics, Painting, Poster making + slogan writing.

There are free health checkup camps every day of the Mela, as also today.

Entry to the Mela is free for all.

I welcome you and your family and friends to the Mela.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

“Say No to self-antibiotics”: Join us at the Conclave on Antimicrobial Resistance at the Perfect Health Mela today

Antibiotic resistance is a growing concern and its impact on patients and communities are known to us all. This is a public health problem, one which is rapidly spreading across the globe, with not enough resources to control it. Antibiotic resistance has made it harder for us to treat many infections such as typhoid, pneumonia, tuberculosis. 

A Conclave on “Antimicrobial resistance” from 5 pm onwards is the highlight of the 2nd day of the 25th MTNL Perfect Health Mela, where an expert panel will deliberate on this very important public health issue. “Say No to self-antibiotics”, a campaign against AMR will also be launched at the Conclave with WHO and NCDC.  

The Panelists include Dr Anuj Sharma, Technical Officer AMR, Health Laboratories, WHO; Dr Sujit K Singh Director NCDC; Dr Sunil Gupta Addnl Director, HAG & HOD, NCDC, Ms. Meenakshi Lekhi, Member of Parliament and Mr Sidharth Luthra, Senior Advocate Supreme Court of India.

There will also be a Spiritual Inter-faith Conference today (from 5 pm onwards) moderated by Dr AK Merchant, National Trustee, Lotus Temple & Bahai Community of India.

The panelists for the inter-faith conference are Father Felix Jones, Delhi Archdiocese and Vivat International Masih Church; Dr Shernaz Cama, Zoroastrian Scholar, Rabbi EI Malekar, secretary and head priest, Judah Hyam Synagogue; Acharya Vivek Muni Dharmendra Jain, Acharya Sushil Muni Ashram; Swami Shantatmananda, General Secretary Ramakrishna Mission; Sardar Paramjit Chandhok, Executive Member, Delhi Sikh Gurudwara Management Committee; Mohd. Iqbal Mulla, Secretary Jamaat-e-Islami Hind; Sant Krishna Shah Vidyarthi, Head Priest, Valmiki Mandir & Ashram; Imam Umer Ilyas, President, All India Organization of Imams of Mosques; Ven. Sumithananda Thero, Secretary, Mahabodhi Society Centre, Delhi; Acharya Dr Ravindra Naga, Head Priest, Laxmi Narayan Temple; Pirzada Siraj Madani Nizami, Nizamuddin; Dr Amrit Kaur Basra, Sikh Scholar and Mr Vijay Sharma, scholar in Shirdi Sai Baba’s life and teachings.

The Conclave and Spiritual conference will be followed by an entertaining cultural evening by AIR.

This year, the Perfect Health Mela has introduced a new concept of “Mini Melas”, which are melas within the main Mela with five different themes for each day of the Mela. Today is the “Maths Mela” by SD Public School.

The workshop today should be of interest to many. Nita Mehta, renowned celebrity chef and author will conduct the workshop on Cooking between 1pm and 3 pm.

Children in large numbers are participating in the inter-school competitions “Harmony” and “Eco fest” on Choreography, Skit and Painting.

The Youth Fest, featuring inter-college competitions on painting, choreography, Instrumental fusion melodies, slogan and poster making and model demonstration, is the most popular event among college students.

Join us for the second day of the Mela … Be a part of this unique health event…

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA