Marathoner’s death: Checkup must to rule out heart risks, say doctors ‘Acclimatize Body Before Actual Run’

Mumbai: A 46-year-old Kandivli resident died after completing a halfmarathon in Thane on Sunday. On Monday, the runners' fraternity was abuzz with reports that a second participant in the same marathon, too, had suffered a heart attack. The Mumbai Marathon last month had recorded a cardiac arrest as well. Should these race-related cardiac cases be a cause for concern or be written off as random incidents? 

    The US is concerned enough to undertake a study to examine the correlation between marathons and heart deaths. Called the Race Associated Cardiac Arrest Registry, its findings published in the New England Journal of Medicine (NEJM) last month include 59 deaths among 11 million runners who had participated in marathons or half-marathons between years 2000 and 2010. In other words, a death in every 2,59,000 runners in the US. 
    "Cardiac arrest, most commonly attributable to hypertrophic cardiomyopathy (thickening of the walls of the heart) or atherosclerotic coronary disease (development of blockages in arteries), occurs primarily among male marathon participants; the incidence rate in this group increased during the past decade,'' said the NEJM study. A recent Australian study found that 32% of the runners for the Perth Marathon had elevated levels of cardiac troponin, a substance whose presence in blood suggests cardiac injury. 
    Asenior doctor pointed out that such data makes it clear that marathons are associated with heart risks. City authorities should put a curb on the number of public marathons that can be held in the city every year, he added. 
    But the runners' fraternity is not impressed with these argument. "Most runners who have an episode would have had a risk factor or symptoms that they may have chosen to ignore,'' said Dr Aashish Contractor, preventive cardiologist and medical director of the Mumbai Marathon. 
    Runners' fraternity pointed out that cardiac arrests are not common. Even the New England Journal of Medicine study had suggested that despite the increase in the racerelated deaths in the past decade, the death rate is equivalent to or lower than the risk associated with other vigourous physical activities. 
    All runners need a proper health checkup. Dr Somnath Mallakmir, who is also an associate professor (cardiology) with D Y Patil Medical college in Vashi, said that people should undergo a complete medical checkup before taking up long-distance running. Dr Mallakmir, who is himself a marathon runner, said that people who have a risk factor —either smoking, family history, diabetes or obesity—should certainly get themselves evaluated. "Ideally, people should start acclimatizing their body to the rigours of running a month or two before the actual run,'' he added. 
    Cardiologist Ganesh Kumar said that some Mumbaikars had the habit of literally getting out of their chair to run a race. "A thorough medical checkup is mandatory. There are enough diagnostic tests to rule out any heart problem.'' 
    Dr Contractor said, "For an actual event to occur, six risk factors need to come together and form a perfect storm as such in the body.'' So, the person should have plaque buildup in his arteries, he should have some problem with his blood clotting factors, he should have chronic diseases like diabetes or hypertension and he should have some stress-related problems. "Environmental circumstances like smoking or ingestion of drugs contribute to such storms that lead to cardiac arrest or heart attacks.''

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BREWING TROUBLE Caffeine to blame for ‘tiny’ babies

London: India may soon have to bring in guidelines warning to-bemothers against caffeine intake through coffee or fizzy drinks. 

    The World Health Organization currently suggests a limit of 300mg of intake of caffeine per day during pregnancy but some countries recommend a limit of 200mg, which can be less than a single cup of coffee from some high street cafes. A study has now found that caffeine from all sources and even in the smallest quantity reduced birth weight of the new born. 
    For a child of expected average weight (3.6kg) this equates to 21-28g lost per 100mg caffeine per day. 
    But it was not just caffeine, but the source of caffeine, which affected pregnancy outcomes. Caffeine from all sources increased the length of the pregnancy by 5 hours per 100 mg caffeine per day, but caffeine intake from coffee was associated with an even longer gestational length — 8 hours extra for every 100 mg caffeine per day. 
    Low birth weight is already a serious issue in India. Unicef says more than 20 million infants are born each year weighing less than 2,500 grams, accounting for 17% of all births in the developing world. Infants with low birth weight are at higher risk of dying during their early months and years. 
    Dr Verena Sengpiel from Sahlgrenska University hospital, Sweden, who led the project said, "Caffeine consumption is correlated with smoking which is known to increase the risk for both preterm delivery and the baby being small for gestational age at birth (SGA). In this study we found an association between caffeine and SGA and it remained even when we looked only at non-smoking moms which implies that caffeine is also having an effect on birth weight."

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Temperature fluctuations hit kids hard

 Little Nysha is an active 16-month-old, but has been ill for three days, with a cough and temperature. Her mother blames the freak weather. "Two days back it was hot. Then it turned suddenly cold. Now it is hot again. We can regulate the AC but my baby can't get accustomed to this fluctuation," said Natasha Dhanani, a Kandivli resident. 

    Nysha, however, is not the only child to have been laid low by the weather. Paediatricians across the city are reporting a long line of worried parents at clinics and out-patient departments. Fluctuations in temperature and low temperatures make children younger than five prone to the risk of contracting flu or respiratory ailments, which, if not treated in time, can cause pneumonia due to low immunity. Cold or flu creates an environment easier for the pneumococcal bacteria to trigger infections. 
    Dr Rohit Agarwal, president, Indian Academy of Paediatrics, said changing temperatures and high pollution levels make children ill. "We have more cases of nasal secretion, wheezing and chest congestion. Children, especially those below two years of age, have narrow wind pipes. In cold weather, these contract, making it difficult for a child to breathe," he added. 
    Dr Samir Dalwai, paediatrician at Sion Hospital said, "Pollutants can't mix easily in the environment during winter and cause allergic reactions especially in children, as their immunity systems are not that strong. " 
    Dr Ashok Anand, head of paediatrics at JJ Hospital said, "We are seeing a slight increase in upper and lower respiratory tract problems. If not treated on time, it can lead to pneumonia. A sudden rise of fever is a warning sign."

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Organ transplant: Doctors cheer move to scrap NOC

Paperwork Will Become Easier, Say Nephrologists

Mumbai: Anil, a 50-year-old kidney patient from Bangalore, spent two months running from one government office to another to gather 63 pages of proof that he is a law-abiding resident of Karnataka."Ihadto gothe police station several times and a policeman came to my house later to interview each of my family member for details of my disease," said Anil who is currently in Mumbai to meet his doctor. 
    If all the paperwork is in order, Anil will hopefully undergo a kidney transplant as soon as possible. His Punebased sister will donate one of her kidneys for him. 
    On Friday, Anil had mixed feelings when he heard that the Maharashtra government had decided to do away with the no-objection certificate (NOC) stipulation. "If only this stipulation had come a few months ago, I wouldn't have had to spend time gathering those 63 pages," he told TOI. 
    His doctor, Bharat Shah, who had moved the Bombay high court against the need for an NOC for interstate transplants when the donor and recipient are related, is ecstatic. "The problem is that this NOC was interpreted andfolloweddifferently in different states. Some states never insist on paperwork if the donor and recipient are related," said Dr Shah. 
    For many patients and their doctors,the newscalled for celebration. 
    "It will be a boon for patients,'' said Hinduja Hospital's nephrologist Jatin Kothari, who is also a member of the Zonal Transplantation Coordination Committee. He said securing an NOC adds six to eight weeks to any transplant. "A patient of mine from Uttar Pradesh needed eight months to get his permission. And it was his own sister who was donating a kidney," said Dr Kothari. 
    City doctors are hopeful that several patients will benefit from this amendment, and that it is implemented at the earliest. 
    Dr Shah said that he had moved the high court because of the plight of his patients who hailed from economically poor economic backgrounds. 
    "Such uneducated patients would invariably fall prey to touts who promised to help them with the paperwork. They would spend on dialysis aswell astoutswhile they should be saving for their medical care," said Dr Shah. "We can help and guide patients within the state. But if they are outsiders, even we are not aware of the system in other states, and so we cannot guide them," Dr Shah added.

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Now, painless vaccination minus needles

London: In what would be a real boon for India, scientists have found a way to vaccinate without using an injection. 

    Scientists at King's College London have for the first time demonstrated the ability to deliver a dried live vaccine to the skin without a traditional needle, and shown that this technique is powerful enough to enable specialized immune cells in the skin to kickstart the immunizing properties of the vaccine. 
    This technical advance, they say offers a potential solution to the challenges of delivering live vaccines in resource-limited countries globally, including India, without the need for refrigeration. A cheaper alternative to hypodermic needles, it would also remove safety risks from needle contamination and the pain-free administration could lead to more people taking up a vaccination. 
    Dr Linda Klavinskis from King's College said "We have shown that it is possible to maintain the effectiveness of a live vaccine by drying it in sugar and applying it to the skin using microneedles — a potentially painless alternative to hypodermic needles. We have also uncovered the role of specific cells in the skin which act as a surveillance system, picking up the vaccine by this delivery system and kick-starting body's immune processes." 
    The new discovery involves a silicone mould to create a microneedle array — a tiny disc with several micro-needles made of sugar which dissolve when inserted into the skin. 
    The team formulated a dried version of a live modified adenovirus-based candidate HIV vaccine in sugar (sucrose) and used the mould to create the microneedle array. They found that the dried live vaccine remained stable and effective at room temperature.

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Sunlight cuts diabetes risk by 50%: Study

London: Are you getting enough sunlight? Scientists have now found that Vitamin D deficiency — a common phenomenon among Indians — increase risk of type 1 diabetes. According to a study at Harvard School of Public Health (HSPH), having adequate levels of vitamin D during young adulthood may reduce the risk of adult-onset type 1 diabetes by 50%. 

    The findings, if confirmed, could lead to a role for vitamin D supplementation in preventing this disease in adults. 
    The study provides the strongest findings yet to suggest that vitamin D may protect against type 1 diabetes. 
    Lead author Kassandra Munger from HSPH said, "A blood test by a doctor measuring the vitamin D levels provides the most accurate assessment. However individuals who avoid direct sun exposure, who wear much clothing to protect themselves from the sun, have a diet low in fatty fish, or have darkly-pigmented skin are more likely to have low vitamin D levels."

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Soon, diabetics to get a tailor-made med policy

Mumbai: A public sector insurance company plans to launch a policy that would cover the cost of treating diabetics and diabetes-related ailments soon after the client buys the cover. Presently, diabetics can file a claim for diabetes-related treatment only if the treatment is received at least four years after the patient takes the policy. The Oriental Insurance Company 

(OIC) now wants to enable a diabetic to avail of insurance cover a month after the policy is issued. 
    India is considered the diabetes capital of the world as one in five diabetics in the world is an Indian. The current policies in the market classify diabetes as a pre-existing ailment, hence the four-year waiting period. The diabetic is expected to declare his or her condition at the time of enrolling for the policy. Such policy holders pay for hospitalization from their own pockets during the waiting period. 
    "The new policy will be tailor-made for diabetics. Premiums, terms and conditions are yet to be finalized," said Amitabh Mitra, chief regional manager, OIC. 
SWEET TIDINGS 

• Currently, insurance cos classify diabetes as a pre-existing disease 

• Diabetics can file a claim for diabetes-related treatment only if the treatment is received at least four years after a policy is issued 

• Many diabetics hide their condition while acquiring a medical policy— only to be caught out later 

• Oriental Insurance Company will launch a medical policy that will provide a diabetic insurance cover starting a month after the policy is issued Spl policy will get quality treatment for diabetics 
Mumbai: Presently, several diabetics hide their condition when taking a medical insurance policy so that they don't have to wait four years before filing a claim. "Many patients are unaware that hiding their diabetes can lead to repudiation of a claim," said OIC health manager Bipin Navsariwala. "A claims investigator eventually comes to know the truth on the basis of medical case history, medical reports and the medicines used to control sugar levels. For this reason, insurance firms are apprehensive of providing cover to patients with diabetes." 
    Dr Ajay Thakkar, chairman and managing director, Jupiter Lifeline Hospitals, Thane, said, "It is high time that a policy takes into account the interest of diabetics. Almost 20% of patients over 45 who are admitted in our hospital are diabetics." 
    Diabetics require special medical care because of various factors. For example, heavy fluctuation in sugar levels due to hypoglycaemia can render a patient unconscious, which can also lead to brain damage. Retinopathy could lead to blindness due to damage to the retina. Urinary infection is also common and wounds take a longer time to heal. In such cases, doctors prescribe higher doses of antibiotics, which can make treatment expensive, Thakkar added. 
    "In diabetics, high bloodsugar damages and weakens blood vessels, causing them to narrow," Thakkar said. "This mainly affects the legs. This disease is categorized as peripheral vascular disease, in which amputation of the leg cannot be ruled out. Healing of wounds is prolonged in cases where people have this ailment. A special policy for diabetics would help the patient get quality treatment." 
    Cardiologist Dr Bhaskar Shah said, "Diabetes is one of the risk factors for cardiovascular disease. Heart patients with diabetes take more time to recuperate as compared to others." 
    Parth Bhatt, director, Medsol Plus Pvt Ltd, a wellness firm, said, "There is an increase in demand for diabetic awareness counselling sessions as family members of such patients undergo psychological and financial stress. The first thing they ask is whether any insurance policy is available in the market to cover the cost of treatment."

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WORLD CANCER DAY Detection of cervical cancer may cost 100

Mumbai: The most technologically advanced cancer detection will soon be within the reach of the common man, or woman in this case. The central Food and Drugs Administration is working towards making the optimum cervical cancer screening option available at a lowcost.      Cervical cancers are associated with persistent infection withoncogenichuman papillomavirus(high riskHPV).      An HPV DNA test can detect the presence of oncogenic strains of the virus in cervical cells. The government is working tobring down thecostofthe test to make it available to poor patients.      "Thistestis nowofferedfor Rs900. For below poverty line patients, the test is for Rs300. But the FDA is working towards bringing down the test's cost. Soon, it will be available for lessthan $2(approx Rs100)," saidDr Surendra Shastri,head of preventive oncology, Tata MemorialHospital.      Thetestwill notonly reveal if a woman is suffering from cancerous lesions, but also if shewill getitin future.      Projections from Globocan 2008 reveal that 72,825 women diedduetocervicalcancer.The Globocan software is worked out by the WorldHealth Organization and International Agency for Research on Cancer every few yearstohelp public health officials work out a plan againstcancer.      Dr InduAmbulkar,consultantoncologist, SevenHillsHospital, said it was important for the HPV DNA test to be availablefor the poor, as morecasesof cervicalcancer arefoundin rural areas. With poor genital hygiene, cervical cancer numbershavebeen going up. "Early detection is the need of the hour," she said. "The main symptoms of cervical cancer are unnatural bleeding, apart from the menstrual cycle and post-coital bleeding (after intercourse). In case of any of these, the woman should rush to a doctor," shesaid.      Tata Memorial Hospital doctorssaidthatusing vinegar (4% acetic acid) is the easiest way to detect abnormality in thecervix.  THE HPV TEST      A human papillomavirus (HPV) test is done to find high-risk HPV infection in women      HPV is a sexuallytransmitted disease. An HPV test checks for genetic material (DNA) of virus. Like Pap test, HPV test is done on sample of cells collected from cervix      Projections from Globocan 2008 reveal 72,825 women died due to cervical cancer      More incidences of cervical cancer are seen in rural areas owing to lack of genital hygiene and awareness

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