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M. P. Ravindra Nathan

On the first day of the March 24-27 Scientific Session of American College of Cardiology (ACC) convention, I spent most of my time attending the special course on CT (Computed Tomography) Imaging conducted by Johns Hopkins Medical Center. The changing face of diagnosis and intervention is most exemplified by the introduction of 64 and now 128 slice cardiac CT imaging. Let me tell you, cardiac CT is hot! It opens the door to the diagnosis of heart disease without having to insert catheters into your heart. And to enhance image quality and functional analysis of cardiac problems further, new tools and digital processors were presented. “Powering imaging along the imaging pathway” was the slogan of one company, which dealt with cardiac CT and MR (Magnetic Resonance).

There were many satellite symposia in the evenings after the main programs, presenting core curriculum data on interesting topics. And these meetings were accompanied by cheese and wine receptions and dinners, so the attendance was great. Actually, doctors were camping outside the doors half an hour before the ballroom opened, eager to get in, as if there was a million dollar giveaway!

Drs. S. Padmavathy and Ravindra Nathan.
One such program that attracted a good many people was “Crossfire,” consisting of debates and peer exchange with audience participation. Managing global cardio-metabolic risk was the topic and the distinguished faculty included Deepak Bhatt, the highly acclaimed, young research cardiologist from Cleveland Clinic. Very common among South Asians, cardiometabolic syndrome includes: abdominal obesity (killer bellies?), cholesterol abnormalities, hypertension and diabetes. A major risk factor for heart attacks in Indians, it is absolutely important to disrupt the pathological process leading to this syndrome. A novel therapeutic approach is to manipulate the “the endocannabinoid system via CB1 blockers.” which promises to be of great value.

There is a virtual tsunami of heart disease about to wash on the shores of USA and many other developing countries. Around 64 million people in USA have metabolic syndrome. And 1 in 4 patients with type 2 diabetes in USA dies of heart attack or stroke. So, why can’t we convince the diabetics that glucose control is so important? We shouldn’t wait till diabetes is already set in because vascular changes start much earlier, during the pre-diabetic phase. Tight control also is a moving target. Normal Hb A1 C (a measure of the control of diabetes over a period of several weeks), which used to be <8 before, is now < 6.5 and ideal may be even <6. With drugs such as TZD, Januvia, Metformin, etc., this goal is achievable.

The recommended abdominal girth now is 30” for females and 35” for males, down from the old 35” and 40” respectively. Similarly, the BMI (Body Mass Index) calculated from the height and weight should be less than 25, may be even 23 or less in Indians. In short, the fewer calories you ingest and the less you weigh with a thin waist, especially if you exercise 30 minutes a day, one can significantly lower one’s chance of getting diabetes and heart disease.

Dyslipidemia featured prominently in several discussions. By this time, you are well aware that blood lipid abnormalities exemplified by elevated LDL cholesterol, low HDL cholesterol and increase in the triglycerides, pose a major risk for Indians. Many patients who could benefit from medications like statins are under treated and the majority on treatment is not achieving therapeutic goals either. “Why is this and how can we correct the situation to bring optimal outcomes benefits?” was a major concern among the pundits. Individualizing the therapeutic strategy for every patient, especially the Indian patient, is a challenge, so work with your doctors to achieve the best protection you can. And make sure all CV risk factors are treated simultaneously.

On Sunday evening, AACIO (American Association of Cardiologists of Indian Origin) met at Hilton Riverside for its semiannual dinner meeting and lecture. Two young investigators were given awards for their distinguished work. A surprise guest of honor was Bobby Jindal, the U.S. congressman for the First District of Louisiana and currently the front runner for governor of Louisiana. There were many cardiologists who came from India too. Later when I took the tour of the post-Katrina New Orleans, I had the good fortune to meet S. Padmavathy, the famous Indian cardiologist and director of National Heart Institute of Delhi. “Cardiology has come of age in India,” she said. “Hospital beds are filled to capacity, more from patients from other countries.”

The new cynosure in the exhibit booths was the imaging and IT equipments for advancing cardiology practice. Walking through the maze of CT and MRI scanners, video presentations, fancy rides (medical, that is), hands –on- training tools, ‘virtual experience modules’ and other gimmicks to attract the learning-minded attendees, I felt like a kid at Disney World.

As always, there is an information overload during these sessions but the principal value is to recapitulate the major advances to date and provide an interactive venue with participation from regional, national and international thought leaders and investigators. Roundtable discussions, brown bag lunches, didactic lectures, satellite symposia, live case demonstrations … all make this the premier cardiology conference of the world.

An array of dazzling technologies – general, bio and genetic- seem to be the future of cardiology. Would the human element eventually become obsolete? Your guess is as good as mine.

This concludes our series on the ACC convention.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.

Payal Patel

Summer is here, and the hot weather draws everyone to the pool. As we know, children love water and when it comes to swimming pools safety guidelines needs to be discussed.

Living in Florida has its pros and cons. Many homes have a swimming pool and therefore instilling swimming pool safety is the key. Florida is one of the leading states in pool drowning. Each year, about 300 children under 5 years of age drown in swimming pools, but the number grows to more than 2,000 children under 5 years of age who become near-drowning victims.

Seventy-five percent of children in swimming-pool submersion accidents were between the ages of 1 and 3 years old, and most of them were boys.

Toddlers are a special concern and because they move so fast and get into everything, a pool drowning can occur anytime. Most kids this age don’t scream for help and can drown silently. Most victims of near-drowning accidents drown silently in less than five minutes of when the child was last seen.


1. Always have a pool fence in place that is at least 4 feet high, and completely separates the pool from the home and the play area. A good fence should prevent a child from getting over, under or through the barrier. Have self-closing gate latches that are out of reach for children. (Remember, a pool fence is the law in Florida for all homes)

2. It may be wise to have a pool alarm – a door alarm if the pool gate is opened. Wrist- alarm bands make noise when a child gets wet. A pool alarm also is good, which is activated if anything more than 10 pounds falls into the pool.

3. Discuss basic pool safety rules with children before entering the pool.

4. Never leave children alone or out of eye contact when he or she is in or near a pool.

5. Always have an adult supervising the pool (who knows how to swim).

6. Remove toys, floats, balls from the swimming pool, which may attract children to the pool when they are not supposed to be in it.

7. If you own a pool, learn CPR in order to resuscitate a drowning child.

8. Always use an approved flotation device to keep child afloat, but don’t let this let your guard up.

9. Prohibit any kind of diving or rough play in and around pools.

10. Teach kids how to swim as early as possible (good age is around 3 years of age), but they are not drown-proof. Therefore, close supervision is still necessary.

11. Precautions should be taken for children with seizure disorder who can seize and drown in the pool.


* First and foremost, don’t panic.

* If you see a child drowning, send someone to call 911.

* If a child is in shallow water, turn him or her face up and face out of water.

* If the child is in deep water, get a flotation device before going to him/her.

* Look for signs of breathing (If not breathing, start rescue breathing, which is mouth-to-mouth breathing) while child is in the water.

* Check the pulse. If no pulse, start CPR once child is removed from the pool.

Finally, I hope these guidelines will help parents take charge of swimming pool safety guidelines, to protect children from pool accidents and drowning.

Happy Fourth of July to all.

Payal Patel, a board-certified pediatrician, has recently started her own practice – Sunshine Pediatrics, 18928 N. Dale Mabry Highway, Suite 102, Lutz, FL 33548. She also can be reached at (813) 948-2679.

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