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M. P. Ravindra Nathan

The 2007 annual Scientific Session of American College of Cardiology (ACC) March 24-27 in New Orleans was everything it was cracked up to be: cardiovascular updates, unveiling of results of the latest clinical trials, presentation of innovative new technology, spectacular scientific exhibits and more. And the city, eager to establish its old glory after the devastating Katrina, extended a warm welcome to all those who ventured to attend. Many cardiologists from Tampa Bay also were present.

As in the past year, this was a joint session with i2 summit, (‘Innovation in Intervention )’, a scientific session used to be conducted separately for interventional cardiologists. This special i2 session, building on its success in the past year, gave a chance for all cardiologists irrespective of their special interests, to mingle and learn from one another.

Medical conventions of this caliber are quite complex with many sessions and programs occurring simultaneously; so I had to pick the ones that will be most useful in my practice such as new drug trials, new concepts in the management of common cardiac problems, new tools for imaging of the heart – a highpoint of this convention, etc. Here are some of the highlights.

The opening session, presided by Dr. Steven E. Nissen, was colorful with a moving presentation from the Marine Force Reserve Color guard of New Orleans, a musical interlude and a video presentation from Larry King followed by the Simon Dack Lecture, which focused on “Seeking Balance: Research and Education.” While it is important to have clinical trials which will energize development of new treatments, in order to implement these, physicians, patients, insurance companies and regulators need to work together. Education, not marketing, is the keyword, stressed Dr. Marc A. Pfeiffer who gave this prestigious lecture.

‘Changing face of Cardiovascular Risk’ was the focus of several discussions. Over the past years, with constant public education, there has been a steady decline of certain risks – such as cigarette smoking (yes, less people are smoking now), cholesterol- related problems (thanks to aggressive management with statins) and hypertension (better control by increased use of modern drugs, although we still have a long way to go). Even the mortality from coronary heart disease (CHD) seems to be improving. However, two major stumbling blocks for any further improvement are increasing incidence of diabetes mellitus and overweight and obesity. An often-quoted statement is that by the year 2020, 20 percent of all diabetics in the world would be of Indian heritage. A frightening statistics!

Heart Failure (HF), often the end result of many types of heart disease in adults and a common cause of death), received a lot of attention. Asian Indians who develop CHD may be at higher risk for developing HF. Diabetes is an ominous marker too for HF. So is hypertension; the impact of even high normal BP can be significant, so one must meticulously control one’s BP. “By increasing the effectiveness of care, which in return lead to optimization of the outcomes, favorably affecting the cost of care, we can become the best physicians,” said Mariell Jessup, M.D., director of HF program at the University of Penn School of Medicine. New guidelines for classification of heart failure and therapies are being developed.

‘Medicine enough for chest pain?’ was the essence of a thought-provoking and much-publicized study by Dr. William Boden of Western New York. This study involving 2,287 heart patients with chronic but stable chest pain is the first to show that taking medications alone is just as effective as combining them with angioplasty (unblocking the arteries with or without stents). Of course, these findings do not challenge the benefit of emergency angioplasty done to stop heart attacks. This is all good news for patients but may not be applicable to everybody and the final decision is always up to your treating cardiologist.

The controversy surrounding the safety of drug eluting (coated) stents (DES) still remains. When the two types of stents (bare metal versus drug coated) are compared there may be slight increase in late occlusions with DES, especially when used for ‘off label’ indications. The consensus is that more data is needed before definitive conclusions can be made. It also was emphasized that ‘dual antiplatelet therapy’ (using aspirin and plavix) should not be stopped prematurely for those who have received DES.

We will conclude this mini series in the next issue.

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

Acne is a common problem during the teenage years that affect about 85 percent of children, from ages 9-17 years. It occurs more commonly in boys and can range from mild to severe forms. Acne most commonly affects the face but also can occur on the neck, chest and upper back. Some children may have acne into adulthood. Acne in teenagers should not be taken lightly since it can lead to anxiety and low self-esteem.


There are glands on our skin called the sebaceous glands, which produce an oily liquid called sebum to lubricate and protect our skin. During puberty, there is an over- stimulation of these glands caused by hormones, mainly androgens, which can lead to blockage of these glands leading to acne (whiteheads and blackheads). If bacteria called P. Acne get into the pimple, it can worsen the pimple by causing an infection leading to painful red swelling and even pus. This is called nodulocystic acne and can lead to severe scarring.

For females, menstrual cycles can improve as well as worsen acne during certain times during the month. Stress also can worsen acne. Myths related to food such as chocolate, fatty foods, sodas, etc., are dismissed as causes of acne.


Topical treatments such as Benzoyl Peroxide and Retinoids are available as the first line of therapy. This may be combined with topical or oral antibiotics for acne that are more inflammatory or worsening. Also available to girls is birth control pills, which help regulate the hormones and decrease the acne. Oral Isotretinoin (Accutane) is considered for acne that is nodulocystic with scarring and is used more commonly in males because of the risk of fetal malformations if used in a pregnant woman. Therefore, for girls it is important to make sure that she is not pregnant or not planning to get pregnant. Accutane is usually prescribed by a dermatologist who most likely will put a girl on birth control pills to avoid pregnancy-related risk. Other treatments such as laser, etc., are available through a dermatologist whom you can be referred to by your pediatrician.

Tips for home management:

Do wash your face once or twice daily only with an oil-free acne cleanser.

Do not let sweat drip on the forehead when exercising by using a head band to control the sweat.

Do clean your face with a gentle cleanser if you have sweat on your face from exercising or being out in the hot weather.

Do use oil-free non-comedogenic hair products, skin care products, and make up.

Don’t let your hair sit on your forehead, such as bangs or long hair that falls on the face. This will irritate the skin by rubbing the forehead and surrounding areas causing pimples.

Don’t wear tight clothing that will rub against the skin and irritate it.

Don’t scrub your face with a washcloth since this will make pimples worse.

Don’t constantly touch pimples or pick at them, which will introduce bacteria from the skin and make the pimples worse.

Don’t squeeze or try to pop a pimple because it is more likely to lead to scarring.

At the pediatrician:

Your goal as a parent is to determine how bad is your child’s acne and whether it has any impact on your child’s self-esteem. For acne that is mild, trying over-the-counter preparations may be enough. For more moderate to severe forms of acne, it is important to bring it up to the doctor to discuss the ideal management for your child. Follow-up is important for acne that does not improve or is worsening to try a different management or even consider seeing the dermatologist.

Dr. Payal Patel, a board-certified pediatrician with practice location (Lutz Pediatrics 18928 N. Dale Mabry Highway, Lutz, FL 33548) can be reached at (813) 272-0300 or (813) 909-2199 or by e-mail at

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