“Woh to theek hai, par mara kyon”? Preventable deaths should be unacceptable

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Most deaths are preventable as most deaths are caused by preventable factors. People with diseases such as heart attack, cancer, stroke, pneumonia, chronic respiratory diseases, vector-borne diseases, diarrhea, tuberculosis should live and not die unless there is a complicating factor.

India ranks first among countries with the highest number of child deaths in the world. In 2015, out of the total 5.9 million child deaths globally, 1.2 million i.e. 20% of the world’s share, occurred in India. A significant majority of these deaths are due to preventable causes such as diarrhea, pneumonia, malnutrition etc.

Whenever a person dies of preventable illnesses, questions should arise as a routine “Why did he die”? Was the death preventable?

All deaths should be self-audited to look for preventable causes. If no cause is found, then virtual autopsy can be done. Virtopsy or virtual autopsy is an alternative to traditional autopsy, conducted with scanning and imaging technology. IMA is for establishing virtual autopsies at clinical level for non-medicolegal cases (whole body CT, whole body MRI, postmortem angio, molecular autopsy).

In every death, IMA members should give an option for virtual biopsy with or without mini FNAC/ tissue biopsy. And informed refusal must be noted.

“Woh to theek hai, par mara kyon” is one of the major IMA campaigns this year to audit every preventable death with the objective of preventing these avoidable illnesses and mortalities through strategic planning, awareness campaigns and mutual collaboration with concerned authorities. If we are able to find a cause of death, then we must act on preventing a second such death in the family; look for preventable complications in the future.

Nobody should die a preventable death in this time and age.

Dr KK Aggarwal
National President IMA

Donating blood reduces chances of heart attack

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One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion.

All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

In the current medical tourism scenario, many patients who are Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. They also do not accept transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.

Neck Artery Wall Thickness and Plaque Area to diagnose early heart diseases

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Treadmill, stress echocardiography, Thallium and Angiography do not detect early blockages. Treadmill can miss blockages up to 70%; stress echocardiography up to 60% and angiography up to 40%.

Most heart attacks occur because of a plaque rupture in patients with blockages of less than 50%. If the blockage is more than 70%, the patient usually presents with heart pain and not massive heart attack.

The only way to detect heart blockages before they cause symptoms or are detected in conventional tests is to measure the wall thickness of the neck artery or the leg artery. Normally, the wall thickness is less than 0.5mm. If the wall thickness is more than 0.75mm, it is suggestive of underlying heart blockages and if it is more than 1mm, it is suggestive of blockages in all three arteries of the heart.

Any thickness of more than 1mm is called as a plaque and a plaque area calculated by high resolution ultrasound is a new marker for heart blockages, progression as well as regression.

If the artery wall is thick in both the neck artery and the leg artery, it is very likely that the patient will also have blockages in the arteries of the heart.

All high risk individuals, therefore, should have their neck and leg artery wall thickness assessed. Only 2% of patients with blockages in all three arteries of the heart have a neck artery wall thickness of less than 1mm and 94% of patients with a neck artery wall thickness of more than 1.15mm will have multiple blockages in the heart.

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