The Tribune, Chandigarh, India

HEALTH

BODY & MIND
It’s easy to kick Lady Nicotine now
Tripti Nath

Metro Heart Institute in Sector 12, Noida, has taken up the herculean task of persuading smokers to quit smoking and drawing their attention to the twin benefits of health and money saving. The initiative has been conceptualised by Dr Deepak Talwar, Chairman, Metro Centre for Respiratory Diseases who brings with him the experience of working in a quit smoking centre in a tertiary care medical college hospital in the Middle East.

But, it was a visit to the Thomas Jefferson University Hospital in December 1995 that inspired him to do something similar for the smoking population in his home country. And why not? According to Indian Council of Medical Research, about 40 per cent of men and 8 to 10 per cent of women in India smoke.

According to a 1997 WHO report on ‘Tobacco or death - a global status report’, out of 1.1 billion smokers throughout the world, 800 million smokers are in developing world mainly in China and India.

Again, findings of an ICMR study in November 2000 highlighted the burning problem of smoking in India. According to the report, India has the dubious distinction of 18.4 crore users, which include four crore cigarette smokers, eight crore beedi smokers and another 6 crore using guthka and jarda. Since its inauguration on November 4, the clinic has got 150 patients in the 18 to 70 age-group including eight women. Most of these patients are in the 40 to 60 age-group and have very strong reasons to give up smoking. When a smoker comes to the clinic, he goes through medical evaluation, which last barely seven minutes. If any abnormality is detected, it is highlighted to the counsellor. He is then sent for laboratory investigations including measurement of Carbon Monoxide level, Peak Expiratory Flow Rate (PEFR) for lung capacity) and Oxygen

saturation (oxygen level in the blood). He is then referred to the counsellor, who prepares a smoker’s diary. The counsellor motivates the patient to quit smoking and encourages him to celebrate the quit smoking day by experiencing the non-smoker status and visiting a non-smoking zone in a restaurant. Depending on the degree of addiction, the smokers’ quitting day is fixed. Some patients take it up as a challenge and give up before the actual quitting date fixed by the doctor. After motivation, the patient is prescribed two doses of Bupripion HCL (available in India under various brandnames as Zyban or Nicotex or Smokequit) once a day. The dose is later increased to two times day.

According to Dr Talwar, bupripion hcl is sold in 80 countries and has FDA approval since 1997. It was used as an anti depressant drug in the US till it was found that it has anti-smoking potential in 1992. The total amount of dose required for six weeks tots to about Rs 3000. But patients are required to complete the entire treatment ranging from six to eight weeks because relapse rate is highest during this period. This rule applies even to those who give up before the quitting deadline.

This is followed by acupuncture, homeopathy and behaviour modification. The most important parameter to test nicotine dependence is the standard Fagerstorm test.

The smoker is asked to spell out how soon he starts smoking after waking up, number of smokers he takes everyday.

According to Dr Talwar, diabetic smokers run much higher risk of developing peripheral vascular disease, which can even necessitate amputation. The team of six doctors led by Dr Talwar have succeeded in de addicting about 102 patients. The clinic claims a relapse rate of less than five per cent. Patients who revert to smoking are asked whether they have quit smoking before, how many times. They are also asked to mention the longest quitting period and spell out reason for starting smoking afresh. To ensure that the smokers have not reverted to nicotine, a doctor from the team calls up once every month for a year till he is convinced that that the smoker has turned a non-smoker.

The doctors in the team are Dr Kavita Fotedar, Counsellor, Dr Shubhra Shiwangi,

Physiotherapist who also helps smokers with behaviour modification, Dr Ruchi Srivastav, homoeopath and Dr Vinay Sheel, medical evaluator. Summing up the therapy, Dr Talwar explained that Nicotine is an alkaloid, which has more addicting powers than Cocaine and Heroin. Since smoking is a major risk factor for heart disease, some patients who come to treatment at the heart institute are referred to the clinic by cardiologists.

While the Noida clinic is open on Monday and Thursday, the clinic in the hospital’s peripheral medical centre on Aurobindo Marg is open on Tuesday and Friday. The health risks of cigarette smoking include stroke, Cancers of the mouth, throat and oesophagus, larynx, coronary heart disease, chronic obstructive pulmonary disease, lung cancer, pancreatic cancer, ulcer, bladder cancer, cervical cancer, low birth weight babies and artery disease.

Former President of DMA and presently consultant, Respiratory Medicine, Indraprastha Apollo hospital who spearheaded a campaign against smoking in 1997 said that the anti-smoking campaigns have served to create awareness and new starters are less. He had moved a PIL to ban smoking in the public places.

Dr Chawla is of the view that the legislation brought by the Delhi government to check smoking in public places has not been enforced properly.

He says that although several restaurants in the city have altogether banned smoking in the premises, it has not made any significant change in sale of cigarettes. “These anti-smoking clinics are good. If treatments in such clinics are made free of cost, then more people can be helped. It will not help beedi workers. Most of them are paid clinics. The Delhi government should set up clinics in all hospitals,” according to Dr Chawla.

COMBO DEVICE

Dr T.S. Kler, senior consultant and head of the department of Electro Physiology, Escorts Heart Institute and Research Centre, has introduced a technique by implanting India’s first ever ‘Combo device’. The device implant is a path-breaking surgery in the area of cardiac medicine and can save lives of many patients.

A combo device is a high tech gadget implanted in the body and serves the purpose of a bi-ventricular pacemaker and an ICD to counter heart failure and a sudden cardiac death. According to Dr Kler, the combo device provides electric stimulation to the heart and simultaneously monitors the electrical activity of the heart for any potentially fatal rhythm abnormality. He added that when the heart detects such an abnormality, it delivers an electric shock to the heart, which brings the heart rhythms back to normal and save the patient’s life. Heart failure is a condition in which heart muscles are weakened.

Consequently, the heart needs to work more to ensure flow of blood throughout the body. This stresses the heart and results in enlargement of heart muscles. Heart failure patients experience SCDs at six to nine times the rate of general population. Heart failure is the only major cardiovascular disorder, which is increasing in incidence all over the world. It is a progressive disease and leaves clinicians facing two separate types of mortalities deaths from pumping failure and sudden cardiac deaths. The technique assumes significance in light of the incidence of heart failure in India, which is estimated at 20 million.

The hard fact is that heart failure and sudden cardiac deaths kill more people than AIDS and Cancer put together.

MRI UNIT OPENS

Delhi Health and Family Welfare minister, Dr A.K. Walia inaugurated a state-of-the-art MRI unit in the Master Amir Chand block of G.B. Pant Hospital recently.

Speaking on the occasion, Dr Walia said that the MRI unit is a gift to the hospital on its 38th Foundation Day. He said that the charges for MRI test have been kept very nominal. Dr Walia said that they plan to set up a liver transplantation unit in the hospital. The hospital has to cater to a large number of patients, as it is the only referral hospital of Delhi government. Keeping this in mind, a 600-bed Rajiv Gandhi Hospital in East Delhi and a 300-bed hospital in West Delhi are being constructed to work under the supervision of G.B. Pant hospital.

SPORTS

Indian sport loses a friend
Our Sports Reporter

New Delhi, May 4
The medical fraternity in particular, and India in general, lost a good friend in the tragic death of Dr Nishat Mallick, who was shot dead in Pakistan last week.

Dr Mallick, a former Minister for Science and Technology in Nawaz Sharif’s Government in Pakistan, was assassinated in Karachi along with Mr Mustapha Kamal Rizwi, a former Senator. They were gunned down by unidentified assailants when they stepped out of Dr Mallick’s house in Karachi.

Both were active leaders of the MQM Party, which was a coalition partner in Nawaz Sharif’s Government, and had worked hard for the reorganisation of the party, particularly in the Sindh region.

The 45-year-old Dr Mallick was president of the Asian Federation of Sports Medicine besides being a member of the Executive Committee of the International Federation of Sports Medicine (FIMS) and president of the Sports Medicine Association of Pakistan. He is survived by his wife, Shirala, a son and a daughter and a large number of friends on both sides of the border.

According to Dr PSM Chandran, director of Sports Medicine, Sports Authority of India, and a close associate of Dr Mallick, the Pakistan sports medicine specialist was also a specialist in physical medicine and rehabilitation.

Dr Chandran said Dr Nishat Mallick, known among his friends as ‘Nish’, had been a regular visitor to India as a member of the Parliamentary delegation and as an ambassador of sports medicine in the sub-continent.

Dr Chandran recalled that Dr Mallick was a guest of honour at the Indian Sports Medicine Congress organised by the Sports Authority of India in New Delhi in December 2000. Dr Mallick was also instrumental in bringing Dr Edwardo de Rose, president of the International Federation of Sports Medicine, from Brazil to India — the first visit by an FIMS president to India..

“Nish was full of praise for the warm hospitality extended by the Union Minister of Sports Uma Bharti when he had called on her at her residence along with Dr Rose”, recalled Dr Chandran.

“Dr Mallick showed his keenness in strengthening bilateral relations between India and Pakistan when he invited the Minister to visit Pakistan, and had assured her that he will show her around Lahore, a place she was interested in considering its place in India’s history”, noted Dr Chandran.

Dr Mallick’s last visit to India was in February this year when he came to attend the National Conference on Sports Medicine at Patna as the chief guest. While in Patna, he found time to visit his ancestral house in a remote village near Gaya, by walking ten kilometres through unpaved paths. Dr Chandran said Dr Mallick was keen to start a primary school at the village in the memory of his father.

Dr Chandran said Dr Mallick was a “strong supporter of India” in world forums of sports medicine and he wanted India to play a pivotal role in the promotion of sports medicine at the Asian and World level.

In a keenly contested Asian Federation of Sports Medicine elections in Oman in January 2000, he threw his weight behind India and ensured its election to the AFSM executive committee for the first time.

Dr Chandran said at the time of his death, Dr Mallick was negotiating with the International Olympic Committee to get an IOC sports medicine course for India next year. He was all set to receive the guest speakers from India next Tuesday at Karachi for the IOC Sports Medicine course, he was scheduled to organise there from May 8 to 11.