Patients who have a heart attack and undergo procedures to open blocked arteries are getting proven treatments in U.S. hospitals faster and more safely than ever before, according to the results of a large-scale study.

Data on more than 131,000 heart attack patients treated at about 250 hospitals from January 2007 through June 2009 also showed that the patients themselves have become more aware of the signs of heart attack and are showing up at hospitals faster for help.

Lead researcher Dr. Matthew T. Roe, an associate professor of medicine at Duke University Medical Center and the Duke Clinical Research Institute, thinks a combination of improved treatment guidelines and the ability of hospitals to gather data on the quality of their care accounts for many of the improvements the researchers found.

"We are in an era of health care reform where we shouldn't be accepting inferior quality of care for any condition," Roe noted.

"Patients should be aware that we are trying to be on the leading edge of making rapid improvements in care and sustaining those," he added. "Patients should also be aware that the U.S. is on the leading front of cardiovascular care worldwide."

The report is published in the July 20 issue of the Journal of the American College of Cardiology.

Roe's team, using data from two large registry programs of the American College of Cardiology Foundation's National Cardiovascular Data Registry, found there were significant improvements in a number of areas in heart attack care:

• An increase from 90.8 percent to 93.8 percent in the use of treatments to clear blocked blood vessels.
• An increase from 64.5 percent to 88 percent in the number of patients given angioplasty within 90 minutes of arriving at the hospital.
• An improvement from 89.6 percent to 92.3 percent in performance scores that measure timeliness and appropriateness of therapy.
• Better prescribing of blood thinners.
• A significant drop in hospital death rates among heart patients.
• Improvement in prescribing necessary medications, including aspirin, anti-platelet drugs, statins, beta blockers, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers.
• Improvement in counseling patients to quit smoking and referring patients to cardiac rehabilitation.

In addition, patients were more aware of the signs of heart attack and the time from the onset of the attack until patients arrived at the hospital was cut from an average 1.7 hours to 1.5 hours, the researchers found.

Roe's group also found that for patients undergoing an angioplasty:

• There was an increase in the complexity of the procedure, including more patients with more challenging conditions.
• There were reductions in complications, including bleeding or injury to the arteries.
• There were changes in medications to prevent blood clots, which reflect the results of clinical trials and recommendations in new clinical practice guidelines.
• And there was a reduction in the use of older drug-eluting stents, but an increase in the use of new types of drug-eluting stents.

Despite all the good news, Roe's team said there was still room for improvement in care, particularly in ways to reduce the risk of bleeding that is present with even the most advanced treatments.

"We need to do ongoing and regular surveillance of care patterns" Roe said.

Dr. Gregg C. Fonarow, a cardiology professor at the University of California, Los Angeles, commented that "national clinical registries provide valuable data to characterize recent trends in the treatment and in-hospital clinical outcomes for patients hospitalized with cardiovascular disease or those undergoing cardiovascular procedures."

This new report demonstrates improvements in the speed in which reperfusion is offered in heart attack patients, better use of guideline-recommended medications in heart attack patients, and decreases in complications in patients undergoing coronary procedures, Fonarow said.

"These findings show the substantial efforts to provide physicians and hospitals with detailed feedback on performance coupled with targeted quality improvement efforts are producing measurable and meaningful benefits to cardiovascular disease patients," Fonarow added.

However, he said, there are further opportunities to improve care and clinical outcomes for patients with heart attacks and those undergoing cardiovascular procedures. Because "not all U.S. hospitals are participating in these voluntary clinical registries, there is a very important need to expand hospital participation," Fonarow noted. Fonarow is the unpaid chair of the Get With The Guidelines committee of the American College of Cardiology ACTION registry.

Seven new cases of swine flu were reported from the city on Wednesday. With this, the number of swine flu cases in the city in July alone has gone upto 27.

Wednesday's number of positive cases is the highest reported in a single day during the recent H1N1 spurt. Currently 13 swine flu patients are under treatment in the state eight at the state run ID Hospital at Beliaghta and five in different private hospitals. The condition of two patients in two private hospitals is critical.

H1N1 claimed its first victim on Tuesday when a 58-year-old suffering from multiple myeloma died in a private hospital. An H1N1 infected 25-year-old renal failure patient admitted at a private hospital too has been in critical condition for the past one week. There has been no improvement in his condition. Now the condition of a new case amongst those tested positive on Wednesday is very critical.

The 20-year-old youth from Metiabruz was admitted to a private hospital on July 13 with high fever. When the patient developed respiratory distress the doctors at the hospital took his swab sample and sent to National Institute of Cholera and Enteric Diseases (NICED). The sample tested on Wednesday confirmed swine flu.

"We have been keeping the patient in an isolation from the time doctors suspected him to be a case of swine flu. All other protocols are being followed," said the hospital's spokesperson.

Fifteen samples were tested during the day for swine flu. The fact that nearly 50% of the samples tested positive on Wednesday has put the state government health department on alert. Given the rising number of swine flu affected in the state, the department is speeding up the vaccination of doctors and other health workers.

"We have vaccinated about 3,000 doctors and other health workers so far. Work at ID Hospital and SSKM are almost complete. Vaccination in other government hospitals is on," said state swine flu nodal officer dr Asit Biswas.

What is worrying health officials this time is that unlike the outbreak last year, the virus is attacking those with no travel history. For example, the patient from Metiabruz had not travelled anywhere in the recent past. Since this is also the time for seasonal flu, sometimes it is difficult even for doctors to make a distinction in the symptoms of H1N1 and common influenza.

And unlike last year when all the infected were admitted to ID hospital, this time private hospitals have admitted swine flu patients. Though these hospitals have been told to create isolation wards, health officials said that keeping the patients under one roof in the isolation ward at ID Hospital made it much easier to monitor the patients.

"We are going to meet representatives of private hospitals in the city to discuss on the kind of infrastructure they have. We may also issue new guidelines on the isolation, sample collection and shifting of patients to the ID hospitals," said Biswas.

A "Robin Hood" tax of just a fraction of a percent on financial transactions could smash the funding crisis gripping the war on AIDS, activists said at the world AIDS forum here on Wednesday.

"Robin Hood taxes are the answer to the question that everyone at this conference has been asking, which is: 'How can we keep financing a great scale-up in services against HIV/AIDS?'," Khalil Elouardighi of Coalition PLUS, a group of anti-AIDS organisations, told journalists.

A micro-tax of just 0.005 percent on all financial transactions would raise some 33 billion dollars (25.75 billion euros) per year worldwide, he said.

"It acts like an invisible micro withdrawal. Knowing that 97 percent of transactions are of a speculative nature, there will be no consequence on the real economy," noted Philippe Douste-Blazy, UN under secretary general for innovative financing for development.

The time was right to push for the tax, ahead of a summit on Millennium Development Goals in September and a G20 meeting in November, campaigners said.

"It is up to us to explain to the heads of state that they do not have any other solution because we know that it only depends on political will," said Douste-Blazy, a former French foreign minister.

The tax was technically feasible but the key was now to make sure the money was used for development, rather than to reimburse state debt or rescue banks, he said.

His own organisation, UNITAID, has blazed the trail with a small tax on airline tickets, implemented by France and 11 other countries, that has provided drugs to prevent HIV infections from mothers to their babies.

"Global commitments, particularly around HIV, are really first in line when it comes to what the right beneficiaries would be for that financial transaction tax," Asia Russell of the US advocacy group HealthGAP noted.

The Robin Hood tax would not make countries any less subject to aid contributions however, warned Christoph Benn of the Global Fund to fight AIDS, Tuberculosis and Malaria.

"We are not taking away any pressure from governments to provide additional resources from their development budgets: that is a given, that is our first request, that they increase their contributions."

The Global Fund is seeking 17 billion dollars in pledges from 2011 to 2013.

Funding by rich economies for poor countries fighting HIV/AIDS fell back slightly last year, to 7.6 billion dollars after 7.7 billion dollars in 2008, as a result of the economic recession, according to an analysis issued in Vienna by the Kaiser Family Foundation and UNAIDS.

The decline brought to a close six successive years of double digit increases. In 2002 funding for anti-HIV drugs and other initiatives was a mere 1.2 billion.

The report said that for poorer countries -- "low- and middle-income" economies -- 23.6 billion dollars was needed from all sources for 2009. The gap in funding last year was 7.7 billion dollars.

For 2010, 25 billion dollars has to be mustered for fighting AIDS in poorer countries, according to a previous UNAIDS estimate. So far, there is a funding shortfall of 11.3 billion, according to an analysis published this month in the US journal Science.

The association of private hospitals have sought state government’s intervention to settle the ongoing dispute with insurance companies over cashless mediclaim policy.

The association, which includes hospitals like Jalok, Breach Candy, Hinduja and Hurkisondas, has said that the demands of uniform rates for medical procedures that had been put forth by insurance firms were not plausible. “Rates differ according to available equipment and location of hospitals. Even within hospitals, rates vary according to the class of service patients opt for,” said CEO of Jaslok Hospital Colonel Manesh Masand. He added that costs also vary for different procedures for the same ailment. “Cancer can be treated by focused MRI and through surgery, at exponentially different costs. The choice of treatment is finally up to the patient,” said Colonel Masand.

“Government intervention is required here. Petrol is being made duty free, whereas hospitals have to pay the highest custom duties for all imported equipment. It is important to understand that our costs are determined by all these factors,” said Breach Candy Hospital CEO Major General Vijay Krishna. 

The National Institute of Virology (NIV) has cautioned people to be alert and take all precautionary measures as the infection rate of the H1N1 influenza has gone up to 40 per cent during the second wave of the pandemic virus.

"There is a significant rise in number of people suffering from the infection this year compared to last year, when the infection rate was between 15 and 25 per cent. However, this year it has already touched 40 per cent with a spurt in fresh cases during the second wave. Precaution is the key to ward off the infection," A C Mishra, director of the NIV told TOI in an exclusive interview on Wednesday.

 
"We, at the NIV, have been receiving over 200 throat swab samples from all over the state every day. Many of them come from far-flung areas which remained unscathed last year. There is an increase in cases as well as an increase in the infection rate," he said.

Elaborating further, Mishra said, "The H1N1 virus has become a dominant strain now. However, a few cases of seasonal influenza strains are also being seen along with H1N1."

"Since the infection rate has gone up, any kind of flu symptoms should be aggressively treated. Precautionary measures like frequent hand-washing and following healthy, hygienic habits are very important," he added.

"The most surprising, and perhaps most important point, is that the H1N1 virus behaves unpredictably and variably from one patient to the other. So we must be on our toes and react fast," said Mishra.

 
Asked whether the virus will behave more virulantly, Mishra said, "Two other flu pandemics of the 20th century, those of 1957 and 1968, showed no more than a single seasonal recurrence; and in each case, the causative virus did not become significantly more pathogenic over the early years of its circulation. The variable track record of past flu pandemics makes predicting the future course of the pandemic H1N1 virus difficult."

Asked about the efficacy of the currently available vaccines to prevent H1N1 infection, Mishra said, "The vaccine is definitely advised. However, thinking that once vaccinated, there is no need to be cautious is absolutely wrong. The vaccines are found to give immunity to 90 per cent of people who have undergone vaccination. However, a few people may catch the infection even after taking the shot. Hence, taking all precautions is always advised."

Commenting on the media frenzy over the second wave of the virus, Mishra said, " Call it the second wave, second episode or second phase, the point is that there has been a sudden spurt in fresh cases, and going by the past experience of influenza pandemics, a second wave is characterised by a brief lull followed by a sudden spurt in fresh cases of infection and illness. Instead of focusing too much on whether it is the second wave or not, the media should alert people about being cautious."

       A three-day youth carnival has been organised in Chennai to spread AIDS awareness and sensitise masses about the deadly disease.

Pledging their solidarity with the people living with HIV, scores of people participated in the special 'Illavatam' (Youth Carnival) amid fanfare and exuberance.

In a bid to strengthen social amalgamation, the activists also held plays and musical shows with a 'humanist' approach and condemned the widespread practice of marginalisation and discrimination against the HIV infected people.

Hosted by the Indian Community Welfare Organisation (ICWO), a spate of mesmerising cultural performances and breathtaking acrobatics were also held during the course of the inaugural session.

The organisers said the main objective behind the festival is to enlighten youngsters about HIV-AIDS and remove misconceptions and doubts that instigate fear with regard to the ailment.

"Specifically, this platform is used to give opportunity for the HIV infected people to come and express their status and mobilize support for people living with HIV-AIDS. There are also performances by them, lot of interactions and small group meetings," said A.J. Hariharan, Founder Secretary of the ICWO.

"This platform is to provide information, not to discriminate or isolate people living with HIV-AIDS," he added.

The event that began on Tuesday garnered a lot of support with the participation of the locals.

Exhibition matches of volleyball and football were also organised to spread AIDS awareness, while over 3,000 students from schools and colleges of the city actively presented their artistic skills in diverse competitions.

"In today's scenario, people are not even aware of the difference between HIV and AIDS. They are two different things and people are not aware of that. I think it will be good if they are educated on HIV," said Bharathi, a college student.

"This will be more beneficial because it is told through entertainment which reaches people very easily. I am very happy to be a part of this programme, and I am very happy to contribute a little bit for the eradication of AIDS," he added.

As per the report of the United Nations, over 5.7 million people in India are infected with HIV/AIDS. (ANI)

A warning shout rings out to one Mahesh, who was entering the emergency block of Gandhi Hospital, “Do not go inside without wearing a mask.” Fear abounds every corner after three doctors contracted swine flu. Panic is widespread in the hospital premises, as people are gripped by the fear of H1N1 influenza.

The moment one enters the Gandhi Hospital, one is greeted by the sight of security men, patients and their attendants, doctors and everybody else wearing masks or handkerchiefs. None of the attendants of swine flu patients are allowed to spend time near their wards.

“We have been told to wear masks as we are constantly exposed to the hospital environment. With news spreading that the flu had been contracted by a few hospital doctors, it is giving us sleepless nights,” said a security guard. All hospital officials are tight-lipped about the status of patients being treated. When Express tried to contact the superintendent Dr Ashok Kumar in his chambers, he declined to speak. “The superintendent has given us instructions not to allow any mediapersons who want to talk about swine flu,” said the superintendent’s assistant.

The three doctors undergoing treatment include two house surgeons and one assistant professor. They are being treated in isolated wards, where patients who are critical are treated.  Interestingly, despite all three of them taking the preventive swine flu vaccine several days ago, they still contracted the virus. Meanwhile,  seven nursing students who had contracted swine flu are said to be recovering.

It should be recalled that 175 nursing students who had been agitating for them to be given the swine flu vaccine were administered the vaccine.

The Ministry of Health protested against a British study which blamed India for exporting a multiple drug-resistant superbug to the rest of the world. "India strongly refutes the naming of this enzyme as New Delhi metallo beta lactamase (NDM-1) and also refutes that hospitals in India are not safe for treatment, including medical tourism," a statement from the Union Health Ministry said.

"It is ridiculous to call it NDM-1 when none of the samples that tested positive were picked in New Delhi," said Dr Naresh Trehan, Chairman, Medanta-The Medicity, who called it a commercially-motivated campaign to hurt India's Rs 1,200-crore medical tourism industry.

He got support from Dr V M Katoch, secretary, department of health research.

"Getting infection by such drug-resistant bacteria is a matter of chance and can happen anywhere. A national resistance alert was issued in UK hospitals in July 2009, and similar alert has been sounded now. Similar superbugs have been reported from Israel, US, Greece and Scotland..." said Dr Katoch.

The Government said that there was a conflict of interest in the publication of the report, as the study was funded by the European Union and two pharma companies - Wellcome Trust and Wyeth - who produce the antibiotics for treatment of such cases, according to reports.

According to reports, the superbug is present in the UK and Europe.

Sources say Karthikeyan K Kumaraswamy, the scientist who was heading the study, received a travel grant from Wyeth. David M Livermore, another scientist on the team, received conference support from numerous pharma companies and also holds shares in AstraZeneca, Merck, Pfizer, Dechra and GlaxoSmithKline and as Enduring Attorney, manages more holdings in GlaxoSmithKline and Eco Animal.

The Government has also asked for a detailed report from the National Institute of Communicable Diseases and the Director General of Health Services on the NDM1 superbug.

The Government has said that the conclusions of the study that hospitals in India were not safe for treatment were totally baseless and were likely to dent the prospects of medical tourism in the country.

Pune, which is considered as the epicentre of Swine Flu in India, has once again seen a surge in Swine Flu deaths. At least 8 people died of Swine Flu in the city in the last two days.

The Swine Flu death toll in Pune since August 2009, has gone up to 331 - the highest in the country. The latest victims included a 10-month-old baby.

At least 46 people tested positive for Swine Flu in Pune on Wednesday. The latest Swine Flu positive cases and casualties have alerted the medical authorities. They have urged people to take precautions to avoid H1N1 infection.