Address At The Inauguration Of 6th Biannual International Congress Of Asian Vascular Society And Vsi

NETWORK IN A HUMAN : ROLE OF VASCULAR SCIENCE

I am indeed very happy to be with the specialists in the field of vascular diseases and inaugurate 6th International Congress of Asian Vascular Society and 11th Annual Conference of Vascular Society of India. I greet the organizers, vascular surgeons, medical technologists, pharmacologists, academicians and distinguished guests.

Vascular diseases

Recently, I participated in the Annual Convention of South Asian Society for Atherosclerosis and Thrombosis. I understand the vascular surgery deals with the diseases of all the blood vessels [arteries, veins and lymphatics] in the body except those in the brain which are dealt by neurosurgeons and those around the heart which comes under cardiac surgery. Though the term cardiovascular surgery was commonly used, in the past, now vascular surgery has emerged as a separate superspeciality. Vascular surgeon deals exclusively with the treatment of blood vessel diseases, whether it requires medical therapy, surgery or newer minimally invasive endovascular procedures.

For example, still we have not fully understood the phenomena, why the prevalence of heart diseases are more in Indian population especially in the urban area which is said to be 8%, and why the phenomenon of artery thickening takes place leading to blood clotting. I can see there is a commonality between the Cardio vascular and other vascular diseases. I understand, that the main factors contributing to these diseases are fatty material (bad cholesterol), fibrous tissues accumulate inside the arterial walls, presence of blood clot (thrombus) attached to the inner wall of an artery (intima), obstruction of the blood flow due to small fatty particles (embolus), air bubble or usually blood clot.

I can visualize the human body functions due to the network of arteries and veins connecting all the organs of the body. The healthy condition of this vascular network is essential for the smooth functioning of the all the organs which makes the entire body healthy. How do we ensure that the network is seamless and fully functional, that appears to the challenges before the all kind of vascular experts.

Dear friends, when I am in the midst of experts in the field of vascular diseases, I am reminded of the famous statement by Norman Cousins in his book, Anatomy of the illness,Patients are today reaching out to the doctor not just for medical help. They are reaching out for kindness, assurance and hope.I would also like to share with you a quote in the paper which I came across on the topic One World, One people, One surgery by Dr.T.E.Udwadia which states:  The poorest of the poor have as much right as anyone to less pain after surgery, reduced medication, less morbidity, shorter hospitalization, and early return to home, family, and work. Minimal access surgery and the expensive technology it requires are advocated, not as homage or tribute to new technology, but in appreciation of the manifold benefits this new technology gives our patients and our people. This thought has to be the focus of the specialist in Vascular diseases.

Treatment of vascular diseases

The occurrence of vascular disease is increasing rapidly, particularly in the Indian community. Multi-dimensional solutions are available for management of the diseases based on my discussion with experts. The solutions include medicinal treatment using Statins, which lowers the cholesterol in the blood by reducing the production of cholesterol by the liver. Statins block the enzyme in the liver responsible for making excess cholesterol. However one has to be careful about the side effects and take adequate precautions while treating the patients. The second is through angiography and angioplasty using stents. If the vein blockage is severe, surgical intervention will be necessary. The recent advances in medical research have opened several new opportunities for treating vascular disorders. Let us discuss.

(a) Stem cell therapy for future heart ailments

Newer knowledge emerging out of research on stem cells from abroad and India has to be taken note of and studied. Drawing of tens of thousands of stem cell - immature cells that are capable of transforming themselves into almost any kind of tissues from the suffering patients and inject them into the heart to stimulate heart repair. In one case, it is reported that the pumping efficiency has increased from 25% to 40% over a period of four months. In 2003, successful stem cell procedures that resulted in measurable boost in blood pumping capacity have increased substantially in many countries across the globe. This holds a big promise for effective heart repair for ailing people. Vascular surgeons must see that whether the stem cell can help in curing all kind of vascular diseases.

(b) Experience in stem cell:

During my visit to various laboratories, I happened to see the beginning of stem cell research for different purposes including brain research. I would like to share with you an important stem cell research application in the field of cardiology. When I met Dr. P. Venugopal, Director, All India Institute of Medical Sciences (AIIMS) a famous cardiovascular and thoracic surgeon, he told me about his experiences. He said in one of the cardiac diseases, where conventional medical and surgical treatment were ineffective because of the affliction of the heart muscle, use of autologous bone marrow stem cells implantation into the diseased heart muscles had been applied in order to improve the function of heart muscle. This kind of application of this procedure is the latest and very few cases have been done in the world, the first time in India. This is expected to open new frontiers in the treatment of patients for regeneration of heart muscles, thereby giving new hope for the patients suffering from end stage heart disease. I would suggest the vascular surgeons assembled here should work with the AIIMS in a collaborative venture to find solutions for vascular problems.

The New Scientist (dated 25th September) has reported another remarkable recovery of a heart patient at the John Wolfgong Goethe University at Frankfurt. Of course for the first time, I have come across a warning, stating that risk is very high. Against stem cell solution for every aspect of human disease, it is reported that large amount of tests on animals is needed before applying it on humans.

When we are progressing with stem cell research, it is essential to create a regulatory mechanism regarding the production of stem cell through embryo generated either from human foetus or through cloning in the laboratory. I am of the opinion that use of embryo for stem cell production in any form should be banned.

We have seen, that the incidence of vascular diseases arises out of human stress, food habit and living style. It is said that the prevention is better than cure. I would like to share with you an experience on life style intervention for prevention of heart diseases, which also could be applicable for vascular diseases  because of the common factor contributing to the disease are the same.

(c)Life style intervention

There is a need to propagate the importance of appropriate food habit and life style among the urban population to combat the situation of increased occurrence of heart ailment. Hospitals in the country should take proactive steps to counsel their clients in a family atmosphere for ensuring reduction in this number in the years to come. Another feature which has been noticed is that there is a competition, between cardiologists and surgeons in treating heart cases. The ideal practice should be to provide only the minimum essential treatment instead of going in for surgical intervention as a routine management of the disease.

It has been reported that the repeated occurrence of heart ailments is caused by diet, smoking, and lack of exercise and uncontrolled diabetes. All these factors can be controlled by an appropriate life style intervention. I have seen the change of life style pattern practically taking place in Global Hospital and Research Center, Mount Abu. There was a joint project of Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO and the Global Hospital and Research Center for studying the effect of "holistic lifestyle intervention" on the patients suffering from Coronary Artery Diseases during the year 1997-98. The project involved both Control Group and the Experimental Group. The Control Group was subjected to conventional treatment whereas the Experimental Group was supported by an intervention involving low fat, high fiber vegetarian diet, aerobic exercises and meditation. This three-dimensional psycho-physiological mind-body approach in treating heart patients of the Experimental Group resulted in dissolution of angiographic plaque and improvement in microcirculation of blood in heart muscles of the patients. The treatment was also supported by participation of spouses and other family members of the patients, leading to a unique family system approach to Medicare. The vascular surgeons may also like to conduct experiments on this type of life style intervention for patients who are vulnerable to have vascular diseases. I would like to share with you a diagnostic mechanism for early detection of vascular diseases.

(d) Research in Gene Chip

Indian population is highly susceptible for coronary heart diseases that too at a relatively young age irrespective of where they live. As you are aware, Gene Chip arrays have tremendous potential to reach goals from identifying genetic variations associated with heart disease for discovering new drug targets.

Recently, I was in Chennai at Dr. Cherians Medical Centre. It is known as, International Centre for Biomedical Sciences and Technology (Research & Applications). There I interacted with Dr. Emmanuel, who is working in the area of Gene Chip. He says the Gene Chip can be used for finding the existence of genetic diseases including coronary artery diseases in the baby during a certain stage of pregnancy itself.

As many as 50 different mutated genes are identified as responsible for heart problems in Indian population. If a person is not having any of these harmful mutated genes, then he may not suffer from heart ailments. The Gene Chip is one which on contacting with the blood, immediately identifies the mutated genes in the person. Based on this information, proper guidance can be given to the patients and parents. The chip could also be modified to suggest to the patient�s system to develop those chemicals which in turn will help the patient recover from the present situation.

It is reported that gene differences between humans and most animals are very nominal. More than 90% of our DNA is similar. This property is a boon to researchers since animal models can be subsequently used for curing human diseases based on trial data. It has also been found that Gene Chips can be used for early diagnosis of tumors and their treatment. Integrating molecular biology, cytogenetics and bio-chemistry, bio-chip technology is regarded as one of the important inventions in the research of gene functions. It is far superior to molecular biological technology in terms of speed and accuracy. I would recommend the medical researchers to progress further in this area for finding the application of Gene Chip as a diagnostic tool and as a treatment regime for many diseases.

Conclusion

Medical profession is a noble profession and it has always been patient centric. The patient has the right to have right type of medical care, with right type of medical practitioners. How does a patient know, whether he should go to a cardiologist or a neurologist or a nephrologists or vascular surgeons? He is made to go from one place to another in search of the right specialists. An integrated mechanism is needed to see that patient without frustration is directed to the right specialist for right diagnosis at the right time at a right cost. Medical community particularly in the vascular area may discuss in the international conference from the patients point of view.

The human vascular network is the life line for the healthy functioning of the entire body. In this domain of yours, you will collaborate with the other specialists and experts in the field of cardiology, neurology, nephrology etc to find a total solution with minimum intervention and bring a smile in the patients.

I wish you all success for the conference and the deliberations leading to providing cost effective treatment to the patients.

May God bless you.