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Editorial

"Healing takes courage, and we all have courage, even if we have to dig a little to find it."
Tori Amos

One of the chief missions of the Cardiology chapter of IAP has been to provide opportunities for paediatricians, obstetricians, pediatric cardiologist to incessantly refine their clinical appreciation of heart diseases in population, and keep abreast of the latest developments in the field. How far we reached after adopting a 5 point program in year 2008? Let's Discuss the current concerns and their addressing tools of interventions what we have done till now.

Unexplored Horizon of Pediatric cardiology:

A Word on world of research

Clinical research in the field of pediatric cardiology is a turtle walking slow, yet it has enormous implications for cardiovascular care and long-term benefits .So, question is, when we will decide to adopt a comprehensive research agenda that identifies the most-needed studies to bring forth the informational necessities to formulate policy on cardiac care and who will organize, supervise and fund the overall financial and scientific efficiency of research? Targeted research efforts only can tailor truly customised evidence-based practice guidelines, and more rapid and safer development of drugs. Then, another big task is to get cost effective lab to identify genetic markers. We need potential breakthroughs in areas such as development of epidemiological investigation tools, genetic screening, biomarkers, cardio-protective strategies, long-term monitoring technologies. Also, we need to understand influence of digital technology on upgradation of tertiary care in the field. IAP and PCSI has developed teaching modules through internet and regular informative lectures are being delivered.

Insurance: Plan for long term care

The sore fact for families having patient suffering from cardiac defects and service providers in the field of pediatric cardiology is the need for high cost extremely efficient tertiary care set up in absence of satisfactory insurance facilities. The pediatric patients treated for congenital heart diseases are prospective high risk group for adulthood diseases like ischemic heart disease and hypertension. A family having such patients hinges between arranging finances for immediate treatment and future unseen threats of suboptimal capabilities of person and constant requirement for lifelong care. There can be few options for insurance and they must be tried at family, NGOs and government levels. Generally, the best way to get coverage is to go for group health insurance or family insurance. Most large companies will offer group health plans at reasonable rates, irrespective of person’s heart condition. If group coverage isn't possible, one may need to get insurance through a "high-risk" pool. Unfortunately, this can be expensive.
We appreciate efforts made by many state governments to support the financial aspect of pediatric cardiac care. But government needs to go deeper to bring the justifiable policies for long term care.

Eisenmenger syndrome: Ignorance or negligence

We are worried about neonatal mortality secondary to unrecognised treatable CHDs, most of them are duct dependent amenable to medical rescue management with prostaglandins and transportation. But biggest cause of concern is persistent prevalence of Eisenmenger Syndrome secondary to relatively simple untreated CHDs like ASD, VSD, PDA and AP window. Frequently, ignorance of parents as well as treating physicians is the basic cause.

Lifestyle diseases in pediatric age group:

The incidence of lifestyle diseases in children is alarmingly high and the trend has been continuing for the last few years. A sedate lifestyle and high intake of junk food drive these ‘silent killers’. Pediatric hypertension, now commonly observed, is known to be a major cause of morbidity and mortality world-over. The long-term health risks to children with hypertension may be substantial particularly in an obese child with hyperinsulinemia and altered sodium excretion. Time has come when office practice of pediatrics must include BP recording in children with 3years and above.

Pediatric cardiac care and PCPNDT Act

This brings us to the calamity that is secondary to PCPNDT act which has reached to level of prohibition where an easy diagnostic tool is losing its virtue. Cardiology chapters of IAP request all professional bodies to come together and bring a unanimous resolution against female feticide and propose a strategy to help the cause.

ACHIEVEMENTS

National guidelines

Cardiology chapter of IAP has convened the first-ever consensus meeting on rheumatic fever and related heart disease and it associated itself with formulation of guidelines on timing of intervention in CHD (2007) and guideline on drugs in pediatric cardiology (2008) Chapter also contributed in formulation of IAP drug formulary (2006) and participated in creation of Emergency drug-list in collaboration with WHO. Are Thankful to Dr Naveen Thacker (IAP president 2007-2008) and Dr RK agrawal IAP President (2008-2009) for providing support for the activity?

Awards

To recognise the leadership in individual capacity chapter has felicitated Dr Anita Khalil (2011), Dr (prof) N. K. Anand (2012), for life time achievement awards and Dr Rani gera (2011), Dr (prof) Zulfikar Ahmed (2012) for their excellent presidential innings.

Registry

Cardiology chapter under the guidance of central IAP leadership has developed a software program for national registry on pediatric hypertension. The implementation of registry is underway. Our thanks to Dr Deepak Ugra (President IAP2010-11), Dr Amit shah and Mr Rupak Parekh for help in developing the software and to dr Puspendra Singh Who helped for the financial aspects. The honourable IAP President Dr Rohit Agrwal and Secretary Dr Sailesh Gupta have agreed to go for a pilot study before starting it at the national level.

Regional units

We have expanded to accommodate regional bodies and website remained a good achievement. In year 2011, we conducted CME for the postgraduates in Delhi on the basics of pediatric cardiology. In future we are ready to have cyclical publication of news-letter for different states and regional representation at website.

Workshop and CMEs: Role of state units

It is the proud moment for chapter that it has been able to conduct very successful chapter program in PEDICON 2010, 2011, 2012. Hyderabad PEDICON (2010) had happening cardiology chapter program due to efforts done by Dr Nageshwer Rao and Dr Ashok Mittal who supported program in Hyderabad and with their efforts distribution of booklet ‘review on pediatric rheumatic fever and rheumatic heart disease’ was possible. Dr Nageshwer Rao also wrote a review on ECG distributed in Jaipur PEDICON. We had very successful pre conference workshops under the leadership of Prof (Dr) ML Gupta (Coordinator Rajasthan), Dr Meenakshi Sharma (Vice Chairperson), (2011, Jaipur), Dr Ajay Karkara (2012, Gurgaon). We are going to get good program at Kolkatta in PEDICON 2013 under the leadership of Dr Amitabh Chattopadhyay and Dr Biswejit Bandopadhyay. Dr NP Narayan (Bihar) , Dr SS Beriha (Odissa ) , Dr Jyoti Singh (MP) Dr Kshitij Sharma and Dr P Gupta (UP) , Dr Kashyp Seth (Gujrat )all are eager to hold programs and research oriented activities in their respective states. I must express my gratitude to all of them and to Dr Arun Gupta (treasurer) who showed keen interest in chapter activities despite being distant from cardiology.

Our Leaders

We must be indebted to Dr (Prof) NK Anand, Dr Anita Khalil, Dr (Prof) Zulfikar and Dr Rani Gera for their great perseverance and guidance to shape the chapter. Factually, unlike many other fields of paediatrics, cardiology remained poor cousin and less recognised till late.

Training program on Echocardiography.

Friends, we promised to bring workshops on echocardiography training for paediatricians in intensive care and fulfilled it by conduction first totally dedicated pre-pedicon (2012) workshop on hands-on training of echocardiography. Cardiology chapter advocates the ultrasound training for all postgraduates which is known as “Point of Care use of Ultrasound in neonatal and pediatric care” and request IAP to work on those lines.

ELECTIONS

Registration of chapter, member’s web page and Elections.

Dear friends, we are heading toward elections which are already delayed. The last but not the least, there is issue of registration of chapter as an independent organization to avail a PAN card. A procedure has been started but could not be completed due to various reasons. There have been financial issues in getting funds to carry on any activities. I would request to all of you to communicate your views regarding it.
For me, it has been an intellectual and emotional relationship so far. I am responsible for some inadequacies as things happened at far much slower rate than expected. We promised to start personal web page connectivity and we worked on that successfully. The financial constrains now we face is due to reasons mentioned above. Though not visible vividly, a web of information is created where all of you need to be active and influential. All of those now again need to contact if they have sent any draft for membership. Many of them could not be used. But if you have paid but not acknowledged, kindly report me at earliest.
Now, to conclude this conversation with committing ourselves for care of babies suffering from heart diseases. Let’s have high index of suspicion in a sick baby even without a murmur unless proved otherwise. If you encounter a vaccinated baby with measles like rashes having no cough, kindly try to rule out Kawasaki Disease. I request all of you to be involved with HIV awareness program. We have to ensure that every patients suffering from HIV must undergo antiretroviaral therapy to decrease the infectivity of patient. HIV patients can be adopted and cared with love and can be useful for society. My best wishes and thanks to all of you.

Dr Smita Mishra
Editor in chief.

www.cardioiap.org