Beta Blockers combined with ACE Inhibitors will further reduce mortality in heart failure-Dr. M. Waqas


 SMDC Second Int. Med. Conference proceedings

Beta Blockers combined with ACE Inhibitors will
further reduce mortality in heart failure-Dr. M. Waqas

Goal of treatment is improve symptoms, quality of life,
slow progression of disease and reduce mortality

LAHORE: Dr. Mohammad Waqas was one of the invited Keynote speakers in the State of the Art session-III of the just concluded Second International Medical Conference organized by Shalamar Medical & Dental College held from February 2-4, 2018. The topic of his presentation was Advanced Heart Failure Past, Present and Future. This session was chaired by Dr. John Lantos while Prof. Bilal Bin Younis was the moderator.

Dr. Waqas first described in detail the American College of Cardiology and American Heart Association classification of heart failure and pointed out that if Ejection Fraction is less than 40%, the mortality goes up. Majority of these patients are suffering from AIDs, Leukemia, lung cancer, pancreatic cancer. The goal of treatment is to improve symptoms, improve quality of life, slow progression of the disease and reduce mortality. Speaking about therapy for heart failure, he stated that beta blockers results in biggest reduction in mortality. If they are combined with ACE Inhibitors it will reduce the mortality further. He then gave details of SHIFT trial in reduced heart rate, PARADIGM-HF trial wherein the combination of ARN1 plus Enalapril was used. Device therapy resulted in 54% reduction in mortality with low ejection fraction.

On left Dr. John Lantos presenting mementoes to Dr. Waqas and Dr. Majid Mushtaq while on right
Prof. Bilal Bin Younis is presenting the Memento to Prof. Vugar Mammdov from Azarbijan during one
of the Plenary Sessions at recently held Second International Medical Conference organized by
Shalimar Medical & Dental College at Lahore from February 2-4, 2018.

Continuing Dr. Waqas said that ICDs have become more popular than transplants. It provides mechanical support for the heart. According to reports there are about 5-7% prevalence of heart failure all over the world and these patients die of multiple reasons including infections. VAD is contra indicated in patients over the age of seventy years and there is need for appropriate mechanism for follow up. In the recent years LVAD use has increased. Hypotension and cardiogenic shock patients can be referred for these devices. He laid emphasis on starting a Heart Failure Registry, publication of data and collaboration with some overseas institutions. Dream should be combined with passion which makes it great. Device therapy significantly reduces morbidity and mortality in heart failure, he added.

Bioethics and Medical Law

Prof. Vugar g. Mammadov from Azarbijan was the next invited keynote speaker in this session who talked about importance of Bioethics and Medical Law courses. Bioethics, he opined, goes far than human rights. He then discussed bioethics course curriculum and contributions by UNESCO. It is taught in Medical and Law universities and covers various laws including human rights and human dignity. Human Rights is the key element of bioethics. He discussed how it all developed and the global changes which occurred in view of the changing values, technologies. It is important that all these should be useful for people. Bioethics also covers end of life issues, birth related issues, global changes and technology, corruption in health sector. It is extremely important to speak about all these issues.

Continuing Prof. Vugar Mammadov opined that we must find out what is morally right and what is wrong. Differentiate between personal and public interest. The Bioethics curriculum includes thirty six hours academic teaching. These subjects in our region are taught by forensic medicine departments. We have had 324 TV Talk shows about doctors and bioethics, patient rights etc. Medical Errors, he said, was the third leading cause of death but it is never taught in medical schools. Corruption is prevalent much more in our countries. He concluded his presentation by a quotation from late Nelson Mandela who had said that “Education is the most powerful weapon you can use to change the world”.

Minimal Invasive procedures
in Chest Medicine

Dr. Majid Mushtaq talked about Minimal Invasive procedures in Chest Medicine and discussed at length what we can do and how cost effective various procedures are. Many of these minimally invasive procedures, he opined, are not only effective but also cost effective. With the new advances, we can do a lot in respiratory patients. He then talked about FNA, Medial Thoroscopies, Pleural ultrasound etc. Lung biopsy, he said, never give full picture, endo bronchial ultrasound is quite informative and useful. Lymph node biopsy is helpful to stage the disease. Most of these procedures can be done in endoscopy room, are day procedures, are minimally invasive and have high patient acceptance with high margin of safety. EBUS, he reiterated is a safe procedure for diagnosis and staging of the disease but cannot cure it which should be told to the patient.

Second part of his presentation was on Medical Thoroscopies wherein he talked about pleural effusion, pleural tap to thorascopy. Pleural effusion is seen in stage-4 of cancer and survival used to be three months which can now be extended to two years or so. He discussed the procedure in detail. So far we have done 127 Medical Thoroscopies of malignant pleural effusion.  One has to look at every procedure from the point of view of cost and extension in life. This procedure, he further stated, is safe, effective, and readily available. It gives as good results as detailed invasive procedures. Lung cancer patient survival has now increased to 20% and one in five patients is also cured. We must use cost effective procedures to increase life span, he conceded.

© Professional Medical Publications. All rights reserved.