SUNDAY, FEBRUARY 14, 2016 (PAGE-4)

MOVIE-REVIEW HEALTHLINES Not upto expectations Adult Congenital Heart Disease

fall on the eternally beautiful Firdaus Jaan Naqvi. Because, she takes a 'liking' for Noor's (torn) shoes, he gets hired as their stable's caretaker. Gradually, the duo start liking each other and each other's company. One day Noor comes looking out for Firdaus at her palace when Begum informs him that she has been sent away to London for education. The film then fast forwards a few years and now a grown up Noor (Aditya Roy Kapur) leaves his hometown to move to Delhi to build his career as an artist. As luck would have it, Noor meets Firdaus (Katrina Kaif) at a party and this time round, they try to 'com- plete' their 'incomplete' love. That's when Firdaus confesses to Noor that she will be soon getting married to an upcoming Pak- istani politician Bilal (Rahul Bhatt). The level of obsession that Noor has for Firdaus reaches crazy heights. Will Noor let go of Dr Amit Misri What are the risks patients with Adult CHD face? his childhood love Firdaus, will Firdaus have a change of heart The most life threatening risk is that of sudden death. This and leave Bilal and get married to Noor or does the extremely Congenital heart disease is a type of defect in is predominantly because of arrhythmias (irregular heart protective Begam have a way different plan for Firdaus is what which one or more structures of the heart or blood beats) secondary to effect of CHD on heart muscle. Apart from forms the rest of the film. that, infection of heart is not uncommon and could be diffi- FITOOR's director Abhishek Kapoor (who is best known vessels that occur before birth. The heart structures, cult to treat. Patients with hypertension secondary to for his films like KAI PO CHE and ROCK ON), seems extreme- or vessels, do not form as they should during preg- obstructed vessels can lead to brain hemorrhage. Patients who ly confused in his narrative of FITOOR. While the film does nancy. The incidence is about 8-10 case per 1000 live have mixing of oxygenated and deoxygenated blood have have its moments under the sun, FITOOR turns out to be such births. Many of these lesions are life threatening and chance of developing intracranial abscess because impure a BIG disappointment for all those who really had 'great expec- blood can reach brain which otherwise would have been fil- tations' (no pun intended) from the film. The film is nothing if not treated at the right time cause death within the tered in lungs. but an amalgamation of senseless, confusing and disjointed first year of life. On the other hand there are other What are the management possibilities? screenplay (Supratik Sen, Abhishek Kapoor) and poor direc- heart defects which are not so serious and remain The foremost important step is to consult a doctor who tion (Abhishek Kapoor). The screenplay is sorely disappoint- undetected till adulthood. deals with congenital heart disease and is fully aware of the ing, thus making the film look like an arthouse cinema featur- To make the general population aware about the occur- hemodynamics in such situations .A correct diagnosis and the ing popular stars. What adds to the downfall of the film is also rence of Congenital Heart Disease (CHD), its symptoms, and natural history of the specific CHD is important in formulat- the odd pairing of Aditya Roy Kapur and Katrina Kaif, who lack treatment, a full week Feb 7 to Feb 14 is celebrated as CHD ing a management plan. While some CHDs like small holes or the much needed chemistry to 'light up' a movie of this genre. awareness week. milder form of valvular obstruction may just need a regular After a point, the film's proceedings become way too difficult This article predominantly is dedicated to adolescent and follow up and certain precautions, other more significant to comprehend. The makers of the film have focused on every adult patients who are having some form of congenital heart lesions will require surgery or intervention in cath lab to cor- minute detail of the visuals in the movie, however one won- disease. rect the defect. ders why they didn't do the same level of detailing in the screen- What is the incidence of Adult CHD? Issues related to adult CHD? play. There are many scenes in the film that do no good to the Adult congenital heart disease is not uncommon. 1 in 150 Adults having congenital heart disease face many issues. film, but only land up confusing the viewers. Testimonials to adults are expected to have some form of congenital heart dis- These are related to job hunting, pregnancy and contracep- this are in the form of Ajay Devgn's role in the film, and also ease in US. 800,000 adults in the United States have grown tion, insurance, requirement of non cardiac surgical proce- the scene wherein Aditya reads a news article about a Begam into adulthood with congenital heart disease. This number dures. There is a lot of apprehension in general population spending a fortune on her heiress' wedding, whereas, the so- increases by about 20,000 each year. In India the prevalence and physicians regarding management of such persons. As far called 'wedding' never seems to take place in the movie. Despite of CHD in adults has been estimated to be 2.4 per 1000 pop- as pregnancy is concerned most of the treated cases and all the flaws and shortcomings, one has to admit that the film ulation. This difference from the western world may be attrib- females with non significant cardiac lesions can safely give looks extremely appealing visually. uted to lack of awareness about the disease and availability of birth. However it is imperative to have a multi disciplinary As for the performances, even though it's the film's lead pair limited screening tests. approach involving the obstetrician and cardiologist having Aditya Roy Kapur and Katrina Kaif who carry the film on their Which group reaches Adulthood? knowledge of adult CHD. In certain types of adult CHD oral 'able' shoulders, the confusing and lacklustre script acts as a The mortality rates of CHD if untreated is about 30-40% contraceptives may be contra indicated as they can lead to speed breaker in their respective performances. Both, Aditya during first year of life. But there are many forms of CHD coagulation disorders. Getting medical insurance may be an and Katrina seem to struggle in the film with their respective which either remain asymptomatic or cause limited symptoms uphill task and most do not cover cardiac interventions for characters. Even though Tabu does a decent job, the explana- till adulthood. These include small holes in heart or milder CHD. Jobs involving aviation or deep sea diving are more or tion for her weird behaviour throughout the film comes in too varieties of valvular or vascular obstructions. With increase in less prohibited. Anesthesia for non cardiac surgeries in such Many films in Bollywood have been made based on classic late. Ajay Devgn and Lara Dutta are totally wasted in the film. activity the demands of body increase and thereby symptoms patients is also challenging. novels. This week's release FITOOR too falls in the same cat- Rahul Bhatt, Aditi Rao Hydari, Akshay Oberoi, Delbar Arya Future road ahead? egory. The film's makers went on record to say that FITOOR and others try their level best to help the film move forward. tend to manifest. On the other hand there are people who are is based on Charles Dickens' 'Great Expectations', the very nov- The film's music (Amit Trivedi) is nothing to write about as diagnosed cases of CHD but cannot afford treatment. They With advancement in technology, diagnosis and treatment el that showcased forbidden love, betrayal and class struggles. only Fitoor title track and 'Pashmina' stands out. The film's tend to modify their lifestyle according to the symptoms. Then has become much easier. More and more patients are being With a starcast that boasts of the stunning Katrina Kaif and background score is average. While the film's cinematography there is other group which has received timely treatment in diagnosed early and receive timely appropriate treatment. In the hunky Aditya Roy Kapur, whether FITOOR lives upto the (Anay Goswamy) is outstanding, the film's editing (Deepa Bha- form of surgery or cardiac intervention and thus has been able near future we are going to see more treated cases of adult 'great expectations' or will it turn out to be a let-down, let's ana- tia) is decent. A special mention to the people behind the film's to reach adulthood. CHDs than untreated cases as is already happening in west- lyze. costumes. Though the film is only 2 hours and 11 minutes long, What are the symptoms? ern countries. Multi interdisciplinary approach involving car- FITOOR starts off with with the flashback that reflects the it feels like a never ending saga, due to its snail pace. Unlike infants whose symptoms remain mainly cyanosis, diologist having knowledge of CHD, general physician, obste- childhood of a young Kashmiri boy Noor Nizami and his 'blink- On the whole, FITOOR is a huge letdown despite its great inability to feed and fast breathing adults present with myri- trician, endocrinologist is going to be the way ahead. With and-you-miss' tryst with a random stranger (Ajay Devgn), who visuals, as it fails to connect emotionally. At the Box-Office, the ad of symptoms. These can be exertional breathlessness, exer- small life style adjustments and regular follow up this group turns out to be a certain Mirza Baig eventually. One of the days, movie will appeal only to a minuscule set of multiplex audi- tional fatigue, chest pain, syncope, haemoptysis, palpitations of population is going to live a near normal life and enjoy it to when Noor accompanies his brother-in-law to Begam (Tabu)'s ence. and cyanosis. Obstruction to aorta (artery supplying the whole the fullest palace for some carpentry work, his young and innocent eyes Courtesy http://www.bollywoodhungama.com. lower body) can present as hypertension or just exertional (The author is Dr Amit Misri Sr. Consultant Division of Pediatric Cardiology pain in calf muscles. (Medanta Heart Institute)Gurgaon Haryana. [email protected].) NAUTRE Understanding Genetic Diseases in J&K Dr Swarkar Singh In Jammu and Kashmir (J&K), the rate of consanguinity is relatively high due to restricted geographical localization, Have ever wondered why humans give birth to humans, ele- Puppy Training endogamous population groups and utmost, majority popula- phants to elephants, fish to fish and it remains the same for all tion performs relatively high consanguinity. During the past the living beings. Nature works here in a peculiar way and decade, few rare genetic disorders, such as Cystic Fibrosis (CF), answer to this lies in a molecule called Deoxyribonucleic Acid Rogers Syndrome, Rabson-Mendenhall Syndrome, abnormal- (DNA). DNA contains biological instructions to make each ities in normal sexual differentiation, Wolfram Syndrome have species unique and along with the instructions it contains is been reported in scientific literature in some consanguineous inherited to next generation. This biological information is families from J&K. Since, consanguinity is widely prevalent in encoded in fragments of DNA called Genes. There are approx- majority population, a very high prevalence of several rare imately 20,000-25,000 Genes in humans. These individually human genetic disorders, yet to be identified and character- or in combinations, including interactions with environment, ized, is suspected. These disorders might have remained take care of composition and all the functions of Human body. unidentified due to geographical isolation, less awareness and Each Gene has two copies and Mother and Father contribute limited clinical resources. We hear about many mysterious and equally, one copy each. In this way, transmission of characters unidentified disorders prevailing in the region in local media. from parents to offsprings is controlled (known as heredity). Genetics is a field of biology that helps us understand these In light of the population structure of the state very high pos- principles and mechanisms. During course of inheri- tance, from one generation to another, many a times some changes arise in DNA, which are called mutation or varia- tions and are inherited to the next generation. These varia- tions can be neutral or may have negative or positive impact as they may affect func- tion of a Gene. When a positive effect, it can be beneficial by helping in adaptation to envi- ronment and better survival. However, if negative impact, may result in a disease condi- Dr. Atul Anand notice while training session, the dog`s response intensi- tion: the scenario in Genetic Diseases. In Jammu and Kashmir (J&K), sibility is such disorders ty will decrease with the complexity of the task. If your pet As there are two copies of each Gene have a Genetic association. Many studies and articles on dog`s behavior have doesn't respond your orders or disobey, never punish it, present in an individual, mutations revealed that dogs have a complex range of simple unpleas- the rate of consanguinity is relatively With this rationale, key area just don't reward when it fails, and be little bit harder. If effect differentially in causation of dis- of our research is identifica- ant emotions such as jealousy and pride. The dog reacts you are rewarding it with food then start training session eases. In an individual, if one copy of high due to restricted geographical when another dog gets the food or when the new pet arrives tion and genetic characteri- before meal otherwise if you are rewarding it by praising, the gene inherited has mutation, the localization, endogamous or when they are ignored. They feel the emotions coming zation of these rare genetic then you must begin at the time you think your pet wants disease may show up but with a milder disorders in the populations from their owners. Mostly dogs develop to seek your attention, for example, while population groups and utmost, effect or no effect. However, if both the of Jammu and Kashmir. Our their behavior at the age of one year right You must returning from office or when it is playing in inherited copies of Gene are with majority population performs research group has recently from the birth. When a new puppy is the park etc. The food item you choose for mutation the situation turns severe identified and genetically brought to your house, you should intro- follow simple to reward must be favorite food of your dog for relatively high consanguinity. and many a times lethal and are called characterized a very rare duce it with surroundings slowly and slow- keeping your dog motivated for training ses- complex approach recessive genetic disorders. Because severe skeletal disorder, with incidence of one in million in UK, ly as it is new to the sight. Show it every sion. Food item must be small, not so large; object and make it sure there is nothing to recessive disorders have severe implications and are lethal seen affecting many individuals. The disorder remained of training. You it's just for attaining attention of your pet. It these diseases are very rare in incidences and most of the times be afraid of anything. When a new puppy may remain busy with chewing of food in unidentified for decades in a village of Poonch district of Jam- is brought to your home, they should be should use a are restricted to closely related individuals and families. Yet, mu and Kashmir. With cause unknown and no management, remaining task. You should praise your pet all the rare disorders together affect more individuals than socialized with the basic training. by patting it on back or rubbing the hairs this otherwise rare disorder, known as Progressive You and your pet should enjoy the command for common diseases like Cancer and Diabetes. So, it is important Pseudorheumatoid Dysplasia, started to appear profusely in along the direction it grows. Do not irritate to be aware and understand these disorders. At present, about training. Don't start training, if you are ending your training by annoying it like touching of your hand on the village in recent years. thousands of different types of rare disorders are known, some impatient. Training sessions should their head is disliked by some dogs. You In many of such disorders, that are not lethal in early age, of which are Cystic Fibrosis, Sickle Cell Disease, Fragile X Syn- remain short to that of hardly 5-10 min- session by using should reward the dog only when you get individuals remain normal at birth and have disease symptoms drome, Muscular Dystrophy, or Huntington disease. Rare utes which keeps your dog motivated for desired response from it. Avoid repeating later in age that keep on intensifying with advancement of age, training. While training, if there is no word like "free" and genetic disorders can have detrimental effects on any part of your commands because it is believed that sometimes resulting in loss of life. These disorders as such response to your command then don't should omit the use they remember your command for at least the body. These may appear in an individual randomly but appreciate it, by rewarding it. Repeat the rarely, inheriting two different mutations in same Gene by appear rare however, if unattended in due course may turn out two minutes. Using short commands are to be huge problem. Worldwide, Genetics has started to attain command again after few seconds. You of common words better than longer ones for your pet to chance. However, scientific evidences exist suggesting such key position in healthcare services and rare disorders screen- must follow simple to complex approach such as "okay". respond. With your cheerful voice, call your disorders are found more frequently among those families that of training. You should use a command for dog's name, give command and then praise, follow a trend of performing repetitive consanguineous mar- ing and Orphan drug development is attaining importance as ending your training session by using word so that it can understand that it is not in trou- riages, that is, marriages between and restricted to close blood- altogether these pose huge health burdens. However, such prac- like "free" and should omit the use of common words such ble. "Affection and love is a vaccine of socialization". It is relatives. Closer the relationship, higher is the possibility of tices are still lacking in India, especially Jammu and Kashmir. as "okay". Begin with some basic commands such as come, love and affection which makes your dog immune to its inheritance of both mutated Gene copies and appearance of a ( The author is Coordinator of Human genetics Research Group, Department of Biotech- sit, down and stay. Also go for teaching common com- wild instinct. Be loving, kind, familiar, attentive, and disorder. Especially it is alarming and critical for the families nology, Shri Mata Vaishno Devi University, Katra.) mands like leave it, give it, stop it, and enough. You must friendly towards your pet. where incidences of such disorders already exist. (Contact author swarkar. [email protected] [email protected].