ta and given the difference in prevalence and age of onset among this Haitian cohort as compared to higher-income settings,” Justin R. Kingery, MD, PhD, associate professor of medicine at

Nevertheless, your holiday can still run smoothly if you utilise resources such as telemedicine — doctors available to you online via phone call, video call or text messaging. Whether this flu season causes you to get sick, your seasonal allergies get worse, an accident happens while prepping for the holidays or any other non-emergent mishap, you can turn to digital health-care platforms, such as MDLink, for safe, convenient and reliable services,

Keep reading to understand how you can count on telemedicine services this holiday.

How telemedicine can be useful this holiday

• Helps to avoid the holiday traffic. While telemedicine allows you to avoid long waits in the doctor's office and pharmacy, you may still get caught up in the holiday rush. This can include increased traffic as well as crowding on public transportation. Instead, speak with a specialist online from the comfort of your home, or wherever you may be, through platforms such as MDLink — helping you to avoid the roads as much as possible.

•Facilitates treatment from familiar providers during travel. Whether you're travelling locally or abroad, you can use MDLink's platform anywhere that has access to the Internet — allowing you access to your local health-care provider(s) who are aware of your medical history and can provide diagnosis/treatment within minutes virtually. Additionally, if you are in a rural area where the nearest health-care facility is not nearby, you can use this platform to access immediate health care without having to travel a far distance.

• Monitoring and care for chronic illnesses. Most take time off during the holiday season, but your chronic illnesses does not. Whether you have a specific concern about your illness, need to do a routine check-up or have a monthly prescription refilled, telemedicine can assist you to get all this done without running the risk of further complications.

When not to use telemedicine over the holidays

While telemedicine is extremely convenient and will prove to be a useful tool for many this holiday, there are some instances where this form of treatment is not appropriate. If you have any of the following symptoms please visit an urgent care facility immediately:

•Excess bleeding and/or vomiting

• Falling unconscious or severe head trauma

• Breaking or fracturing a body part

• Severe allergic reactions

• Emergent flare-ups of chronic illnesses (such as lupus, cancer, diabetes, etc)

• Severe chest pain

Additionally, if you do choose to contact a doctor via telemedicine for an accident such as a fracture, for example, they may send you a referral to go to an in-person facility to get some X-rays done. If your doctor online suggests that you get in-person care, please do so immediately.

We hope for everyone a safe, enjoyable, and accident-free holiday. However, if anything does happen, know that you can count on MDLink wherever you are and whenever you need medical advice.

Dr Ché Bowen, a digital health entrepreneur and family physician, is the CEO & founder of MDLink, a digital health company that provides telemedicine options. Check out the company's website at
www.theMDLink.com. You can also contact him at drchebowen@themdlink.com.

The unfortunate reality, however, is that for some individuals, chronic illness may exacerbate, and sudden illness may occur. Top on this list is cardiovascular diseases which remain the top causes of death and disability in most countries including Jamaica. Studies have shown that cardiovascular problems occur more frequently during the end of year festivities, peaking in the new year. Hypertension, for example, is a leading risk factor for heart attack and stroke. To enter the holidays in good health and stay in good health, it is prudent to keep your blood pressure under control during the holidays.

But we can play a role in keeping heart disease at bay during the holidays. How can we do that? By taking precautionary measures to limit or risk and control our risks.

Don't eat with your eyes

During the holiday period, most of us will be out of work and exposed to a lot more food and beverages than usual. We are also likely to exercise less. It is okay to party and have fun but be mindful of what goes into your mouth, especially if you have high blood pressure, diabetes, or heart failure. A good habit to help you along is to have a heart healthy meal at home before stepping out so you would be less likely to overindulge. A vegetable tray is almost always a good idea but be cautious about the dip that may come with it, which often is not as healthy as the vegetables they are served with.

Watch the sodium

Cardiologists are familiar with rising cases of acute heart failures presenting as emergencies at this time of the year. Sodium is the culprit in many of these cases often resulting from dietary indiscretion this time of the year. Surrounded by families and friends with fun times rolling, it is not unusual for patients with weak hearts and heart failure to indulge in meals with high sodium content. This is often compounded by poor compliance with medications at this time of the year.

Limiting sodium intake is very critical but can be quite challenging this time of year. Excess sodium in your bloodstream results in increased water retention in your blood vessels, leading to a rise in blood pressure or hypertension. While many individuals tend to focus on table salt, the reality is that most sodium in the typical urban diet is derived from processed foods. Anything that is canned or processed (and this includes different types of hams) is likely very rich in sodium and should be avoided especially by individuals with known medical history of high blood pressure or heart failure.

Dietary guidelines in the US recommend that adults consume no more than 2,300 milligrams of sodium a day while the American Heart Association recommends an ideal maximum of 1,500 milligrams a day for most adults. The body has an incredible ability to adapt and so the less salt you use, the less salt you would crave for resulting in an overall healthier you. Keep this in mind while you enjoy the holidays.

Do not drink to be merry

Alcohol is a culprit in raising blood pressure and can also lead to fluid overload in individuals with weak hearts or heart failure. Heavy alcohol intake can raise your blood pressure. In most countries, dietary guidelines allow for moderate drinking (two drinks or less in a day for men, and one or less for women), but paying attention to what's in your holiday cocktail is a wise idea. Not all cocktails are created equally. Margaritas, for example, are served in salt-rimmed glasses. Watch those.

Lower your stress level

The holidays can be fun but for some people, it brings a lot of stress. The pressure to achieve a perfect holiday can lead to unwarranted pressure. Stress-related hormones have been linked to increased risk for depression, diabetes, and high blood pressure. Increased stress is also associated with immuno-suppression and increased susceptibility to several illnesses. Stress can also lead to excess alcohol intake, overeating and drug use which can all be detrimental to your health. It's important to dial down the pressure to control your stress level and increase your chill factor. Consider massage therapy, yoga, long walks, visits to nature parks or art shows or simply rest.

What about medications?

While over-the-counter medications are generally safe, there are some pointers that are worth noting. Many commonly used decongestants can elevate your blood pressure. Be sure to look at the warning labels and when in doubt, speak to your doctor or health-care provider for guidance.

As previously noted, compliance with routine medications may pose a problem to some individuals at this time of the year. We recommend proactive efforts to set reminders and trackers to assist you in remembering to take your medications. This can keep you away from an unplanned trip to the hospital emergency room. Now you know some simple measures to take to protect your heart health during this holiday. What if you have a heart-related emergency despite all these precautions.

Your health insurance card is neither your credit card nor debit card

Many individuals with health insurance are under the false impression that they are covered in cases of heart-related emergencies. This is far from reality. In almost all cases, insurance pre-authorisation cannot be obtained in a timely manner when emergency situations require immediate intervention as in heart attack cases. In most instances, your insurance company may insist on a five–seven day window for pre-authorisation which may be detrimental to your care if this is your only source of financing for care and most likely, they would be unavailable to respond during the holiday period. In these situations, unless there is an alternative way of financing emergency treatment, care may be unduly delayed with potentially adverse consequences. It is advisable therefore to have contingency plans for emergency situations irrespective of your health insurance coverage. This is particularly important for family members and friends visiting from overseas as the health system in Jamaica is structured differently from those in the USA and UK ,for example, when it comes to emergency care services.

What to do in heart-related emergencies

Forward planning is always an advantage in dealing with heart related emergencies especially for those individuals with prior history or higher risk for heart disease. It is wise to have a good understanding of the resources available for emergency heart care in your area including knowing which ambulance services are available and how to access them and most importantly knowing which hospitals have the required infrastructure and medical personnel to handle emergency heart conditions. The telephone number and address of these services and facilities should be readily accessible to everyone in the household.

If all fails, DO NOT PANIC. The heart team at the Heart Institute of the Caribbean Heart Hospital is open 24/7 during the holiday period with medical officers on duty at the hospital 24/7, and we have waived emergency room doctors charges until December 31, 2022, to ensure that our citizens are better protected and can enjoy their holidays without worry. This is our Christmas gift to Jamaicans. The call number is 876-906-2106.

HIC Heart Hospital Emergency Room is open for all heart-related emergencies, 24/7 during this holiday period. Merry Christmas and stay safe.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Correspondence to info@caribbeanheart.com or call 876-906-2107

A recent study published in the International Journal of Environmental Research and Public Health challenged prior definitions of healthy or successful aging by adopting a broader perspective. The researchers Mabel Ho et al, observed older adults in Canada and identified unique attributes among people who age optimally. They also assessed how well people age despite any chronic illnesses that may develop as they grow older.

Reference:

Ho, M.; Pullenayegum, E.; Burnes, D.; Fuller-Thomson, E. Successful Aging among Immigrant and Canadian-Born Older Adults: Findings from the Canadian Longitudinal Study on Aging (CLSA). Int. J. Environ. Res. Public Health 2022, 19, 13199. https://doi.org/10.3390/ijerph192013199

Older adults who walked up to 9000 steps had healthier hearts: Study

Findings from the latest study led by Amanda Paluch, assistant professor of kinesiology in the School of Public Health and Health Sciences, show that older adults who walked between 6,000 and 9,000 steps per day had a 40-50% reduced risk of a cardiovascular event, such as a heart attack or stroke, compared to those who walked 2,000 steps per day.

The evidence-based health benefits of walking continue to accumulate, according to ongoing research by a University of Massachusetts Amherst physical activity epidemiologist, who leads an international consortium known as the Steps for Health Collaborative.

Reference:

Amanda Paluch et al, Prospective Association of Daily Steps With Cardiovascular Disease: A Harmonized Meta-Analysis, Circulation, DOI 10.1161/CIRCULATIONAHA.122.061288

Mystery behind a deadly brain cancer cracked by CHSL researchers

Glioblastomas, also known as GBMs, are grade 4 malignant (cancerous) tumours in which a sizable percentage of tumour cells are actively dividing and reproducing at any given time. They are fed by a plentiful and unusual blood supply from tumour vessels.

The brain cancer, glioblastoma, is a fierce and formidable opponent. Its millions of victims include Senator John McCain, President Biden's son, Beau, and famed film critic Gene Siskel, to name just a few. Most patients succumb within two years and few make it past five, a statistic that hasn't improved in decades due to lack of effective treatment options.

Reference:

Alea Mills et al,BRD8 maintains glioblastoma by epigenetic reprogramming of the P53 network,Nature,DOI:10.1038/s41586-022-05551-x

Smoking heightens the likelihood of having mid-life memory loss, confusion, finds study

The self-reported experience of greater or more frequent confusion or memory loss is known as subjective cognitive decline (SCD). One of the first obvious signs of Alzheimer's disease and other dementias is this type of cognitive impairment.

Middle-aged smokers are far more likely to report having memory loss and confusion than nonsmokers, and the likelihood of cognitive decline is lower for those who have quit, even recently, a new study has found.

Reference:

Jenna Rajczyk et al,Journal of Alzheimer s Disease,DOI10.3233/JAD-220501

The U.S. Court of Appeals for the Federal Circuit upheld a decision rejecting Genentech's bid to block the generic idiopathic pulmonary fibrosis (IPF) drug.

The Federal Circuit said Sandoz's drug would not infringe Genentech patents related to methods for managing side effects while using Esbriet. Other patents Genentech accused Sandoz of infringing were invalid, the appeals court said.

Representatives for both Genentech and Sandoz declined to comment, citing ongoing litigation.

San Francisco-based Genentech's Esbriet is used to treat IPF, a serious chronic lung disease. Roche earned over $1 billion last year from worldwide Esbriet sales.

Genentech sued Switzerland-based Sandoz and several other drugmakers, including Amneal Pharmaceuticals Inc and Teva Pharmaceutical Industries Ltd, for patent infringement in 2019 over their proposed Esbriet generics. Sandoz defeated Genentech's lawsuit against it in Delaware federal court in March and launched its generic in May.

Read also: Roche, Chugai Pharma to transfer Bonviva business in Japan to Taisho Pharma

The Federal Circuit agreed with the district court that Sandoz's generic would not infringe patents covering ways to avoid adverse interactions between Esbriet and another drug. It also upheld the decision that some of Genentech's patents were invalid.

"Varying doses in response to the occurrence of side effects would seem to be a well-established, hence obvious, practice," the appeals court said. "Thus, claiming it as an invention would appear to be at best a long shot."

Read also: Submit Phase IV CT protocol: CDSCO Panel tells Roche over Anti-Cancer drug Pralsetinib

The case is Genentech Inc v. Sandoz Inc, U.S. Court of Appeals for the Federal Circuit, No. 22-1595.

For Genentech: Daralyn Durie of Durie Tangri

For Sandoz: William Jay of Goodwin Procter

Read also: Roche Actemra gets USFDA okay to treat COVID in hospitalised adults

The course is a full-time course pursued at various accredited institutes/hospitals across the country. Some of the top accredited institutes/hospitals offering this course include: Apollo Hospital-Bhubaneshwar, Army Hospital (R and R)-New Delhi, B.M. Birla Heart Research Centre- Kolkata,and more

Admission to this course is done through the NEET-SS Entrance exam conducted by the National Board of Examinations, followed by counselling based on the scores of the exam that is conducted by DGHS/MCC/State Authorities.

The fee for pursuing DrNB (Cardiology) varies from accredited institutes/hospital to hospital and may range from Rs. 50,000 to Rs. 10,00,000 per year.

After completion of their respective course, doctors can either join the job market or can pursue certificate courses and Fellowship programmes recognized by NMC and NBE. Candidates can take reputed jobs at positions as Senior residents,Consultants, etc. with an approximate salary range of Rs. 6,00,000 toRs. 30,00,000 per year.

DNB is equivalent to MD/MS/DM/MCh degrees awarded respectively in medical and surgical super specialities. The list of recognised qualifications awarded by the Board in various broad and super specialties as approved by the Government of India are included in the first schedule of the Indian Medical Council Act, 1956.

The Diplomate of National Board in broad-speciality qualifications and super speciality qualifications when granted in a medical institution with attached hospital or in a hospital with the strength of five hundred or more beds, by the National Board of Examinations, shall be equivalent in all respects to the corresponding postgraduate qualification and the super-speciality qualification granted under the Act, but in all other cases, senior residency in a medical college for an additional period of one year shall be required for such qualification to be equivalent for the purposes of teaching also.

What is DrNB in Cardiology?

Doctorate of National Board in Cardiology, also known as DrNB (Cardiology) or DrNB in (Cardiology) is a three-year superspecialty programme that candidates can pursue after completing a postgraduate degree.

Cardiology is the branch of medical science dealing with the prevention and treatment of heart diseases.

The National Board of Examinations (NBE) has released a curriculum for DrNB in Cardiology.

The curriculum governs the education and training of DrNB in Cardiology.

The postgraduate students must gain ample of knowledge and experience in the diagnosis, treatment of patients with acute, serious, and life-threatening medical and surgical diseases.

The PG education intends to create specialists who can contribute to high-quality health care and advances in science through research and training.

The required training done by a postgraduate specialist in the field of Cardiology would help the specialist to recognize the health needs of the community. The students should be competent to handle medical problems effectively and should be aware of the recent advances in their speciality.

The candidate is also expected to know the principles of research methodology and modes of the consulting library. The candidate should regularly attend conferences, workshops and CMEs to upgrade her/ his knowledge.

Course Highlights

Here are some of the course highlights of DrNB in Cardiology

Name of Course

DrNB in Cardiology

Level

Doctorate

Duration of Course

Three years

Course Mode

Full Time

Minimum Academic Requirement

MD/DNB (General Medicine/Paediatrics/Respiratory Medicine) obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE

Admission Process / Entrance Process / Entrance Modalities

Entrance Exam (NEET-SS)

INI CET for various AIIMS, PGIMER Chandigarh, JIPMER Puducherry, NIMHANS Bengaluru

INI CET for various AIIMS, PGIMER Chandigarh, JIPMER Puducherry, NIMHANS Bengaluru

Course Fees

Rs. 50,000 to Rs. 10,00,000 per year

Average Salary

Rs. 6,00,000 to Rs. 30,00,000 per year

Eligibility Criteria

The eligibility criteria for DrNB in Cardiology are defined as the set of rules or minimum prerequisites that aspirants must meet in order to be eligible for admission, which includes:

• Candidates must be in possession of a postgraduate medical Degree (MD/MS/DNB) from any college/university recognized by the MCI (Now NMC)/NBE.

•The eligible feeder specialty qualification for DrNB in Cardiology is mentioned below

Name of Super Specialty course Course Type Prior Eligibility Requirement Cardiology DM/DrNB MD/DNB (General Medicine) MD/DNB (Paediatrics) MD/DNB (Respiratory Medicine)

•The prior entry qualifications shall be strictly in accordance with Post Graduate Medical Education Regulations, 2000 and its amendments notified by the NMC and any clarification issued from NMC in this regard.

•The candidate must have obtained permanent registration of any State Medical Council to be eligible for admission.

•The medical college's recognition cut-off dates for the Postgraduate Degree courses shall be as prescribed by the Medical Council of India (now NMC).

Admission Process

The admission process contains a few steps tobe followed in order by the candidates for admission to DrNB in Cardiology. Candidates can view the complete admissionprocess for DrNB in Cardiologymentioned below:

• The NEET-SS orNational Eligibility Entrance Test for Super specialty courses is anational-level master's level examination conducted by the NBE for admission toDM/MCh/DrNB Courses.
• Qualifying Criteria-Candidates placed at the50th percentile or above shall be declared as qualified in the NEET-SS in theirrespective specialty.
• The following Medical institutions are notcovered under centralized admissions for DM/MCh courses through NEET-SS:

1.AIIMS, New Delhi and other AIIMS

2.PGIMER, Chandigarh

3.JIPMER, Puducherry

4.NIMHANS, Bengaluru

• Candidates from all eligible feeder specialtysubjects shall be required to appear in the question paper of respective group,if they are willing to opt for a superspecialty course in any of the superspecialty courses covered in that group.
• A candidate can opt for appearing in thequestion papers of as many groups for which his/her Postgraduate specialtyqualification is an eligible feeder qualification.
• By appearing in the question paper of a groupand on qualifying the examination, a candidate shall be eligible to exercisehis/her choices in the counseling only for those superspecialty subjectscovered in said group for which his/ her broad specialty is an eligible feederqualification.

Fees Structure

The fee structure for DrNB in Cardiology varies from accredited institute/hospital to hospital. The fee isgenerally less for Government Institutes and more for private institutes. The average fee structure for DrNB in Cardiology is around Rs.50,000 to Rs. 10,00,000 per year.

Colleges offering DrNB in Cardiology

There are various accredited institutes/hospitals across India thatoffer courses for pursuing DrNB in Cardiology.

As per the National Board of Examinations website, the following accreditedinstitutes/hospitals are offering DrNB (Cardiology)courses for the academic year 2022-23.

Hospital/Institute

Specialty

No. of Accredited Seat(s) (Broad/Super/Fellowship)

AIG Hospital Mind Space Road, Gachibowli, Hyderabad Telangana-500032

Cardiology

3

Amandeep Hospital Dalhousie Road, Mamun Cantt, Pathankot Punjab-145001

Cardiology

1

Apex Heart Institute Block: G-L, Mondeal Business Park, Near Gurudwara, S. G. Highway, Ahmedabad Gujarat-380059

Cardiology

2

Apollo BGS Hospital Adichunchanagiri Road, Kuvempunagar, Mysore Karnataka-570023

Cardiology

1

Apollo Hospital 154/11, Opp. I.I.M., Bannerghatta Road, Bangalore Karnataka-560076

Cardiology

3

Apollo Hospital 21, Greams lane, Off Greams Rd, Thousand Lights, Chennai. Tamil Nadu-600006

Cardiology

6

Apollo Hospital Health City, Chinagdhili, Visakhapatnam Andhra Pradesh-530040

Cardiology

3

Apollo Hospital Parsik Hill Road, Plot no 13, Sector 23,CBD Belapur, Navi Mumbai Maharashtra-400614

Cardiology

2

Apollo Hospital Plot No. 251 Sainik School Road Unit-15, Bhubaneshwar Orissa-751005

Cardiology

2

Apollo Hospital Room No. 306, Office of the Director of Medical Education Jubilee Hills, Hyderabad Telangana-500033

Cardiology

3

Apollo Hospital Village Lingiadih, Seepat Road, Bilaspur Chhattisgarh-495006

Cardiology

1

Apollo Hospital International Plot No. 1A, GIDC Estate Bhat, District - Gandhi Nagar Gujarat-382428

Cardiology

2

Apollo Multispecialty Hospitals Limited 58, Canal Circular Road, Kolkata West Bengal-700054

Cardiology

5

Apollo Specialty Hospital No. 64, Vanagaram Ambattur Main Road, Off PH Road, Near Srivaru Kalyanamandapan, Ayanambakkam Tamil Nadu-600095

Cardiology

2

Apollomedics Superspeciality Hospital Sector B, Bargawan, LDA Colony , Lucknow Uttar Pradesh Uttar Pradesh-226012

Cardiology

1

Apple Saraswati Multispecialty Hospital (Apple Hospitals and Research Institute Ltd.) 804/2, 805/2, E Ward, Bhosalewadi, Kadamwadi Road, Kolhapur Maharashtra-416003

Cardiology

2

Army Hospital (R and R) Delhi Cantt, New Delhi Delhi-110010

Cardiology

2

Artemis Health Institute Sector 51, Gurgaon Haryana-122001

Cardiology

1

Asian Heart Institute and Research Centre G/N Block, Bandra Kurla Complex, Bandra East, Mumbai Maharashtra-400051

Cardiology

2

Asian Institute of Medical Sciences Sector 21-A, Badhkal Flyover Road, Faridabad Haryana-121001

Cardiology

2

Aster Medcity Kuttisahib Road, Near Kothad Bridge, South Chittoor P. O., Cheranalloor, Kochi Kerala-682027

Cardiology

1

Aster Prime Hospital (A Unit of Sri Sainatha Multi Specialty Hospital) Plot No. 2 and 4, Behind Mitrivanam Building, Ameerpet, Hyderabad Telangana Telangana-500038

Cardiology

2

B.M. Birla Heart Research Centre 1/1 National Library Avenue, KOLKATA West Bengal-27

Cardiology

1

Baderia Metro Prime Multispecialty Hospital (Formerly Metro Hospital and Cancer Research Centre) Kuchaini Parisar, Damoh Naka, Jabalpur Madhya Pradesh-482002

Cardiology

1

Bankers Heart Institute Near Tagore Nagar, Opp. Suryakiran Complex, Old Padra Road, Vadodara Gujarat-390015

Cardiology

2

Bansal Hospital C Sector, Shahpura Bhopal Madhya Pradesh-462016

Cardiology

1

Batra Hospital and Medical Research Centre 1, Tuglakabad Institutional Area, M.B. Road, Delhi-110062

Cardiology

2

Believers Church Medical College Hospital St. Thomas Nagar, Kuttapuzha P O, Thiruvalla Kerala-689103

Cardiology

2

BGS Global Hospital 67, Uttrahalli Road, Kengeri, Bangalore Karnataka-560060

Cardiology

1

Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital Sangli Miraj Road Sangli Maharashtra-416416

Cardiology

1

Capitol Hospital C/O Capitol Hospital Jalandhar Pathankot Road Nh 44 Near Reru Chowk Jal Punjab-144001

Cardiology

1

Care Hospital Exhibition Road, Nampally, Hyderabad Telangana-500001

Cardiology

3

Care Hospital Road No. 1, Banjara Hills, Hyderabad Telangana-500034

Cardiology

4

Care Hospital- Hi Tech City Old Mumbai Highway, Near Cyberbad Police Commisionerate, Gachibowli,Hyderabad, Telangana-500032

Cardiology

1

Caritas Hospital Thellakom P. O Kottayam Kerala-686630

Cardiology

2

CHL Hospital A.B Road, LIG Square, Indore Madhya Pradesh-452008

Cardiology

1

Continental Hospital Plot No. 3, Road No. 2, IT and Financial District, Nanakramguda, Gachibowli, Hyderabad Telangana-500032

Cardiology

2

Deenanath Mangeshkar Hospital and Research Centre. 8+13/2, Erandwane, Near Mhatre Bridge, Pune Maharashtra-411004

Cardiology

2

Delhi Heart and Lung Institute 3 MM, II, Panchkuian Road, Delhi-110055

Cardiology

2

Down Town Hospital G S Road, Dispur GUWAHATI Assam-781006

Cardiology

1

Dr. B L Kapur Memorial Hospital Pusa Road, New Delhi Delhi-110005

Cardiology

1

Dr. B. Nanavati Hospital Vivekanand Rd., Vile Parle West, Mumbai Maharashtra-400056

Cardiology

1

Dr. L H Hiranandani Hospital Hillside Avenue, Hiranandani Gardens, Powai, Mumbai Maharashtra-400076

Cardiology

2

Dr. Rajendra Prasad Govt. Medical College Dist. Kangra At Tanda, Himachal Pradesh-176002

Cardiology

2

Dr. Ramesh Cardiac and Multi Speciality Hospital D. no. 26-14-1, Nagarampalem Collector Office Road. Guntur Andhra Pradesh-522004

Cardiology

1

Dr. Ramesh Cardiac and Multispeciality Hospital (Formerly Citi Cardiac Research Centre Ltd.) Ring Road, Near ITI College, Vijayawada Andhra Pradesh-52008

Cardiology

3

Eternal Heart Care Centre and Research Institute 3-A, jagatpura Road, Near Jawahar Circle, Jaipur Rajasthan-302017

Cardiology

2

Fortis Escorts Heart Institute Okhla Road, New Delhi Delhi-110025

Cardiology

7

Fortis Hospital 14, Cunningham Road, Bangalore Karnataka-0

Cardiology

2

Fortis Hospital 154/9, Opp. IIMB Bannerghatta Road, Bangalore Karnataka-560076

Cardiology

2

Fortis Hospital A- Block, Shalimar Bagh Delhi-110088

Cardiology

2

Fortis Hospital Mulund Goregaon Link Road, Mumbai Maharashtra-400078

Cardiology

1

Fortis Hospital Sector-62, Phase-VIII, Mohali Punjab-160062

Cardiology

3

Fortis Hospital, 730, Anandapur, EM Bypass Road, Kolkata West Bengal-700010

Cardiology

1

Fortis Memorial Research Institute Sector-44, Opposite HUDA CITY centre Metro Station, Gurgaon, Haryana-122002

Cardiology

1

Frontier Lifeline Hospital International Centre for Cardio Thoracic and Vascular Diseases, R-30-C, Ambattur Industrial Estate Road, Mogappair, Chennai Tamil Nadu-600101

Cardiology

2

G Kuppuswamy Naidu Memorial Hospital Post Box No. 6327, Nethaji Road, Pappanaickenpalayam, Coimbatore Tamil Nadu-641037

Cardiology

6

Global Hospital and Health City (A unit of Ravindernath GE Medical Associate Pvt Ltd) No-439, Cheran Nagar, Perumbakkam, Chennai Tamil Nadu-600100

Cardiology

1

Government General Hospital Ernakulam Road, Cochin Kerala-682011

Cardiology

2

Government Medical College Karan- Nagar, Srinagar Jammu and Kashmir-190010

Cardiology

2

Govt. Medical College B-5, Medical Enclave, Jammu Jammu and Kashmir-180001

Cardiology

2

Grecian Super Speciality Hospital (A unit of R.G.S Healthcare Pvt. Ltd), Sector-69, Opp. Village Kumbra, S.A.S Nagar, Mohali Punjab-60062

Cardiology

2

HCG Hospital, 1, Maharastra Society, Mithakhali, Ellisbridge Ahmedabad Gujarat-380006

Cardiology

2

Heart and General Hospital 7, Vivekanand Marg, C- Scheme, Jaipur Rajasthan-302001

Cardiology

1

Holy Family Hospital St. Andrew`s Road, Bandra West, Mumbai Maharashtra-400050

Cardiology

2

Holy Heart Super Speciality and Trauma Centre 330, Vinay Nagar, Delhi Bypass Chowk, Rohtak Haryana-124001

Cardiology

1

Indiana hospital and Heart Institute Near Mahaveer Circle, Pumpwell, Kankanady, Manglore Karnataka-575002

Cardiology

1

Indira Gandhi Institute of Cardiology PMCH Campus, Ashok Raj Path, Patna Bihar-800004

Cardiology

2

Indraprastha Apollo Hospital Delhi-Mathura Road, Sarita Vihar, New Delhi Delhi-110076

Cardiology

2

Ivy Health and Life Sciences Sector 71 SAS Nagar Mohali, Punjab-160071

Cardiology

2

Jagjivan Ram Railway Hospital Maratha Mandir Road, Mumbai Central, Mumbai Maharashtra-400008

Cardiology

1

Janakpuri Super Speciality Hospital Society (An Autonomous Institute) Under Govt. of NCT of Delhi C-2B, Janakpuri, West Delhi, Delhi-110058

Cardiology

2

Jaslok Hospital and Research Centre 15, Dr. Gopalrao Deshmukh Marg, Mumbai Maharashtra-400026

Cardiology

1

Jehangir Hospital 32, Sassoon Road, Pune Maharashtra-411001

Cardiology

1

Jupiter Hospital Eastern Express Highway, Thane (West) Maharashtra-400601

Cardiology

1

K.G. Hospital and PG Medical Institute No.5, Arts College Rd, COIMBATORE Tamil Nadu-641018

Cardiology

1

Kamalnayan Bajaj Hospital (Marathwada Medical and Research Institutes) Gut No. 43, Beed Bypass Road, Satara Parisar, Aurangabad Maharashtra-431005

Cardiology

1

Kasturba Medical College Hospital (KMC Hospital) Dr. B R Ambedkar Circle, Jyothi Balmatta Road, Mangalore Karnataka-575001

Cardiology

4

Kauvery Hospital No. 199, Luz Church Road, Mylapore, Chennai Tamil Nadu-600004

Cardiology

1

Kauvery Hospital Heart City Old No. 12, New No.52 Alexandria Road Cantonment Trichy Tamil Nadu-620001

Cardiology

2

Kerala Institute of Medical Sciences P B No.1, Anayara P O, Trivandrum Kerala-695029

Cardiology

2

KIMS Hospital # 1-112/86, Survey No 55/ EE, Kondapur Village, Serilingampally Mandal, Hyderabad Telangana-500084

Cardiology

1

KIMS Icon Hospital (A Unit of Iconkrishi Institute of Medical Sciences Pvt.Ltd) 32-11-02, BHPV Post, Sheelanagar, Visakhapatnam Andhra Pradesh-53001

Cardiology

1

KIMS Saveera Hospital #1-1348,Srinagar Colony Extention,Opp Sakshi Office,Anantapuram Andhra Pradesh-515004

Cardiology

1

Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute Achyutrao Patwardhan Marg, 4 Bunglows, Andheri (W), Mumbai Maharashtra-400053

Cardiology

1

Kovai Medical Centre Post Box No. 3209, Avinashi Road, Civil Arodrom Post, COIMBATORE Tamil Nadu-641014

Cardiology

2

Krishna Institute of Medical Sciences 1-8-31/1, Minister Road, Secunderabad Telangana-500003

Cardiology

3

Krishna Institute of Medical Sciences 77-7-7, Seelam Nukaraju Complex Road, Katari Gadens, Rajahmundry Andhra Pradesh-533103

Cardiology

1

Krishna Institute of Medical Sciences Ltd Dargamitta, Nellore Andhra Pradesh-524003

Cardiology

1

Lalitha Super Specialty Hospital Kothapet, Guntur Andhra Pradesh-522001

Cardiology

2

Lilavati Hospital and Research Centre A-791, Bandra Reclaimation, Bandra West, Mumbai Maharashtra-400050

Cardiology

3

Lisie Medical Institution P.O. Box 3053, KOCHI-18 Kerala Kerala-682018

Cardiology

3

M.I.O.T. Hospital 4/112, Mt-Poonamallee Rd, Nanapakkam, CHENNAI Tamil Nadu-600089

Cardiology

1

Madras Medical Mission Hospital 4A Dr Jayalalitha Ngr, Mogappair CHENNAI Tamil Nadu-600037

Cardiology

4

Maharaja Agrasen Hospital Rohtak Road, West Punjabi Bagh New Delhi Delhi-110026

Cardiology

2

Malabar Institute of Medical Sciences Mini Bye Pass, Govindapuram, Calicut Kerala-673016

Cardiology

2

MALABAR INSTITUTE OF MEDICAL SCIENCES Ltd CHALA EAST, KANNUR Kerala-670621

Cardiology

2

Manipal Hospital No. 98, Rustum Bagh, Old Airport Road, Bangalore Karnataka-560017

Cardiology

2

Max Smart Super Specialty Hospital (Formerly Known as Saket City Hospital), Mandir Marg, Press Enclave Marg, Saket, Delhi-110017

Cardiology

1

Max Super Specialty Hospital (A unit of Balaji Medical and Diagnostic Research Centre) 108A, Opp Sanchar Apartments, IP Extension, Patparganj,New Delhi Delhi-110092

Cardiology

2

Max Super Specialty Hospital 1,2, Press Enclave Road, Saket, Delhi-110017

Cardiology

5

Medanta The Medicity Sector-38, Gurgaon Haryana-122001

Cardiology

3

Medica Superspecialty Hospital 127 Mukundapur, E M Bypass, Kolkata West Bengal-700099

Cardiology

2

Medicover Hospitals (Formerly MaxCure Hospital) Behind Cyber Tower, Lane next to McDonald, Hi-tech City, Madhapur, Hyderabad Telangana-500081

Cardiology

2

Medicover Hospitals MVP 1-1-83, NH16, Beside Petrol Bunk, Sector- 6, Venkojipalem, Visakhapatnam Andhra Pradesh-530017

Cardiology

3

Meenakshi Mission Hospital and Research Centre Lake Area, Melur Road, MADURAI Tamil Nadu-625107

Cardiology

1

N M Virani Wockhardt Hospital Kalawad Road, Rajkot Gujarat-360005

Cardiology

1

Narayana Hrudayalaya Monogram Mill Compound Opp. Rakhial Police Station, Rakhial Gujarat-380023

Cardiology

2

Narayana Hrudayalaya Hospital (NH-Narayana Health City, Bangalore) #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore Karnataka-560099

Cardiology

8

Narayana Hrudayalaya Surgical Hospital CAH 1, 3rd Phase, Devanur, Mysuru Karnataka-570019

Cardiology

2

Narayana Multispecialty Hospital Sec-28, Rana Sanga Marg, Pratap Nagar, Jaipur Rajasthan-302033

Cardiology

2

National Heart Institute 49 Community Centre, East of Kailash, New Delhi Delhi-110065

Cardiology

3

NIMS Medicity Noorul Islam Institute of Medical Sciences and Research Foundation Aralummoodu, Neyyattinkara, Trivandrum Kerala-695123

Cardiology

2

P.D. Hinduja National Hospital and Medical Research Centre Veer Savarkar Marg, Mahim, Mumbai Maharashtra-400016

Cardiology

1

Paras HMRI Hospital NH - 30, Raja Bazar, Bailey Road, Patna Bihar-800014

Cardiology

2

Peerless Hospital and B K Roy Research Centre 360, Panchasayar, KOLKATA West Bengal-700094

Cardiology

1

Polakulath Narayanan Renai Medicity Multi Super Specialty Hospital PB No. 2259, Palarivattom (PO), Cochin Kerala-682025

Cardiology

1

PRS Hospital Tc 21/53 Killippalam Karamana Trivandrum Kerala-695002

Cardiology

1

Pushpawati Singhania Hospital Press Enclave, Sheikh Sarai Ph-II, Delhi-110017

Cardiology

1

Quality Care India Limited (Care Hospital) (Formerly Visakha Hospital and Diagnostics (Care Hospital)) A.S. Raja Complex, Door No: 10-50-11/5, Waltair Main Road, Ramnagar, Visakhapatnam Andhra Pradesh-530002

Cardiology

2

Rabindranath Tagore International Institute of Cardiac Sciences Premises No.1489, 124, Mukundapur, E M Bypass, Near Santhoshpur Connector, KOLKATA West Bengal-700099

Cardiology

4

Rajiv Gandhi Super Speciality Hospital Tahirpur, Delhi-110093

Cardiology

1

Ramkrishna Care Hospital Aurobindo Enclave, Pachpedhi Naka, Dhamtari Road, N. H. 43, Raipur Chhattisgarh-492001

Cardiology

1

Rhythm Heart Institute Near Siddharth Buglows, SAMA-SAVLI Road, Vadodara Gujarat-390022

Cardiology

1

Ruby Hall Clinic 40 Sassoon Road Pune Maharashtra-411001

Cardiology

2

Sahyadri Narayana Multispecialty Hospital Harakere, N T Road, Shimoga Karnataka-577202

Cardiology

2

Saideep Healthcare and Research Pvt Ltd Viraj Estate, Yashwant Colony, Tarakpur Ahmednagar Maharashtra-414003

Cardiology

1

Sakra World Hospital (A Unit of Takshasila Hospitals Operating Private Limited) No. 52/2, 52/3, Devarabeesanahalli, Varthur Hobli, Bangalore Karnataka-560103

Cardiology

1

Santokbha Durlabhji Memorial Hospital Cum Medical Research Institute Bhawani Singh Marg, JAIPUR Rajasthan-302015

Cardiology

1

Sarvodaya Hospital and Research Centre YMCA Road, Sector-08, Faridabad Haryana-121006

Cardiology

2

Shree Mahavir Health and Medical Relief Society Hospital (Smt. R B Shah Mahavir Super Specialty Hospital and Shri B D Mehta Mahavir Heart Institute) Shree Mahavir Health Campus, Athwagate, Ring Road, Surat Gujarat-395001

Cardiology

1

Sir Ganga Ram Hospital Rajinder Nagar, New Delhi Delhi-110060

Cardiology

4

Sir Hurkisondas Nurrotumdas Hospital and Research Centre Raja Ram Mohan Roy Road, Gordhan Bapa Chowk, Prathana Samaj, Mumbai Maharashtra-40004

Cardiology

1

Sky Hospital and Research Centre RIMS Road District Imphal-west Manipur-795004

Cardiology

1

Southern Railway Head Quarter Hospital Aynavaram, Perumbur, CHENNAI Tamil Nadu-600023

Cardiology

2

Sparsh Super Specialty Hospital #4/1, Tumkur Road, Yeshwanthpur, Bangalore Karnataka-560022

Cardiology

1

Sri Ramakrishna Hospital 395, Sarojini Naidu Road, Sidhapudur, COIMBATORE Tamil Nadu-641044

Cardiology

2

Sri Sathya Sai Institute of Higher Medical Sciences Prasantha Gram, ANANTHPUR Andhra Pradesh-515134

Cardiology

2

Sri Sathya Sai Instt. of Higher Medical Sciences EPIP Area, Whitefield, Bangalore Karnataka-560066

Cardiology

2

Sri Sri Holistic Hospital #1-2-49/13b, Nizampet Road, Hydernagar, Kukatpally, Medchal, Telangana-500072

Cardiology

1

SRM Institutes for Medical Sciences No. 1, Jawaharlal Nehru Salai, 100 ft Road, Vadapalani, Chennai Tamil Nadu-600026

Cardiology

1

Star Hospital 8-2-596/5, RD. NO-10, Banjara Hills, Hyderabad Telangana-500034

Cardiology

3

Star Pinnacle Heart Center 10-11-12,Apiic Health City Chinagadili,Visakhapatnam Andhra Pradesh-530040

Cardiology

2

Sterling Hospital Plot No. 251, 150 ft Ring Road, Near Raiya Circle. Nanavati Chowk, Rajkot Gujarat-360005

Cardiology

1

SunShine Hospital 1-7-201 to 205 PG Road, Beside Paradise Hotel, Secunderabad Telangana-3

Cardiology

2

Tamil Nadu Government Multi Superspeciality Hospital Anna Salai,Chennai Tamil Nadu-600007

Cardiology

2

The Gujarat Research and Medical Institute (Rajasthan Hospitals) Camp Road, Shahibag, Ahmedabad Gujarat-380004

Cardiology

1

Tirumala Hospital Lower Tank Bund Road, Opp. R T C Complex, Vizianagaram Andhra Pradesh-535003

Cardiology

1

Tricolour Hospital Dr.Vikram Sarabhai Road,Near Genda Circle, Wadi Vadi, Vadodara Gujarat-390007

Cardiology

1

Tristar Hospital Nanpura, Athwagate, Surat Gujarat-395001

Cardiology

1

Vijaya Hospital New No. 434, Old No. 180, N S K Salai, Vadapalani, CHENNAI Tamil Nadu-600026

Cardiology

2

Virinchi Hospital Door No. 6-3-2,3 and 3/1 Road No 1, Banjara Hills, Virinchi Circle, Hyderabad Telangana-500034

Cardiology

2

Yashoda Hospital Behind Hari Hara Kala Bhawan, S.P. Road, Secunderabad Telangana-500003

Cardiology

2

Yashoda Super Speciality Hospital Nalgonda X Road, Malakpet, Hyderabad Telangana-500036

Cardiology

1

Yashoda Super Speciality Hospital Raj Bhavan Road, Somajiguda, Hyderabad Telangana-500082

Cardiology

2

Zydus Hospital Near Sola Bridge, S G Highway, Ahmedabad Gujarat-380054

Cardiology

2

Syllabus

A DrNBin Cardiology is a three years specialization course that providestraining in the stream of Cardiology.

The coursecontent for DrNB in Cardiology is given in the NBE Curriculum releasedby the National Board of Examinations, which can be assessed through the linkmentioned below:

DrNB Cardiology In India: Check Out NBE Released Curriculum

1. Fundamentals of Cardiovascular Disease

i. Global Burden of Cardiovascular Disease,

ii. Heart Disease in Varied Populations,

iii. Economics and Cardiovascular Disease,

iv. Clinical Decision-Making in Cardiology,

v. Measurement and Improvement of Quality of Cardiovascular Care,

vi. The Principles of Drug Therapy

2. Molecular Biology

i. The Cardiovascular History and Physical Examination the Electrocardiogram

ii. Choice of imaging technique Cardiac Ultra sound

iii. Cardiovascular Magnetic Resonance Cardiovascular Computed Tomography Nuclear Cardiology

3. Evaluation of the Patient

i. The History and Physical Examination:

ii. An Evidence-Based Approach,

iii. Electrocardiography

iv. Exercise Stress Testing, Echocardiography,

v. Genetics of Myocardial Disease, Genetics of Myocardial Disease,

vi. The Chest Radiograph in Cardiovascular Disease,

vii. Nuclear Cardiology,

viii. Cardiovascular Magnetic Resonance,

ix. Computed Tomography of the Heart,

x. Cardiac Catheterization,

xi. Coronary Angiography and

xii. Intravascular Ultrasound Imaging.

4. Preventive Cardiology

i. The Vascular Biology of Atherosclerosis,

ii. Risk Factors for Atherothrombotic Disease,

iii. Systemic Hypertension: Mechanisms and Diagnosis,

iv. Systemic Hypertension:

v. Therapy

vi. Lipoprotein Disorders and Cardiovascular Disease,

vii. The Metabolic Syndrome, Diabetes Mellitus, and Atherosclerotic Vascular Disease,

viii. Nutrition and Cardiovascular Disease,

ix. Primary and Secondary Prevention of Coronary Heart Disease,

x. Comprehensive Rehabilitation of Patients with Cardiovascular Disease,

xi. Complementary and Alternative Approaches to Management.

5. Basic Sciences related to Cardiology Cardiac Anatomy

i. The cardiac anatomy with special emphasis

ii. Development of heart and blood vessels,

iii. Foetal circulation and its changes in post-natal life;

iv. Coronary circulation

v. Venous drainage of heart; the heart and pericardium and its relation to neighbouring structures; anatomy of cardiac chambers and valves;

vi. Arteries and veins; histology of heart and blood vessels.

vii. Functional anatomy of the heart,

viii. Orientation of the heart within the Thorax,

ix. Methods used to study cardiac anatomy, correlative anatomy,

x. New developments and future challenges,

xi. Quantum computing, Ultrastructure of the heart,

xii. Cardiac Embryology and Histology.

6. Cardiac Physiology

Cardiac Physiology will cover all the physiological changes in the heart during its normal function with special reference to cardiac cycle; myocardial contractility; pressure changes in the cardiac chambers; cardiac output; factors controlling blood flow; regulation of cardiac function; cardiac reflexes; coronary blood flow; exercise physiology; physiology of blood pressure regulation; normal influence on cardiovascular system; preload; after-load; assessment ofventricular function; regulation of cardiac contraction; action potentials; the cellular basis of cardiac contraction, Integration of the cardiovascular system the response to dynamic exercise, etc.

7. Cardiac Molecular Biology

i. Principles of molecular biology including Gene Structure,

ii. Expression and regulation;

iii. Recombinant DNA Technology; PCR Techniques,

iv. Molecular basis for cellular growth,

v. Molecular and cellular bilology of the normal, hypertrohied and failing heart including cardiac growth and hypertrophy

vi. Molecular and Cellular biology of the blood vessels including endothelial cell vascular smooth muscle interactions, atherosclerosis etc,

vii. The Human Genome and its future implications for cardiology including bioethical implications and genetic counselling,

viii. Cardiovascular Tissue modification by genetic approaches including Gene Transfer etc, Molecular Development of the heart including anomalies.

8. Cardiac Biochemistry

All aspects of normal and abnormal patterns of cardiac biochemistry including cardiac enzymes; lipid profile, cardiac metabolism, electrolytes and their effect on cardiac function etc.

9. Cardiac Pharmacology

All the drugs used in the treatment of cardiac disorders inclusive of antianginal agents like

i. Beta-blocking agents,

ii. Nitrates and calcium channel blockers,

iii. Antifailure agents like diuretics,

iv. Angiotensin-Converting Enzyme (ACE) Inhibitors,

v. Angiotensin-II Receptor Blocking Drugs (ARBs) and aldosterone antagonism, Digitalis,

vi. Acute Inotropes and inotropic Dilators

vii. Antihypertensive Drugs,

viii. Antiarrhythmic Drugs

ix. Antithrombotic agents like Platelet Inhibitors, Anticoagulants and Fibrinolytics, Lipid-Lowering and Atherosclerotic Drugs, choice of drugs, which drug for which disease? Adverse Cardiovascular Drug Interactions and Complications.

10. Cardiac Pathology

i. All pathological changes in various cardiac diseases with special reference to clinical correlation included.

ii. Special emphasis on pathological changes in the pulmonary vascular system in various cardiac disorders;

iii. Pathogenesis and pathology of rheumatic fever and rheumatic heart disease;

iv. cardiomyopathies

v. Dilated hypertrophic and obliterative / restrictive; congenital heart diasease -

vi. Cyanotic and acyanotic; atherosclerosis;

vii. Coronary artery disease;

viii. Cardiac involvement in other systemic diseases and storage disorders etc.

11. Cardiac Microbiology

The various microbiological aspects of cardiac diseases including rheumatic fever, infective endocarditis, myocarditis is included. Cardiac Molecular Biology has been included under a separate head.

12. Clinical Cardiology including Pediatric Cardiology

i. General Evaluation of the Patient

The History,

Physical Examination and Cardiac Auscultation including elements of accurate history taking, symptoms associated with cardiovascular disease,

The physical examination of adults, children, infants and neonates,

syndromes associated with congenital heart disease,

measurement of arterial blood pressure, venous pulse,

examination of the retina,

inspection and palpation of the precordium,

Cardiac auscultation.

13. Heart Failure

i. Pathophysiology and diagnosis of Heart Failure,

ii. Diagnosis and management of heart failure,

iii. Cardiac transplantation and mechanical ventricular support.

14. Rhythm aqnd Conduction Disturbances

i. Mechanisms of cardiac arrhythmias and conduction disturbances,

ii. Recognition,

iii. clinical assesment and management of arrhthmias and conduction disturbances, antiarrhythmic drugs, etc

15. Syncope, Sudden Death and Cardio-Pulmonary Resuscitation

i. Diagnosis and management of syncope,

ii. sudden cardiac death,

iii. Cardiopulmonary Resuscitiation and the subsequent management of the patient etc.

16. Coronary Heart Disease

i. Atherogenesis and its determinants,

ii. Pathology of coronary atherosclerosis,

iii. Coronary blood flow and myocardial ischemia,

iv. Dyslipidemia, other risk factors, and the prevention of coronary heart disease

v. Non atherosclerotic coronary heart disease,

vi. Diagnosis and management of patients with chronic ischemic heart disease,

vii. Diagnosis and management of patients with unstable angina,

viii. Diagnosis and management of patients with acute myocardial infarction,

ix. The electrocardiogram in Acute myocardial infarction,

x. Thrombogenesis, antithrombotic and thrombolytic therapy,

xi. rehabilitation of the patient with coronary heart disease etc.

xii. Congenital heart disease and other paediatric cardiac disorders.

17. Systemic Arterial Hypertension

i. Hypertension, epidemiology,

ii. pathophysiology,

iii. diagnosis and treatment.

18. Pulmonary Hypertension and Pulmonary Disease

i. Pulmonary hypertension,

ii. Pulmonary embolism,

iii. Chronic Corpulmonale etc.

19. Valvular Heart Disease

i. Acute rheumatic fever

ii. Aortic valve disease,

iii. Mitral valve disease, Mitral valve prolapse syndrome,

iv. tricuspid valve,

v. pulmonic valve and multivalvulardisaese,

vi. Clinical performance of prosthetic heart valves,

vii. Antitihrombotic therapy for valvular heart disease etc.

20. Congenital Heart Disease

i. Cardiovascular disease due to genetic abnormalities

ii. the pathology,

iii. pathophysiology,

iv. recognition and treatment of congenital heart diseases,

v. Congenital heart disease in adults etc

21. Cardiomyopathy and Specific Heart Muscle Diseases

i. Classification of cardiomyopathies,

ii. Dilated cardiomyopathy,

iii. hypertrophic cardiomyopathy,

iv. Restrictive, obliterative and infiltrative cardiomyopathies,

v. Myocarditis and specific cardiomyopathies

vi. endocrine disease and alcohol,

vii. AIDS and the cardiovascular system,

viii. Effect of noncardiac drugs,

ix. electricity, poisons and radiation and the heart etc.

22. Pericardial Diseases and Endocarditis

i. Diseases of the pericardium,

ii. Infective endocarditis

23. The Heart, Anesthesia and Surgery

i. Perioperative evaluation and management of patients with known or suspected cardiovascular disease who undergo noncardiac surgery

ii. Anesthesia and the patient with cardiovascular disease, etc

24. Miscellaneous Diseases and Conditions

i. The connective tissue diseases and the cardiovascular system,

ii. Neoplastic heart disease,

iii. Diabetes and cardiovascular disease,

iv. traumatic heart disease,

v. effects of mood and anxiety disorders on the cardiovascular system,

vi. Heart disease and pregnancy,

vii. The heart and obesity,

viii. the heart and kidney disease,

ix. exercise and the cardiovascular system,

x. Acute hemodynamics conditioning training the athelete's heart and sudden death,

xi. Cardiovascular aging in health and therapeutic considerations in older patients with cardiovascular diseases, women and coronary artery disease

xii. Cardiac trauma.

xiii. Tumors of hear

xiv. Geriatric heart disease.

xv. General Anaesthesia and non-cardiac surgery in patients with heart disease

xvi. Sports and Heart Disease

xvii. Cardiac rehabilitation

A. Psychological factors in heart disease Occupational and Regulatory Aspects of Heart Disease Non -cardiac Surgery in Cardiac Patients

1. TROPICAL CARDIOLOGY Conditions which are specifically found in the tropics like

i. Rheumatic heart disease,

ii. Endomyocardial Fibrosis

iii. Eosinophilic Heart Disease,

iv. Aortoarteritis etc.

2. Diseases of The Great Vessels and Peripheral Vessels

i. Diagnosis and treatment of diseases of the aorta,

ii. Cerebrovascular disease and neurologic manifestations of heart disease,

iii. diagnosis and management of diseases of the peripheral arteries and veins,

iv. surgical treatment of peripheral vascular diseases, etc.

3. Cardiovascular Disease and Disorders of Other Organs

i. Endocrine Disorders and Cardiovascular Disease,

ii. Hemostasis,

iii. Thrombosis,

iv. Fibrinolysis, and Cardiovascular Disease,

v. Rheumatic Fever, Rheumatic Diseases and the Cardiovascular System,

vi. The Patient with Cardiovascular Disease and Cancer,

vii. Psychiatric Behavioral Aspects of Cardiovascular Disease,

viii. Neurological Disorders and Cardiovascular Disease,

ix. Interface Between Renal Disease and Cardiovascular Illness, Cardiovascular

x. Manifestations of Autonomic Disorders.

B. Diagnostic and Interventional Cardiology Including Cardiac Instrumentation

1. Diagnostic Cardiology

i. The resting Electrocardiogram,

ii. The Chest roentgenogram and cardiac fluoroscopy,

iii. The Echocardiogram,

iv. ECG Exercise Testing

v. , Cardiac Catheterization,

vi. Coronary Arteriography,

vii. Coronary Blood Flow and Pressure Measurements,

viii. Cardiac Ventriculography

ix. Pulmonary Angiography, Angiography of the Aorta and Peripheral Vessels,

x. Nuclear Cardiology, Computed tomography of the Heart,

xi. Magnetic resonance Imaging of the heart,

xii. Magnetic Resonance imaging of the Vascular System,

xiii. Positron Emission Tomography for the noninvasive study and quantification of blood flow and metabolism in human cardiac disease,

xiv. long-term continuous electrocardiographic recordings

xv. Signal Averaging techniques and measurement of Late Potentials,

xvi. Techniques of Electrophysiologic evaluation of Brady and tachyarrhythmias,

xvii. Coronary Intravascular

xviii. Ultrasound Imaging endomyocardial biopsy etc.

2. Interventional Cardiology

i. Percutaneous Coronary Interventions,

ii. Coronary Angioplasty,

iii. Atherectomy, Atheroablation and Thrombectomy,

iv. Coronary Stenting, Balloon Valvuloplasty,

v. Peripheral Intervention, Pediatric interventions,

vi. Intraaortic Balloon

vii. Counterpulsation and other Circulatory Assist Devices

viii. ,Interventional Electrophysiology

ix. ,Cardiac pacemakers,

x. Implantable devices for heart failure and for the treatment of cardiac arrhythmias etc.

3. Cardiac Instrumentation

i. Principles of cardiac instrumentation,

ii. pressure recording, ECG Machines

iii. Cardiac Monitors,

iv. Defibrillators

v. Cath-Lab Equipment,

vi. EP Lab Equipment,

vii. Gamma Camera,

viii. CT Scan, MRI Equipment, PET Scans,

ix. Echocardiography including Stress Echo, Colour Doppler and TEE, Pacemakers temporary and Permanent, ICDs,

x. Triple Chamber Devices

xi. radiofrequency ablation equipment,

xii. programmed stimulators

xiii. IABP, Holter and Signal Averaging and ABP machines,

xiv. Treadmill equipments,

xv. Hemodynamic recorders

xvi. oximeters,

xvii. Computers and image processing in Cardiology etc.

C. Recent Advances in Cardiology, Cardiac Epidemiology, Preventive Cardiology Including Related Cardiac Surgery

1. Atherosclerosis and Prevention Epidemiology of Cardiovascular Diseases, Risk Factors for Atherosclerotic Diseases & Assessment Of Cardiac Risk Special Problems in the prevention of cardiovascular disease

i. Diabetes mellitus type 2

ii. Menopausal women;

iii. Non-traditional risk factors for coronary disease

Special problems in hyperlipidemia therapy

i. Child with hypercholesterolemia;

ii. Transplant patient;

iii. Hypercholesterolemia in the elderly;

iv. Elevated lipoprotein.

2. Cardiac Vascular Disease

Special problems in Vascular Disease;

i. Compromise of an internal thoracic artery to coronary artery graft by subclavian artery disease; localized lymph edema

3. Ischemic Heart Disease

Special Diagnostic issues in Ischemic Heart Disease:

i. The patient with chest pain, a positive stress test and normal coronary arteries;

ii. The patient with coronary artery disease and acute and chronic heart failure

4. Stable Coronary Syndromes

Special problems in myocardial ischemia;

i. Management of variant angina breakthrough;

ii. Management of the non-revascularization patient with severe angina;

iii. Treatment of silent ischemia;

iv. Treatment of microvascular angina;

v. Viagra, sexual activity and the cardiac patient.

5. Acute Coronary Syndromes

Special problems in Acute Myocardial Infarction;

i. Right ventricular infarction

ii. Acute myocardial infarction and normal coronary arteries;

iii. Non perfused acute myocardial infarction after thrombolytic therapy.

6. Non Pharmacological treatment of Ischemic Heart Disease: Special problems in non-pharmacologic therapy:

i. unprotected left main coronary angioplasty;

ii. chronic total occlusion;

iii. saphenous vein graft interventions;

iv. percutaneous intervention of cardiac allograft vasculopathy;

v. In-stent restenosis.

7. Hypertension: Management issues in difficult hypertension like

i. Hypertension and ethnicity;

ii. hypertension in pregnancy preeclampsia;

iii. perioperative hypertension;

iv. ambulatory blood pressure monitoring;

v. diabetes and hypertension;

vi. resistant hypertension;

vii. hypertension in the context of acute myocardial infarction or coronary interventions;

viii. concomitant therapy in hypertension.

8. Cardiac Arrhythmias Special problems in cardiac pacing like

i. pacemaker syndrome;

ii. temporary cardiac pacing;

iii. diagnostic and surgical procedures in pacemaker patients;

iv. pacemaker lead extraction;

v. biventricular pacing for congestive heart failure.

Special problems in supraventricular arrhythmias like

i. Syncope in PSVT;

ii. paroxysmal and perioperative atrial fibrillation;

iii. cycle length alternantion in supraventricular tachycardia;

iv. atrial flutter;

v. atrial fibrillation and anticoagulants.

Special problems in ventricular arrhthmias like;

i. problems of implanted defibrillators;

ii. syncope in a patient;

iii. palpitations and VT in a young woman.

9. Heart Failure and Cardiomyopathy:

Special problems in chronic heart failure like;

i. mechanisms of exercise intolerance and exercise testing;

ii. cardiac cachexia;

iii. anemia, renal dysfunction and depression inn heart failure;

iv. disease management programs.

Special problems in myocarditis and cardiomyopathy like

i. peripartum cardiomyopathy

ii. HIV myocarditis and cardiomyopathy;

iii. Adriamycin induced cardiomyopathy;

iv. Tachcardiomyopathy;

v. Diabetic Cardiomyopathy

10. Valvular Heart Disease

Special problems in valvular heart diseases like;

i. new onset atrial fibrillation in asymptomatic mitral stenosis;

ii. mitral stenosis and pregnancy;

iii. low gradient, low ouput aortic stenosis;

iv. mild to moderate aortic stenosis in patients undergoing bypass surgery;

Special problems in surgical treatment of valvular diseases:

i. perivalvular leaks;

ii. pregnancy and anticoagulation;

iii. postoperative management of valvular dysfunction in valvular surgical treatment.

11. Congenital Heart Disease:

Special problems in Adult Congenital heart diseases:

i. pregnancy in a woman with eisenmenger syndrome;

ii. thromboembolism after fontan procedure;

iii. late systemic RV failure in patients with TGA.

12. Special problems for the Cardiology Consultant

Community Cardiology: The training of PG students will involve learning experience "Derived from" or "Targeted to" the needs of the community. It shall therefore be necessary to expose the students to community based activities. Throughout the course of training the emphasis shall be on acquiring knowledge, skill and attitudes through first hand experiences as far as possible. The emphasis will be on self learning rather than on didactic lectures

13. Schedule of posting Ward & ICCU's Duties: 12 months

i. Duties should include diagnostic case workup and day to day management of common cases (angina, myocardial infarction, rheumatic heart disease, hypertension, congestive heart failure, congenital heart disease,).

ii. The resident should acquire the expertise / knowledge to diagnose and manage the cardiac emergencies (acute myocardial infarction and its complications, LVF, common arrhythmias, cardiogenic shock, pericardial tamponade etc)

14. Cardiac Emergency posting: 6 months

i. The resident should learn prompt diagnosis and management of cardiac emergencies.

ii. The trainee should fortify the skills of hemodynamic monitoring in emergency situations and should learn procedures like arterial line insertion, temporary venous pacing, central line insertion, pericardiocentesis, intra aortic balloon pump insertion, swan ganz catheter insertion etc.

15. Cath Lab posting: 8 months

i. The resident should acquaint himself with the pre, peri and post procedural management of patients to be taken up for intervention in a cath lab.

ii. The trainee should assist and perform procedures like coronary angiography, percutaneous coronary angioplasty, balloon valvoloplasty, cardiac catheterization of congenital heart disease patients, temporary pacemaker, permanent pacemaker,

iii. Electrophysiological diagnosis and management of arrhythmias,

iv. AICD, Bi-ventricular pacemaker, IABP insertion etc.

16. Non-invasive lab posting: 8 months

i. The resident should learn the principles and fundamentals of echocardiography.

ii. The trainee should be able to perform echo-cardiograms of adults, adolescents and infants under direct supervision. The trainee should observe transesophageal echo's and should also master the skills of performing and interpreting stress tests and holter monitoring.

17. Cardiac surgery posting: 2 months

i. Mandatory Posting with certificate of satisfactory attendance from the CTVS Dept Head.

ii. The resident should learnedpre operative preparation and management of post operative recovery patients.

iii. The trainee should have seen CABG, valve replacement, congenital heart disease surgery and aortic surgery.

18. Practical:

i. History, examination and writing of records:

ii. History taking should include the background information, presenting complaints and the history of present illness, history of previous illness, family history, social and occupational history and treatment history.

iii. Detailed physical examination should include general physical and CVS examination

iv. Skills in writing up notes, maintaining problem-oriented medical records (POMR), progress notes, and presentation of cases during ward rounds, planning investigation and making a treatment plan should be taught.

v. The resident should fortify the skills of hemodynamic monitoring in emergency situations and should learn procedures like arterial line insertion, temporary venous pacing, central line insertion, pericardiocentesis, intra aortic balloon pump insertion, swan ganz catheter insertion etc.

vi. The resident should assist and perform procedures like coronary angiography, percutaneous coronary angioplasty, balloon valvoloplasty, cardiac catheterization of congenital heart disease patients, temporary pacemaker, permanent pacemaker, Electrophysiological diagnosis and management of arrhythmias, AICD, Bi-ventricular pacemaker, IABP insertion etc.

vii. Ability to perform echo-cardiograms of adults, adolescents and infants under direct supervision. He should observe transesophageal echo's and should also should also master the skills of performing and interpreting stress tests and holter monitoring.

viii. Simulation based training should be given particularly in Transesophageal Echocardiography, Some Complex Structural Interventions and Coronary Interventions, CRTs, and TAVRs. Biostatistics, Research Methodology and Clinical Epidemiology Ethics Medico legal aspects relevant to the discipline Health Policy issues as may be applicable to the discipline

19. Job Responsibilities - Outdoor Patient (OPD) Responsibilities:

i. The working of the residents in the OPD should be fully supervised.

ii. They should evaluate each patient and write the observations on the OPD card with date and signature.

iii. Investigations should be ordered as and when necessary using prescribed forms

iv. Residents should discuss all the cases with the consultant and formulate a management plan.

v. Patient requiring admission according to resident's assessment should be shown to the consultant on duty.

vi. Patient requiring immediate medical attention should be sent to the casualty services with details of the clinical problem clearly written on the card.

vii. Patient should be clearly explained as to the nature of the illness, the treatment advice and the investigations to be done.

viii. Resident should specify the date and time when the patient has to return for follow up. In-Patient Responsibilities Each resident should be responsible and accountable for all the patients admitted under his care.

20. In-Patient Responsibilities

The following are the general guidelines for the functioning of the residents in the ward:

i. Detailed work up of the case and case sheet maintenance:

ii. The trainee should record a proper history and document the various symptoms.

iii. Perform a proper patient examination using standard methodology.

iv. The trainee should develop skills to ensure patient comfort/consent for examination.

v. Based on the above evaluation The trainee should be able to formulate a differential diagnosis and prepare a management plan.

vi. Should develop skills for recording of medical notes, investigations and be able to properly document the consultant round notes.

vii. To organize his/her investigations and ensure collection of reports.

viii. Bedside procedures for therapeutic or diagnostic purpose. • Presentation of a precise and comprehensive overview of the patient in clinical rounds to facilitate discussion with senior residents and consultants ix. To evaluate the patient twice daily (and more frequently if necessary) and maintain a progress report in the case file.

x. To establish rapport with the patient for communication regarding the nature of illness and further plan management.)

xi. To write instructions about patient's treatment clearly in the instruction book along with time, date and the bed number with legible signature of the resident.

xii. All treatment alterations should be done by the residents with the advice of the concerned consultants and senior residents of the unit.

21. Admission day

Following guidelines should be observed by the resident during admission day.

i. Resident should work up the patient in detail and be ready with the preliminary necessary investigations reports for the evening discussion with the consultant on duty

ii. After the evening round the resident should make changes in the treatment and plan out the investigations for the next day in advance. Doctor on Duty

iii. Duty days for each Resident should be allotted according to the duty roster.

iv. The resident on duty for the day should know about all sick patients in the wards and relevant problems of all other patients, so that the trainee could face an emergency situation effectively

v. In the morning, detailed over (written and verbal) should be given to the next resident on duty. This practice should be rigidly observed.

vi. If a patient is critically ill, discussion about management should be done with the consultant at any time.

vii. The doctor on duty should be available in the ward throughout the duty hours. Care of Sick Patients • Care of sick patients in the ward should have precedence over all other routine work for the doctor on duty.

viii. Patients in critical condition should be meticulously monitored and records maintained

ix. If patient merits ICU care, then it must be discussed with the senior residents and consultants for transfer to ICU.

22. Discharge of the Patient

i. Patient should be informed about his/her discharge one day in advance and discharge cards should be prepared 1 day prior to the planned discharge.

ii. The discharge card should include the salient points in history and examination, complete diagnosis, important management decisions, hospital course and procedures done during hospital stay and the final advice to the patient.

iii. Consultants and DNB Residents should check the particulars of the discharge card and counter sign it.

iv. Patient should be briefed regarding the date, time and location of OPD for the follow up visit

23. In Case of Death

i. In case it is anticipated that a particular patient is in a serious condition, relatives should be informed about the critical condition of the patient beforehand.

ii. Residents should be expected to develop appropriate skills for breaking bad news and bereavements.

iii. Follow up death summary should be written in the file and face sheet notes must be filled up and the sister in charge should be requested to send the body to the mortuary with respect and dignity from where the patient's relatives can be handed over the body.

iv. In case of a medico legal case, death certificate has to be prepared in triplicate and the body handed over to the mortuary and the local police authorities should be informed.

v. Autopsy should be attempted for all patients who have died in the hospital especially if the patient died of an undiagnosed illness. Bedside Procedures The following guidelines should be observed strictly

vi. Be aware of the indications and contraindications for the procedure and record it in the case sheet. Rule out contraindications like low platelet count, prolonged prothrombin time, etc.

vii. Plan the procedure during routine working hours, unless it is an emergency.

viii. Explain the procedure with its complications to the patient and his/her relative and obtain written informed consent on a proper form. Perform the procedure under strict aseptic precautions using standard techniques. Emergency tray should be ready during the procedure.

ix. Make a brief note on the case sheet with the date, time, nature of the procedureand immediate complications, if any.

x. Monitor the patient and watch for complications(s). Medico-Legal Responsibilities of the Residents • All the residents are given education regarding medico-legal responsibilities at the time of admission in a short workshop.

xi. They must be aware of the formalities and steps involved in making the correct death certificates, mortuary slips, medico-legal entries, requisition for autopsy etc

xii. They should be fully aware of the ethical angle of their responsibilities and should learn how to take legally valid consent for different hospital procedures & therapies.

xiii. They should ensure confidentiality at every stage.

24. Bedside Procedures

The following guidelines should be observed strictly:

i. Be aware of the indications and contraindications for the procedure and record it in the case sheet. Rule out contraindications like low platelet count, prolonged prothrombin time, etc.

ii. Plan the procedure during routine working hours, unless it is an emergency. Explain the procedure with its complications to the patient and his/her relative and obtain written informed consent on a proper form. Perform the procedure under strict aseptic precautions using standard techniques. Emergency tray should be ready during the procedure.

iii. Make a brief note on the case sheet with the date, time, nature of the procedure and immediate complications, if any.

iv. Monitor the patient and watch for complications(s).

25. Medico-Legal Responsibilities

i. All the residents are given education regarding medico-legal responsibilities at the time of admission in a short workshop.

ii. They must be aware of the formalities and steps involved in making the correct death certificates, mortuary slips, medico-legal entries, requisition for autopsy etc.

iii. They should be fully aware of the ethical angle of their responsibilities and should learn how to take legally valid consent for different hospital procedures & therapies.

iv. They should ensure confidentiality at every stage.

v. The Candidate should be trained in some Medico-Legal Aspects regarding patient management like how to obtain informed consent, how to approach litigations and what problems can occr on the unexpected death of patients.

vi. They should also be trained in laws especially with regards to Medico-Legal Cases and Transplantation laws. The student would be given adequate training during the course so that the trainee will be able to perform and interpret various non-invasive and invasive techniques as outlined below:

26. Non - invasive

i. Electrocardiography

ii. Stress ECG

iii. Ambulatory ECG

iv. Echocardiography – M-mode, Two dimensional, Doppler, Colour flow imaging, Transoesophageal echocardiography and stress echocardiography.

v. Ambulatory BP monitoring.

27. Invasive

i. To perform temporary pacemaker insertion and pericardiocentesis.

ii. To perform left and right heart catheterization, to calculate and interpret various hemodynamic parameters.

iii. To assist in various interventions including Valvuloplasty, coronary and congenital interventions.

iv. To interpret electrophysiological data and assist in electrophysiology procedures, permanent pacemaker implantation and AICD implantation

28. Minimum No. of Procedures for competency

i. Trans thoracic Echocardiography………………………400

ii. Transoesophageal Echocardiography………………….25

iii. Stress ECG………………….………………….…………100

iv. Temporary Pacemaker………………….…………………20

v. Ambulatory ECG's analysed………………….…………..50

vi. Permanent pacemaker Implantation's assisted………….5

vii. Cardiovascular Catheterization………………….………100

viii. Percutaneous Cardiovascular Intervention's assisted…10

29. Affective Domain

i. To adopt ethicalpractices in dealing with patients, colleagues, subordinates superiors and health care workers.

ii. To promote cordial interpersonal relation

iii. To perform as a team

iv. To learn to be a leader when the need arises.

v. To learn to order investigations and prescribe drugs rationally.

vi. To be aware of ethical issues in human and animal research.

vii. Take rationale decision in the face of ethical dilemmas in cardiac diseases.

viii. Demonstrate sympathy & Humane approach towards patients & their families & exhibit interpersonal behaviour in accordance with social norms & expectations.

30. Attitude & Values

Demonstrate empathy and humane approach towards patients and their families and exhibit interpersonal behaviour in accordance with the societal norms and expectation.

Career Options

After completing a DrNB in Cardiology, candidates will getemployment opportunities in Government as well as in the Private sector.

In the Government sector,candidates have various options to choose from which include Registrar, SeniorResident, Demonstrator, Tutor etc.

While in the Private sector theoptions include Resident Doctor, Consultant, Visiting Consultant (Cardiology),Junior Consultant, Senior Consultant (Cardiology), Critical Care Specialist,etc.

Courses After DrNBin Cardiology Course

DrNB in Cardiology is a specialisation course whichcan be pursued after finishing a Postgraduate medical course. After pursuingspecialisation in DrNB in Cardiology,a candidate could also pursue certificate courses and Fellowship programmesrecognised by NMC and NBE, where DrNB inCardiology is a feeder qualification.

Frequently Asked Question (FAQs) – DrNBin Cardiology Course

Question: What is the full form of DrNB?

Answer: The full form of DrNB is Doctorate ofNational Board.

Question: What is a DrNB in Cardiology?

Answer: DrNB Cardiology or Doctorate of National Boardin Cardiology also known as DrNB in Cardiology is a super specialty level course for doctors in India that is done bythem after completion of their postgraduate medical degree course.

Question: What is the duration of a DrNB in Cardiology?

Answer: DrNB in Cardiology is asuper specialty programme of three years.

Question: What is the eligibility of a DrNB in Cardiology?

Answer: Candidates must be in possession of a MD/DNB (General Medicine/Paediatrics/Respiratory Medicine) from any college/university recognized by theMedical Council of India (now NMC)/NBE.

Question:What is the scope of a DrNB in Cardiology?

Answer:DrNB in Cardiology offers candidatesvarious employment opportunities and career prospects.

Question:What is the average salary for a DrNB inCardiology candidate?

Answer:The DrNB in Cardiology candidate'saverage salary is between Rs. 6,00,000to Rs. 30,00,000 per annum depending on the experience.

Question: Can you teach after completing DrNB Course?

Answer: Yes, candidate can teach in a medical college/hospitalafter completing DM course.

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But molnupiravir showed no obvious benefit at reducing hospital cases and deaths, a study found.

According to Rivera, due to the high levels of contamination in its waters, which are possibly sponsors of the country’s current cases of cholera, located in the La Zurza sector that maintains a spring that flows into the Isabela River, studies are already being conducted pertinent to determine fence their surroundings and definitively evade the insistent bathers.

Similarly, the doctor stated that, while the interpretations agreed with the Ministry of the Environment and the Santo Domingo Aqueduct and Sewerage Corporation (CAASD), Public Health would benefit from greater control over the bacteria’s prevalence. “Other State entities are already required to use this strategy, which will benefit Public Health by controlling the emergence of new cases in the area,” he assured.

This proposal to surround and prohibit access to both river sources stems from an editorial published today in the newspaper Listin Diario, which identifies this and other measures as possible channels of cholera retention.