Morning MEDtalks with Dr K K Aggarwal 27^th July 2018

Trial Halted After 11 Infants Die in the Netherlands

A Dutch trial of the use of sildenafil in pregnant women has been abruptly stopped after 11 infants born to women who received the medication died according to the Amsterdam University Medical Center (Amsterdam UMC).

The STRIDER (Sildenafil Therapy in Dismal Prognosis Early-Onset Fetal Growth Restriction) trial, which included 11 hospitals across the Netherlands and in other countries, started in 2015 and was to have finished in 2020. It was designed to determine whether sildenafil could increase fetal growth by increasing blood flow to the placenta in women whose fetus was severely underdeveloped. (Medscape)

Tickborne diseases are likely to increase

The incidence of tickborne infections are rising. We should build a robust understanding of pathogenesis, design improved diagnostics, and develop preventive vaccines, according to New England Journal of Medicine.

Bacteria cause most tickborne diseases with Lyme disease representing 82% of reported cases. The spirochete Borrelia burgdorferi is the primary cause. It is carried by hard-bodied ticks that then feed on smaller mammals, such as white-footed mice, and larger animals, such as white-tailed deer.

Most cases of Lyme disease are successfully treated with antibiotics, 10 to 20 percent of patients report lingering symptoms after effective antimicrobial therapy. Scientists need to better understand this lingering morbidity.

Tickborne virus infections are also increasing and could cause serious illness and death. For example, Powassan virus (POWV), recognized in 1958, causes a febrile illness that can be followed by progressive and severe neurologic conditions, resulting in death in 10 to 15 percent of cases and long-term symptoms in as many as 70 percent of survivors. Only 20 U.S. cases of POWV infection were reported before 2006; 99 cases were reported between 2006 and 2016.  

Prevention techniques: wear insect repellant, wear long pants when walking in the woods or working outdoors, and check for ticks.

Microbiome update

Each microbe has its own genes. The first big surprise was that, collectively, all the microbes that live on us or in us have more than 100 times as many genes as we have human genes. All their genes, taken as a group, are called our microbiome.

The function of any gene is to make a particular protein. Many of the proteins made by our microbiome are like the proteins made by our own genes. Those microbiome-produced proteins get into our bloodstream, travel around our body, and affect our health. In other words, it has suddenly become very plausible to imagine that bacteria (or other microbes) living in our gut could affect other organs in our body, including the heart.

Around the globe

1. Eating an egg a day may help protect against cardiovascular disease, according to a study published online May 21 by the journal Heart. 
2. Estimates suggest that Americans consumed 3.4 billion pounds of coffee last year
3. Researchers have reported the results of the first randomized clinical trial to test a novel strategy involving waking up and then killing the sleeping HIV that is hiding in the body using an experimental approach known as kick and kill. ( Science Daily)
4. Plastic surgery patients were getting infections with antibiotic resistant bacteria, and no one knew why. UConn microbiologists found the answer in a leechs gut. Their research, published today in mBio, provides proof that tiny levels of antibiotics found in the environment can encourage bacterial resistance.
5. University of Illinois at Urbana-Champaign: In one of the largest studies of its kind, researchers analyzed chikungunya and dengue outbreak data from 76 countries over a period of 50 years, focusing on regions across the Indian Ocean. The analysis of 1959-2009 data revealed that population density and proximity to a country already experiencing an outbreak were the factors most closely associated with a countrys own likelihood of experiencing an outbreak. 
6. Loyola University Health System: Everyone gets hiccups, but some people suffer intractable hiccups that last longer than a month. 
7. Lawson Health Research Institute: Scientists have demonstrated that a blood test can predict how patients with advanced prostate cancer will respond to specific treatments, leading to improved survival.
8. Carb backloading diet encourages eating minimal carbs during the day, and then - after a hard workout - eating loads of carbs at night. The theory of carb backloading is based on the fact that insulin sensitivity is higher earlier in the day, which promotes carbohydrate absorption into your muscles and fat tissue.

 Participate in survey on Inflammatory bowel disease:

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Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO