Morning MEDtalks with Dr KK Aggarwal 2^nd August 2018

DAMA vs LAMA after Stenting

A new study of more than 2 million PCI procedures shows that patients who discharged against medical advice (DAMA) are uncommon but are twice as likely to be readmitted with an acute myocardial infarction (MI) as those discharged home. If DAMA patients are readmitted with MI, the mortality rate is double that of non-DAMA patients readmitted with MI.

Data from the Paris registry show that mortality risk is "stratospheric in the first 7 days" after PCI if dual antiplatelet therapy (DAPT) is discontinued.

So it may be that patients are just simply not surviving to be readmitted with a myocardial infarction. We see only those patients that survive to discharge. What we do not see are the patients who discharge themselves against medical advice that die in the community.

DAMA represents up to 2% or so of all hospital discharges and is associated with a higher likelihood of worse outcomes.

The present study is published in July 23 in JACC Cardiovascular Interventions. Predicting DAMA.

Breastfeeding

An estimated 78 million babies – or three in five – are not breastfed within the first hour of life, putting them at higher risk of death and disease and making them less likely to continue breastfeeding, say UNICEF and WHO. Most of these babies are born in low- and middle-income countries.

High cost on medical expenditure 

As per a recently published research paper based on cross-sectional analysis of National Sample Survey Office (NSSO) data, 55 million Indians were pushed into poverty in a single year because of having to fund their own healthcare, and out of this, 38 million fell below the poverty line due to spending on medicines alone. As per the 71st Round (January-June 2014) of the National Sample Survey Office(NSSO) on Health in India, purchase of medicine accounted for around 72% in rural sector, and 68% in urban sector, of the total expenditure on non-hospitalized treatment of ailments (Source: PIB).

Statins and myositis

Exposure to statin medications is associated with the development of idiopathic inflammatory myositis (IMM), new research suggests. In a population-based case-controlled study of adults age 40 years and older in South Australia, there was an almost twofold increased likelihood of statin exposure in patients with IIM compared with controls. The finding is published online July 30, 2018 in JAMA Internal Medicine.

Surgical errors

Every year an estimated 4,000 people who undergo surgery are injured by surgical errors. These preventable mistakes are called “never events” because they never should have happened.

Common surgical errors include: Leaving surgical equipment (e.g., sponges or instruments) inside a patient; using unsterile surgical instruments; performing surgery on the wrong body part; performing the wrong procedure; performing surgery on the wrong patient; damaging nerves during procedure; cutting or puncturing organs that were not involved in the procedure; failing to administer an appropriate dose of anesthesia.

There are a number of reasons why surgical errors occur. They include:

1. A surgeon may not have performed a particular procedure very often and simply lacks the skill to perform the surgery properly.
2. Failure to communicate properly is often a major factor in wrong-procedure, wrong-site and wrong-patient surgeries.
3. Insufficient pre-operative planning
4. Surgeons may not perform certain steps during the procedure, incorrectly concluding that they are not necessary.
5. Fatigue: Surgeons often work long shifts.
6. Negligence: Failure to make sure that all instruments are properly sterilized and equipment is functioning properly.
7. A bad outcome does not necessarily prove that a mistake was made or that medical malpractice occurred.

Hand, foot and mouth disease outbreak in Malaysia

Hand, foot and mouth disease can damage the brain, lungs or heart, though such complications are rare.  Last week, five schools in Malaysia were ordered to close for 10 days following an increase in the number of HFMD cases across the country. Since January, 39,174 cases of HFMD have been recorded throughout the country.

1. HFMD is most common in children under the age of five. However, older children and adults can contract it. The illness tends to be more severe in adults.
2. People who have had HFMD develop an immunity to the particular strain of HFMD that infected them.
3. HFMD is transmitted through contact with an infected persons nose and throat secretions (such as phlegm and mucus), blister fluid or feces.
4. Symptoms include fever, sore throat, fatigue and a decreased appetite. Ulcers and blisters will develop in the mouth and on the hands and feet a few days after infection.
5. HFMD can damage the brain, lungs or heart, though such complications are rare. The greatest danger is dehydration, as ulcers make it painful to drink.
6. There is no specific cure.
7. Avoid close physical contact, such as kissing and hugging, with those infected with HFMD. Do not share food or cutlery with others if you suspect one of you is infected. Eat fruits, vegetables, nuts and grains to improve your immunity.

New AI softwares

The US Food and Drug Administration (FDA) has approved three artificial intelligence (AI)-based tools this year for use in clinics.

1. LVO Stroke Platform flags signs of stroke on computed tomography scans.
2. IDx-DR device can be used in primary care to screen for diabetic retinopathy.
3. OsteoDetect is used to diagnosis wrist fractures in adults.

Northern plain in China set to become deadliest heat wave zone

The northern plain in China, one of the most densely populated regions on Earth, is on its way to becoming the worlds deadliest heatwave zone by the end of the century, scientists say. New scientific research suggests that unless there are heavy cuts in carbon emissions, climate change will lead to humid heatwaves that could push the area "against the boundaries of habitability" by 2070. Heat and high humidity can create conditions that kill even healthy people within 6 hours of being outside.

"This spot is going to be the hottest spot for deadly heatwaves in the future," said Professor Elfatih Eltahir, at the Massachusetts Institute of Technology (MIT), who led the new study reported July 31, 2018 in Nature Communications (Source: CNN).

Outbreak and Current Disease Status Information

1. According to the European Food Safety Authority (EFSA), 5 European countries have reported 147 people infected with Salmonella [enterica serotype] Agona, which could be linked to ready-to-eat food. In the UK, 129 people have been infected, while Finland counts 15 cases, Denmark 1, Germany 1 and Ireland 1. Experts from EFSA and the European Centre for Disease Prevention and Control (ECDC) believe that ready-to-eat products containing cucumbers and prepared in the UK may be the source.
2. The outbreak of Crimean-Congo hemorrhagic fever (CCHF) has killed 7 people in Iran so far.
3. The Rwandan Ministry of Agriculture and Animal Resources, on [Mon 30 Jul 2018] announced it was lifting the quarantine on the movement of cattle that was imposed to control the deadly Rift Valley fever (RVF) in several parts of Eastern province.
4. In Cote dIvoire, swollen shoot disease is worsening in the cocoa belt in the central region.
5. At least 50 people were victims of food poisoning as of Sunday (July 29, 2018) in Montreuil, Bagnolet, Meaux (Seine-et-Marne), and Courbevoie (Hauts-de-Seine) after eating tuna sandwiches, distributed by a bakery in Bagnolet Seine-Saint-Denis in the region of Ile-de-France.
6. The food court illness that sickened 350 people in Kentucky has been identified as norovirus.
7. Since 2013, the Central African Republic has been experiencing at least one monkeypox outbreak every year, especially in its eastern region. Since the beginning of 2018, outbreaks have been reported in 3 health districts, namely Bambari in the centre, Bangassou in the eastern part of the country, and more recently Mbaiki in the southwest.
8. Authorities on (Mon 30 Jul 2018) confirmed that 12 people died from an unknown disease with symptoms similar to Ebola in north-eastern Congo.
9. The bacterial disease tularemia has surfaced again in Champaign County (Illinois), this time in a dead rabbit found in Urbana.
10. In a follow-up on the trichinosis outbreak in (Córdoba province) Argentina, the outbreak has grown from a several dozen to 232, according to a Telediario Digital report (computer translated).

Video to watch: https://www.facebook.com/drkkaggarwal/videos/1934225719932055/

Participate in survey on inflammatory bowel disease:

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Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

President HCFI