Morning MEDtalks with Dr KK Aggarwal 10^th August 2018

Breaking News: Induced labor at 39 weeks may reduce likelihood of C-section

Elective induction at 39 weeks also linked to lower risk of maternal high blood pressure disorders.

Healthy first-time mothers whose labor was induced in the 39th week of pregnancy were less likely to deliver by cesarean section, compared to those who waited for labor to begin naturally, according to a study funded by the National Institutes of Health. Researchers also found that infants born to women induced at 39 weeks were no more likely to experience stillbirth, newborn death or other severe complications, compared to infants born to uninduced women. The study results are published in the New England Journal of Medicine.

“Our analysis suggests that elective induction at 39 weeks is associated with a lower rate of cesarean delivery and does not increase the risk of major complications for newborns.” Said the authors.

The study enrolled more than 6,000 pregnant women at 41 hospitals participating in the NICHD-supported Maternal-Fetal Medicine Units Network. Roughly half of the women were assigned at random to have their labor induced in the 39th week of pregnancy; the remaining women received expectant management.

The researchers compared births between the two groups in terms of a primary outcome, a composite measure that included death of the baby during or after birth; the newborn’s need for respiratory support; seizure, infection, birth trauma (injury) or hemorrhage; and other birth complications.

The primary outcome occurred in 4.3 percent of the induced labor group and 5.4 percent of the expectant management group, a difference that was not statistically significant. However, the proportion of cesarean delivery was significantly lower for the induced group (18.6 percent), compared to the other group (22.2 percent). Similarly, the rate of blood pressure disorders of pregnancy was significantly lower in women who were induced (9.1 percent), compared to the other group (14.1 percent).

The researchers estimate that one cesarean delivery could be avoided for every 28 low-risk, first-time mothers undergoing elective induction at 39 weeks.

Randomized control times are needed only if…?

Randomized trials are for interventions that are thought, or hoped, to offer benefits and not for where there is obvious benefit or harm.

We do not need a randomized trial to know that smoking is harmful, that drinking a glass of battery acid is not good etc. Randomized trials are run for interventions that, at best, offer modest to medium benefits. For instance, wearing a parachute when jumping out of an airplane—an intervention that improves mortality from a nearly 100% chance of death to a nearly 100% chance of survival. No one would ask for an RCT.

Today is World Biofuel Day

World Biofuel Day is observed every year on 10th August to create awareness about the importance of non-fossil fuels (green fuels) as an alternative to conventional fossil fuels and to highlight the various efforts made by the Government in the biofuel sector. The World Biofuel Day is being observed by the Ministry of Petroleum & Natural Gas for the last three years. Biofuels have the benefits of reducing import dependency on crude oil, cleaner environment, and additional income to farmers and employment generation in rural areas.  

On this day in 1893, Sir Rudolf Diesel (inventor of the diesel engine) for the first time successfully ran mechanical engine with Peanut Oil. His research experiment had predicted that vegetable oil is going to replace the fossil fuels in the next century to fuel different mechanical engines.Pfizer’s patent for Viagra ends in US in 2020

This will open doors for Indian companies to target the nearly 5 crore Americans who suffer from erectile dysfunction in what is India’s largest market for exports of medicines. Seven Indian companies have already secured required permissions. They are among 15 companies worldwide that have been granted approval by US health watchdog the FDA to produce sildenafil citrate, the formulation patented as Viagra.

Indian companies in the fray to sell the blue pill are Rubicon Research, Hetero Drugs, Macleods Pharma, Dr.Reddy’s, Aurobindo Pharma, Torrent Pharmaceuticals and Ajanta Pharma.

Pfizer’s global sales from just Viagra touched $1.685 billion, over Rs 10,900 crore, in 2014. According to an American company, Transparency Market Research, the global erectile dysfunction drugs market was valued at $4.35 billion in 2016 (Hindustan Times)

Optimal fluid volume during surgery

The authors of a study published in the Annals of Surgery investigated the optimal fluid volume during surgery in 92,094 patients undergoing noncardiac surgery with endotracheal intubation. The amount of fluid administered was divided into five groups, ranging from the most restrictive (< 900 mL) to most liberal (> 2700 mL).

A U-shaped curve was observed, with higher 30-day mortality being associated with the most restrictive and most liberal fluid administration patterns. The lowest overall mortality was observed in the second quintile (fluid intake > 900 to 1100 mL). This quintile had the lowest frequency of respiratory complications and the shortest postoperative length of stay; quintile four (fluid intake > 1750 to 2700 mL) had the lowest frequency of acute renal injury.

China orders recall of vaccines from abroad

Chinese investigators said they have recalled faulty vaccines produced by the company Changchun Changsheng Biotechnology, some of which have been sold abroad. The vaccine scandal that is believed to have affected hundreds of thousands of children in China is now spreading overseas, according to a statement available Wednesday on the National Health Commission’s website.

According to investigators, Changsheng seriously violated production and quality-management protocols in making its rabies vaccine. “Some batches are mixed with an expired solution, and the date and batch number are not accurate,” the commission said. The commission did not specify which countries the faulty vaccines have been sold to.

Changsheng unleashed a huge public health scare in July, after being accused of forging data and failing safety protocols for its rabies vaccine. Additionally, the pharma company last autumn reportedly sold substandard diphtheria, tetanus and pertussis vaccines, known as the DTaP vaccine, to at least 200,000 infants. After the allegations became known, President Xi Jinping called for a swift investigation and severe punishment for those responsible. Authorities have issued arrest warrants for 18 Changsheng employees, including chairwoman … (www.pmnewsnigeria.com)

Around the globe

1. A final statement from the US Preventive Services Task Force concludes that there is insufficient evidence to determine the balance of benefits and harms of screening for atrial fibrillation with electrocardiography in asymptomatic adults. Evidence is lacking, and the balance of benefits and harms cannot be determined.
2. About 1 in 7 babies (14%) currently aged 1 year or older who were exposed to Zika virus before birth have one or more health problems possibly related to Zika, including some serious health problems that were not apparent at birth, federal health officials with the Centers for Disease Control and Prevention said.
3. The Delhi High Court has constituted a Committee to consider all issues relating to sexual violence, including preventive measures for controlling incidents of sexual violence as well as appropriate steps to be taken in the field of sentencing in such cases based on scientific principles and data.
4. Poteligeo, a new drug (injection for IV use) has been approved by the US FDA for the treatment of adult patients with relapsed or refractory mycosis fungoides or Sézary syndrome after at least one prior systemic therapy. This approval provides a new treatment option for patients with mycosis fungoides and is the first FDA approval of a drug specifically for Sezary syndrome.
5. The US FDA has alerted doctors and women about serious adverse events associated with improper use of tests to detect rupture of membranes. FDA is concerned that misuse, relying solely on ROM tests without using other assessments and inaccurate interpretation of lab test results of ROM tests could result in an increased risk of fetal harm or death.
6. Higher high-density lipoprotein cholesterol (HDL-C) could be a marker of HDL dysfunction rather than cardioprotection in postmenopausal women, as per analysis of a new Multi-Ethnic Study of Atherosclerosis (MESA). The proatherogenic association reported for HDL-C with carotid plaque was most evident in women with later age at menopause who were >10 years postmenopausal.

Video to watch: Wheat disorders

https://www.facebook.com/drkkaggarwal/videos/1945381452149815/

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO