Morning MEDtalks with Dr KK Aggarwal 23^rd August 2018

Medicine, as we know, is a constantly evolving field. Scientists world over are engaged in research to decipher the etiopathogenesis of diseases and then to develop treatments. Some are new researches, while some are an extension or offshoots of previous researches. Everyday, scores of researches are published. Some have positive outcomes and offer new hopes and also update our current knowledge, while some highlight negative outcomes.

Let’s take a look today at some positive ‘good’ news stories and some stories with negative results ‘bad’ news.

No outbreak of communicable disease reported from flood-hit Kerala so far, says Health minister. This is good news for Kerala, battling its worst floods in 100 years and struggling to find its feet in the aftermath. The National Centre for Disease Control (NCDC) has issued health advisories to support the state in meeting with post-flood public health management challenges when the threat of water borne, vector borne and viral hepatitis diseases becomes potent.

NCDC teams are ready for deployment to support the state in preventing outbreak of diseases. "The outbreak (of disease) situation is being monitored on a daily basis and the strategic health operation centre has been activated. No outbreak of communicable disease has been reported yet," Nadda said, adding that he was personally monitoring the situation and was in regular communication with Kerala health minister K K Shailaja (PTI, August 21, 2018). 

There is good news for elderly men. Existing evidence provides benefits of testosterone therapy in older men without known aetiology for testosterone deficiency (Clin Endocrinol. 2018;89(1):3-10)

For those who deal with thyroid nodules, a percutaneous ethanol injection is an effective means of treatment for benign cystic and mixed thyroid nodules, without any serious side effects. Percutaneous ethanol injection is not a trigger for autoimmunity and malignancy development over the short term. (Endocr Pract. 2018;24(6):548-555)

There is a new updated classification of adult congenital heart disease from the American Heart Association /American College of Cardiology (AHA/ACC). This new classification retains the three previous anatomic categories of "simple," "moderate," or "great" complexity in the 2008 guideline but adds the physiologic classification of A through D, which is somewhat similar to the AHA heart failure stages.

For example, a patient with tetralogy of Fallot who is extremely functional, who has no arrhythmias, and whose heart looks good on imaging would be classified as IIA. A second patient with the same diagnosis who has several arrhythmias, some degree of heart failure, limited exercise capacity, and some kidney and liver dysfunction would be classified as class IID.

There is a new use for alcohol. A study in Liver International. 2018;38(8):1475-1486 has shown that cannabis use is associated with a reduced incidence of liver disease in alcoholics.

Do you know the next gluten? A new element in our diet, which if eliminated, can restore our waistline is lectins. They are carbohydrate-binding glycoproteins found in many foods and called the next gluten.

Coming as bad news for those who take benzodiazepenes for sleep problems, a study has linked benzodiazepines to an increased risk for Alzheimers disease even though the association is small. The efficacy for this indication diminishes over time, whereas the risks for adverse events remain (Acta Psychiatrica Scandinavica, August 2018)

In what may have been bad news for some patients, around two thirds of lung cancers detected with low-dose CT on screening represent overdiagnosis (detection of indolent cancers) as per Danish Lung Cancer Screening Trial investigators. 

Indolent or potentially inconsequential malignancy is inherent to cancer screening and can be defined as a cancer that would not become symptomatic in a patient’s lifetime and would not contribute to death. Indolent, is a relatively new concept. Lung cancer has a high case fatality rate such that the idea of clinically inconsequential lung cancers never had much traction in the clinic. Also lung cancer screening was nonexistent until the recent advent of LDCT as a research tool in the early 2000s, so these tumors were rarely identified.

Measles is showing a resurgence in Europe. Do you know that a record number of measles cases has been recorded in Europe as per WHO estimates? More than 41,000 people have been infected and at least 37 have died as a result of the contagious disease in 2018 so far. It is the highest number of infections this decade, beating last years number of 23,927.

Just to revise: Measles is a highly contagious viral illness characterized by fever, malaise, rash, cough, coryza, and conjunctivitis that occurs worldwide; it remains endemic in areas with low vaccination rates, particularly in the developing world. It has been targeted for eradication given the favorable biologic characteristic that humans are the only reservoir.

However, measles is highly contagious; the attack rate in a susceptible individual exposed to measles is 90%. The period of contagiousness is estimated to be from five days before the appearance of rash to four days afterward. Infectious droplets from the respiratory secretions of a patient with measles can remain airborne for up to two hours. Therefore, the illness may be transmitted in public spaces, even in the absence of person-to-person contact.

In the field of spirituality, let’s revise some Vedic codes. Given a choice of Dharma, Artha and Kama, which of the three is of more value? When all the three Dharma, Artha and Kama, come together, the former is better than the one which follows it, i.e. Dharma is better than Artha, and Artha is better than Kama. Kama is the enjoyment of appropriate objects by the five senses of hearing, feeling, seeing, tasting and smelling, assisted by the mind together with the soul.

Vedic laws: The Nyaya metaphysics recognizes 16 padarthas or categories: Pramāṇa (valid means of knowledge), prameya (objects of valid knowledge), saṁśaya (doubt), prayojana (aim), dṛṣṭānta (example), siddhānta (conclusion), avayava (members of syllogism), tarka (hypothetical reasoning), nirṇaya (settlement), vāda (discussion), jalpa (wrangling), vitaṇḍā (cavilling), hetvābhāsa (fallacy), chala (quibbling), jāti (sophisticated refutation) and nigrahasthāna (point of defeat).

Video to watch: TEDx Talk by Dr KK Aggarwal: Modern day doctor-patient relationship

https://www.youtube.com/watch?v=i9ml1vKK2DQ

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO