Morning MEDtalks with Dr KK Aggarwal 11^th October 2018

Dear Colleague

Zika Update. A Zika outbreak has been reported in India. The virus has been detected in 22 people in Jaipur. The state of Bihar is also on alert as one person diagnosed in Jaipur is a native of Siwan district in the northern province and had recently visited home. Zika had first broken out in the western state of Gujarat and Tamil Nadu in the south in 2017. This year, the first case in Jaipur was reported on Sept. 22. The Zika virus, passed by the Aedes mosquito, caused the 2015 epidemic in Brazil and later spread to South America and North America.  For Zika the first case in the community means a focal outbreak and needs intensive surgical strike to contain the disease.

Dr Dog: A trained dog can distinguish between malignant and benign pulmonary nodules in exhaled breath samples from patients with and those without pulmonary nodules virtually 100% of the time as per Angela Guirao, MD, a thoracic surgeon from the Hospital Clinic of Barcelona in Spain. All dogs can be trained to detect volatile organic compounds (VOCs), which are contained in exhaled breath samples from patients with malignant pulmonary nodules.

The dog achieved successful results with a 97% sensitivity, a 99% specificity, a 97% positive predictive value, and a 99% negative predictive value. It takes an experienced dog trainer about 5 months to teach a dog how to distinguish breath samples from a patient with lung cancer from those from a patient without cancer, she noted. The new data were presented at the recent International Association for the Study of Lung Cancer (IASLC) 19th World Conference on Lung Cancer (WCLC) held in Toronto.

Dilemmas we often face

1. Short visits: Doctors are under enormous pressure to see as many patients as possible. The standard amount or time allotted for each patients is 10-12 minutes. Short visits force many doctors to concentrate on immediate biomedical issues, such as dealing with a high blood-pressure reading, rather than exploring psychosocial aspects of the patients life.
2. Pressure to refer to in-house could deny patients better care
3. Reducing opioid dosages could leave patients suffering
4. Worry that providing telehealth services might create inferior care
5. Giving genetic test results while being unsure of how to interpret them

Declared dead by doctors in UP, elderly man comes alive (Dr KK Aggarwal and Advocate Ira Gupta). Doctors at a private Ram Shiva hospital in Kanpur declared a 55-year-old road accident victim Phool Singh dead on Sunday, but he regained senses while being shifted to the mortuary at Lala Lajpat Rai hospital for postmortem on the same day. He was immediately taken back to the hospital by his relatives, where he died while undergoing treatment several hours later on Monday. His kin have filed a complaint to the police, who are investigating the matter.

Quoting Singhs family, the police said he had sustained critical injuries in a road accident in Fatehpur on Sunday morning and was admitted to Rama Shiv hospital in Kanpur. After preliminary treatment, doctors at the hospital declared Singh dead around 4pm the same day and allegedly issued a death certificate. However, while his body was being shifted to the mortuary, his family members found him breathing and informed the doctors who later confirmed that he was alive.

Situations where this can happen

1. In extreme hypothermia you can mistake a person is clinically dead while he is not
2. Lazarus syndrome also known as autoresuscitation after failed cardiopulmonary resuscitation is the spontaneous return of circulation after failed attempts at CPR  due to buildup of pressure in the chest as a result of CPR. The relaxation of pressure after resuscitation efforts have ended is thought to allow the heart to expand, triggering the hearts electrical impulses and restarting the heartbeat. Other possible factors are hyperkalemia or high doses of adrenaline.
3. Deep coma mistaken as clinical death
4. Apathy in dealing with terminal cases and believing on paramedical staff

The seven biggest mistakes

1. Babies allegedly damaged during birth
2. Spinal surgery outcomes: Even if spinal procedures were “perfectly performed”, there would be no guarantee of an improvement in the quality of life of the patient, and this leads to dissatisfaction and complaints.
3. Consistent appropriateness of dosages administered by anaesthetists
4. ‘Wrong site’ surgery and swabs or other medical equipment being left in the patient’s body
5. Mortality rates of patients with comorbidities
6. Poor bedside manner
7. Billing issues (Businesslive)

Start nurturing your mental health ‘at an early age’ urges UN chief. “Poor mental health during adolescence has an impact on educational achievement and increases the risk of alcohol and substance use and violent behavior,” said UN Secretary-General António Guterres, in a statement, stressing that many children and teenagers caught up in conflicts and disasters worldwide, are particularly at risk of psychological distress. “A great deal of mental health conditions are both preventable and treatable, especially if we start looking after our mental health at an early age,” said Mr. Guterres… (WHO)

A faith (church)-based program to encourage a healthy lifestyle lowered systolic BP more than an educational program alone delivered in other churches in the Faith-based Approaches in the Treatment of Hypertension (FAITH) trial, the results of which were published Oct. 9, 2018 in the journal Circulation: Cardiovascular Quality and Outcomes.

The FAITH trial compared the effectiveness of a comprehensive faith-based therapeutic lifestyle change + motivational interviewing (MINT) sessions led by church members who were trained lay health advisors in churches vs the usual health education alone, on BP reduction among blacks with uncontrolled hypertension. After the six-month intensive phase of the program, systolic BP was reduced 5.8 mm Hg more in the faith-based lifestyle change group vs the health education group. The benefit was sustained but smaller (5.2 mm Hg) after nine months.

China has approved 17 anti-cancer drugs for inclusion in its national health insurance system, the government said on Wednesday, part of its efforts to make cancer treatment more affordable as the number of cases increases, as reported in ET Healthworld, Oct.10, 2018. Chinas State Medical Insurance Administration has been in negotiations with domestic and overseas pharmaceutical companies to lower prices and put more cancer drugs on the list of medicines eligible for reimbursement. The administration said in a notice that the negotiations were a major part of the governments strategy to make cancer drugs more affordable to the general public. The 17 drugs, which include azacitidine, will remain eligible until Nov. 30, 2020…All countries in Asia should follow suit.

Mammosphere has launched “Where’s My Mammogram?” a public service campaign to help women obtain copies of prior diagnostic breast images from their physicians. The campaign is intended to empower women to become active participants in their breast health, and to improve clinical outcomes of regular breast cancer screening for women over 40. Under current federal law, women can request copies of their mammograms from their doctors, who are obligated to provide them in whatever format patients request at a reasonable expense, and within 30 days. Having prior images and health history available to clinicians at the time of diagnosis has long been shown to significantly improve clinical outcomes and save lives. When doctors have immediate access to prior breast images, false positives are reduced by 40-60%; 30% of actual cancers are caught earlier, and diagnosis of breast cancer that has spread to the lymph nodes is reduced by 12%, according to clinical studies... (Business Wire)

Video to watch: TEDx Video: Doctor-patient relationship www.youtube(dot)com/ watch?v=i9ml1vKK2DQ

Dr KK Aggarwal

Padma Shri Awardee

President Elect CMAAO

President Heart Care Foundation of India