Morning MEDtalks with Dr KK Aggarwal 23^rd November 2018

Which oil to choose for cooking? Canola oil and olive oil are very versatile and are great to use in many different recipes, even in baking. These unsaturated oils in place of saturated fats can help reduce the incidence of chronic conditions, such as type 2 diabetes and cardiovascular disease. Plant and seed oils have mono and polyunsaturated fats, which help to increase the good cholesterol – the high-density lipoprotein (HDL) cholesterol. They also help lower the bad cholesterol – the low-density lipoprotein (LDL) cholesterol. Oils like peanut and sesame have stronger flavor and higher smoke points, so they’re great in marinades and stir-fries. The lower smoke point of walnut oil makes it better for dressings.

My view: All oils are high in calories. So you just want to use them in moderation.

Top News From ESMO 2018: New hope in triple-negative breast cancer with immunotherapy. For the first time, immunotherapy has shown a survival benefit in breast cancer. The result was seen with the anti-programmed cell death ligand 1(PD-L1) drug atezolizumab used with chemotherapy in triple-negative breast cancer in PD-L1-positive patients. The results from the Impassion130 study were presented by Peter Schmid, MD, PhD, Clinical Director of St. Bartholomew’s Breast Cancer center, Barts Health NHS Trust, London UK and were simultaneously published in the New England Journal of Medicine.

The trial randomly assigned more than 900 women who had triple-negative disease to receive atezolizumab or placebo + chemotherapy as first line therapy. Across the board, the addition of atezolizumab was associated with a 20% improvement in progression-free survival. However, when the researchers assessed a subgroup of patients who were PD-L1+, addition of atezolizumab improved PFS by 38% and increased overall survival by the same percentage, offering patients an additional 10 months of life in comparison with the patients who received chemotherapy alone (Medscape).

USPSTF recommends HIV PrEP for all high-risk patients: In a draft recommendation statement published online Nov. 20, 2018 on its website, the US Preventive Services Task Force (USPSTF) recommends (“A” recommendation) that clinicians offer pre-exposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition.

Daurismo (glasdegib) is the first and only Hedgehog pathway inhibitor to be approved by the US FDA for the treatment of acute myeloid leukemia (AML). The tablets are to be used along with low-dose cytarabine for the treatment of newly-diagnosed AML in adults who are 75 years of age or older or who have other comorbidities that may preclude the use of intensive chemotherapy. The prescribing information for Daurismo includes a Boxed Warning to advise health care professionals and patients about the risk of embryo-fetal death or severe birth defects. The drug should be avoided during pregnancy or while breastfeeding. 

More than half of the data breaches of protected health information (PHI) reported by US health systems over the past decade were attributable to internal mistakes or neglect, a study has shown. Although hacking or other information technology (IT) incidents were not leading causes of data breaches, they did compromise the largest volume of patient records. The causes of data breaches, in rank order, were theft by outsiders or unknown parties (32.5%), mailing mistakes by employees (10.5%), theft by former or current employees (9.0%), employees taking PHI home or forwarding it to personal accounts or devices (6.5%), unspecified IT incidents (6.2%), accidental exposure of PHI through the Internet (5.4%), malware or viruses (5.3%) and the loss or misplacement of unencrypted equipment (4.7%)… (Nov. 19, 2018, JAMA Internal Medicine)

9 causes of altered mental status in the elderly: Delirium: Occurs in 7-10% of geriatric patients in the ED (Clin Geriatr Med. 2013;29(1):101-36; Ann Emerg Med. 2014;63(5):551-560.e2). It presents as an acute change in consciousness and loss of cognition that waxes and wanes. Patients’ conditions can range from sleepy to agitated and combative. Inattention is the hallmark sign/symptom (Clin Geriatr Med. 2013;29(1):101-36). Delirium is easier to recognize in patients who become hyperactive; “quiet” delirium may be more difficult to identify.

Delirium is often mistaken for dementia, but the risk of morbidity for delirium is high; therefore, clinicians should make an effort to identify delirium, if present. In addition, inquire about sleep-wake cycle disturbances, hallucinations, confused thinking and symptoms of lethargy or agitation, because these signs/symptoms are not associated with dementia and, if present, should trigger further clinical evaluation (Clin Geriatr Med. 2013;29(1):101-36).

Unlike dementia, delirium is sudden in onset, reversible, of waxing and waning nature, disorientation occurs at the onset and the altered mental status presents early.

The American Academy of Pediatrics (AAP) has published new guidelines on diagnosing and managing serious infections in infants born at less than 34 weeks gestation and those born at more than 34 weeks of gestation in two clinical reports published online Nov. 19, 2018 in the journal Pediatrics. It includes recommendations on how to identify babies most likely to develop early-onset sepsis, based on their gestational age, circumstances of birth and other factors, and addresses the use of multivariate sepsis risk models in clinical care. 

Tweet of the Day: Medscape (@Medscape) tweeted at 8:43 am on Thu, Nov 22, 2018: Evidence shows stable weight maintenance over time is best for preventing premature death. 

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