Morning MEDtalks with Dr KK Aggarwal 26^th November 2018

Early HIV diagnosis means successful treatment: Late diagnosis of HIV remains a challenge across the WHO European Region. Every second newly diagnosed person has already reached an advanced stage of the infection. In the European Union/European Economic Area, the latest data from 2017 show that almost 90% of AIDS diagnoses happened within just 90 days of the HIV diagnosis. This indicates that the majority of these AIDS cases could have been avoided with early diagnosis.

Yet being tested for HIV has never been easier. Across Europe, peer counsellors, who are not necessarily medical professionals but have received special training, give advice, support and are able to deliver results in a matter of minutes at community-based testing facilities. In the event of a positive test result, confirmation at a health-care facility will be needed. If confirmed, doctors follow up and are then able to provide treatment using antiretroviral drugs. These drugs prevent the HIV infection from developing into AIDS and make it possible for people to live long, healthy lives with HIV. In the majority of cases, treatment leads to an undetectable level of the virus in the blood, meaning there is no need to fear transmitting the virus to sexual partners ... (WHO Europe).

#TakeYourSeat at the UN Climate Change Conference: a way for all people to join the global conversation: To bring the voice of the people to the upcoming Climate Change Conference in Poland (known by the shorthand COP 24, from 2 to 14 December), the United Nations has launched  the ‘People’s Seat’ initiative, calling millions of change advocates worldwide to submit messages for an address that will be delivered to leaders attending the conference, by renowned naturalist Sir David Attenborough. “This is an opportunity for people from across the globe, regardless of their nationality or circumstances, to be part of the most important discussion of this century; the unprecedented action needed to reach the Paris Agreement targets,” said Sir David Attenborough.

Ezetimibe reduced the rate of a first cardiac event — a composite of sudden cardiac death, myocardial infarction (MI), coronary revascularization, and stroke — more than diet alone in 75- to 104-year-old Japanese patients with elevated LDL-cholesterol (LDL-C) and a second risk factor as per results of the ezetimibe in prevention of cerebro- and cardiovascular events in middle- to high-risk, elderly (75 years old or over) patients with elevated LDL-cholesterol (EWTOPIA75) presented at the American Heart Association Scientific Sessions 2018 in Chicago.

Hydrocephalus may be a complication of congenital Zika syndrome, and the presenting signs and symptoms are challenging to recognize, says a study published online November 19, 2018 in JAMA Neurology. The researchers recommend that monitoring for hydrocephalus, including assessing the potential harbinger of cerebellar or brainstem hypoplasia, should be part of the standard care of these patients.

Over half of former ICU patients report symptoms of psychological disorders. A study from the UK published in journal Critical Care shows that patients who have survived critical illnesses requiring care in an intensive care unit (ICU) frequently report symptoms of anxiety, PTSD and/or depression. Those reporting symptoms of depression after critical illness were a greater risk of death.

National Blood Transfusion Council (NBTC) advisory for blood banks and potential blood donors to prevent Zika virus infection in the country by blood transfusion

All blood banks in the country should ensure following precautions:

1. Blood banks strictly adhere to donor selection criteria and do proper donor screening. Blood banks must ask for travel history to ensure that individuals returning from outbreak zone are not accepted for blood donation till 120 days of return. These donors must be symptom free during this period prior to blood donation.
2. Blood banks should not accept blood from donors till 2 weeks following complete recovery from acute viral infection and cessation of any therapy/ medications.
3. Potential blood donors who have returned from outbreak zone should:
4. Not donate blood for 120 days from date of return.
5. Blood donors should report to blood bank if they develop sign and symptoms of Zika infection within 2 weeks of blood donation.
6. NBTC has not approved any blood donor screening tests for Zika virus.
7. No human plasma should be imported from Zika outbreak regions/countries

B12 deficiency is common in patients on metformin: Vitamin B12 should be monitored in patients with diabetes on metformin to avoid peripheral neuropathy, suggests a study presented Nov. 21, 2018 at the Society for Endocrinology BES 2018 conference in Glasgow. The study found that 64% of patients had not been tested for vitamin B12 deficiency. Almost 10% of patients were found to have vitamin B12 deficiency, although only just over 6% were being treated.

Top News From ESMO 2018: Palbociclib in breast cancer: New overall survival data: The new class of cyclin-dependent kinase (CDK) 4/6 inhibitors offer hope for patients with advanced breast cancer who have stopped responding to endocrine therapy. In the PALOMA-3 trial, conducted in patients with advanced HR+, HER2- breast cancer who had stopped responding to endocrine therapy, adding palbociclib to fulvestrant improved OS by 7 months compared with fulvestrant alone. For patients with prior endocrine sensitivity, the difference in median OS with palbociclib and fulvestrant was 10 months. The primary endpoint for median progression-free survival was reported previously and was significant for the combination. Massimo Cristofanilli, MD of the Feinberg School of Medicine, Northwestern University, Chicago, Illinois indicated that for patients with advanced HR+, HER2- breast cancer whose disease has progressed or relapsed with prior endocrine therapy, the combination of palbociclib and fulvestrant should be standard of care. (Medscape)

9 causes of altered mental status in the elderly: Normal pressure hydrocephalous: The average age of onset is 70 years and its incidence increases after 80 years (Continuum (Minneap Minn). 2016 Apr;22(2 Dementia):579-99). It usually presents with impaired cognition, changes in gait (symmetric) and urinary incontinence that progressively worsens over 3 or more months. Obtain CT scan, which will show ventriculomegaly, but ventriculomegaly alone should not trigger an NPH work up. (Continuum (Minneap Minn). 2016 Apr;22(2 Dementia):579-99) Rather, the diagnosis should be pursued in patients with suspicious clinical findings, such as impaired executive thinking and memory. The Mini mental state examination (MMSE) or the Montreal Cognitive Assessment (MoCA) tool can be used to quickly evaluate patients.

Difficulty with naming, hallucinations and failure to recognize family members are not characteristic of NPH and should trigger a workup for other causes of dementia (Continuum (Minneap Minn). 2016 Apr;22(2 Dementia):579-99). Placement of CSF shunt is the only treatment for NPH and should be pursued expediently (Continuum (Minneap Minn). 2016 Apr;22(2 Dementia):579-99). (Medscape)

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