Morning MEDtalks with Dr KK Aggarwal 27^th November 2018

Ebola in Congo now infecting newborn babies, says UN. The World Health Organization says a worrying number of the newest Ebola cases amid Congo’s ongoing outbreak are in patients not usually known to catch the disease: babies. In an update published this week, the U.N. health agency reported 36 new confirmed cases of Ebola, including seven in newborn babies and infants younger than 2 years old. Six cases were reported in children aged between 2 and 17 and one case was in a pregnant woman. While Ebola typically infects adults, as they are most likely to be exposed to the lethal virus, children have been known in some instances to catch the disease when they act as caregivers… (Nov. 23, 2018, Stat news)

CDC Directors Statement: E. coli. “CDC continues to investigate a multistate outbreak of E. coli O157 infections linked to romaine lettuce. We understand this outbreak is of concern to many Americans – especially with so many gathering for meals this Thanksgiving week. CDC’s disease detectives are working with federal regulatory partners to investigate and determine the source of contamination as quickly as possible. We will continue to provide more information as it becomes available. The good news is we were able to detect and identify the outbreak quickly through our disease surveillance system, which can prevent further illness.

However, until we know more, it’s crucial that Americans continue to follow the guidance that CDC issued. There are no exceptions – all romaine lettuce must be discarded, regardless of brand, type, or if it is in a mixture. We also continue to urge people to follow our tips to help prevent E. coli illness. In addition, we remind clinicians that antibiotics are not recommended for patients in whom E. coli O157 is suspected until diagnostic testing rules out this infection.” – Robert R. Redfield, M.D., CDC Director

A second human case of rat hepatitis discovered, making it also the second recorded globally. A 70-year-old woman from the Wong Tai Sin district of Hong Kong was diagnosed with the disease this month, according to Hong Kongs Department of Health. She does not recall having direct contact with rodents or their excreta (feces and bodily fluids) and didnt notice any rodents in her residence, the Department of Health said in a statement. The woman was admitted to a public hospital on May 4, 2017, for headache, anorexia, malaise, abdominal pain and palpitations, which she had developed since May 1, 2017. She soon recovered and was discharged four days later, on May 8. The woman had underlying illnesses, according to the Department of Health.

In September, the first case was reported, involving a 56-year old man. Before this, it was not known that the disease could be passed from rats to humans… (CNN)

Top News from ESMO 2018: Chemo-free therapy for head and cancer a step closer: Patients with recurrent or metastatic head and neck cancer with relatively high expression of the PD-L1 could eventually be treated first line with the immunotherapy pembrolizumab rather than traditional chemotherapy. This was the conclusion from experts discussing the results of KEYNOTE-048, the first study to assess immunotherapy used first line in this patient population. The new results show an improvement in overall survival over initial use of standard of care chemotherapy – the first time such a benefit has been seen in a decade. Immunotherapy is already used second line in advanced head and neck cancer; pembrolizumab and nivolumab are already approved for this indication. The KEYNOTE-048 results show that “patients with PD-L1 expression liver longer when they have initial treatment with pembrolizumab” said lead author Barbara Burtness, MD Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut (Medscape)

Violence against women and girls is not only a fundamental human rights issue but also a “moral affront” against them and a “mark of shame” on all societies, United Nations Secretary-General António Guterres has said, calling greater action by everyone around the world to root out the scourge. In a message on the International Day for the Elimination of Violence against Women, Mr. Guterres also underscored that such violence and abuse is a major obstacle to inclusive, equitable and sustainable development. “Not until the half of our population represented by women and girls can live free from fear, violence and everyday insecurity, can we truly say we live in a fair and equal world,” said the Secretary-General. The UN chief also noted that at its core, violence against women and girls is the manifestation of a profound lack of respect – a failure by men to recognize the inherent equality and dignity of women – and that it is tied to the broader issues of power and control in societies… (UN, Nov. 25, 2018).

Use of tanning bed increases risk of second melanoma: Frequent use of indoor tanning beds significantly increased the risk of users developing a second primary melanoma compared with non-users, and they did so far more quickly than non-users, according to a retrospective study reported in the Journal of the American Academy of Dermatology. In an analysis involving 434 patients with melanoma, 56% of patients exposed to artificial ultraviolet radiation (arUVR) were diagnosed with a second primary melanoma within 1 year of their first diagnosis compared with 18% of patients who had not been exposed to arUVR (P=0.011).

9 causes of altered mental status in the elderly: Wernicke encephalopathy: It is caused by thiamine deficiency and can present with changes in gait, altered mental status and ophthalmoplegia (Mayo Clin Proc. 2017 Jun;92(6):899-907). Classically associated with patients suffering from alcoholism, it can be overlooked in other patients at risk for thiamine deficiency such as those with cancer or malnutrition. Alcoholic patients are more likely to present with cerebellar symptoms, whereas patients without alcoholism more frequently experiences ocular symptoms and altered mental status (Mayo Clin Proc. 2017 Jun;92(6):899-907).

WE is more quickly recognised in patients with alcoholism, and they are treated earlier with thiamine and have shorter hospital stays (Mayo Clin Proc. 2017 Jun;92(6):899-907). If these patients are concurrently hypoglycaemic, thiamine and glucose must be given simultaneously. However, no imaging test can confirm or refute the diagnosis of WE and response to thiamine or lack thereof, does not disprove the diagnosis as some symptoms such as memory loss may be permanent (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