Morning MEDtalks with Dr KK Aggarwal 1^st December, 2018

Around 80 adolescents will die of AIDS every day by 2030, at current trends, says UNICEF. Some 360,000 adolescents are projected to die of AIDS-related diseases between 2018 and 2030. This means 76 adolescent deaths every day – without additional investment in HIV prevention, testing and treatment programmes, UNICEF said in a new report “Children, HIV and AIDS: The world in 2030” released on Thursday. The report notes that based on population projections, and at current trends, the number of 0-19 year-olds newly infected with HIV will reach an estimated 270,000 in 2030, decreasing by one third over current estimates. It shows that the number of children and adolescents dying from AIDS-related causes will decline, from a current 119,000 to 56,000 in 2030.

However, this downward trajectory is too slow, particularly among adolescents. According to the report, by 2030, the number of new HIV infections among children in the first decade of life will be cut in half, while new infections among adolescents aged 10 to 19 years old will only decrease by 29 per cent. AIDS-related deaths are projected to decrease by 57 per cent among children below the age of 14, compared with a 35 per cent decrease among those aged 15 to 19 years. “The report makes it clear, without the shadow of a doubt, that the world is off track when it comes to ending AIDS among children and adolescents by 2030,” said Henrietta Fore, UNICEF Executive Director… (UNICEF, Nov. 29, 2018)

Measles cases spike globally due to gaps in vaccination coverage: Reported measles cases spiked in 2017, as multiple countries experienced severe and protracted outbreaks of the disease, according to a new report jointly “Progress Toward Regional Measles Elimination - Worldwide, 2000-2017” published by the WHO and CDC. Because of gaps in vaccination coverage, measles outbreaks occurred in all regions, while there were an estimated 110 000 deaths related to the disease. Using updated disease modelling data, the new report provides the most comprehensive estimates of measles trends over the last 17 years. It shows that since 2000, over 21 million lives have been saved through measles immunizations. However, reported cases increased by more than 30 percent worldwide from 2016. The Americas, the Eastern Mediterranean Region, and Europe experienced the greatest upsurges in cases in 2017, with the Western Pacific the only WHO region where measles incidence fell.

“The resurgence of measles is of serious concern, with extended outbreaks occurring across regions, and particularly in countries that had achieved, or were close to achieving measles elimination,” said Dr Soumya Swaminathan, Deputy Director General for Programmes at WHO. “Without urgent efforts to increase vaccination coverage and identify populations with unacceptable levels of under-, or unimmunized children, we risk losing decades of progress in protecting children and communities against this devastating, but entirely preventable disease.” (WHO, Nov. 29, 2018)

Do You Know? By the time you reach your 50th birthday, youve probably also reached another milestone: youve put 75,000 miles on your feet. You may reach this milestone much earlier if youve led a foot-active lifestyle. By age 50, you may have lost nearly half of the fatty padding on the soles of your feet. And you may be wearing a shoe thats a size bigger than what you wore in your 20s, in part because of weight gain that puts greater pressure on your feet, and in part because your ligaments and tendons have lost some of their elasticity (which also predisposes them to potentially painful ruptures or microtears). If youve given birth, you have another reason for the increase in shoe size: hormones released during pregnancy also cause ligaments to relax. (Harvard)

Antarctic Ozone hole is healing: IIT Kharagpur study: Kolkata, Nov 30 (PTI) A research team of the Indian Institute of Technology, Kharagpur have come up with new data "confirming" that the Antarctic Ozone hole is on a "healing" path, a statement issued by the institute said Friday. Researchers of the Center of Oceans, Rivers, Atmosphere and Law Science (CORAL) of IIT Kharagpur have collected data from 1979 to 2017, which shows though there was a loss in saturation of Ozone since 1987 over the Antarctic, the saturation of loss at 12-21 km stretch has significantly reduced over the period 20012017, the statement said. While the world is debating on climate change and global warming, the findings by CORAL researchers have given environmentalists a reason to rejoice, it said. This is the first of its kind research providing detailed long-term (over four decades) analysis of Antarctic ozone loss saturation in terms of its occurrence, timing using high-resolution ozonesondes (a balloon borne instrument that measures concentration of ozone) and satellite measurements inside the vortex (a whirling mass of fluid or air) for the said period, the statement said.

"We have observed over the past four decades the Ozone layer depletion peaked during winters each year except the warm winters of 1988 and 2002. However, our analysis shows a clear reduction in the frequency of occurrence of ozone loss saturation over the period 20012017 consistently throughout various datasets," Prof Jayanarayanan Kuttippurath said. "This reveals the emergence of an important milestone in ozone recovery," he said.

ACP position paper on Principles for Patient and Family Partnership in Care: In this position paper published Nov. 27, 2018 in the Annals of Internal Medicine, the American College of Physicians (ACP) has examined the rationale for patient and family partnership in care and reviews outcomes associated with this concept, including greater adherence to care plans, improved satisfaction and lower costs. The

1. Principle 1: Patients and families should be treated with dignity and respect: Each patients and familys uniqueness should be respected, and their preferences, values, beliefs, and personal goals incorporated into the promotion of health and delivery of health care.
2. Principle 2: Patients and families should be active partners in all aspects of their care: Patients and families should participate in care at the level they choose, and their perspectives should be recognized as essential to optimizing quality and value.
3. Principle 3: Patients and families should contribute to the development and improvement of health care system: Patients and families should collaborate as partners in designing, improving, and evaluating the health care system (the entities that encompass where the care of patients is provided, including physician practices, hospitals, retail health and urgent care clinics, home health, and others).
4. Principle 4: Patients and families should be partners in the education of health care professional: Patients and families should actively participate in the educational process for todays and the next generation of physicians and other health care professionals, including serving as teachers and evaluators.

The US FDA has approved Firdapse (amifampridine) tablets as the first treatment of Lambert-Eaton myasthenic syndrome (LEMS) in adults. LEMS is a rare autoimmune disorder that affects the connection between nerves and muscles and causes weakness and other symptoms in affected patients.

CDC Director’s Media Statement on US life expectancy: “The latest CDC data show that the US life expectancy has declined over the past few years. Tragically, this troubling trend is largely driven by deaths from drug overdose and suicide. Life expectancy gives us a snapshot of the Nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable. CDC is committed to putting science into action to protect U.S. health, but we must all work together to reverse this trend and help ensure that all Americans live longer and healthier lives.” Robert R. Redfield, M.D., CDC Director

ODYSSEY OUTCOMES trial: Among patients who had a previous acute coronary syndrome and who were receiving high-intensity statin therapy, the risk of recurrent ischemic cardiovascular events was lower among those who received alirocumab (a PCSK9 inhibitor) than among those who received placebo (New England Journal of Medicine, Nov. 29, 2018)

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