Morning MEDtalks with Dr KK Aggarwal 2^nd December, 2018

Thirty years after the first World AIDS Day, the HIV response stands at a crossroads, UN Secretary-General António Guterres has said, marking this year’s commemorations. The direction taken now, may determine whether the epidemic can be ended by 2030, or if future generations will have to continue the battle, he said. In his message for the Day, which falls each 1 December, Mr. Guterres said that “more than 77 million people have become infected with HIV, and more than 35 million have died of an AIDS-related illness.”

Noting that huge progress has been made in diagnosis and treatment, and prevention efforts have avoided millions of new infections, he stressed that “the pace of progress is not matching global ambition.” “New HIV infections are not falling rapidly enough,” he spelled out, adding that some regions are lagging, and financial resources are insufficient. Stigma and discrimination continue to hold people back, especially key populations – including men who have sex with men, sex workers, transgenders, intravenous drug users, prisoners and migrants – and young women and adolescent girls. Moreover, one-in-four people living with HIV do not know that they have the virus, keeping them from making informed decisions on prevention, treatment and other services.

The UN chief flagged “there is still time” to scale-up testing for HIV; to enable more people to access treatment; to increase resources needed to prevent new infections; and to end the stigma. “At this critical juncture, we need to take the right turn now,” concluded the Secretary-General ... (UN, Nov. 30, 2018)

Polio cases no longer declining; WHO fears global resurgence: Progress has stalled in ridding the world of polio. An emergency committee of the World Health Organization unanimously agreed Friday to continue to designate the paralyzing disease a "Public Health Emergency of International Concern." WHO originally designated polio in this way in 2014, deeming it a health threat serious enough to endanger communities worldwide. This year, WHO has recorded 27 cases of wild poliovirus worldwide, compared with 22 total cases last year. Though the small number of cases may appear insignificant, the committee said the trend is noteworthy because it shows stagnation… (CNN)

CDC issues Level 2 (practice enhanced precautions) alert for Niger: An outbreak of polio has been reported in the Zinder Region in Niger. This outbreak is caused by vaccine-derived poliovirus (VDPV). To help control the outbreak, the United Nations is supporting the government of Niger in launching a polio campaign to vaccinate children under 5 years old in Agadez, Diffa, Maradi, and Zinder provinces. For travelers going to countries with circulating VDPV who have completed their routine polio vaccine series but who have not already received an adult booster dose, CDC recommends administering a single lifetime inactivated poliovirus vaccine (IPV) booster dose. Outbreaks of vaccine-derived poliovirus are a sign of low polio vaccine coverage in the country … (CDC)

FIRS highlights link between HIV and TB on World AIDS Day: Tuberculosis (TB) is the world’s leading infectious disease and it accounts for one in three deaths from HIV/AIDS, according to the WHO’s 2018 report on TB. This is why on World AIDS Day, Dec. 1, the Forum of International Respiratory Societies (FIRS), of which the American Thoracic Society is a founding member, is calling on governments, health advocates and non-government organizations to strengthen their response to AIDS and TB. “AIDS and TB are a deadly combination,” said ATS President Polly Parsons, MD. “In the developing world, TB is often the first sign a person has HIV. Together, the diseases are far worse than they are alone.” WHO estimates that the risk of developing TB is 16-27 times greater in people who are infected with HIV than those who are not … (ATS)

The current Congo Ebola outbreak is the 2nd largest and the 2nd deadliest: The current Ebola epidemic in the Democratic Republic of Congo, with 426 total cases, including 245 deaths, is now the second largest and second deadliest in history, according to Thursdays report from the nations Ministry of Health. An outbreak in Uganda in 2000-01 included 425 cases and caused 224 deaths, according to the WHO. The deadliest outbreak occurred in West Africa in 2014, when the disease killed more than 11,000 people.

The latest outbreak in Congo, which began in August, has a case fatality rate of 57%. Of the total cases, 379 have been confirmed, and 47 are probable. An additional 87 suspected cases are under investigation. On a positive note, 126 patients have recovered, the ministry said. North Kivu province, which includes the cities Beni, Kalunguta and Mabalako, remains the epicenter of the outbreak, though cases have been reported in neighboring Ituri province… (CNN)

Cardiologists should consider adding a glucose-lowering drug proven to have cardiovascular benefits for patients with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD) to reduce risk in these patients, according to consensus recommendations from the American College of Cardiology (ACC) published online Nov. 26, 2018 in the Journal of the American College of Cardiology. They should be aware of the evidence supporting the use of SGLT2 inhibitors and GLP-1RAs in this regard.

Deltoid muscle echogenicity may help detect unrecognized diabetes in patients with shoulder pain. A study presented at the Radiological Society of North America annual meeting in Chicago has suggested that the echogenic appearance of the deltoid muscle may detect unrecognized diabetes in patients complaining of shoulder pain, with good. A diagnosis of either definite diabetes or suspected diabetes was made in 106 out of 137 subjects who actually had a diabetes diagnosis (sensitivity 77%).The positive predictive value was 89%. 

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