Who is at risk of suicide

Who is at risk of suicide

Dr KK Aggarwal

President CMAAO and HCFI

A new California NIH funded study has shown that people who presented to  emergency departments with deliberate self-harm had a suicide rate in the year after their visit 56.8 times higher than those of demographically similar people.  People who presented with suicidal ideation had suicide rates 31.4 times higher than those of demographically similar people in the year after discharge. 

The findings, published in JAMA Network Open, reinforce the importance of universal screening for suicide risk in emergency departments and the need for follow-up care. 

Question: Like suicide ideation do we also have criminal ideation. Can we prevent crime and rapes?

Immune markers

A Cleveland Clinic study published in JAMA Network Open showed that lymphopenia is associated with death due to heart disease, cancer and respiratory infections, including influenza and pneumonia. The strength of the association increased when it presented in combination with elevated red blood cell distribution width and CRP.

1.     Absolute lymphocyte count is used to quantitate lymphocytes in peripheral blood (rather than the percentage of lymphocytes in the WBC differential count). ALC (cells/microL) = WBC (cells/microL) x percent lymphocytes ÷ 100. Normal values for ALC generally correspond to 1000 to 4000 lymphocytes/microL.

2.      The red cell distribution width (RDW), is an indicator of the degree of variation in RBC size (ie, anisocytosis). RDW has been proposed as a tool to distinguish iron deficiency (elevated RDW) from thalassemia trait (normal RDW) in samples with low MCV.

3.     CRP: <0.3 mg/dL (3 mg/L), is normal

CRP concentrations >1 mg/dL (10 mg/L) as indicating clinically significant inflammation while concentrations between 0.3 and 1 mg/dL (3 and 10 mg/L) indicate what is commonly referred to as low-grade inflammation

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

#AskDrKK:Is Viagra (sildenafil) in heart patients not on nitrates?

#DrKKAnswers:
1. Viagra is generally well tolerated in men with severe coronary disease not using nitrates. [1].
2. Sildenafil is also safe during exercise in patients with stable coronary disease. [2].

References
1. N Engl J Med 2000; 342:1622.
2. JAMA 2002; 287:719.

#AskDrKK: Does exercise reduces chances of heart attack after sex in heart patients?

#DrKKAnswers:

1. The risk of acute heart attack after sexual act is reduced in patients who exercise regularly (1,2).
2. Regular physical exercise should be done at levels of ≥6 METs to reduce the risk (3).
3. The more regularly a person exercises the lower will be the heart attack risk.
4. Regular exercise also reduces the risk of heart attack and sudden death from heavy physical exertion (4,5)
5. Exercise training increases the aerobic capacity and decreases the peak heart rate in post-heart attack subjects engaging in sexual act (6).

References
1. JAMA 1996; 275:1405.
2. Heart 2001; 86:387.
3. Am J Cardiol 2000; 86:14F.
4. N Engl J Med 1993; 329:1677.
5. N Engl J Med 2000; 343:1355.
6. Circulation 1977; 55:738.

#AskDrKK:What is the risk of acute heart attack after a sexual act?

#DrKKAnswers:
Sexual act contributes to the onset of acute heart attack in only 0.9 percent of patients.

The relative risk of acute heart attack within two hours after sexual activity is 2.5. There is no increased risk of heart attack beyond this time period.

This risk is reduced in patients who undergo regular exercise. The risk is same irrespective of past history of heart disease.

Source:JAMA 1996; 275:1405.

AskDrKK: How a sexual act linked to physical exercise?

#DrKKAnswers:
1. Both are measured in terms of MET (metabolic equivalent of oxygen consumption).
2. 1 MET = 3.5 mL O2 uptake/kg per min (resting oxygen uptake in a sitting position).
3. Sexual act is equated to 2-3m METS during the pre-orgasmic phase and 3 to 4 METS during orgasm.
4. This is equivalent to walking at two to four miles per hour on a level surface [1].
5. Exercise stress testing is used to assess both exercise tolerance and tolerance for sex [2].
6. A sexual act causes a modest increase in myocardial oxygen demand that lasts only a brief time [3].
7. Exercise training attenuates the heart rate response [4] and reduces the small risk of heart attack following sex [5,6].

References:
1. Arch Intern Med 1984; 144:1745.
2. Am J Cardiol 2000; 86:51F.
3. Am J Cardiol 2000; 86:27F.
4. Circulation 1977; 55:738.
5. JAMA 1996; 275:1405.
6. Heart 2001; 86:387.

emedinews: Dr Good Dr Bad: A female on bisphosphonate developed femoral fracture.

Situation: A female on bisphosphonate developed femoral fracture.
Dr. Bad: They are unrelated.
Dr. Good: It may be related to the drug
Lesson: February 23 issue of JAMA has shown that bisphosphonates can cause atypical femoral fractures.

Dr KK Answers: Is prolonged TV viewing harmful to the health?

A meta-analysis of prospective cohort studies concluded that prolonged TV viewing is associated with increased risk of type 2 diabetes, cardiovascular disease, and all-cause mortality.

Source: JAMA 2011 Jun 15; 305 (23):2448-55.

Dr KK Answers: Should I double the dose of clopidogrel if there is resistance?

The risk of stent clot (thrombosis) is significantly increased in patients who demonstrate resistance to the drug clopidogrel.

GRAVITAS trial compared a high to a standard dose of clopidogrel in over 2000 such patients and showed no difference in the incidence of major cardiovascular events at six months.

Source: JAMA 2011; 305:1097

Dr KK Answers: What is high sensitivity troponin assay?

In a two-phase study of 2700 patients with suspected heart attack two cutoff levels for the sensitive troponin assay were evaluated: ≥0.20 ng/mL (a typical cutoff for the diagnosis of heart attack using standard assays), and, in a second phase, ≥0.05 ng/mL (high sensitivity assay).

The frequency of detection of heart attack was greater at the lower cutoff level, and was associated with reductions in mortality and rate of recurrent heart attacks.

(Source: JAMA 2011; 305:1210).