China Virus Outbreak Linked to Seafood Market

CMAAO News: Around the globe

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

1.               China Virus Outbreak Linked to Seafood Market: An outbreak of pneumonia that has killed one person in China and infected 40 others appears to be linked to a single seafood market in the central city of Wuhan and has not so far spread beyond there as per WHO. The cluster of infections had raised fears of a potential epidemic after China said last week that the virus causing it was a previously unknown type but came from the same family of viruses that caused the SARS and MERS epidemics. The seafood market in Wuhan - a major domestic and international transport hub - is now closed and no cases have been reported elsewhere in China or internationally.

2.               Mayo Clinic research solves deadly Amish medical mystery: Research led by Mayo Clinic has solved a 2-decade-old mystery about why so many otherwise healthy children and young people in Amish communities have been dying from sudden unexplained cardiac deaths. Examining the DNA of four Amish siblings who suffered cardiac deaths while playing or exercising, researchers found they all had a duplication of specific genetic material that put them at risk.

3.               The cancer death rate declined by 29 percent from 1991 to 2017, including a 2.2 percent drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported, according to the American Cancer Society's annual report on cancer rates and trends. The steady 26-year decline in overall cancer mortality is driven by long-term drops in death rates for the four major cancers -- lung, colorectal, breast, and prostate.

4.               In a study published in the journal Current Biology, Güler and his colleagues demonstrate that the pleasure center of the brain that produces the chemical dopamine, and the brain's separate biological clock that regulates daily physiological rhythms, are linked, and that high-calorie foods, which bring pleasure, disrupt normal feeding schedules, resulting in overconsumption. Using mice as study models, the researchers mimicked the 24/7 availability of a high-fat diet, and showed that anytime snacking eventually results in obesity and related health problems.

Baby dies in mother's womb: Every death does not mean negligence

The family members of a pregnant woman staged a protest demonstration at Murshidabad Medical College and Hospital in West Bengal alleging that their baby died in her womb due to medical negligence of the doctors as reported by Millennium Post last week. The family members of the woman alleged that during the examination, the nursing staff members told the patient that the baby was moving inside the womb. But later, the family members of the patient were told that the baby had died inside the mother's womb. 

WHO/ICD defines stillbirths as the death of a fetus with a birth weight of 500 g, gestational age of 22 weeks or crown-to-heel length of 25 cm. Within this category, ICD classifies late fetal deaths (greater than 1000 g or after 28 weeks) and early fetal deaths (500–1000 g or 22–28 weeks). The WHO recommends using the higher limit (1000 g/28 weeks/35 cm) of third-trimester stillbirths for international comparisons and reporting. The European Medicines Agency (EMA) uses the term stillbirth as the synonym of late fetal death, which is the death after 22 completed weeks of gestation (Vaccine. 2016;34(49): 6057–6068). Fetal deaths later in pregnancy (at 20 weeks of gestation or more, or 28 weeks or more) are referred to as stillbirths as per CDC.

The stillbirth rate is approximately 6.2/1000 live births and fetal deaths.

Several factors may account for stillbirths including maternal, fetal, and placental factors.  Risk factors for stillbirth include older maternal age, obesity, multiple gestation, concurrent medical disorders, smoking and pregnancy complications. But, about 25-60% of stillbirths, especially late in gestation are unexplained.

No intervention has been proven to significantly reduce the stillbirth rate in the general obstetrical population. While in high-risk women, achieving good glycemic control, induction of labor, Doppler velocimetry and early induction of labor may help. A full autopsy without restrictions and including placental pathologic examination is optimal for determining the cause of death

Fetal death is diagnosed on ultrasound examination that documents absence of fetal cardiac activity. Once fetal death has been confirmed by ultrasound, the mother or parents should be informed in person without delay, in an empathetic and straightforward manner, in surroundings where she/they can react privately.

Women or couples who lose a baby may also experience the five stages of grief experienced by individuals when told that they have a terminal illness: Denial, anger, bargaining, depression and acceptance).  The six-step SPIKES protocol can be followed to deliver bad news

lS: SETTING up the interview with the patient and others she chooses to include

lP: Assessing the Patient's PERCEPTION of the situation

lI: Obtaining the Patient's INVITATION i.e. understanding the amount of information that the patient wants to receive

lK: Providing KNOWLEDGE and information to the patient

lE: Addressing the EMOTIONS of the patient with empathic responses

lS: STRATEGY and SUMMARY

Adverse events are an undeniable part of clinical practice. Death of a patient does not always mean negligence as no doctor practices medicine with an intention to harm the patient. Despite all care, however, sometimes errors may happen inadvertently.

The point to be re-emphasized here is documented informed consent. In addition to other relevant information, anticipate and inform the patient of every possible complication that may occur during treatment, however rare they might be.

The Hon’ble Supreme Court of India has defined ‘adequate information’ in the landmark case of Samira Kohli vs Dr Prabha Manchanda. This includes “(a) nature and procedure of the treatment and its purpose, benefits and effect (b) alternatives if any available (c) an outline of the substantial risks and (d) adverse consequences of refusing treatment.”

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

It’s time to change food labeling policy to tackle the obesity epidemic in the country

It’s time to change food labeling policy to tackle the obesity epidemic in the country

The Health Ministry has made it mandatory for some medicines to have a red vertical line on their strips to sensitize the public to the fact that these medicines are meant to be consumed only with the doctor's prescription. Most notable of these ‘prescription-only’ drugs are antibiotics. This Red line campaign is intended to create public awareness about antibiotic resistance, which has emerged as a major public health problem.  

It is also now mandatory to display pictorial health warnings covering 85% of the tobacco product packages as a means to discourage consumption of tobacco by the people.

There is an upsurge of obesity in India, which is rising at an alarming pace. India has the second highest number of obese children in the world after China. Normal weight obesity is the new epidemic of the society. A person could be obese even if his/her body weight was within the normal range. An extra inch of fat around the abdomen increases the chances of heart disease by 1.5 times.

Overweight and obesity are well recognized as predisposing to lifestyle disorders such as type 2 diabetes, hypertension, dyslipidemia, metabolic syndrome. Unhealthy diet comprising of foods high in saturated fats, sugar and salt (junk food, processed food) along with a sedentary lifestyle are major contributors to overweight and obesity. Hence, there is an urgent need to prevent and control obesity.

Along the lines of the Medicines with red line campaign and pictorial health warnings on tobacco products, the Heart Care Foundation of India (HCFI) suggests that packages of all food products that contain high levels of sugar, calories, salt and saturated fats should carry a ‘red dot’ or a ‘red arrow pointing upwards” on the food label, which carries the nutritional content of that particular food product as a symbol warning the consumer that the food product contains unhealthy amounts of fats, sugar and salt. 

Chile introduced a new food labeling system in 2016 to tackle obesity. Food packages that are high in sugar, calories, saturated fat, and salt now carry black, stop-sign warnings with the words “Alto en” or “high in.”  “Alto En Calorias” – high in calories, “Alto En Grasas saturadas” – high in saturated fats, “Alto En Sodio” – high in sodium and “Alto En Azucares” – high in sugar.

Such a change in the food labeling policy may discourage the public from choosing such foods products not only for themselves, but most importantly for their children.

Overweight and obesity in childhood also predispose children to lifestyle diseases later in life. Hence, it is important to encourage healthy eating habits early in life.

HCFI has also written to the health ministry for consideration of this suggestion.

Dr KK Aggarwal

Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

#AskDrKK: How common is vein clots in pregnancy?

#DrKKAnswers: The risk of vein and lung clots is increased in pregnancy especially in the post partum period, particularly in those undergoing caesarean delivery.

Overall, the risk in low risk pregnant women after 20 weeks is quite low (estimated as less than 1 per 3000) and approaches the background risk in non pregnant women.

Routine blood thinning of pregnant women on bed rest is not recommended unless other risk factors for VTE are present.

However, the presence of single or multiple risk factors like marked obesity, prior episode of vein clots markedly increases the risk of clots during pregnancy.

#AskDrKK: How common is obesity in young heart patients?

#DrKKAnswers: Obesity is a independent risk factor and is linked with abdominal obesity. Fatty liver is usually present.