Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 23 th March, 2019

Morning Medtalks with Dr KK

1. Patients with chronic hepatitis B (CHB) who take daily aspirin may lower their risk for developing hepatocellular carcinoma (HCC), according to a study published online March 18 in JAMA Internal Medicine.

2. In surgical treatment of gastroesophageal reflux disease (GERD), partial fundoplication (PF) prompts less dysphagia than total fundoplication (TF), according to randomized trial results reported by Scandinavian researchers.

3. The American College of Cardiology (ACC) and the American Heart Association (AHA) have released new guidance on the primary prevention of cardiovascular disease. As expected, one of the major changes is a recommendation against the broad use of aspirin in primary prevention, after recently reported results of the ARRIVE, ASCEND, and ASPREE trials called the balance of risk and benefit with treatment into question in a variety of populations.

4. Based on scientific evidence, we now know that only 10% to 20% of our health is actually determined by the healthcare that we receive, and 70% to 80% is impacted by social determinants of health. Underserved and low-income populations have a higher risk of heart disease and life expectancy can vary by more than 20 years in people living only 5 miles apart."

5. Through lifestyle choices and modifications, nearly 80% of all cardiovascular disease can be prevented

Liquid biopsy?

1. A liquid biopsy is a simple and non-invasive alternative to surgical biopsies

2. It detects information about a tumour through a simple blood sample.

3. Traces of the cancers DNA in the blood can give clues about which treatments are most likely to work for that patient.

4. Example: Epidermal growth factor receptor (EGFR ) gene mutations, which occur in 10-35 per cent of patients with non-small cell lung cancer (NSCLC)

5. Much of the early research on liquid biopsies has been in lung, breast and prostate cancers but this technology is expected to have an impact on all types of cancer.

6. 5 millilitres of blood is spun down to get 2 millilitres of plasma which can be analysed for tumour DNA.

7. It can detect disease progression or treatment resistance long before it would trigger clinical symptoms or appear on imaging scans.

8. The tissue samples removed for biopsy may not show all mutations whereas liquid biopsies offer an improved chance of detecting these genetic changes.

9. In the longer term, liquid biopsies may ultimately be used to catch signs of cancer early, before symptoms arise.

10. In high-risk patients with asymptomatic hepatitis B virus (HBV) infection, a liquid biopsy shows promise in detecting early-stage hepatocellular carcinoma (HCC), according to Chinese and U.S. researchers.

In a paper online March 11 in PNAS, Dr. Yuchen Jiao of Peking Union Medical College, in Beijing, and colleagues explain that the assay they developed (HCCscreen) works by detecting HCC via cell-free DNA (cfDNA) alterations and proteins from the surface antigen of HBV.

Individuals at risk of diabetes could benefit from moderately increasing their body strength. The researchers looked at more than 4600 participants without type 2 diabetes at baseline from a prospective health outcomes study.

After adjusting for multiple factors, including cardiorespiratory fitness, they found that moderate muscular strength was associated with a significant 32% reduction in the incidence of type 2 diabetes versus the lowest strength level. [Yuehan Wang, BMed, of the Department of Kinesiology, Iowa State University, Ames]

New therapy for liver diseases

Drug therapy may treat portal hypertension associated with cirrhosis according to a new study by Mayo Clinic researchers. The study was posted in March on Gastroenterology, the online journal of the American Gastroenterological Association.

The drug sivelestat may effectively lower portal hypertension, improving symptoms and outcomes for those patients. The study results were obtained from mouse models but have since been confirmed in liver samples from humans, according to Vijay Shah, M.D., a Mayo Clinic gastroenterologist and senior author.

Sivelestat has been safely used in humans with acute lung injury and bronchopulmonary dysplasia.

Deposits of fibrin -- microvascular blood clots -- contributed to portal hypertension, and inflammatory cells known as neutrophils contributed to the formation of fibrin. By inhibiting neutrophil function with sivelestat, they were able to decrease portal hypertension.

Dated: 23 th March, 2019

Current Temperature Status and Warning for next 24 hours

Heat Wave and Temperatures Observed Yesterday (Past 24 hours from 0830 hrs IST of 22 nd March to 0830 hrs IST of 23 rd March, 2019)

Heat Wave:

.Yesterday, No heat wave conditions were observed.

Maximum Temperatures Recorded at 1730 Hours IST of 22nd March, 2019:

Maximum Temperature more than 40.0C was recorded at isolated pockets over Vidarbha, Marathwada, North Interior Karnataka and Rayalaseema. (Annexure-1).

Maximum temperature departures as on 22-03-2019: Maximum temperatures were appreciably above normal (3.1C to 5.0C) at a few places over Jammu & Kashmir, Lakshadweep and Andaman & Nicobar Islands; at isolated places over South Interior Karnataka and Tamilnadu & Puducherry; above normal (1.6C to 3.0C) at a few places over Himachal Pradesh, Saurashtra & Kutch, and Rayalaseema and Kerala; at isolated places over Sub-Himalayan West Bengal & Sikkim, Odisha, Gujarat region, Marathwada and Coastal & North Interior Karnataka. They were markedly below normal (-5.1C or more) at a few places over Assam & Meghalaya; at isolated places over Gangetic West Bengal; appreciably below normal (-3.1C to -5.0C) at isolated places over Haryana, Chandigarh & Delhi; below normal (-1.6C to -3.0C) at isolated places over East Rajasthan, Nagaland, Manipur, Mizoram & Tripura and Madhya Pradesh; at isolated places over Uttar Pradesh, Chhattisgarh, Konkan & Goa, Madhya Maharashtra and Coastal Andhra Pradesh and near normal over rest parts of the country (Annexure-2).

Yesterday, the highest maximum temperature of 41.4C was recorded at Anantapur (Rayalaseema) over the country.

Heat Wave Warnings for Next 24 hours(From 0830 hrs IST of 23 rd to 0830 hrs IST of 24 th March 2019):-


Baby's head separated from torso during delivery at the PHC: The medical possibilities behind such cases

The head of a baby got separated from its torso during delivery at a primary health centre in Koovathur near Chennai, as per a recent report. Doctors said the baby had died in the mother's womb.

Allegation:: Staff nurses at the health care centre ignored her pleas for pain relief medication and went ahead with vaginal delivery. There were no doctors at the PHC. Nurses removed only the baby's head from the mother's womb, leaving the torso inside. The woman was then rushed to the Chengalpattu Government Medical College in Kancheepuram for an emergency surgery, where doctors extracted the torso....read more

24th March is World TB Day (3): Contact tracing prevention and control of TB

Contact screening is an important strategy for control of tuberculosis (TB). Contacts are persons who are in close proximity to patients who have TB and are therefore at high risk of acquiring the infection.

Contact:Any person who has contact with an index case with infectious TB....read more


Spiritual prescriptions learnt from patients