Morning MEDtalks with Dr K K Aggarwal

Morning Health Talk :

New Delhi, May 30, 2018 :

Clinical

Eating bitter pumpkins can lead hair loss in women, as two women have been poisoned and lost hairs after their dinners including pumpkins and squashes that might have contained potent toxins. (JAMA Dermatology)

Public Health

• France has seen a sharp fall in the number of people smoking daily, with one million fewer lighting up from 2016-2017, a survey by Public Health France. The study pointed to the slew of anti-smoking measures introduced to France as a likely reason for the decline. Recent years have seen neutral packaging, reimbursements for people using tobacco substitutes, higher cigarette pricing and campaigns like the national tobacco-free month.
• Today relevant stakeholders from the medical fraternity- Heart Care Foundation India (HDFI), National Neonatology Forum (NNF) and other institutions discussed the why and how of screening newborns for heart defects at the launch of the campaign for formulating a national policy on making Critical Congenital Heart Diseases (CCHD) on making screening mandatory in all healthcare establishments in India.

Dr Anne de-Wahl Granelli, a specialized biomedical scientist who visited India to raise awareness about CCHD screening was also part of the discussion.

At the Government level, Kerala is already working towards making CCHD screening mandatory in all their state-run hospitals.

There is an urgent need to formulate a national policy on the compulsory screening of Critical Congenital Heart Diseases (CCHD) in India.

• Limiting global warming to 1.5°C could avoid around 3.3 million cases of dengue fever per year in Latin America and the Caribbean alone—according to new research from the University of East Anglia (UEA). A new report published today in the Proceedings of the National Academy of Sciences (PNAS) reveals that limiting warming to the goal of the UN Paris Agreement would also stop dengue spreading to areas where incidence is currently low. A global warming trajectory of 3.7°C could lead to an increase of up to 7.5 million additional cases per year by the middle of this century.
• Read more at: https://phys.org/news/2018-05-limiting-global-millions-dengue-fever.html

Dr Radhakrishnan Siddharth

• All critical CHD should ideally be diagnosed in utero. This will ensure that the parents are appropriately counselled on the expectation for their babies and also if they wish to continue with the pregnancy then appropriate steps can be taken for delivery of the baby where immediate neonatal care can be provided.  For this to happen a) The gynaecologist should identify the “high risk” pregnancies for CHD and refer them to the Ultrasonologist at the appropriate time (16 to 20 week) gestation.
• Our own study found out that a high percentage of referrals continue to happen much beyond 20 weeks when proper counselling may be too late. This can have devastating psychological impact for parents especially when we deal with complex CHD.
• All Ultrasonologist should train themselves in looking at the heart in order not to miss critical CHD and them immediately refer to an appropriate centre (with Foetal Cardiology unit). This is very important because when as Paediatric Cardiologist we counsel parents with critical CHD the most frequently asked question is ” Why were we not told about this during our multiple ultrasound examination “. Many parents are of course also very agitated and devastated when this news is broken to them
•  Pulse oximetry remains a very simple, inexpensive tool to screen babies who are born with some critical CHD associated with low oxygen levels. Meticulous attention should be paid during recordings of oxygen level by the instrument. Clear guidelines are available for this. However, there are many critical CHD which may be associated with normal pulse oximetry results and this should not be a substitute for a thorough clinical examination at discharge from nursery.
• The screening should continue beyond discharge of a new born baby especially during the first visit to the Paediatrician. This will further ensure that some critical CHD which are associated with normal Oximetry at discharge are picked up early and diagnosed after referral to a unit with Paediatric Cardiology services

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI