Morning MEDtalks with Dr K K Aggarwal

Morning Health Talk:

New Delhi, June 18, 2018:

Flu Vaccine

The quadrivalent flu vaccine have two A virus strains — H1N1 and H3N2 — and two B virus strains — Victoria and Yamagata. Sanofi Pasteur’s injectable influenza vaccine (FluQuadri) for active immunisation of adults of age 18 to 64 years was approved in May last year by DCGI. The application for the paediatric indication is under review by the DCGI and final approval is expected by the end of this month. The vaccine was licensed for use by the U.S. Food and Drug Administration (FDA) in 2013; it is licensed in 26 countries.

In the case of H1N1, there are two strains — California and Michigan — that cause influenza. In India, the Michigan strain was earlier circulating and has been replaced by the California strain. For 2018, the WHO has recommended the Michigan strain for India.

ASCO Highlights (American Society of Clinical Oncology) 

• Most patients with advanced non-small cell lung cancer do not need chemo upfront
• Skip adjunct chemo in most HR positive HER2 negative early breast cancer
• In advanced kidney cancer surgery is not the only treatment. Consider sunitnib.
• Aspirin plus PPI prevent oesophageal cancer in high risk individuals

WhatsApp notices legally valid, if you have opened it

The Bombay high court has held that service of notice about a litigation through WhatsApp is valid. Following the enactment of the IT Act, courts have allowed parties in a litigation to serve notice through email, in addition to traditional methods. Justice Gautam Patel observed that a credit card defaulter who was evading the bank had not only received the notice in a PDF file but also opened it and read its contents. The blue ticks on the message revealed that Jadhav had received the message and read it. The court had said that the “double tick” on WhatsApp showed that the summons has been delivered.

Revival after death

A 55-year-old alive ICU-admitted patient was declared dead by a state-run hospital in Kolkata on Friday morning, but her son found her breathing at the burning ghat but even as he took her to another hospital, she died in front of another hospital on Friday night.

Possible reasons

1.  Severe hypothermia with cardiac arrest. CPR may be effective after hours
2. Lazarus syndrome, (the Lazarus heart) also known as autoresuscitation after failed cardiopulmonary resuscitation, is the spontaneous return of circulation after failed attempts at resuscitation. Its occurrence has been noted in medical literature at least 38 times since 1982. Occurrences of the syndrome are extremely rare. One hypothesis is that one factor is the build-up of pressure in the chest as a result of cardiopulmonary resuscitation. The relaxation of pressure after resuscitation efforts have ended is thought to allow the heart to expand, triggering the heart’s electrical impulses and restarting the heartbeat. Other possible factors are hyperkalemia or high doses of epinephrine.
3. Definition of deathAn individual is dead if the individual has sustained either:
   a.     irreversible cessation of circulatory and respiratory functions; or
   b.     irreversible cessation of all functions of the entire brain, including the brain stem.

Mistake: Reversible or irreversible, error of judgment.

Increased Salt, Decreased Cognitive Function

High salt intake may have a dramatic impact on memory and cognitive functioning, independent of its effect on blood pressure, according to an animal study published in Nature Neuroscience.

After only a few weeks, mice fed a sodium-rich diet experienced significantly reduced blood flow to regions of the brain associated with learning and memory. The mice had difficulty building a nest and struggled to find their way out of mazes, as decreased blood flow appeared to affect both cognition and spatial memory.

Feeding mice a diet with a high content of salt (8-16 times the normal diet), corresponding to the highest levels of salt consumption in humans, is what results in cognitive impairment.

Weather

Heat wave conditions are likely to prevail over eastern parts of the country during next 48 hours.

CRT in Narrow QRS heart failure

A wide electrocardiographic QRS duration is a key part of the indication for cardiac resynchronization therapy (CRT) in heart failure (HF), but patients with narrow QRS who are of shorter stature and have smaller ventricles might also make good candidates as per a randomized EchoCRT trial.

Erectile dysfunction linked to future cardiovascular disease

Using data from the ongoing Multi-Ethnic Study of Atherosclerosis (MESA), researchers found men who reported ED had increased risks for both coronary heart disease (CHD) and CVD events over 3.8 years of follow-up. The report was published online June 11 in Circulation.

How to treat paracetamol poisoning

• Patients who present within 24 hours after an acute ingestion are generally asymptomatic. Patients who present later may manifest symptoms and signs of hepatic injury.
• Patients who present soon after a potentially toxic ingestion of paracetamol (single dose ≥7.5 g) are likely to benefit from gastrointestinal decontamination. Start with activated charcoal, 1 g/kg (maximum dose 50 g) by mouth in all patients who present within four hours of a known or suspected ingestion, unless there are contraindications to its administration
• Give N-acetylcysteine in all patients with paracetamiol poisoning at significant risk for hepatotoxicity. Start therapy before the onset of SGPT elevation. This is accomplished by initiating treatment within eight hours of an acute ingestion.
• N-acetylcysteine may be given intravenously (IV), using a 20 hour protocol, or orally, using a 72 hour protocol.
• Measure the SGPT prior to stopping N-acetylcysteine and continue treatment if the SGPT is abnormal