World is not prepared for next pandemic- claims report

The Wall Street Journal (1/14, McKay, Subscription Publication) says that global health experts released a report(pdf) Wednesday calling on the Group of Seven advanced industrial nations, the larger G-20 bloc, and the United Nations to put up $4.5 billion a year to strengthen the world’s defense against pandemics. The group called for improving public health systems, strengthening the UN’s World Health Organization, and accelerating the development of vaccines, drugs and other medical interventions necessary to combat outbreaks. Further, the group said in a report that pandemics are among the greatest risks to mankind and economic losses can be costly.

        Bloomberg News (1/13, Tozzi) reports the authors estimated that pandemics “could cost humanity $6 trillion in the 21st century, or $60 billion a year,” and “argued for the investing $4.5 billion a year—or 65 cents for every resident of the planet—to prepare.” The reports said that there are few threats “that can compare with infectious diseases in terms of their potential to result in catastrophic loss of life,” yet “nations devote only a fraction of the resources spent on national security to prevent and prepare for pandemics.” Moreover, the report said the WHO was “unprepared” to combat pandemics and needs to make “significant changes in order to play this role effectively.” They noted that “there is no realistic alternative” to the underfunded agency. The document was drawn up by 17 academics, policymakers, and nonprofit and industry leaders from around the world.

        Reuters (1/14, Kelland) says that the report by the Commission on Creating a Global Health Risk Framework for the Future was coordinated by the US National Academy of Medicine, along with the Bill & Melinda Gates Foundation, the Rockefeller Foundation and several other organizations.

Implanted Coils In Lungs May Benefit People With Severe Emphysema

By Dr Deepu

The AP (1/13, Tanner) reports that research published in the Journal of the American Medical Association suggests that a new “minimally invasive way to treat severe breathing problems caused by” emphysema “showed modest but promising benefits.” This “technique involves inserting several small metal alloy coils through a scope into the lungs, aiming to tighten diseased tissue and open up healthy airways.” The research “involved 100 patients randomly assigned to receive usual care or coil treatment at 10 hospitals.”

       Here is the abstract 

Importance  Therapeutic options for severe emphysema are limited. Lung volume reduction using nitinol coils is a bronchoscopic intervention inducing regional parenchymal volume reduction and restoring lung recoil.

Objective  To evaluate the efficacy, safety, cost, and cost-effectiveness of nitinol coils in treatment of severe emphysema.

Design, Setting, and Participants  Multicenter 1:1 randomized superiority trial comparing coils with usual care at 10 university hospitals in France. Enrollment of patients with emphysema occurred from March to October 2013, with 12-month follow-up (last follow-up, December 2014).

Interventions  Patients randomized to usual care (n = 50) received rehabilitation and bronchodilators with or without inhaled corticosteroids and oxygen; those randomized to bilateral coil treatment (n = 50) received usual care plus additional therapy in which approximately 10 coils per lobe were placed in 2 bilateral lobes in 2 procedures.

Main Outcomes and Measures  The primary outcome was improvement of at least 54 m in the 6-minute walk test at 6 months (1-sided hypothesis test). Secondary outcomes included changes at 6 and 12 months in the 6-minute walk test, lung function, quality of life as assessed by St George’s Respiratory Questionnaire (range, 0-100; 0 being the best and 100 being the worst quality of life; minimal clinically important difference, ≥4), morbidity, mortality, total cost, and cost-effectiveness.

Results can be seen through the link

Conclusions and Relevance  In this preliminary study of patients with severe emphysema followed up for 6 months, bronchoscopic treatment with nitinol coils compared with usual care resulted in improved exercise capacity with high short-term costs. Further investigation is needed to assess durability of benefit and long-term cost implications.

Facts : Cystic Fibrosis - 65 Roses

By Dr Deepu

The “65 Roses” story dates back to 1965 when an observant 4-year-old, hearing the name of his disease for the first time, pronounced cystic fibrosis as “65 Roses.” Today, “65 Roses” is a term often used by young children with cystic fibrosis to pronounce the name of their disease.

Doctors Please de stress yourself.

By Dr Deepu

Off late there are many instances where questions on stress levels of doctors are raised. Recently a survey also revealed that a majority of resident doctors are under stress and also a startling revelation about increased suicide rates among young doctors. Here I want to share a message received on social media.

Dr.Amol Pampatwar 2011 batch Gmch Aurangabad ms Obgy died due to massive ami today at 9.20 am while travelling from miraj to Kolhapur .
He was very soft spoken person n.married a year ago .
Pm showed lad infarct with multiple plaques in coronaries.neglected chest pain for two days....
May his soul rest in peace..... Recently we are hearing news about many young doctors facing morbidity/mortality due to life style diseases like MI etc.
Here are views, though from very short experience:

Doctors are the one who neglect health and healthy lifestyle the most.
Few things that I found helpful are:
1. Practice is a continuous process... You are there in hospital for patients and not vice a versa. So dont get bothered much by fluctuations in practice.

2. Patients need you more than, you need them..
So set your limits. Stop OPD on time. Avoid patients who want to take ur leasure time (few patients feel pride in visiting u on sundays or off ur opd time).

3. 'Put your eggs in different baskets' is a good saying, but dont put them in too many baskets that you are worried about missing few. So dont keep so many attachments to hospitals.  Every new attachment demands time plus travel. Stressing us further.

4. Most important, Set your own targets ..  not the targets that ur colleague/competator has set. He may be  earning much more .. but he might be paying the cost in some other ways (family.. hobbies.. friends etc).

5. When in doubt about health  dont be your own doctor.

6. Give time to family and friends, in hour of trouble they are the one who will be with you in hospital and not ur bosses or professional colleagues. ..

7. "Happiness lies in satisfaction". If we are not satisfied, we will not be happy even if we earn highest in world.
8. Best time to be happy is now, best moment to be happy is present moment. Learn to enjoy the whole  journey, dont wait to be happy till u reach the destination!!

Statins May Reduce Heart Risks Associated With Sleep Apnea, Study Suggests

By Dr Deepu

The NPR (1/7, Chen) “Shots” blog reports that a study (1/7) published in Science Translational Medicine “suggests that cholesterol...plays a special role in raising risk for people with sleep apnea.” The research also “hint[s] that...statins could limit the damage sleep apnea does to blood vessels.” Investigators thought “there might be something happening to the cells lining our blood vessels since they would be the first to experience the particular rise and fall in oxygen afflicting sleep apnea patients.”

        STAT (1/7, Boodman) reports that the investigators “extracted these cells from the arms of 76 patients with obstructive sleep apnea and 52 others who” did not have OSA. Sleep apnea patients were found to have higher CD59 levels. The researchers found that “the CD59 of people with sleep apnea had been pulled inside the cell, instead of guarding the cell’s surface, leaving the cell vulnerable to attacks from the immune system.” The “damaged cells, in turn, would be more likely to obstruct blood flow – the first such cellular explanation of how apnea may cause heart problems.” The investigators found, however, that patients with OSA who were taking statins did not exhibit “these abnormal CD59 effects.”

        HealthDay (1/7, Haelle) reports, “How much protein the cells pulled inside them depended on how much cholesterol...was present.” The researchers found that “statins stopped the cells from bringing the protein inside them.”

Obstructive sleep apnea is a common medical condition characterized by intermittent cessation of breathing during sleep, which results in intermittent hypoxia. It greatly increases patients’ risk of cardiovascular disease, and now Emin et al. provide a mechanism, which helps to explain this correlation. The authors discovered that intermittent hypoxia causes internalization of CD59, a protein that is normally found on the membrane of endothelial cells and protects them from being injured by circulating complement. After internalization, CD59 could no longer protect the cells, resulting in damage to the vascular walls. In contrast, statins stabilized CD59 on the endothelial cell surface and protected them from injury, revealing yet another mechanism by which these versatile drugs protect against cardiovascular disease.

Some Physicians Using Stem Cell Therapy To Treat COPD

By Dr Deepu

Fox News (1/8) reports that some physicians are using stem cells drawn from a “patient’s buttocks or midsection during liposuction” to treat chronic obstructive pulmonary disorder (COPD). After the stem cells are separated in a centrifuge, they are “mixed in a solution, which is administered through an IV and put into a nebulizer, from which the patient inhales them.”

you can get more information in Fox News Channel and Dr Borentsein website

American College of Chest Physicians Offers New Guidelines on Antithrombosis for VTE

By Dr Deepu

The American College of Chest Physicians has issued new guidelines on antithrombotic therapy for venous thromboembolism (VTE), including guidance on use of non-vitamin K antagonist oral anticoagulants.

Among the recently changed or added recommendations, published in Chest:

• For patients without cancer who have deep vein thrombosis (DVT) of the leg or pulmonary embolism (PE), the guidelines suggest using dabigatran, rivaroxaban, apixaban, or edoxaban instead of vitamin K antagonists for the first 3 months' treatment and beyond.
• Patients with unprovoked proximal DVT or PE who are stopping anticoagulation should receive aspirin to reduce the risk for recurrent VTE, assuming aspirin is not contraindicated.
• For patients who have acute DVT of the leg, compression stockings are not recommended to prevent post-thrombotic syndrome (PTS). However, for patients with PTS symptoms, "a trial of graduated compression stockings is often justified."
• Patients with low-risk PE may be treated at home or receive an early discharge.

Links:

Guidelines in Chest (Free)

ACCP news release (Free)

Tin Man Syndromes or Ectopia cordis Interna

By Dr Deepu

The following case was reported by Dr Matt Skalski in radiopedia.
The chest X ray was done on a person for employment screeing. The chest X ray showed no heart. Rare isn't it. On enquiry he didnt have any symptoms other than gastric reflux. Then a CT was done which showed heart inside the stomach.
This was the X ray picture

Now let us compare this X ray with a normal one.

The heart shadow is absent in the previous X rays compared to this.
This condition is called as Tin Man syndrome or Ectopia cardiac internalis, meaning heart is present at a different site inside the body.
Let us have a look at the CT films of the abdomen.

The CT images shows heart in the  abdomen.
Now let's know the historical aspects of TIN MAN syndrome which is extremely rare.

This picture is  of Da Vincis organ newotks of the thoracoabdominal cavity.There remains debate as to whether Leonardo Da Vinci's "Organ networks of the thoracoabdominal cavity" illustration (c.1502) was based off a corpse with ectopia cordis interna, or whether his depiction of the heart's location was a deliberate distortion of reality. Most legitimate scholars believe Da Vinci created the work as a flight of anatomical fancy.           

The first ever description of the condition in the medical literature was in a controversial monograph submitted to the Royal Society in 1874 by Dr. Nohear Lubdub. Entitled "An unusual case of ectopia cardia epigasticum in a Haryana boy", the monograph was later retracted when accusations were made that the images accompanying the text had been doctored.

It was not until 1908 that Dr Lubdub's work was vindicated when existence of the condition was confirmed during the early years of chest radiography. Unfortunately, Dr Lubdub had fallen into a deep depression following his expulsion from the Royal Society, only occasionally seen wandering the streets of Chandigarh mumbling "and yet it beats". His death was unrecorded. 

Disclaimer : this was a April Fool Case published in Radiopedia.org and is Imaginary.

Case courtesy of Dr Matt Skalski, 

Radiopaedia.org. From the case rID: 33437

Erlotinib May Be Effective As First-Line Treatment For Asian Patients With EGFR Mutation-Positive NSCLC

By Dr Deepu

Healio (12/31) reports that in a phase 2 study, “erlotinib appeared effective as first-line treatment for Asian patients with EGFR mutation-positive non–small cell lung cancer.” Researchers also found that “treatment beyond progression appeared feasible and may delay salvage therapy in certain patients.” The findings were published in JAMA Oncology.

The objective was study the efficacy of first-line erlotinib therapy in patients with NSCLC with activating EGFR mutations and postprogression erlotinib therapy.

Patients received erlotinib 150 mg/d orally until disease progression, after which erlotinib therapy could be continued at patient and/or investigator discretion.

Overall response rate was 66.2%; disease control rate was 82.6%. Median overall survival was 31.0 months (95% CI, 27.3 months to not reached). In the safety population (n = 207) serious adverse events were reported in 27.1%, with events of at least grade 3 experienced by 50.2%. Sensitivity and specificity of plasma-based EGFR mutation analysis was 77% and 92%, respectively.

Image Archives SVC obstruction- CT findings

By Dr Deepu

Image Archives - Lung Mass

By Dr Deepu

Homogenous well defined opacity in right
Lower zone

Lateral radiograph shows a well defined
Opacity anterior to the spine in the lower
Lobe region.

Image Archives- Bronchiectasis

By Dr Deepu

Chest X ray shows bilateral cystic bronchiectasis with air fluid levels, suggesting ongoing infective process

Sarcoidosis- CT findings

By Dr Deepu

conglomerated micronodules and centrilobular
 nodules in both lungs

Enlarged mediastinal  lymph nodes

 Bilateral hilar lymph nodes

Chest CT scans show conglomerated micronodules and centrilobular nodules in both lungs. We can see the enlarged mediastinal and bilateral hilar lymph nodes.

Sarcoidosis is a multi-system disease of unknown etiology, usually affecting the respiratory tract and other organs, and is characterized by the formation of nonnecrotizing epithelioid granulomas. The diagnosis depends on a combination of a typical clinicoradiological presentation, the finding of nonnecrotizing epithelioid granulomas in a tissue biopsy, and exclusion of other possible diseases, especially those of infectious etiology.

 Sarcoidosis results from an uncontrolled cell-mediated immune reaction. Interactions between chemokines and receptors that activate mitogen-activated protein kinase pathways play a major role in inflammation and T-cell responses. Tumor necrosis factor (TNF)-[alpha] is an important player in granuloma formation, and recent clinical trials have investigated the efficacy of TNF-[alpha] inhibitors in sarcoidosis.