To win combat against HIV worldwide, ‘knowledge is power’, says UNAIDS report released ahead of the World AIDS Day falling on 1st December. The report “Knowledge is Power” highlights the critical importance of scaling up HIV testing worldwide and presents evidence on progress made against AIDS thanks to early detection and treatment and calls on countries to step up their efforts. “To reach the millions who do not know their status, we need universal access to HIV testing services. HIV testing should be as widely available as pregnancy testing,” said Michel Sidibé, Executive Director of UNAIDS, the coalition of 11 UN agencies established in 1994 to tackle the global AIDS epidemic.
40 million people with diabetes will be left without insulin by 2030: A new study published Wednesday in the journal Lancet Diabetes and Endocrinology has predicted that as the number of people living with diabetes continues to rise, the access to insulin needed to meet growing demand will fall short. By 2030, 79 million adults with type 2 diabetes are expected to need insulin to manage their condition and if current levels of access remain, only half of them will be able to be able to get an adequate supply. Access to the drug must be significantly improved, the researchers warn, particularly in the African, Asian and Oceania regions, which will be most affected… (CNN)
Top News From ESMO 2018: “Outstanding” ovarian cancer progression-free survival with olaparib maintenance: A first-of-its kind phase III study found that for patients with advanced ovarian cancer who carry a BRCA mutation, PFS was markedly increased if they are given maintenance therapy with the PARP inhibitor olaparib following successful first-line chemotherapy. In the SOLO1 study, Kathleen Moore, MD, from the Stephenson Cancer Center, University of Oklahoma and colleagues found that after more than 3 years of follow-up, olaparib was associated with a 70% increase in PFS compared with placebo, caused few toxicities and had no impact on quality of life. The outstanding improvement in PFS was maintained even after stopping treatment at 2 years, Moore said that the findings “herald a new era in treatment for women diagnosed with advanced ovarian cancer who carry a BRCA mutation. While it is too early to say that we have impacted the fraction of women who could be cured with their frontline therapy, the fact that it is estimated that over 50% of women in the olaparib arm were still progression free at 4 years as compared to only 11% for placebo speaks to this hope.” (Medscape)
CDC has detected coxsackievirus A16, EV-A71, and EV-D68 in the spinal fluid of four of 430 confirmed cases of acute flaccid myelitis AFM since 2014, which points to the cause of their AFM. For all other patients, no pathogen has been detected in their spinal fluid to confirm a cause. Most patients had onset of AFM between August and October, with increases in AFM cases every two years since 2014. At this same time of year, many viruses commonly circulate, including enteroviruses, and will be temporally associated with AFM … (CDC)
9 causes of altered mental status in the elderly: Strokes: Most strokes do not impact a patient’s LOC or mental state; however, some strokes can cause altered mental status (Clin Med (Lond). 2017 Apr;17(2):156-60.). Thus, stroke should be included in the differential diagnosis of any geriatric patient presenting to the ED for confusion. Occlusion of the distal portion of the basilar artery can manifest as LOC. Bilateral thalamic infarcts can also affect a patient’s LOC or cause sudden-onset memory loss. Vertical gaze palsy may provide a clue to the diagnosis. Strokes in the occipital lobe or non dominant parietal lobe can present with confusion. An abrupt onset of confusion (within minutes) should raise the suspicion for stroke (Clin Med (Lond). 2017 Apr;17(2):156-60.). Many of these strokes are amenable to reperfusion therapy and endovascular intervention and must be identified quickly (Medscape)
Chickenpox outbreak in North Carolina, US blamed on vaccination exemptions: A chickenpox outbreak among students at Asheville Waldorf School in North Carolina has grown to 36 cases as of Monday, and exemptions from vaccination were a contributing factor, according to the Buncombe County Health Department, which has been monitoring the situation since the end of October. Though North Carolina requires vaccination for all children attending schools, the state permits both medical and religious exemptions. Still, vaccination rates in the state outperformed national figures in 2013 and 2014, according to publicly available information.
ACOG new guidelines on dysmenorrhea and endometriosis in adolescents: The American College of Obstetricians and Gynecologists (ACOG) has published a new committee opinion on dysmenorrhea and endometriosis in adolescents, online Nov. 20, 2018. Some key recommendations include:
- Most adolescents experience primary dysmenorrhea, defined as painful menstruation in the absence of another pelvic disease.
- Recommended treatment is conservative surgical therapy for diagnosis and treatment combined with ongoing suppressive medical therapies to prevent endometrial proliferation.
- Nonsteroidal antiinflammatory drugs should be the mainstay of pain relief for adolescents with endometriosis.
- Evaluate for secondary endometriosis, if dysmenorrhea does not improve or worsens while using recommended treatments, or who present with other symptoms immediately indicating secondary dysmenorrhea (e.g. a family history of endometriosis, abnormal or irregular bleeding, or severe pain immediately following their first period).
- In adolescents, endometriotic lesions differ from those in older women; they are typically clear or red and can be difficult to identify for gynecologists unfamiliar with endometriosis in adolescents.
Video to watch: TEDx Video: Doctor-patient relationship www.youtube(dot)com/ watch?v=i9ml1vKK2DQ
Dr KK Aggarwal