Folic acid during pregnancy can reduce risk of autism and other defects

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Higher doses recommended in women with certain medical conditions

New Delhi, 12th March 2018: Mothers taking the recommended amounts of folic acid during pregnancy can help lower the risk of their children developing pesticide-related autism, says recent research. Folate has an important role to play in DNA methylation, a process by which genes are turned off or on, as well as in DNA repair and synthesis. As there is a lot of cell division happening in a developing fetus, adding folic acid might help in a number of these genomic functions.

Folic acid, also called folate, is a B vitamin. It plays a role in cell production and division, including the production of red blood cells. A daily intake of 400-microgram (mcg) folic acid supplement is recommended while trying to conceive, and then for the first 12 weeks of pregnancy.A higher dose is recommended for women with certain medical conditions or a personal or family history of neural tube defects.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “Folic acid is important before and during pregnancy. It helps in preventing birth defects known as neural-tube defects, including spina bifida. Foods containing folate [the natural form of folic acid], such as green, leafy vegetables should be consumed regularly. However, it is not possible to get the amount of recommended folate from food alone, which is why it is important to take a folic acid supplement. Additionally, preconception folate supplementation is associated with a 50% to 70% reduction in the incidence of early spontaneous preterm birth.”

Apart from anemia and congenital deformities, folic acid deficiency can also result in the following: risk of developing clinical depression, possible problems with memory and brain function, higher risk of developing allergic diseases, and long-term risk of lower bone density.

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “Although the signs of a deficiency may be subtle, one can experience diarrhea, anemia, loss of appetite, and weight loss, as well as weakness, a sore tongue, headaches, heart palpitations, and irritability. Those who are mildly deficient may not notice any symptoms but will also be lacking the optimal amount of this nutrient needed for the baby’s early embryonic development.”

Some tips from HCFI.

  • Pregnant women should include as many food categories rich in Folic Acid as possible in their diet, apart from supplementation.
  • Fruit and vegetables should be eaten raw whenever possible as cooking destroys Folic Acid.
  • Avoid alcohol as it leads to Folic Acid deficiency
  • Pregnant women have higher requirements for Folic Acidand should take supplementsas advised by the doctor/dietician/nurse.
  • Increase the use of wheat flour and soya flour in baking and food preparation

Understanding Heath Care Differently

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Dr KK Aggarwal

Recipient of Padma Shri

“A six year old boy is admitted to the Children’s Assessment Unit (CAU) at Leicester Royal Infirmary following a referral from his GP. Jack Adcock, who had Downs syndrome and a known heart condition, had been suffering from diarrhea, vomiting and had difficulty breathing.

Dr Hadiza Bawa-Garba was a specialist registrar in year six of her postgraduate training (ST6) with an impeccable record. She had recently returned from maternity leave and this was her first shift in an acute setting. She was the most senior doctor covering the CAU, the emergency department and the ward CAU that day. She saw Jack at about 10.30am. Jack was receiving supplementary oxygen and Dr Bawa-Garba prescribed a fluid bolus and arranged for blood tests and a chest x-ray. At 10.44am the first blood gas test was available and showed a worryingly high lactate reading. The x-ray became available from around 12.30pm and showed evidence of a chest infection.

Dr Bawa-Garba was heavily involved in treating other children between 12-3pm, including a baby that needed a lumbar puncture. At 3pm Dr Bawa-Garba reviewed Jacks X-ray (she was not informed before then that it was available) and prescribed a dose of antibiotics immediately, which Jack received an hour later from the nurses.

A failure in the hospitals electronic computer system that day meant that although she had ordered blood tests at about 10.45am, Dr Bawa-Garba did not receive them until about 4.15pm. It also meant her senior house officer was unavailable.

During a handover meeting with a consultant, which took place about 4.30pm, Dr Bawa-Garba raised the high level of CRP in Jacks blood test results and a diagnosis of pneumonia, but she did not ask the consultant to review the patient. She said Jack had been much improved and was bouncing about. At 6.30 pm, she spoke to the consultant a second time, but again did not raise any concerns.

When she wrote up the initial notes, she did not specify that Jack’s enalapril (for his heart condition) should be discontinued. Jack was subsequently given his evening dose of enalapril by his mother after he was transferred to the ward around 7pm.

At 8pm a ‘crash call’ went out and Dr Bawa-Garba was one of the doctors who responded to it. On entering the room she mistakenly confused Jack with another patient and called off the resuscitation. Her mistake was identified within 30 seconds to two minutes and resuscitation continued. This hiatus did not contribute to Jack’s death, as his condition was already too far advanced. At 9.20pm, Jack died.

November 2, 2015: Portuguese agency nurse, 47-year-old Isabel Amaro, of Manchester is given a two-year suspended jail sentence for manslaughter on the grounds of gross negligence.

November 4, 2015: At Nottingham Crown Court, Dr Bawa-Garba is convicted of manslaughter on the grounds of gross negligence.

December 14, 2015: Dr Bawa-Garba is given a 24 month suspended sentence.

December 8, 2016: Dr Bawa-Garbas appeal against her sentence is quashed at the Court of Appeal.

June 13, 2017: The Medical Practitioners Tribunal service says Dr Bawa-Garba should be suspended for 12 months and rejects an application from the GMC to strike her off the register. It says: ‘In the circumstances of this case, balancing the mitigating and aggravating factors, the tribunal concluded that erasure would be disproportionate.’

December 8, 2017: GMC takes the MPTS to the High Court and argues its own tribunal was wrong to allow Dr Bawa-Garba to continue to practice.

January 25, 2018: The GMC successfully appeals at the High Court bid to have the MPTS decision overruled, leading to Dr Bawa-Garba being struck off the medical register. Lord Justice Ouseley says: The Tribunal did not respect the verdict of the jury as it should have. In fact, it reached its own and less severe view of the degree of Dr Bawa-Garba’s personal culpability.’ Health secretary Jeremy Hunt says that he is deeply concerned about its implications.

January 26, 2018: Prominent GPs tell Pulse that the ruling raises serious questions about how doctors reflections are used and recorded, and that new guidance is now needed urgently.

January 30, 2018: An influential international doctors group accuses the GMC of treating black and minority ethnic doctors ‘differently and harshly’, following the High Court case.

January 31, 2018: Dr Bawa-Garba’s defence body releases a statement saying e-portfolio reflections were not used against her in court, despite ‘wide misreporting’ that they were. But Pulse uncovers that her reflections were used in court, from a document submitted as evidence by the on-call consultant on the day.

February 7, 2018: Following a crowd funding campaign, which raised over £335,000, Dr Bawa-Garba decides to appeal the ruling, and considers appealing the manslaughter conviction from 2015.

February 12, 2018: The GMC refutes claims that there was discrimination in its decision to launch a High Court bid. In response to an open letter from the British Association of Physicians of Indian Origin (BAPIO), the GMC said the accusations were ‘troubling and without merit’.” [From media reports]

Dr KK: This is a historic case and will be remembered in the history of medical profession. We also must react, or this will lead to unnecessary antibiotics. In history, no case has been filed for giving an antibiotic, but all cases filed are due to delay in instituting an antibiotic, as also happened in this case. One of the experts in this case said in the court if antibiotics were given at admission the child would not have died.

Dr KK Aggarwal

Padma Shri Awardee Vice President CMAAO Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Night shifts increase breast cancer risk, especially for nurses

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