Morning MEDtalks with Dr KK Aggarwal 9th August 2018

Is it easy to be on gluten-free diet?

Celiac disease requires strict avoidance of exposure to gluten. However, the challenge is that variable amounts of gluten contaminate gluten-free foods because of less than precise food production, processing, packaging, or preparation. In addition, labeling may be inexact. Inadvertent exposure may be associated with exposure to nonfoodstuffs (e.g., lipstick, toothpaste).

What is high risk drinking?

High risk drinking is considered as

1. 4 or more drinks (US) in one day or 84 or more drinks per week for women
2. 5 or more drinks in one day or 15 or more drinks per week for men
3. Binge drinking is defined as 4 or more drinks over 2 hours for women and 5 or more drinks over 2 hours for men.

Digital health

A recent study published in the Journal of American Medical Association has shown an increased risk of ADHD (Attention Deficit Hyperactivity Disorder) in teenagers who constantly use digital media. The constant notifications, text messages and addiction to social media cause a disruption in maintaining sustained attention. Increased use of digital media decreases the “grey matter” of the brain. Grey matter is directly linked to cognition and emotional control.

The always available new content online also increases the urge to check phones too often.

New diseases associated with smartphones

Overuse of smartphones is becoming a public health problem. With an increased use of smartphones, a whole new spectrum of diseases has starting becoming common.

1. Insomnia and fragmented sleep
2. Blackberry thumb: Injury of muscles of thumb
3. Cellphone elbow: Compression of ulnar nerve, which causes steep pain in elbows
4. Nomophobia: Fear of being without a mobile phone
5. Ringxiety: Confusing the sound of a cell phone ringing with a sound similar to it
6. Text neck: Stress injury and pain in the neck    
7. Smartphone pinky: Deformed or bend in the pinky or little finger as a result of tightly gripping the big smartphones   
8. Text claw: Pain in the whole hand as a consequence of repetitive fine motor activity because many people work on their phones in a position that’s not natural for the thumb, wrist or finger joints

Here’s what you can do:

1. Do NOT using your cell phone 30 minutes before sleep.
2. Practice “social media fasting” once a week.
3. Don’t talk over a voice call for more than 2 hours a day.
4. Charge your cellphones only once a day.

There is never a 100% chance of success in sterilization operations

The Delhi High Court refused to hold a hospital and its doctors guilty of medical negligence merely on the allegation that the sterilization operation performed on a woman was unsuccessful. Justice Valmiki J. Mehta observed, since medically there is never a 100% chance of success in sterilization operations, the mere fact that the operation was not successful, that by itself cannot be a reason to hold the appellant/defendant and its doctors guilty of negligence. Read more at: http://www.livelaw.in/doctors-cannot-be-held-guilty-of-medical-negligence-merely-because-sterilization-operation-was-unsuccessful-delhi-hc-read-judgment/

Injections by Homeopath

Delhi Police arrested a 40-year-old homeopathy doctor for allegedly giving wrong medicine to a one-and-half-year-old girl, who later died in southwest Delhi’s Kapashera area. FIR was filed under IPC Sections 304-a (causing death by negligence), 420 (cheating) and Section 27 of the Delhi Medical Council Act.

Leading health groups urge FDA to stop sales of new, Juul-like e-cigarettes illegally introduced without agency review

Six leading public health and medical organizations - Campaign for Tobacco-Free Kids, American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association and Truth Initiative - have urged the US Food and Drug Administration (FDA) to stop the sale of new electronic cigarette products that have been illegally introduced in recent months without the agency’s prior review and authorization. These include numerous products similar to the Juul e-cigarettes that have become wildly popular with teens across the United States. Despite this requirement, the letter documents that manufacturers recently have introduced numerous new e-cigarette products without any evidence that they have filed premarket applications or received a marketing order from the FDA.

These include products that look like and seek to capitalize on the success of Juul, which is sleek, high-tech and easy to hide (it looks like a USB flash drive), comes in sweet flavors including mango and fruit medley, and delivers a powerful dose of nicotine. 

India is home to one-fourth of world’s MDR TB population

As per Global TB report 2017, estimated number of multi-drug resistant (MDR) TB patients are 6,01,000 globally, of which 147000 (1/4th) are estimated from India. Bedaquiline drug was introduced in India in 2016 under conditional access program for selective group of the MDR TB patients based on drug sensitivity results of second line anti-TB drugs (PIB-MOHFW).

Spironolactone as 4th-line agent in resistant HT

A randomized-controlled trial published in the journal Hypertension evaluated two potential medications used as a fourth-line agent to treat resistant hypertension: spironolactone or clonidine tablet. Nearly 30 healthcare centers in Brazil participated in this randomized trial. Enrolled patients had uncontrolled HT despite taking three different classes of antihypertensive medications (chlorthalidone 25 mg daily, enalapril 20 mg twice daily, losartan 50 mg twice daily and/or amlodipine 5 mg twice daily). These patients were given either spironolactone 12.5 mg daily (titrated up to 50 mg daily) or clonidine 0.1 mg twice daily (titrated up to 0.3 mg twice daily).

BP readings were taken in the office and at home; controlled in-office BP was defined as < 140/90 mm Hg, and controlled ambulatory BP was defined at < 130/80 mm Hg. The study included 113 patients, who were followed for 12 weeks, after which both groups showed a non-statistically different decrease in in-office systolic and diastolic BP. However, those receiving spironolactone showed a statistically significant decrease in ambulatory systolic and diastolic pressures. The spironolactone group showed a decrease of 11.8 mm Hg (systolic) and 6.3 mm Hg (diastolic) vs clonidine (7.3 and 3.9 mm Hg, respectively). The overall side effects in either group were similar. No cases of gynecomastia were detected during the 12-week study period, but patients on spironolactone had greater instances of asymptomatic hyperkalemia and azotemia.

Spironolactone should be considered the fourth-line agent in treating patients with resistant hypertension. (Medscape)

Video to watch: Wheat disorders

https://www.facebook.com/drkkaggarwal/videos/1945381452149815/

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO