Morning Medtalks with Dr KK

1. A retrospective study in JAMA explores the association between long-term mortality and various levels of cardiorespiratory fitness. The more fit you are, the higher your level of CRF. Regular exercise, and vigorous exercise, can both boost CRF. The researchers looked at over 122,000 patients at a large academic medical center who underwent exercise testing on a treadmill, an objective measure of CRF. While the average age was 53, participants ranged in age from 18 to over 80. Being fit was associated with living longer. This held true at any age. Higher the level of fitness, the higher the survival rate. This was especially notable in older people and people with high blood pressure.
2. Current guidelines recommend 150 to 300 minutes per week of moderate aerobic activity (walking, running, swimming, biking), or 75 minutes of vigorous activity, or a mix of both. Twice-weekly resistance training to strengthen muscles is also recommended.
3. start with a simple routine of walking 10 to 20 minutes three times per week. Every week or two, add five minutes per walk until you reach a goal of 30 minutes. Then, every week or two, add a day until you reach at least 150 minutes per week. Over time you can try to increase intensity. Remember, small goals are more achievable, and these little victories will continue to fuel your motivation.
4. Building muscle strength may be one way to lower the risk of type 2 diabetes. A recent study which involved over 4,500 adults, found that moderate muscle mass reduced the risk of type 2 diabetes by 32%. The benefits were independent of cardiorespiratory fitness, and higher levels of muscle strength did not provide additional protection.

According to the researchers, the results are encouraging because even small amounts of resistance exercise may be helpful in preventing type 2 diabetes by improving muscle strength. Study was published in the Journal of Mayo Clinic Proceedings.

5. Friday, March 15, 2019 is the 12th annual World Sleep Day®. Created and hosted by World Sleep Society,

Whereas Rule 65 (11 A) of Drugs & Cosmetics Rules, 1945 states that no person dispensing a prescription containing substances specified in Schedule H, H1, or Schedule X may supply any other preparation whether containing same substances or not in lieu thereof.

6. A sleep medicine physician dedicates care toward diagnosing and treating sleep disorders such as sleep apnea, insomnia, restless legs syndrome, and other common problems with sleep quality, but mainly in getting the right amount of sleep every night.
7. Researchers from the Moscow Institute of Physics and Technology teamed up with colleagues from the U.S. and Switzerland and returned the state of a quantum computer a fraction of a second into the past. They also calculated the probability that an electron in empty interstellar space will spontaneously travel back into its recent past. The study is published in Scientific Reports.
8. The Hindu:In a hard hitting judgement, the Madras High Court on Wednesday came down hard on doctors who enter into government service, secure admission in post graduate and speciality courses as in-service candidates, get educated at State cost, gain experience by treating poor patients in government hospitals and then leave the job for personal enrichment. Justice S.M. Subramaniam “deprecated” the conduct of government doctors who learn medical intricacies and diagnosis utilising the “poor man’s body” as well as the infrastructure provided in government hospitals at public cost but do not want to serve in those hospitals for long as per terms and conditions agreed upon while entering into government service.
9. Build a better bladder: For urge incontinence, you can try timed voiding (urinating on a schedule) and bladder guarding, which teaches you to cope with triggers that set off the urge to go, such as washing dishes or hearing water. You squeeze your muscles to hold in urine before a trigger, which sends a message to the brain that this is not the time to go. Other lifestyle changes include watching fluid intake; quitting smoking, to reduce coughing and pressure on the bladder; and minimizing bladder irritants such as caffeine, alcohol, and carbonated drinks.

Mumbai businessman dies 2 days after getting hair transplant

A dermatologist was called in for a statement by the police in Mumbai, Maharashtra when a businessman died after undergoing hair transplant at the dermatologists clinic. The businessman, who was in his early 40s, died on Saturday (March 9).

According to media reports the businessman was rushed to a hospital on Friday (March 8) with breathlessness and swelling on the face and throat. The preliminary observation, the businessman had symptoms of anaphylaxis, a severe allergic reaction, and suffered multi-organ failure.

The dermatologist told the police that the businessman wanted over 9,000 hair grafts in one go. The report further said that according to the experts, getting more than 3,000 grafts in one sitting is not advisable.

Views

1. Anaphylaxis can not occur after 48 hours due to the procedure. It must occur within minutes
2. Anaphylaxis occurring after 48 hours can be due to anything that was ingested, injected, or otherwise taken into the body. Foods are the most common trigger of immunoglobulin E (IgE)-mediated anaphylaxis in children, teenagers, and young adults, while insect stings and medications are more common triggers in middle-aged or older adults.
3. One should not blame the surgery or the doctors for such situations
4. Causes of anaphylaxis

Allergens (IgE-dependent immunologic mechanism)

• Foods, especially peanut, tree nut, crustacean shellfish, finned fish, milk, egg
• Insect stings (eg, Hymenoptera venom) and insect bites (eg, kissing bugs)
• Medications (eg, antibiotics, NSAIDs)
• Biologic materials, including allergen immunotherapy, monoclonal antibodies, chemotherapy agents, and vaccines*
• Natural rubber latex
• Food additives, including spices, insect-derived colorants (eg, carmine), and vegetable gums
• Inhalants (rare) (eg, horse dander, cat dander, grass pollen)
• Human seminal fluid (rare trigger of anaphylaxis in women)
• Occupational allergens (eg, stinging insects, natural rubber latex)

Immunologic triggers (IgE-independent mechanism)

• IgG-dependent (rare) (eg, to high-molecular weight dextran, infliximab)
• Coagulation system activation (eg, heparin contaminated with oversulfated chondroitin sulfate)

Idiopathic anaphylaxis

• Consider the possibility of a hidden or previously unrecognized trigger
• Consider the possibility of a mast cell activation syndrome, including systemic mastocytosis

Nonimmunologic triggers (direct activation of mast cells and basophils)

• Physical factors (eg, exercise¶, cold, heat)
• Medications (eg, opioids, NSAIDs)
• Radiocontrast agents
• Alcohol (ethanol) (may augment, rarely induces)

Any food, insect sting or bite, or medication or biologic can potentially trigger anaphylaxis.

Novel or unusual allergen triggers include storage mite-contaminated flour and saliva from kissing bugs.

They also include mosquitoes, pigeon ticks, green ants, and pharaoh ants and venoms from jellyfish, scorpions, and snakes.

Medications include taxanes, platins, and other chemotherapy drugs, biologic agents, including monoclonal antibodies, such as rituximab, cetuximab, infliximab, and uncommonly, omalizumab.

Some triggers, such as radiocontrast media, insect venoms, and medications (such as NSAIDs) can act through more than one mechanism.

5.The chronology of events (time elapsed between exposure to trigger and onset of first symptom[S]) should be consistent with the diagnosis of anaphylaxis.

IgE-mediated anaphylaxis usually develops within minutes to one hour or so of exposure.

However, there are rare exceptions to this, such as IgE-mediated reactions to the carbohydrate galactose alpha-1,3-galactose (alpha-gal) in red meat, which develop four to six hours after ingestion. But not after 48 hours.

World Kidney Day: Same serum creatinine value may mean different eGFR for persons of different body weight

Serum creatinine is a commonly used test to evaluate kidney function. And, if the creatinine value falls within the lab reference range, then all is considered well. However, this is not so because the creatinine level is affected by age, race, gender and also the body weight. Hence, serum creatinine level alone is an unreliable marker for impaired kidney function or chronic kidney disease.

The GFR or glomerular filtration rate is the best measure to assess the function of the kidneys.

There are several ways to calculate the GFR.

The most common is Cockcroft Gault equation. It calculates creatinine clearance (mL/min) as a surrogate for GFR. It provides an estimate of GFR based on serum creatinine, age, gender and body weight.

The formula is:

Estimated or eGFR = 140 – age x body weight (in kg)/72 × serum creatinine (in mg/dL)

• A value of 60 or higher is normal (GFR decreases with age).
• A value less than 60 is low and may indicate kidney disease.
• A value of 15 or lower may mean kidney failure.

The same serum creatinine value may mean different GFR for similarly aged persons of different body weight.

• A 40 kg man, aged 40 years, with serum creatinine of 1, the GFR is 55.
• A 50 kg man, aged 40 years, with serum creatinine of 1, the GFR is 69.
• A 60 kg man, aged 40 years, with serum creatinine of 1, the GFR is 83.
• A 70 kg man, aged 40 years, with serum creatinine of 1, the GFR is 97.
• A 80 kg man, aged 40 years, with serum creatinine of 1, the GFR is 111.

If you are at increased risk for kidney disease i.e. if you have diabetes, high blood pressure, or family history of diabetes, high blood pressure or kidney disease, then calculate your GFR to know if you have kidney disease.

The GFR may show impaired kidney function, even if the serum creatinine level is in the normal range.

Another important point to take note of is that instead of looking at a single test result, one should look for trends in the results.

Always compare the results of a particular test with previous reports even when a result is normal. Results that show change over time i.e. show a rising or declining trend by 0.3 are important and should not be ignored.

Any result which has been in the low normal range for the last many years, but is now in the high normal range even though still within normal limits, should be investigated accordingly.