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Short CME with Dr KK

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Dr KK Aggarwal    04 January 2018

  1. Administer antiviral medications to all hospitalized, severely ill and high-risk patients with suspected or confirmed influenza: The flu strain primarily responsible for this pronounced increase in viral activity is influenza A (H3N2). This strain has been associated with increased hospitalizations and deaths among elderly adults and young children in previous flu seasons. Additionally, the flu shot has displayed less efficacy against the H3N2 strain than other influenza A strains and influenza B.
  2.  CDC has recommended "all hospitalized patients and all high-risk patients (either hospitalized or outpatient) with suspected influenza should be treated as soon as possible with a neuraminidase inhibitor antiviral."
  3.  A patient may share whatever he or she wants on social media. However, clinicians need to follow HIPAAs dictates, which say that a clinician may share a patients protected health information only for the purpose of treatment, payment, and healthcare operations. Use of social media isnt treatment. So, doctors cant disclose any "protected health information," which is any information created or received by a healthcare provider relating to the past, present, or future physical or mental health or condition, including demographic information and any healthcare provided.
  4.  Norwegian investigators studied the risk for autistic traits in the offspring of close to 105,000 mothers with epilepsy and found those who used an Anti Epileptic Drug during pregnancy had a 5 to 8 times increased risk of having a child with autistic traits if they did not use folic acid during the peri-conceptional period.
  5. Typbar typhoid conjugate vaccine can now be supplied globally: Bharat Biotech has received a pre-qualification from the World Health Organisation (WHO) for Typbar Typhoid Conjugate Vaccine. Typbar TCV is the first typhoid vaccine clinically proven to be administered to children from 6 months of age to adults, and confers long-term protection against typhoid fever. With WHO-SAGE recommendation, for use of TCV for use in infants between 6 and 23 months of age and catch up vaccinations for children between 2 and 15 years of age, countries could introduce the vaccine into their immunisation programmes. The company has priced Typbar TCV at $ 1.50/dose for procurement for GAVI-supported countries. The company has announced a further reduction to around $1.0 or below/dose, post procurement of 100 million doses for LIC’s and LMIC’s.
  6. General secretary of the Ayurveda Hospital Management Association Baby Krishnan said he do not agree with the bridge course proposed by NMC. The basic tenet of Ayurveda will be lost with such a course. The integrated diploma in indigenous medicine, which was brought in long before establishing Ayurveda colleges, was considered a kind of bridge course. However, it was abandoned as it did little to promote the traditional medicine system.
  7.  Ayurveda Medical Association of India president G. Vinod Kumar says that NMC in present format will be a major set back to the growth of Ayurveda.
  8.  Research Director at the Amrita School of Ayurveda P. Ram Manohar said the bridge course was not pragmatic. “It is a myopic view of seeing and resolving issues and will make a mockery of traditional medicine.
  9.  In an observational study of patients who were prescribed varenicline (Champix) to stop smoking, treatment was associated with increased risk of cardiovascular events, researchers report[. Online December 20, 2017 in the American Journal of Respiratory and Critical Care Medicine.
  10.  Avoidance of cows milk in infants at high risk for type 1 diabetes doesnt prevent development of the condition during childhood. Long-term results of the randomized multinational Trial to Reduce Insulin-Dependent Diabetes Mellitus in the Genetically at Risk (TRIGR) study were published in the January 2 issue of the Journal of the American Medical Association by Mikael Knip, MD, PhD, of the University of Helsinki, Finland, and colleagues.
  11.  In a new study using 2009 to 2014 data from a Canadian database recording all out-of-hospital sudden cardiac arrests (SCA) in Ontario, Canada, the overall rate of SCA in athletes was 0.76 per 100,000 athlete-years [ N Engl J Med 2017; 377:1943.].
  12.  Idarucizumab (pronounced "I-dare-you-cizumab") is a monoclonal antibody fragment against dabigatran that can reverse the anticoagulant effect within minutes. A preliminary report suggested good efficacy in patients with dabigatran-associated bleeding or those undergoing emergency surgery. In a new report of over 500 patients treated with idarucizumab, most had cessation of bleeding or underwent surgery without abnormal bleeding [N Engl J Med 2017; 377:431.].
  13. The Global Burden of Disease study estimated that there were 33.4 million cases of rheumatic heart disease worldwide in 2015 [N Engl J Med 2017; 377:713.].
  14. The DESSOLVE III trial randomly assigned nearly 1400 patients to a sirolimus-eluting bioresorbable polymer stent or an everolimus-eluting durable polymer stent [Lancet 2017.]. After 12 months, there was no difference in the rate of the composite end point, which included cardiac death, target-vessel myocardial infarction, or clinically indicated target lesion revascularization. Based on this and other randomized trials showing no clear advantage of bioresorbable polymer stent materials, yet higher cost and less long-term experience compared with durable polymer stents, no one should implant bioresorbable polymer drug-eluting stents outside of clinical trials or registries.
  15. In one such trial, vitamin D supplementation (4000 international units daily for three years) compared with placebo did not reduce overall mortality in patients with advanced heart failure and baseline vitamin D levels <30 ng/dL (75 nmol/L) [Eur Heart J 2017; 38:2279.].
  16.  Biotin, which is contained in varying amounts in many vitamins and dietary supplements, may impact the results of high-sensitivity troponin assays. While the reported troponin values are often decreased, elevations have also been reported [. Clin Chem Lab Med 2017; 55:e226.].
  17.  In the large ROOBY trial, the rate of death at five years was significantly higher with off-pump, compared with on-pump, CABG (15.2 versus 11.9 percent) [N Engl J Med 2017; 377:623.].
  18. Several trials have shown reduced arrhythmia-related mortality among patients with nonischemic cardiomyopathy who receive an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden death, but no individual trial has shown a benefit in total mortality. Four meta-analyses that included patients receiving a primary prevention ICD from the same six trials (CAT, AMIOVIRT, DEFINITE, SCD-HeFT, COMPANION, and DANISH), demonstrate a significant benefit for all-cause mortality compared with medical therapy alone (19 to 24 percent hazard reduction) [Ann Intern Med 2017; 167:103.
  19. Biomarkers are going to be of increasing importance in the management of patients with Crohn’s disease. First is C-reactive protein and the second is fecal calprotectin.
  20. How to avoid carbon monoxide poisoning in your homeIn US alone every year an estimated 400 people die from unintentional carbon monoxide poisoning, and more than 4,000 are hospitalized, according to the Centers for Disease Control and Prevention. Carbon monoxide is an odourless and colorless gas.Since carbon monoxide poisoning occurs when a buildup of gas occurs indoors, people need to make sure their equipment is examined every year and get a carbon monoxide detector.Consumers have to know that any fuel-powered appliance — whether charcoal, wood, gas, propane, natural gas or oil — if you run it in or near the house, it can poison you.Fuel-powered appliances should be serviced by someone who carries the proper equipment, a combustion analyzer, which can properly measure CO levels. You cant eyeball it; you have to measure.The CDC says common symptoms of carbon monoxide poisoning are: headache, dizziness, weakness, upset stomach, vomiting, chest pain and confusion. The symptoms are often described as “flu-like.” People who are asleep or drunk can die before experiencing symptoms.Never run a car or truck inside a garage that is attached to a house, even with the garage door open. Always open the door to a detached garage to let in fresh air when running a car or truck inside.Make sure gas appliances are vented properly. Horizontal vent pipes for appliances, such as a water heater, should go up slightly as they go toward the outdoors. This prevents carbon monoxide from leaking if the joints or pipes aren’t fitted tightly.Have your chimney checked or cleaned every year. Chimneys can be blocked by debris. This can cause carbon monoxide buildup.Never patch a vent pipe with tape, gum or something else. Never use a gas range or oven for heating. Doing so can cause a buildup of carbon monoxide inside your home, cabin or camper.Never burn charcoal indoors.Never use a portable gas camp stove indoors. Never use a generator inside your home, basement or garage, or less than 20 feet from any window, door or vent.
  21. Now a new study by the Medical Research Council Laboratory of Molecular Biology at Cambridge University, has found that when the body processes alcohol it produces a chemical called acetaldehyde which is harmful to DNA. Acetaldehyde snaps the DNA of stem cells, permanently altering the genetic code and triggering cancer. acetaldehyde snaps the DNA of stem cells, permanently altering the genetic code and triggering cancer. The study also found that some people carry genetic mutations in two genes - aldh2 and Fancd2 - which make them even more susceptible to the effects of alcohol, making drinking far more dangerous.
  22.  A restrictive strategy for red blood cell transfusion is non-inferior to a more liberal strategy for mortality and major morbidity in patients undergoing cardiac surgery with cardiopulmonary bypass, according to data from the TRICS III trial. The randomized, multicenter, open-label, noninferiority trial included 5,243 patients undergoing cardiac surgery with cardiopulmonary bypass who had moderate to high risk for mortality (EuroSCORE I 6). All patients were randomly assigned to a restrictive red-cell transfusion strategy if hemoglobin was < 7.5 g/dL in the intraoperative or postoperative period or to a liberal strategy if hemoglobin was < 9.5 g/dL in the intraoperative or postoperative period in the ICU, or < 8.5 g/dL in the non-ICU ward.
  23.  Special casual leave the day you donate blood

Heart Care Foundation of India, who is celebrating 25 years of Perfect Health Mela lauded the order from DoPT approving 4 days special casual leave each year for blood donation or apheresis donation at any licensed blood bank for all Central Government employees. The aim is towards ushering in 100% voluntary blood donation by 2020.

HCFI appealed that all private sector establishment should also adopt this rule.

Circular35. No.13020/1/2017-Estt(L): Dated: 29.12.2017Government of India: Ministry of Personnel, Public Grievances and PensionsDepartment of Personnel & Training: Old JNU Campus, New Delhi 110 067Office Memorandum Subject: Grant of Special Casual Leave for the purpose of blood donation – reg.The undersigned is directed to refer to the provisions of this Department’s O.M. dated 8.10.1956, which provides for grant of Special Casual Leave to a Government servant who donates blood on that day.In this regard, it is noted that presently this rule applies only to whole blood donation and does not cover apheresis donation. It is felt that the rule should cover apheresis donation as well since it will have the added advantage of getting blood components like platelets, plasma etc.In view of the above, it has now been decided that Special Casual Leave may be granted for blood donation or for apheresis (blood components such as cells, plasma, platelets etc.,) donation at licensed Blood Banks on a working day (for that day only) up to a maximum of 4 times in a year on submission of valid proof of donation. (Sandeep Saxena) Under Secretary to the Government of India

From Dr K K Aggarwal Recipient of Padma Shri, Vishwa Hindi Samman, National Science Communication Award and Dr B C Roy National Award. Gold Medallist Nagpur University. Limca Book of Record Holder in CPR 10 Vice President Confederation of Medical Associations of Asia and OceaniaPresident Heart Care Foundation of IndiaGroup Editor in Chief IJCP Group & eMedinewSImmediate Past National President IMA

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