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Morning Medtalks with Dr KK Aggarwal
Dr KK Aggarwal,  10 March 2018
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#Multispeciality

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  1. Congrats Dr Shantanu Sen for being selected as Rajya Sabha member as TMC representative
  2. Washington University School of Medicine doctors have found a way to treat UTIs without using antibiotics using galactoside [Proceedings of the National Academy of Sciences}. E. coli when injected in mice bladder gets killed by oral galactose. Ecoli latch on galactose another sugar molecule found on urinary tissues.
  3. Azithromycin also has anti-inflammatory action. AMAZES trial, 420 asthmatics poorly controlled on inhaled steroid & long-acting beta agonist were added with azithromycin 500 mg 3 times weekly for 48 weeks. It reduced exacerbations & improved quality of life. They injected E. coli into the bladders of mice and then gave the mice either the galactoside or a placebo. The numbers of bacteria in the bladders and kidneys of mice given the galactoside dropped by up to a hundredfold.
  4. Advanced directives are Durable Power of Attorney for Health Care (DPAHC or Health Care Proxy) and living will
  5. The American Heart Association recommends that all patients in cardiac arrest should be resuscitated unless they have a valid Do Not Resuscitate (DNR) order, or in cases where resuscitation is physiologically futile (signs of irreversible death)
  6. Living will: Takes effect if the person is terminally ill without chance of recovery, and outlines the desire to withhold heroic measures. Includes CPR ventilatory support, or enteral feeding.
  7. DNR in general applies specifically to cardiopulmonary arrest and not to the current health status, even when the patient becomes progressively more ill
  8. Court: The right to die with dignity as fundamental right in Gian Kaur case. An adult human being having mental capacity to take an informed decision has right to refuse medical treatment including withdrawal from life saving device & to execute an advance medical directive
  9. Fourfold Asthma Study (NEJM) compared two asthma self-management plans in 2000 patients. 50% given quadrupling of inhaled steroid during periods of worsening asthma over 1 year had 20% reduction in severe asthma attacks.
  10. During flu season odds of taking more than 4 g of paracetamol in 1 day increased 24%. Overdoses primarily is due to increased use of OTC drugs. People taking the combination drugs may not even know they contain paracetamol.
  11. Cardiac MRI can noninvasively & accurately detect microvascular coronary obstruction in angina. Gadolinium-based stress perfusion CMR correlate with an elevated index of microcirculatory resistance value on invasive gold standard for assessing fractional flow reserve.
  12. Radiation scatter from orthopedic hardware can harm the eyes of first assistants during mini-C arm fluoroscopy. Surgeons and first assistants should use the mini-C arm in the vertical position as much as possible, and wear lead-lined glasses and other protective clothing.
  13. Benzodiazepine use raises the risk for falls, accidental injuries, and cognitive decline, in addition to the risk for addiction, overdose, and death.
  14. Cluster of cases of progressive Interstitial Lung disease occurred among dentists & dental technicians at Virginia care center (CDC). Exposure to silica, infections, plaster dusts, gases, radiation, polishing appliances, preparing impressions without using a mask are suspect
  15. Long-term maintenance therapy with PPI proton-pump inhibitors is associated with an increased risk for esophageal cancer. Sweden study in February 22 in Cancer Epidemiology
  16. If you walk on busy streets, breathing the traffic fumes may cancel out the health benefits. The London-based Lancet study, included 119 volunteers over 60 who were either healthy or had stable chronic obstructive lung disease or stable heart disease
  17. Safe Home 1: Ambient Air Quality standards in respect of Noise

Residential area: Day time 6am to 10 pm (55) and night time from 10pm to m6am (45). [Dr KK Aggarwal and J K Jain]


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