Morning Medtalks with Dr KK Aggarwal


Dr K K Aggarwal    18 April 2018

Red line should remind one of antibiotics resistance

ICMR surveillance data from January 2017 to December 2017 has shown that among the diarrheal pathogens, Aeromonas spp is one of the most isolated species among diarrheal pathogens. Aeromonas spp showed moderate resistance to all tested antibiotics. Resistance to carbapenems especially imipenem, was higher compared to other classes of antibiotics. Most Aeromonas strains are generally susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, second and third generation cephalosporins, aminoglycosides, carbapenems, chloramphenicol, and tetracyclines. Shigella spp is the second common diarrheal pathogen and the isolates demonstrated increased resistance to nalidixic acid and trimethoprim sulfamethoxazole (89.9%). Tetracycline still appears to be effective for V cholerae.

Gove blood only when it is a must. If the patient is stable, transfusion may not be needed even when the Hb level is 7 to 8 g/dL. For most medical and surgical hospitalized hemodynamically stable patients, including those in the intensive care unit or with septic shock, give blood to maintain the Hb at >7 g/dL rather than a higher threshold however there may be cases in which the patient is asymptomatic at a Hb of 7 g/dL, and clinician judgment may support not administering a transfusion. But for patients with underlying cardiovascular disease, undergoing orthopedic surgery, or cardiac surgery, as well as ambulatory patients, give blood transfusion to maintain the Hb at ≥7 to 8 g/dL rather than 10 g/dL. There may be cases in which the patient is asymptomatic at a Hb <8 g/dL, and clinician judgment may support not administering a transfusion.

10% patients undergoing percutaneous coronary intervention returns for an unplanned readmission within 30 days. In-hospital mortality was 2.4% for the index PCI but rose to 2.8% for cardiac readmissions and 3.1% for noncardiac readmissions as per 

Mamas Mamas from Royal Stoke University Hospital, UK.

One of the reason is increasing pressure to reduce hospital length of stay or to perform PCI as an outpatient procedure.

Patients who were readmitted were older than those who did not return to hospital, were more likely to be female and were more likely to have more comorbidities and a higher Charlson Comorbidity Index score.

Questions to be asked an interventional cardiologist: How many procedures you have done, what is your mortality rate, what is your post stenting 30 days re-admission rate, what is your one-year restenosis and mortality rate.

The meta-analysis has indicated that bariatric surgery improves sex hormone levels and sexual function in men but only slightly improves them in women. (J Endo Soc. 2018;2(2):117-132)

If you see RED LINE anywhere get reminded of AMR and misuse of antibiotics. Circle all antibiotics in your prescription with a red pen from today.

Temperature recoded at 1430 hours of today have risen by 4-8°C at many parts of Jammu & Kashmir; at one or two pockets of Konkan & Goa, East Madhya Pradesh, Jharkhand and northeastern states; by 1-4°C at some parts of rest Jammu & Kashmir, Himachal Pradesh, Jharkhand, West Rajasthan and Rayalaseema and at one or two pockets of Gujarat region, East Rajasthan, Vidarbha, Konkan & Goa, South interior Karnataka, Kerala and coastal Andhra Pradesh.

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