Morning Medtalks with Dr KK Aggarwal


Dr KK Aggarwal    21 April 2018

Topical steroid creams can no longer be sold over the counter in India



As per ICMR Antimicrobial Resistance Surveillance Network January 2017-December 2017 the  “antibiotic used to treat the infection in pediatric patients showed that in OPD oral cefixime and ceftriaxone IV in hospitalized patients were the most common antibiotics used in our hospital. The use of fluoroquinolones is minimal and azithromycin was given mostly as an additional antibiotic in patients showing delayed response to treatment with cephalosporins. About 10% of patients needed more than one antibiotic for complete cure.”

I agree with the Health secretary Preeti Sudan requesting the MCI to “incorporate the obligatory requirement of establishing DR-TB centre for treatment initiation of DR-TB patients as per revised national TB control programme guidelines at each medical college for recognition of medical college”. But it should be AMR as a whole and not MDR TB alone.

Good move by the DCGI. Topical steroid creams can no longer be sold over the counter in India. This is per a notification issued by the Ministry of Health and Family Welfare banning the sale of fourteen topical steroid creams and ointments without prescription. We the doctors must follow it.

Inside the guts of city mice dwell potentially harmful germs — and in New York City, 23 percent of mice tested positive for at least one antimicrobial-resistant gene, according to a study published inmBio.

Public Health

SAGE a WHO expert panel recommended that dengue vaccine be administered only to people who have previously had confirmed dengue. Data published in Nov showed that vaccine actually puts people who are dengue naïve at higher risk of severe dengue than if they were not vaccinated.

The Road Safety week this year happens to be in the last week of April (23rd to 30th), and International Noise pollution awareness day falls on 25th April (last Wednesday of April).  

IMA-NISS is observing 25th April as “No Horn Day” all over the country, as traffic noise especially honking, is a major component of noise pollution in our country.



In Glasgow Coma Scale (GCS) adding pupil response to the GCS more accurately predicts prognosis after traumatic brain injury, including the likelihood of death, than either measure alone. (April 10 in the Journal of Neurosurgery.)

In the cremation ground yesterday, the wife of the diseased heart patient developed vomiting. The issue was whether to give sub lingual ondansetron or not. I put on hold as the history of drugs on was not available.

Domperidone may increase the risk of cardiac arrhythmias. ECG should be performed at baseline and while on treatment. Domperidone should be withheld if the corrected QT is >450 ms in men and >470 ms in women.

Even Ondansetron can cause QTc prolongation and potentially fatal cardiac arrhythmias. QT prolongation is dose dependent. Avoid it in patients with congenital long QT syndrome, and to use ECG monitoring in certain patients, including those with hypokalemia or hypomagnesemia, heart failure, and bradyarrhythmias, and in patients taking other medications that increase the risk of QTc prolongation.

A 20 year old developed chicken pox. The question was whether or not to give anti viral. For healthy children ≤12 years, varicella is typically self-limited require no antiviral therapy but unvaccinated patients ≥13 years old needs it. Antiviral therapy can reduce the severity of symptoms and may decrease the risk of complications. Give oral valacyclovir because it can be given in fewer doses compared with acyclovir and has equivalent activity.

Statins can significantly reduce the risk for complications and death from primary sclerosing cholangitis as per a Swedish registry. Primary sclerosing cholangitis is progressive, with no known therapy to prevent cirrhosis, liver transplant, or progression to cholangiocarcinoma, said Annika Bergquist, MD, PhD, from the Karolinska Institute in Stockholm.

New HIV treatment guidelines

The DHHS guidelines has added bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) to its list of recommended regimens for most patients starting therapy. This means that there are now five regimens recommended for initial therapy for most patients and they are: BIC/TAF/FTC; Dolutegravir/abacavir/lamivudine; Dolutegravir/tenofovir/FTC (DTG/TAF/FTC); Elvitegravir/cobicistat/tenofovir/FTC and Raltegravir/tenofovir/FTC. Out of five two of these are better than the other three regimens, and those are DTC/TAF/FTC (a two-pill regimen) and BIC/TAF/FTC (a single-tablet regimen).



Temperatures Recorded at 1430 Hours IST of Today, the 21 st April, 2018 o Temperatures more than 40.0°C is recorded at many parts of Vidarbha; at some parts of Telangana, Chhattisgarh, Jharkhand, Rayalaseema and interior Odisha and at one or two pockets of Punjab, Madhya Pradesh, East Uttar Pradesh, Marathwada, Gujarat Region, Konkan & Goa, North Interior Karnataka and Tamilnadu (Annexure 3). o Temperature recoded at 1430 hours of today have risen by 3-6°C at one or two pockets of Sikkim, Jharkhand and South Interior Karnataka; by 1-3°C at some parts of Madhya Maharashtra and Kerala and at one or two pockets of Bihar, Assam, Odisha, Konkan & Goa, North Interior Karnataka and Rayalaseema (

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