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Morning Medtalks with Dr KK Aggarwal 27th May 2018

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Dr KK Aggarwal    27 May 2018

New protocol for ventricular tachycardia in electrical storm

Nipah Breaking News: Tests have ruled out bats being behind the spread of the Nipah virus that took 12 lives in Keralas Kozhikode and Malappuram districts. The samples sent to Bhopal included those taken from bats found in the house of disease victim Moosa in the worse-affected Perambara village.

UAE asked its citizens to put off unnecessary travel to Kerala where a Nipah virus outbreak has claimed 12 lives. India has also reportedly procured 50 doses of antibody from Australia, which will help in fighting the virus.

Practice changing up-to-date: For hemodynamically stable patients with ventricular tachycardia in electrical storm (three or more episodes of sustained VT within 24 hours), in addition to amiodarane co-administer propranolol.

In a randomized, double-blind study of patients with ICD and electrical storm in which all patients received IV amiodarone and were randomized to propranolol (40 mg every 6 hours) or metoprolol (50 mg every 6 hours) for the first 48 hours, VT terminated significantly earlier in patients receiving propranolol (3 hours versus 18 hours). Patients receiving propranolol also had lower rates of ICD shocks during the ICU stay and shorter hospitalizations. ( J Am Coll Cardiol 2018; 71:1897.)

AMR

  1. Watch this video: https://www.youtube.com/watch?time_continue=53&v=ZlOudtkiAyQ
  2. Antibiotic resistant UTIs are on the rise: In a WHO report  released earlier this year, scientists found rates above 25 to 50 per cent of resistance to antibiotics commonly used to treat UTIs. They’re most often caused by the bacteria E. coli, and if left untreated could cause complications as serious as kidney damage and sepsis.

Quinolones, resistance to this class may be indicative of resistance to one of the last available oral treatment options, particularly in low-resources settings.

Health professionals may prescribe colistin or carbapenem for severe infections. They’re administered via IV and can cause side effects ranging from diarrhea, nausea, vomiting and skin rash to liver injury. However, even these are losing their potency over E. coli. Researchers note that they have found colistin-resistant E. coli in food animals in China.

A report published by the British government in 2016 revealed that humans are to blame for the excess of antibiotics in our bodies through their overuse in agriculture, over-the-counter medications and spill-off from medical waste.

According to the 2017 Canadian Antimicrobial Resistance Surveillance System report, family physicians were responsible for 65 per cent of all antibiotics prescribed to patients in 2016; among the most common was amoxicillin, a drug used to treat genito-urinary system infections.

Same year, one-million kilograms of antimicrobials were distributed for sale for use in animals by the Canadian Animal Health Institute member companies, of which 99 per cent were used for food-producing animals.

How to prevent UTIs

  1. Drink plenty of water
  2. Drink cranberry juice
  3. Wipe from front to back after using the toilet
  4. Empty your bladder after sex
  5. Avoid potentially irritating feminine products
  6. Switch up your birth control

Clinical

  1. The US FDA has approved the Xience Sierra (Abbott) everolimus-eluting coronary stent, the newest generation of Xience stent. Design innovations include a thinner profile, increased flexibility, increased lengths, and smaller diameters. The stent is not likely to be introduced in India.
  2. ICMR has sought help from Australia, where an antibody against the virus was found to be effective in tests.
  3. DMA delegation led by Dr. Ashwani Goyal, Dr. Girish Tyagi, Dr. Harish Gupta, Dr G.S. Grewal, Dr. Kamal Parwal, Dr. B.B. Wadhwa, Dr. Sunil Singhal & others met Honble Ministers Dr. Harshvradhan, Dr. Mahesh Sharma, & Chief Secretary Mr. Anshu Prakash regarding BMW management rules & harassment of doctors. They very keenly considered issues presented by DMA & assured all possible help regarding this issue. Instructions passed on to local authorities for not taking any coercive actions till matter is resolved by environment ministry. 
  4. Your partner’s BMI can predict your risk of developing diabetes. Men are particularly more prone to developing the metabolic disease if their wife is obese (University of Copenhagen and Aarhus University in Denmark) .

Wellness     

  1. Overweight or obesity is a cause of at least 12 cancers, as follows: liver, ovarian, prostate (advanced), stomach (cardia), oropharyngeal, colorectal, breast (postmenopausal), gallbladder, kidney, esophageal adenocarcinoma, pancreatic, and endometrial.  (American Institute for Cancer Research)

Financial Health

  1. Any repair on a medical equipment is an expense under section 31 in The Income- Tax Act, 1995: Repairs and insurance of machinery, plant and furniture: In respect of repairs and insurance of machinery, plant or furniture used for the purposes of the business or profession, the following deductions shall be allowed-
  2. the amount paid on account of current repairs thereto;
  3. the amount of any premium paid in respect of insurance against risk of damage or destruction thereof.

Legal

  1. “We hold that the expenditure incurred by the assessee-company towards hospitalisation of its employees certainly falls within the wide and inclusive definition of "salary" as defined in Section 17(1) read with Section 17(3) of the said Act. “(Calcutta High Court: Indian Oxygen Ltd. vs Commissioner of Income-Tax on 25 February 1994: Equivalent citations: 1994 210 ITR 274 Cal)
  2. Can we allow a pelvic exam in medical school or residency on an anesthetized woman, who is getting ready to undergo a gynae procedure? American College of Obstetricians and Gynaecologists have issued statements that that should not happen; no one should be using a woman to learn how to do a pelvic exam without consent before that teaching practice is undertaken.

MCI

  1. The Supreme Court on Friday agreed to suggestions that the vacant post-graduate seats in private unaided medical colleges could be filled up as per the order of merit in the All-India National Eligibility cum Entrance Test (NEET) list. MCI said that almost 41.95% of post-graduate medical seats for the academic year 2018-2019 in private unaided medical colleges in the state were vacant. Additional Solicitor General (ASG) Pinky Anand, who appeared for the Centre, suggested to the bench that “a similar dispensation can be followed in other states, if they so desire, while ensuring that the cut-off date of May 31, 2018 is strictly adhered to”. “We agree with this suggestion,” the bench said and disposed of the plea filed by the Uttar Pradesh Unaided Medical Colleges Welfare Association.

One Health: CPR in Dogs

Dogs less than 14 Kg

  1. Lay the dog on a flat surface with his/her right side against the surface.
  2. Cup your palms and hold the dog with one palm on either side above the heart region. (On the dog’s side about 2 inches from the front leg).
  3. Compress the chest for one inch to one-quarter or one-third the width of the chest for a count of one and then let go for a count of one. You will do compressions at a rate of 100 compressions in a minute.
  4. If you are alone, breathe into the dog’s nose once for every five compressions that are done. If two persons are available, give artificial respiration once every two or three compressions are done.
  5. Continue with the CPR and rescue breathing until the dog begins breathing on its own and the pulse becomes steady.

Dogs > 14 Kg

  1. Lay the dog on a flat surface with his/her right side against the surface. (You will need to stand towards the dog’s back.)
  2. Put one of your palms on the dog’s rib cage, near the heart region, and put your other palm on top of it.
  3. Without bending both the elbows, press the rib cage in a downward motion.
  4. Compress the chest for one-quarter to one-third the width of the chest for a count of one and then let go for a count of one. You will do compressions at a rate of 80 compressions per minute.
  5. Close the muzzle with your hand before beginning artificial respiration. If only one person is available, breathe into the dog’s nose once for every five compressions that are done. If two persons are available, give rescue breaths once for every two compressions that are done.
  6. Continue performing CPR until the dog begins to breathe and has a steady pulse.

The difference we see between smaller dogs and bigger dogs is that we may need to use two hands to compress a larger dogs chest. The rate of compressions is also slightly slower for the larger dog.

Any dog that has needed rescue breathing or CPR needs to be seen by a veterinarian as soon as possible. (muskogeephoenix.com)

NIPAH Update

Health Ministry issues advisory on Nipah virus

  1. Avoid consuming raw date palm sap or toddy, half-eaten fruits from the ground and refrain from entering into abandoned wells and eat only washed fruits.
  2. Handling of bodies of those who died due to the disease should be done in accordance with the government advisory and that during this emotional moment traditional rituals and practices may need to be modified to prevent the exposure of family members to the disease.
  3. Nipah virus which commonly affects animals such as bats, pigs, dogs, horses, etc. can spread from animals to humans and can sometimes cause serious illness among humans.
  4. Spread of Nipah virus to humans may occur after close contact with other Nipah infected people, infected bats, or infected pigs. Bat secretions laden with virus can infect people during fruit tree climbing, eating/handling contaminated fallen fruits or consuming raw date palm sap/juice or toddy
  5. Human-to-human infection can occur from close contact with persons affected with Nipah at home while providing care or close contact and in hospital setting if appropriate personal protective equipments are not used
  6. People who are exposed to areas inhabited by fruit bats/ articles contaminated by secretions such as unused wells, fruit orchards, etc. are likely to be at higher risk of infections. 
  7.  Persons with direct contact with sick pigs or their contaminated tissues, persons in close contact with a Nipah virus affected deceased during burial or cremation rituals or health care workers having direct contact with probable or confrmed cases without using standard precautionary measures are also at a high risk of developing the infection.

Advisory for healthcare personnel

  1. Wash hands thoroughly with soap and water for 20 seconds after contact with a sick patient, practice precautions for infection control while handling Nipah cases (suspected/ confirmed), limiting use of injections and sharp objects. 
  2. For aerosol generating procedures, personal protective equipment such as individual gowns (impermeable), gloves, masks and goggles or face shields and shoe cover and the procedure should be performed in airborne isolation room.
  3. All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected as per manufacturers instructions and hospital policies.
  4. If the use of sharp objects cannot be avoided, ensure that precautions are observed like never replace the cap on a used needle, never direct the point of a used needle towards any part of the body, do not remove used needles from disposable syringes by hand, and do not bend, break or otherwise manipulate used needles by hand, never re-use syringes or needles, dispose of syringes, needles, scalpel blades and other sharp objects in appropriate, puncture-resistant containers. 
  5. Ensure that containers for sharps objects are placed as close as possible to the immediate area where the objects are being used (point of use) to limit the distance between use and disposal, and ensure the containers remain upright at all times.

Weather

Heat Wave and Temperature (Past 24 hours from 0830 hrs IST of 25 May to 0830 hrs IST of 26 May, 2018)

Heat Wave: Yesterday, heat wave conditions observed at some parts over Vidarbha and West Rajasthan; at one or two pockets over West Uttar Pradesh, Himachal Pradesh, Uttarakhand East Rajasthan and Madhya Pradesh

Maximum Temperature Maximum temperatures were markedly above normal (5.1°C or more) at some parts of Himachal Pradesh; appreciably above normal (3.1°C to 5.0°C) at most parts of Jammu & Kashmir, Uttarakhand, Punjab and Haryana, Chandigarh & Delhi; at some parts of West Madhya Pradesh, Vidarbha and north Rajasthan. Yesterday, the highest maximum temperature of 46.5°C recorded at Ganganagar (West Rajasthan)

Temperatures Recorded at 1430 Hours IST of Today, the 26 th May, 2018 o Temperatures more than 40.0°C is observed at most parts of Punjab, Haryana, Delhi, Rajasthan, Madhya Pradesh, Uttar Pradesh, Gujarat region, Vidarbha and Marathwada; at some parts of Bihar and Telengana and at one or two pockets of Jammu division, Saurashtra & Kutch, Jharkhand, North Interior Karnataka and Andhra Pradesh (Annexure 3). o Temperature recoded at 1430 hours of today have risen by 3-5°C at many parts of Gujarat region and Kerala and at one or two pockets of Gangetic West Bengal and northeastern states; by 1-3°C at most parts of East Uttar Pradesh, West Madhya Pradesh, East Rajasthan, Madhya Maharashtra and rest Gujarat region; at many parts of West Rajasthan and rest Kerala and at one or two pockets of Jammu & Kashmir, Punjab, Delhi, Bihar, Jharkhand, Chhattisgarh, East Madhya Pradesh, Saurashtra & Kutch, Karnataka, Rayalaseema, Andhra Pradesh and Tamilnadu & Puducherry

Heat Wave Warnings for Next 5 Days (on next page) (For significance of colour code and criteria for Heat Wave

Heat wave conditions are very likely to abate from parts of Northwest India and Central India from 28th May, in view of the likely setting in of easterly winds over the northern plains.

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