Morning Medtalks with Dr KK Aggarwal 16th June 2018


Dr KK Aggarwal    16 June 2018

Minds Vision

Your dreams will always be within your reach when you help others reach theirs as well.

Will we ever get dengue vaccine? May be not.

An analysis of data on Sanofis dengue vaccine, given to over 800,000 school children in the Philippines, confirms it increases the risk of hospitalization and severe dengue in those who had never previously been infected with the mosquito-borne virus.

The findings published in the current issue of New England Journal of Medicine confirms the WHO recommendation that Sanofis vaccine should not be used without testing for prior dengue exposure.

The study authors calculated that if given to 1 million children over age 9, the vaccine could prevent some 11,000 hospitalizations and 2,500 cases of severe dengue. But it could also lead to 1,000 hospitalizations and 500 severe cases of dengue in children who not previously infected.

Iron in CKD or not?

The Lancet: Volume 370, No. 9586, p482, 11 August 2007

Patients with CKD have an exaggerated risk of cardiovascular death which can partly derive from anaemia, but correction to a normal haemoglobin concentration does not ameliorate, and can exacerbate, this risk.

Giving boluses of iron salts can aggravate cardiovascular disease.

Certain microorganisms use iron as a metabolic cofactor and can thus become either more frequent, or more virulent, as causes of infection because of iron use.

New AMA President

The new president-elect of the American Medical Association will be just the fourth psychiatrist to ever hold the position as well as the first female psychiatrist and the first African American woman to do so. Patrice Harris, MD, adjunct assistant professor in the Department of Psychiatry and Behavioral Sciences at the Emory University School of Medicine, Atlanta, Georgia, will be taking the reins of the AMA in June 2019.

Iron Replacement (the Lancet Volume 370, No. 9603, p1906, 8 December 2007)

Adult ferritin concentrations of less than 30 μg/L is iron deficiency. When taking care of patients with chronic illness and associated inflammation, however, this approach seems too narrow.

Research has revealed that well above 50% of patients with chronic heart failure have iron deficiency (as assessed by the gold standard of bone-marrow biopsy), but with mean ferritin concentrations of 75 μg/L.

UK guidelines on anaemia management in chronic kidney disease3 recommend that a ferritin concentration of less than 200 μg/L should trigger initiation of treatment with intravenous iron. These cut-offs define patients with functional iron deficiency.

Benzodiazepines Poisoning in a Small Health Care Establishment

Oral BZD are widely prescribed and commonly involved in cases of drug overdose and substance abuse. 

Oral BZDs taken in overdose without a co-ingestant rarely cause significant toxicity. 

The classic presentation of a patient with an isolated BZD overdose consists of CNS depression with normal vital signs. 

Severe overdose can cause respiratory depression and stupor or coma. 

Co-ingestants are common in cases of overdose.

Altered mental status, a common finding in BZD overdose. Life-threatening causes of depressed mental status include hypoglycemia, carbon monoxide poisoning, stroke, meningitis and encephalitis, and head trauma.

BZDs are NOT detected in standard urine screening tests for drugs of abuse. 

Most cases of isolated BZD ingestion are managed successfully with supportive care alone. 

Gastrointestinal decontamination with activated charcoal (AC) is usually of NO benefit and increases the risk of aspiration. 

Flumazenil is a nonspecific competitive antagonist of the BZD receptor. It is only used to reverse BZD-induced sedation following general anesthesia, procedural sedation, or overdose. 

Ground level ozone is a harmful air pollutant

In addition to particulate matter due to dust storms, the rising ozone levels have added to the pollution burden in Delhi-NCR.

PM2.5 and tropospheric ozone are the two indicators used to quantify exposure to outdoor, or ambient, air pollution in the GBD project as stated in the WHO report “State of Global Air 2018”.

Ozone in the upper atmosphere or stratospheric ozone is good ozone and protects from the harmful UVB rays of the sun. The thinning of this layer due to destruction by chemicals is seen as a hole, called ‘ozone hole’ through which the harmful UV rays reach the earth.

A depleted ozone layer in the stratosphere allows the ultraviolet rays of the sun to reach the earth exposing mankind, flora and fauna to its harmful effects. 

It is the ground level ozone or tropospheric oxygen, which is a harmful air pollutant and affects human health. Ground level ozone is formed when chemical reactions occur between pollutants nitrogen oxides and VOCs from industrial emissions, vehicle exhaust in sunlight.

Traffic emissions constitute more than half of the ozone precursors. Ozone along with particulate matter also forms smog.

Breathing ground level ozone can damage the lung tissue and reduce lung function of anyone and can especially worsen pre-existing respiratory conditions like bronchitis, emphysema and asthma. Children, elderly, outdoor workers are most at risk of breathing air containing ozone.

BZD Withdrawal

Any abrupt or overly rapid reduction in BZD dose among chronic users can produce withdrawal. 

Rapid recognition and treatment of BZD withdrawal is crucial because the syndrome can be life-threatening. Symptoms and signs can include tremors, anxiety, perceptual disturbances, dysphoria, psychosis, and seizures. BZD withdrawal is treated with a BZD that has a prolonged clinical effect (eg, diazepam) given intravenously and titrated to effect. (uptodate dot com)

Economics and Billing Heads

Registration Charges

Consultation Charges 

Monitoring charges

Nursing Charges

Oxygen Charges

Observation charges (number of hours)


Drugs and Disposables

Even NEJM published papers with flawed statistics

The New England Journal of Medicine corrected five previously published studies and retracted and republished a sixth, a year after an analysis suggested the journal published numerous studies with statistical errors, according to Science.

Dr. John Carlise, editor-in-chief of the journal Anaesthesia and an anesthesiologist at Torbay Hospital in Torquay, U.K., published an analysis in June 2017, accusing NEJM — among other journals — of fabricating data. Dr. Carlisle reanalyzed 5,087 randomized trials published in eight health journals using statistical software. He found about 2 percent of the statistics used in these papers were questionable, including studies published in NEJM.

Just days after Dr. Carlises report was published, NEJM identified 11 of its articles with glaring issues. Six contained mistakes — five of which stemmed from a misunderstanding of statistical terms. The sixth study, a 2013 clinical trial suggesting a Mediterranean diet can help prevent heart disease, contained more serious errors. (beckershospitalreview.com)

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