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Morning MEDtalks with Dr K K Aggarwal 12th July 2018
Johns Hopkins Hospital in Baltimore Evacuated Due to Possible TB Exposure
Source Reuters: Two buildings at the Johns Hopkins Hospital in Baltimore, Maryland, were evacuated because people may have been exposed to tuberculosis.
A small amount of the tuberculosis bacteria may have been released while being transported between two of the hospitals cancer research buildings.
Both buildings were evacuated, and employees who were in the area when the incident occurred have been isolated and will be evaluated by the Fire Department.
Condoms not 100% effective
Aidsmap reports a study published in the medical journal AIDS shows that, when used 100% of the time, condoms prevent more than nine out of 10 HIV infections. This number is much higher than previous CDC studies. One 2014study found that, when used all the time, condoms only stopped infections around seven out of 10 times.
Errors in using Speech Recognition Software
A new study published online July 6 in JAMA Network Open calls into question the accuracy of computerized speech recognition time-saving software. The data reveal an error rate of more than seven words per 100 in unedited SR-generated documents, including clinically significant errors in one of every 250 words that could affect care.
Deodorant, shaving cream, toothpaste, trash cans, clothing, cutting boards, credit cards all contains triclosan.
Triclosan, an antibacterial and antimicrobial chemical, has been used in personal care products and as a pesticide for decades.
Scientists in recent years have stepped up their research into its potential health risks, on mitochondria, says University of Maine biochemist Julie Gosse, PhD.
Want to start a statin prescription
- Give Rosuvastatin, atorvastatin when you want to lower LDL by more than 35%
- In CKD severe renal impairment give atorvastatin which does not require dose adjustment.
- In chronic liver disease suggest complete abstinence from alcohol and the use of pravastatin at a low dose (liver disease is unexplained aminotransferase values >3 times above upper normal range confirmed on repeat testing)
- Minimum pharmacokinetic drug interactions with atorvastatin ( not metabolized through the CYP3A4)
- Pravastatin and fluvastatin least muscle toxicity Do a baseline CK levels as a reference
- No routine monitoring of statins
- Report new onset myalgias or weakness
- Check baseline SGOT, SGPT levels prior to initiating statin therapy; routine monitoring of these levels is not necessary for patients on statins.
- Do TSH prior to initiating statin therapy.
- Atorvastatin and rosuvastatin are more effective at lowering triglycerides (14 to 33 percent) than other statins in patients with hypercholesterolemia
- Atorvastatin at doses of 5, 20, or 80 mg/day produces reductions in triglycerides of 27, 32, and 46 percent, respectively, and in LDL cholesterol of 17, 33, and 41 percent, respectively
- Statins are the first choice in virtually all patients with elevated LDL-C.
- In stable patients (outpatients) treat with high intensity statin (atorvastatin 40 to 80 mg or rosuvastatin 20 to 40 mg daily) and prefer the highest approved dose in most cases.
- Start at the lower dosage of high intensity statin in patients 75 years of age or older
- In patients who do not tolerate one statin because of myopathy try another statin that may be better tolerated or to try alternative dosing regimens, often using low doses of rosuvastatin.
- For patients who cannot tolerate statin therapy consider a PCSK9 antibody.
- LDL-C should be monitored approximately six weeks after the initiation or change of treatment. If LDL reduction is substantially less than expected, possible non-tolerance or nonadherence to treatment should be carefully explored. Thereafter, measurement every 6 to 12 months is reasonable in patient’s adherent to lifestyle modifications to examine for continued adherence and increasing LDL levels with aging.
- With statins, lipid levels stabilize within several weeks after a change in dose, and so checking lipid levels six weeks after a dosage change should provide a reliable result.
- The beneficial effects of statins occur sooner than can be explained by changes in LDL-C, and with discontinuation may reverse more quickly as well
- Statin therapy is contraindicated during pregnancy
Teen crash risk highest during first three months after getting driver’s license
Teenage drivers are eight times more likely to be involved in a collision or near miss during the first three months after getting a driver’s license, compared to the previous three months on a learner’s permit, suggests a study led by the National Institutes of Health.
Teens are also four times more likely to engage in risky behaviors, such as rapid acceleration, sudden braking and hard turns, during this period. In contrast, teens on a learner’s permit drove more safely, with their crash/near crash and risky driving rates similar to those of adults. The study appears in the Journal of Adolescent Health.
Supreme Court imposes cost on states and union territories for failure to comply with its orders regarding solid waste management.
In the matter titled as “In re Outrage as Parents end life after Childs dengue” bearing SWC No. 1/2015 the Hon’ble Supreme Court of India has vide order dated 10.07.2018 has held that The tragedy is that more than two-third of the States / UTs in the country have neither bothered to comply with the orders passed by the Court nor bothered to comply with the directions given by the MoEF, Government of India.
The Supreme Court has observed that This is not only a tragic state of affairs but a shocking state of affairs particularly, since solid waste management is a huge problem in this country.
On the following States costs of Rs.1,00,000/- (Rupees One lac only) has been imposed since these States / UTs have not complied with the orders passed by this Court and the directions issued by the Government of India:
- Himachal Pradesh
- Jammu and Kashmir
- West Bengal
- Union Territories Lakshadweep Puducherry
The remaining defaulting States / UTs that were not present or not represented by lawyers were burdened with costs of Rs. 2,00,000/- (Rupees two lacs only).
One final opportunity is given to these States / UTs to comply with the laws governing India failing which we may have to call the Chief Secretary of the concerned States / UTs to inform us why the laws governing India are not applicable to these States / UTs.
Also, the Hon’ble Supreme Court observed that “There is a mountain loads of garbage in Delhi, particularly in Bhalswa, Okhla and Ghazipur. We would like to know who is responsible for clearing the garbage – those answerable to the Lt. Governor or those answerable to the Chief Minister.”
MEDtalk Video of the day: Does CT scan dose matters: https://www.facebook.com/drkkaggarwal/videos/1900824353272192/
Participate in survey on Inflammatory bowel disease: https://docs.google.com/forms/d/e/1FAIpQLSedaDx2iXiwU1vBpYdU6ebfCap-7PYAPSqXRJTeg8ULvNOcLg/viewform
Dr KK Aggarwal
Padma Shri Awardee