Morning MEDtalks with Dr K K Aggarwal 23rd July 2018

AMR now in Leprosy

A six-year study data published in Clinical Microbiology and Infection and carried out across 19 countries has now shown that antimicrobial resistance is emerging in leprosy cases. A total of 8% of the Mycobacterium leprae bacterial strains studied showed gene mutations conferring resistance towards drugs such as rifampicin, dapsone and ofloxacin. Rifampicin resistance was observed in about 5% of the relapse cases and in 2% of the new ones. India and Brazil topped the list with more than 10 rifampicin-resistant cases each.

Low-dose ketamine as effective as morphine

Low dose ketamine is as effective as morphine for controlling acute pain, according to a new literature review, and should be considered as an alternative to opioids for short term pain relief in emergency departments (EDs), a research published in July 17 in Academic Emergency Medicine.

Healthcare wishes

The American Bar Association Commission on Law and Aging suggests that you re-examine your health care wishes whenever any of the following "five ds" occurs:

1. Decade: When you start each new decade of your life.
2. Death: When you experience the death of a loved one.
3. Divorce: When you experience a divorce or other major family change.
4. Diagnosis: When you are diagnosed with a serious medical problem.
5. Decline: When you experience a significant decline or deterioration from an existing health condition, especially when it diminishes your ability to live independently.

No adrenaline in cardiac arrest

Using adrenaline in cardiac arrest may double the risk of severe brain damage among the survivors. It can reduce blood flow in very small blood vessels in the brain, which may worsen brain damage, that leads to one survivor for every 125 patients. "We have found that the benefits of adrenaline are small -- one extra survivor for every 125 patients treated -- but the use of adrenaline almost doubles the risk of a severe brain damage amongst survivors," said lead author Gavin Perkins from the University of Warwick in Britain.

The six-step SPIKES protocol can be followed to deliver bad news

1. S: SETTING up the interview with the patient and others she chooses to include

2. P: Assessing the Patients PERCEPTION of the situation

3. I: Obtaining the Patients INVITATION i.e. understanding the amount of information that the patient wants to receive

4. K: Providing KNOWLEDGE and information to the patient

5. E: Addressing the EMOTIONS of the patient with empathic responses

6. S: STRATEGY and SUMMARY

Around the globe

1. MCI has agreed to consider a proposal by the Dental Council of India to introduce a bridge course for dentists. If it happens the reverse should also be simultaneously introduced.

2. Hepatitis C is a major cause of chronic liver disease. Asia has the highest prevalence of chronic hepatitis C despite availability of newer medications. HCV genotype 2 (GT2) is the second most common genotype in many parts of Asia.

3. Hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) is an independent predictor of mortality. Although liver biopsy is the gold standard for staging hepatic fibrosis, AASLD guideline recommends NAFLD Fibrosis score as a simple and non-invasive method to identify patients with NAFLD with fibrosis risk. InThe best association of steatofibrosis with mortality was higher at NFS threshold of 0.80. (BMJ Open Gastroenterol. 2018 Mar 20;5(1))

4. Recurrent abdominal symptoms, refractory anemia, nutritional deficiencies in patients with NAFLD are indications for screening the patient for Celiac disease.

Participate in survey on Inflammatory bowel disease:

https://docs.google.com/forms/d/e/1FAIpQLSedaDx2iXiwU1vBpYdU6ebfCap-7PYAPSqXRJTeg8ULvNOcLg/viewform

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

President HCFI