Morning MEDtalks with Dr K K Aggarwal 24th July 2018

Around the globe

1. The National Longitudinal Lesbian Family Study (NLLFS) followed a group of lesbian parents since they first planned for kids in the late 1980s and early 1990s. Those children are about 25 years old now. According to the study, published in the New England Journal of Medicine, they’re doing perfectly fine.
2. A new Lancet report has suggested that using HIV screening, antiretroviral therapy (ART) to treat the infection, and antiviral drugs to prevent disease in uninfected people along with testing and treatment for syphilis in female sex workers and men who have sex with men (MSM), can decrease the number of new HIV cases at a national-level by seven per cent between 2018-2028.
3. Indwelling pleural catheters are an established management option for malignant pleural effusion and have advantages over talc slurry pleurodesis. The optimal regimen of drainage after indwelling pleural catheter insertion is debated and ranges from aggressive (daily) drainage to drainage only when symptomatic. A new study in Lancet indicate that daily indwelling pleural catheter drainage is more effective in promoting spontaneous pleurodesis and might improve quality of life.
4. At least 29 new-borns have died from July 1 to 21, and six within the last one week, at a Special New-born Care Unit in Madhya Pradeshs Guna District Hospital. 948 new-borns were admitted in last three months out of which 118 died. Also, 26 new-borns died in April 43 in May and 49 in June.
5. Baharampur: An unidentified patient with several wounds on the body in Murshidabad Medical College and Hospital was found lying unconscious and untreated for several hours outside the casualty ward on the floor. (Violation of which ethics regulation: MCI 1.1.1 A physician shall uphold the dignity and honour of his profession.)
6. Shigella bacteria, which cause diarrhoea and spread mainly through water, has been found in a wide variety of food like beef, chicken, egg, milk, fish, vegetables and fruits collected from farms in and around Hyderabad. The study, published in the Journal of Veterinary Science and Technology, found 17 strains which are resistant to commonly used anti-biotics. The isolated strains showed resistance to antibiotics like ampicillin (82.3 per cent), tetracycline (70.6 per cent), erythromycin (47.1 per cent), ciprofloxacin (41.2 per cent) and chloramphenicol (35.3 per cent).  ( Deccan Chronicle)
7. The results of a study published in July 2018 in the American Journal of cardiology has showed no evidence for either benefit or risk of alcohol consumption, reported at baseline or at follow-up in relation to incident heart failure in both men and women. Although, a high level of alcohol consumption is associated with cardiomyopathy, the results of this study did not find any significant association between alcohol consumption and risk factor for heart failure in older adults with hypertension.

AMR

Fluoroquinolones are the third most commonly prescribed outpatient antibiotic class.

In 2016, the FDA issued a black box warning (its strongest warning) to stress serious and disabling adverse events associated with systemic fluoroquinolone use, including damage to tendons, muscles, joints, nerves, and the central nervous system.

A new study published in Clinical Infectious Diseases] reports that fluoroquinolones are commonly prescribed for conditions when antibiotics are not needed at all, or when fluoroquinolones are not the recommended first-line therapy. In medical offices and emergency departments, about 5% of all fluoroquinolones prescribed for adults are completely unnecessary, and about 20% of all fluoroquinolone prescriptions do not adhere to recommendations about the use of fluoroquinolones as a first-line therapy.

Fluoroquinolones are not recommended for such conditions as uncomplicated urinary tract infections and respiratory conditions, including viral upper respiratory tract infections, acute sinusitis, and acute bronchitis.

According to another study, published in JAMA Internal Medicine] only 52% of patients received the recommended first-line antibiotic therapy for three common infections—otitis media, sinusitis, and pharyngitis.

Healthcare providers often cite patient satisfaction as a reason for prescribing an antibiotic when no antibiotic is recommended.

Based on the FDAs warning, fluoroquinolones should be used only in patients with acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, or uncomplicated urinary tract infections when no other treatment options are available.

Prescribing the right antibiotic, at the right dose, for the right duration, and at the right time helps optimize patient care and fight antibiotic resistance.

Participate in survey on Inflammatory bowel disease:

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