Morning MEDtalks with Dr KK Aggarwal 7^th August 2018

Reversal of diabetes

A clinical trial recently showed that nearly half of individuals with type 2 diabetes achieved remission to a non-diabetic state after a weight-loss intervention delivered within 6 years of diagnosis. Now a study published August 2nd in the journal Cell Metabolism reveals that this successful response to weight loss is associated with the early and sustained improvement in the functioning of pancreatic beta cells. This finding challenges the previous paradigm that beta-cell function is irreversibly lost in patients with type 2 diabetes.

The responders demonstrated early and sustained improvement in beta-cell function. The most striking difference between responders and non-responders was the first-phase insulin response. Pancreatic beta cells secrete insulin in two phases in response to an increase in blood glucose concentration. The first phase, which consists of a brief spike lasting approximately 10 minutes, is typically absent in patients with type 2 diabetes. First-phase insulin secretion increased in responders after weight loss but did not change in non-responders. 

Dabigatran in patients with myocardial injury after non-cardiac surgery

In all patients with perioperative myocardial infarction or myocardial injury after non-cardiac surgery (MINS) not at increased bleeding risk, one should give dabigatran 110 mg twice daily for two years. They are at increased risk for short- and long-term adverse cardiovascular outcomes. Currently we treat all such patients with aspirin and a statin.

In the MANAGE trial, over 1750 MINS patients were randomly assigned to dabigatran 110 mg or placebo twice daily for a maximum of two years. Dabigatran treatment lowered the risk of major vascular complications (vascular mortality and nonfatal myocardial infarction, non-hemorrhagic stroke, peripheral arterial thrombosis, amputation, and symptomatic venous thromboembolism) compared with placebo (11% vs 15%). The risk of major bleeding was similar between the groups (3% vs 4%).

Propranolol in addition to amiodarone for treatment of electrical storm

For hemodynamically stable patients with ventricular tachycardia in electrical storm (three or more episodes of sustained VT within 24 hours), co-administer propranolol, in addition to amiodarone, as they reduce the adrenergic surge associated with frequent ventricular tachyarrhythmias (VT) requiring defibrillator shocks.

In a randomized, double-blind study of patients with an implantable cardioverter-defibrillator (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 vs 18 hours with metoprolol) (J Am Coll Cardiol. 2018;71:1897).

Around the Nation

1. If India remains committed to achieving 100% coverage in terms of safe sanitation services by October 2019, as many as 3,00,000 deaths caused due to diarrheal disease and protein-energy malnutrition since the country launched the Swachh Bharat Mission in 2014 can be averted, the WHO said. As per calculations, if all sanitation services are used, the initiative could result in over 14 million more years of healthy life in the period measured, with the benefits accruing yearly thereafter.
2. Varanasi and Delhi are among 14 Indian cities dubbed most polluted by the WHO because of the air quality measured in terms of PM 2.5. Other cities in this category are: Jaipur, Jodhpur, Srinagar, Kanpur, Faridabad, Gaya, Patna, Lucknow, Agra, Gurgaon, Patiala and Muzaffarpur. Only six other cities of other countries fall in this category in the WHO list.
3. The CPI(M) Politburo has urged the Government to withdraw the “regressive” National Medical Commission Bill and Higher Education Commission of India Bill.
4. A parliamentary panel has asked the Health Ministry to take necessary steps to speed up the process of establishing and linking anti-retroviral treatment centres for the HIV-infected across the country. This will provide consistent access to "affordable and efficacious" medication regime for the treatment of HIV positive patients (The Committee on Petitions on the Ministry of Health and Family Welfare).

Around the globe

1. The prevalence of aspirin intolerance is around 5 to 6%. Up to 20% of the asthmatic population is sensitive to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) and present with a triad of rhinitis, sinusitis, and asthma when exposed to the offending drugs. This syndrome is referred to as aspirin-induced asthma (AIA).
2. Protecting vulnerable people in eastern Democratic Republic of the Congo (DRC) from the latest Ebola Virus outbreak is going to be “very, very complex”, given the huge logistical challenges and ongoing conflict there, said the World Health Organization (WHO). 
3. RQI or Resuscitation Quality Improvement is a self-directed, simulation-based performance and quality improvement program for health care professionals that offers “low-dose, high-frequency” hands-on learning sessions that provide vital CPR skills practice in 10 minutes every 90 days. It is co-developed by the American Heart Association and Laerdal Medical, which is a major, global medical equipment and medical training products manufacturer based in Stavanger, Norway.
4. More than 100,000 people were sickened by food-related illness outbreaks that numbered 5760 between 2009 and 2015. Chicken was the most common food category responsible for outbreak-associated illnesses with 3,114 illnesses [12%]) followed by pork (2,670 [10%]) and seeded vegetables (2,572 [10%]). Fish (222 outbreaks [17%]) and dairy (136 [11%]) caused more individual outbreaks than any other food groups with chicken coming third in this category (123 [10%]). The pathogen-food category pairs that caused the most outbreak-associated illnesses were Salmonella in eggs (2,422 illnesses), Salmonella in seeded vegetables (2,203), and Salmonella in chicken (1,941) (CDC, Surveillance Summaries / July 27, 2018). 

Video to watch: Wheat disorders

https://www.facebook.com/drkkaggarwal/videos/1945381452149815/

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO