Morning MEDtalks with Dr KK Aggarwal 13th August 2018

New bed net to prevent malaria: Lancet

Now a new bed net with a specific combination of an insecticide and insect growth regulator can prevent millions of cases of malaria as per The Lancet.

The net contains a pyrethroid insecticide, which repels and kills the mosquitoes, and an insect growth regulator -- pyriproxyfen -- which shortens the lives of mosquitoes and reduces their ability to reproduce. Compared to conventional nets, this new type of mosquito net reduced the number of cases of clinical malaria by 12 per cent.

In areas with new combination beds, there was also a 51 per cent reduction in risk of a malaria infective mosquito bite. Children sleeping under the new bed nets were 52 per cent less likely to be moderately anaemic.

Insect growth regulators pyriproxyfen (in a sand granule formulation) may also be used in water-filled pits to prevent metamorphosis from larva to pupa to adult. This technique was used in Sri Lanka, where malaria eradication was nearly achieved in the 1960s but disease persisted in areas where pits were dug in search of gems (subsequently, the pits filled with rainwater and became breeding sites for malaria vectors). Treatment of all the pits in four villages achieved reduction in incidence of malaria cases (compared with untreated villages). Retreatment two to three times a year was sufficient.

The Foundation for Disease Elimination and Control of India (FDECINDIA) recommends that bed nets should be available in the open market. As on today they are only under a government supply.

Meditation is a journey: 50 reasons to meditate

1. From sickness to wellness

2. From particle state towards wave particle duality state

3. From wave particle duality state to wave state

4. From manifest to unmanifest

5. From disturbed state of consciousness to undisturbed state of consciousness

6. From sympathetic to parasympathetic mode

7. From exercise to yoga

8. From sahasrara (crown) chakra to muladhara (root) chakra and back

9. Towards a thoughtless state

10. Towards union of mind with the body

11. Towards union of purusha with prakriti

12. Towards achieving silence

13. Of experiencing higher state of consciousness

14. Of experiencing restful alertness

15. Of experiencing ‘para’ state of language

16. Of experiencing ritam bhara pragya

17. Of experiencing the unmanifest

18. Of experiencing losing track of time

19. Of experiencing moksha

20. Of experiencing inner happiness

21. Of experiencing liberation

22. Of experiencing ecstasy

23. Of concentration on the object of concentration and giving preference to the object of communication over thoughts

24. Of achieving turiya state of consciousness

25. Of getting benefits in 20 minutes equivalent to 7 hours of deep sleep

26. Of experiencing critical mass effects

27. Is having a dialogue with Para Brahma

28. Of knowing the unknown

29. Of experiencing synchrodestiny

30. Of experiencing meaningful coincidences

31. Of experiencing spontaneous fulfillment of desires

32. Of experiencing exaggerated telepathy

33. Of experiencing exaggerated reverse telepathy

34. Of experiencing a state of no enmity

35. Of experiencing a state of fearlessness

36. Of experiencing a state of truthfulness

37. Of experiencing a state of getting detached to the results of your actions

38. Of being able to spontaneously reduce the mental noise

39. Of being able to spontaneously neutralize or reduce the mental noise

40. Of being able to spontaneously ignore the mental noise

41. Of improving your concentration power

42. Of experiencing Tyaga

43. Of experiencing Vairagya

44. Of experiencing Sanyasi

45. Of understanding who we are

46. Of experiencing Aham Brahmasmi

47. Of experiencing Tat-tvam-asi

48. Of experiencing Pragnanam Brahma

49. Of achieving a state where God talks to you

50. Of achieving a state of Para Brahma, Para experiences and para language

FDA: Misuse of rupture-of-membranes tests and fetal deaths

The FDA is reminding clinicians that improper use of rupture-of-membranes (ROM) tests in pregnant women can lead to severe adverse events. The warning follows multiple reports of health complications — including 13 fetal deaths — associated with test misuse. The agency emphasized that ROM tests should not be used alone but rather should be part of an overall clinical assessment that may include testing for leaking amniotic fluid. Inaccurate results, including false-negatives, may occur. Both the timeframe in which testing occurs and the presence of blood, meconium, antifungal creams, or lubricants from vaginal exams can affect the results.

The FDA separately announced a recall for a single brand of ROM test (marketed as AmniSure) due to a malfunction that could impact how the results are interpreted.

Preterm prelabor rupture of membranes (PPROM) refers to rupture of fetal membranes prior to labor in pregnancies <370/7thsweeks. It occurs in 3 percent of pregnancies and is responsible for one-third of preterm births.

The diagnosis of PPROM is clinical, based on visualization of amniotic fluid coming out of the cervical canal/pooling in the vaginal fornix of a woman who presents with a history of leaking fluid. Laboratory tests (eg, Nitrazine, fern, AmniSure, Actim PROM, ROM Plus) and ultrasound are used for confirmation in cases of clinical uncertainty.

If PPROM is not obvious after visual inspection, the diagnosis can be confirmed by testing the pH of the vaginal fluid, which is easily accomplished with Nitrazine paper. Amniotic fluid usually has a pH range of 7.0 to 7.3 compared with the normally acidic vaginal pH of 3.8 to 4.2 and the normal acidic pH of urine of 5.0 to 6.0.

3rd dose of MMR for prevention of mumps in an outbreak setting

For individuals who are at increased risk for mumps because of an outbreak and who previously completed a two-dose series of mumps virus-containing vaccine prior to outbreak onset, we suggest a third MMR dose.

In January 2018, the Advisory Committee on Immunization Practices (ACIP) recommended that, in the setting of a mumps outbreak, individuals who have been previously vaccinated with two doses of the measles, mumps and rubella (MMR) vaccine receive a third dose of mumps virus-containing vaccine.

Around the globe

1. FDA announced approval of a vaginal ring designed by the global nonprofit research organization the Population Council. Called Annovera, the device is "the first vaginal ring contraceptive that can be used for an entire year," the FDA said.

2. An app designed to track fertility and prevent pregnancy in women 18 and older is the first to win US Food and Drug Administration approval to be marketed as a contraceptive, the agency announced Friday. The Natural Cycles app was approved as part of the agencys new Digital Health Innovation Action Plan, designed to fast track approval for new low-to-moderate-risk devices.

3. Onpattro (patisiran) infusion for the treatment of peripheral nerve disease (polyneuropathy) caused by hereditary transthyretin-mediated amyloidosis (hATTR) in adult patients has been approved by the FDA. Polyneuropathy caused by hATTR, a rare, debilitating and often fatal genetic disease characterized by the buildup of abnormal amyloid protein in peripheral nerves, the heart and other organs.

4. Non-Clostridium difficile enteric infections were present in almost one in five patients with symptomatic inflammatory bowel disease (IBD) in a study reported in The American Journal of Gastroenterology. "Our data suggest that enteric infection may trigger or coexist with flares of disease," the studys lead author, Jordan E. Axelrad, MD, MPH, of NYU Langone Health and Columbia University in New York City.

5. 52% of the patients afflicted with the mosquito-borne Chikungunya virus may persist with chronic articular pain or arthritis after acute infection, suggests a systematic review and meta-analysis. Despite the high incidence of these symptoms there is no specific treatment besides hydration and analgesics (Joint Bone Spine 2018).

Video to watch: What are the normal CRP levels? https://www.youtube.com/watch?v=NdxJliwBqHQ

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO