Morning MEDtalks with Dr KK Aggarwal 29^th August 2018

No aspirin in diabetes. In the ASCEND trial, aspirin significantly reduced the risk for serious vascular events by 12% but also significantly increased the risk for major bleeding by 29%. No effect on gastrointestinal or any other cancer was seen. Aspirin is not needed in patients with good control of blood sugar, blood pressure and cholesterol and in nonsmokers (European Society of Cardiology (ESC) 2018 Congress; also published simultaneously in the New England Journal of Medicine).

Compounded drugs: The US FDA has proposed excluding three substances from a list of ingredients that could be used to manufacture compounded medications in bulk for use by hospitals and doctors offices. Compounded medications are custom-made medications that traditionally were formulated by pharmacies for specific patients. Those substances included vasopressin, bumetanide and nicardipine hydrochloride.

Pre-authorisation for health insurance claims under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) will be completed and communicated to the hospital within 30 minutes. The pre-authorisation stage is a provisional sanction that would keep a check on any false claims where people avail health insurance despite them not being essential because the money will be reimbursed. The PMJAY scheme will have set guidelines for pre-authorisation and the process will be mandatory for 636 of the 1,350 packages offered. 

Medical apathy: A ward boy at a government hospital in Kanpur, Uttar Pradesh was seen treating a woman with head-injury on the floor outside the emergency ward. The doctor in charge allegedly said that he was tending to other patients at the hospital when the ward boy started to treat to the injured woman. He added that strict action will be taken against the ward boy for starting the treatment in such unhygienic condition as the floor outside the hospital. Anything more than first aid cannot be provided by unqualified persons (TOI).

Indias first biojet fuel flight. SpiceJet operated Indias first test flight powered by biojet fuel, according to the airline. A Bombardier Q400 aircraft, partially using biojet fuel, took off from Dehradun and landed at the airport in the national capital. The airline said it successfully operated "Indias first ever biojet fuel flight". The flight was powered with a blend of 75 per cent air turbine fuel (ATF) and 25 per cent biojet fuel, it said (PTI, August 27, 2018).

Made from Jatropha crop, the fuel has been developed by the CSIR-Indian Institute of Petroleum (IIP), Dehradun, SpiceJet said. Around 20 people, including officials from aviation regulator DGCA and SpiceJet, were in the test flight. The duration of the flight was around 25 minutes, according to an airline executive.

FDA Update: The Food and Drug Administration is warning consumers not to purchase a sexual enhancement product promoted as FDA-approved and sold on social media. Deputy Secretary-general Surachoke Tangwiwat said the product labelled as "Girly Sex" had never been examined or approved for use, and customers are strongly advised not to use it.

Is your gut inflamed? The following may be the symptoms.

1. Food sensitivities:If you feel bloated, gassy, and just downright blah after you eat certain foods, it might be a sign that you have gut inflammation, also known as leaky gut syndrome. The most common food sensitivities are to gluten and dairy, but you can develop sensitivities to other foods as well.
2. Migraines:There is a link between gut and brain health. Inability to concentrate, ADD, migraine and ADHD might actually be linked to whats going on in your gut.
3. Chronic fatigue syndrome or fibromyalgia: Gluten intolerance is a contributing factor
4. Autoimmune diseases
5. Persistent skin problems: acne, rosacea, or eczema. A disruption in your gut bacteria can also allow yeast, commonly called Candida, to thrive. Candida colonizes the gut, causing it to become leaky, which in turn allows the yeast to escape via the bloodstream. Once escaped, this yeast can affect your mood, hair, nails and skin.
6. Anxiety & depression: Inflammation in your gut can negatively affect your mood. Markers of inflammation are elevated in depressed patients.
7. Gastrointestinal issues:Gas, bloating, diarrhea, or irritable bowel syndrome its likely that your gut is inflamed due to stress, food intolerances, infection, or environmental toxins.

Remove all inflammatory foods that can damage the gut such as gluten, dairy, corn, soy, and eggs, as well as toxic foods, including sugar, caffeine, and alcohol. Restore the beneficial bacteria in the gut with high-quality, high-potency probiotics.

Are pacemakers and defibrillators affected by electric cars? Electromagnetic interference from increasingly popular electric cars presents no risk to people with cardiac implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, new research suggests. The cross-sectional study evaluating electric cars and electromagnetic interference with cardiac implantable electronic devices was published online April 24 in the Annals of Internal Medicine.

Labelling for fluoroquinolones to include more side effects. In a written reply to Lok Sabha, Anupriya Patel, Minister of State for Health and Family Welfare, stated that “in view of the action of US FDA on labelling changes of fluoroquinolones, the Drug Controller General of India is examining the issue in consultation with subject expert committee of CDSCO”.

A recent FDA review found instances of hypoglycemic coma where users of fluoroquinolones experienced hypoglycemia. In the US, the Blood Glucose Disturbances subsection of the labelling for all systemic fluoroquinolones will be required to explicitly reflect the potential risk of coma with hypoglycemia. The FDA first added a Boxed Warning to fluoroquinolones in July 2008 for the increased risk of tendinitis and tendon rupture.

Video to watch: TEDx Talk

Dr KK Aggarwal: Modern day doctor-patient relationship

https://www.youtube.com/watch?v=i9ml1vKK2DQ

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO