Morning MEDtalks with Dr KK Aggarwal 1st September 2018

Health Ministry has formulated a draft policy for prevention and control of hemoglobinopathies - thalassemia, sickle cell disease and variant hemoglobins in India. The policy envisages creation of centres of excellence in states that will have advanced facilities required for comprehensive care for patients with thalassemia/sickle cell disease, including a bone marrow transplant unit and a prenatal diagnostic center. The centers of excellence will provide technical support for thalassemia in the medical colleges, tertiary care hospitals, district level health facilities and primary health centers and also impart training to the health professionals.

The policy recommends creation of a hemoglobinopathy unit (clubbed with hemophilia for logistic purposes) in government medical colleges / tertiary care facilities as well as district level hospitals to carry out therapy as well as preventive activities. Therapy will be provided through day care... (MOHFW)

Operating on the wrong limb. A doctor from the Balaji Institute of Surgery, Research and Rehabilitation for Disabled (BIRRD), Andhra Pradesh has operated a 26-year-old accident victim on the wrong leg, leaving the affected leg untouched. The medical negligence was realized when a friend of the victim, who is a doctor at Sri Venkateswara Institute of Medical Sciences in Tirupati, visited him at the hospital and noticed that the unaffected leg has been operated.

The Chairman of Tirumala Tirupati Devasthanams (TTD) had visited the victim and had promised him that the issue will be rectified by the hospital. He has stated that the doctor has operated the healthy leg of the victim being completely negligent and careless of his duties, and the orders to suspend the doctor has already been issued by him.

Think before you prescribe. Do not give nitrofurantoin in suspected pyelonephritis. Nitrofurantoin is an effective and therefore often the first-line choice for cystitis. A 2010 update of the guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis (Clin Infect Dis. 2011;52:e103-e120) recommends against the use of nitrofurantoin when the diagnosis of cystitis is uncertain vis-à-vis pyelonephritis, because it does not achieve adequate renal tissue levels.

According to the guideline, “such uncertainly may exist in the setting of cystitis symptoms accompanied by subjective fever that is not verified at the time of examination, a prolonged duration of cystitis symptoms (typically greater than 5-7 days), or vague flank pain or tenderness which is not otherwise explained”.

In such cases, a urine culture and susceptibility test should always be done and choice of antibiotic should be based on the culture and antibiotic sensitivity testing. Local community resistance prevalence, availability, cost, patient allergy and compliance history are other factors that may influence the choice of antibiotic in these patients.

Forum to be developed soon for stakeholders to make health policy interventions, says union health minister, as reported in ET Health. Noting that there is no formal structure in the health sector as of now where interactions can be facilitated on policy matters Union Health Minister J P Nadda said, “As far as health sector is concerned, we are of the opinion that there is no formal structure where we can have an interaction on policy matters. I take the responsibility and declare that very soon, I will come out with a forum where multiple stakeholders can join hands with the government on policy interventions," he told a delegation during a FICCI event… (ET Health/PTI, August 31, 2018).

There are more than 10 million current e-cigarette users in the US. A new research conducted by the Tobacco Regulation and Addiction Center of the American Heart Association reveals that more than 10.8 million (4.5%) of adults in the US currently use e-cigarettes. More than half of the current users were under the age of 35 years and about 60% are men. People with comorbid conditions like heart disease, asthma, cancer, chronic obstructive pulmonary disease and depression and people who were lesbian, gay, bisexual or transgender were more likely to use e-cigarettes (August 28, 2018 in Annals of Internal Medicine).

The American Academy of Pediatrics (AAP) has updated its recommendations on car safety seats for children. AAP says that children remain in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat. The earlier recommendation was that children should remain rear-facing at least to age 2. This specific age cut-off has been removed in the updated guideline (August 30, 2018, Pediatrics).

Benjamin Hoffman, MD, FAAP, lead author of the policy statement and chair of the AAP Council on Injury, Violence and Poison Prevention said, “It’s best to keep your child rear-facing as long as possible. This is still the safest way for children to ride.”

Swiss Atrial Fibrillation Cohort Study (Swiss-AF) shows an association between dementia and atrial fibrillation (AF) in patients without prior stroke. Four out of ten patients with AF but no history of stroke or transient ischemic attack (TIA) were found to have clinically unrecognised ‘silent’ brain lesions, which could trigger cognitive decline.

In a draft recommendation statement on preventive interventions in perinatal depression, the USPSTF recommends that clinicians provide or refer pregnant and postpartum women who are at increased risk of perinatal depression to counseling interventions. The USPSTF found convincing evidence (Grade B) that counseling interventions, such as cognitive behavioral therapy and interpersonal therapy, are effective in preventing perinatal depression in women at increased risk.

Grade B means “The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial”.

A culinary master class on healthy nutrition for representatives of the media was hosted by WHO together with Russian Federation Ministry of Health in Moscow. Led by famous Russian television personality and celebrity chef, John Warren, a team of WHO and Ministry of Health experts prepared a 3-course meal during the open air event. The menu included a healthy version of one of Russia’s most traditional soups, borsht, as well as a highly nutritious and filling lentil salad, and a naturally sweet and fresh dessert made with pumpkin, orange and dried apricots. Low-fat yogurt with a drizzle of lemon was used to dress the salad.

The objective was to demonstrate to the media that healthy nutrition can be easy, affordable and can be created following a few simple and straightforward rules.

Life expectancy across Africa has improved significantly, says a new United Nations World Health Organization (WHO) report released on Thursday, but national health systems must be improved to ensure that services get to the people who need them most.

The study, launched during the 68th session of the WHO Regional Committee in Dakar shows a continued improvement, with the continent seeing the biggest jump in healthy life expectancy – time spent in full health – anywhere in the world: from 50.9 years in 2012, to 53.8 years in 2015. Deaths resulting from the ten biggest health risks in Africa such as lower respiratory infections, HIV and diarrheal diseases – dropped by half between 2000 and 2015, partly as a result of specialized health programs.

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

Vice President CMAAO

President HCFI