Morning MEDtalks with Dr KK Aggarwal 2nd September 2018

People who use solid fuels for cooking should switch to electricity or gas at the earliest. Long-term use of coal, wood, or charcoal for cooking is associated with an increased risk of death from heart disease. During 3.4 million person-years of follow-up, 8,304 participants died from heart disease. After adjusting for education, smoking and other cardiovascular risk factors, each decade of exposure to solid fuel was associated with a 3% higher risk of cardiovascular death.

Participants who had used solid fuels for 30 years or longer had a 12% greater risk of cardiovascular death than those who had used them for less than 10 years (ESC Congress 2018, August 26, 2018).

US FDA has announced a voluntary recall of Montelukast tablets. One lot of montelukast sodium tablets 10 mg, 30-count bottle from Camber Pharmaceuticals, Inc., Piscataway, N.J were found to instead contain 90 tablets of losartan potassium tablets, 50 mg.

This tablet mix-up may pose a safety risk as taking losartan tablets when not prescribed may cause renal dysfunction, elevated potassium levels and low blood pressure. This risk is especially high for pregnant women because losartan could harm or kill the fetus. This recall unrelated to the recent valsartan recalls that were due to an impurity, N-nitrosodimethylamine (NDMA).

NIOSH has launched a new framework to tackle opioid crisis in the workplace along with the CDC. The framework looks at different workplace conditions that can be risk factors for medically prescribed opioid use becoming opioid misuse. It also focuses on protecting first responders and includes guidance on developing methods to rapidly detect dangerously potent opioids in the workplace and how to effectively and safely decontaminate workplaces.

Key questions guiding the framework include: Identify workplace conditions, Determine risk factors, Protect workers and responders and Develop methods for detection and decontamination.

A new integrated intervention reduces mortality by 50% among people living with HIV who inject illicit drugs. At the end of the study, 15% of participants with HIV who had received the standard of care had died vs 7% of participants with HIV who had received the intervention consisting of psychosocial counseling along with guidance and support navigating the healthcare system.

People who received the intervention were nearly twice as likely to report being in treatment for HIV and substance use after one year as those who received their national standard of care. They also were about twice as likely to have suppressed their HIV to undetectable levels after one year (HPTN 074 trial, The Lancet)

The Fourth International Ayurveda Congress at Netherlands inaugurated by Minister of State for Ayush Shri Shripad Yesso Naik. The Congress is being jointly organized by International Maharishi Ayurveda Foundation, Netherlands; All India Ayurvedic Congress, New Delhi and the International Academy of Ayurveda, Pune in association with the Indian Embassy in the Netherlands. 

A special Seminar “India-Netherlands collaboration in Healthcare, including Ayurveda” on 3rd September 2018 is also organized by the Indian Embassy (PIB, Ayush, Aug. 31, 2018).

Medical practices with an employee appreciation program report lower employee turnover. The Medical Group Management Associations 2018 Practice Operations Survey found a link between employee appreciation programs and medical practice turnover. The survey examined comparative data from more than 1,000 organizations. Participants were physician-owned and hospital-owned practices, along with US organizations at small and large practices (Beckershospitalreview.com). The five major findings were:

1. Medical practices with an employee appreciation program generally saw lower turnover than their counterparts without one, regardless of specialty.
2. Among primary care practices with an employee appreciation program, business operations support staff turnover was 4.55 percent. That compares to 5 percent at their counterparts.
3. Primary care practices with an employee appreciation program also saw lower clinical support staff turnover than their counterparts (14.84 percent versus 16.67 percent). However, front office support staff turnover was higher among primary care practices with an employee appreciation program.
4. Surgical and nonsurgical practices with an employee appreciation program also saw lower clinical support staff turnover compared to their counterparts.
5. Front office support staff turnover was 15.38 percent among surgical practices with an employee appreciation program. Thats lower than the 20 percent among surgical practices without one.

Patients with broken heart syndrome, also called takotsubo cardiomyopathy, and history of previous or current cancer doubled their risk of mortality or re-hospitalization due to post-discharge adverse events within three years. The study presented at the recent ESC Congress 2018 suggested that these patients need strict monitoring at follow-up. These patients may benefit from standard therapy for heart failure, especially an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB).

Molecular testing may facilitate more efficient, patient-centered evaluation for possible TB. A sputum molecular testing algorithm using GeneXpert MTB/RIF to guide discontinuation of respiratory isolation for patients undergoing evaluation for active TB was safe, feasible, widely and sustainably adopted, and provided substantial clinical and economic benefits.

The molecular testing strategy and the assay were associated with a significant reduction in median time to isolation discontinuation (2.9 vs 2.5 days), and hospital discharge (6.0 vs 4.9 days), and saved approximately $13 347 per isolated non-TB patient (JAMA Internal Medicine, published online August 27, 2018)

UNICEF 11 key lessons about water, sanitation and hygiene in schools

1. Globally only 69% of schools have a basic drinking water service (water from an improved source [piped water, boreholes or tubewells, protected dug wells, protected springs and packaged or delivered water], and water is available at the school at the time of the survey)
2. 1 in 4 primary schools and 1 in 6 secondary schools have no drinking water service.
3. Overall, nearly 600 million children lack a basic drinking water service at their school. Less than half the schools in Oceania and two thirds of schools in Central and South Asia have a basic drinking water service.
4. Globally only 66% of schools have a basic sanitation service (improved sanitation [flush/pour flush to piped sewer systems, septic tanks or pit latrines; ventilated improved pit latrines, composting toilets or pit latrines with slabs], at the school that are single-sex and usable (available, functional, private) at the time of the survey).
5. 1 in 5 primary schools and 1 in 8 secondary schools have no sanitation service.
6. One third of schools in sub-Saharan Africa and Oceania have no sanitation service. In most countries where data is available, less than 50% of schools have toilets accessible to students with limited mobility.
7. Globally, 600 million children do not have a basic sanitation service at school
8. Nearly 900 million children worldwide lack a basic hygiene service at their school (handwashing facilities with water and soap available at the school at the time of the survey).
9. 1 in 3 primary schools and over a quarter of secondary schools have no hygiene service.
10. Over one third of schools worldwide and half of schools in the least developed countries have no hygiene service.
11. UNICEF has WASH in school programs in more than 90 countries and reaches an average of 3 million children a year.

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