Morning MEDtalks with Dr KK Aggarwal 16th September 2018

TEDx Video: Doctor-patient relationship: 

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

As per the report HIV Estimations 2017, India had around 21.40 lakh people living with HIV (PLHIV) in 2017 with adult prevalence of 0.22%. Around 87.58 thousand new HIV infections and 69.11 thousand AIDS related deaths happened in 2017 while around 22,675 mothers needed Antiretroviral Therapy (ART) for prevention of mother to child transmission of HIV (NACO).

Free medicines and diagnostic tests will soon be available to patients with dementia as part of an action plan being worked out by the Centre (Union Minister for Health and Family Welfare JP Nadda).

Do you know blood pressure is very dynamic? A reading can change 10 or even 20 points over the course of seconds. Thats why the current blood pressure guidelines recommend waiting one minute, retaking the reading, and averaging the two numbers. If the systolic values (the first number in a blood pressure reading) are more than around 10 points apart, consider doing a third reading a minute later. Averaging three values will likely provide an even more trustworthy result.

Best time to have coffee: Caffeine can increase alertness, so having a cup or two of coffee or tea can help boost your body and sharpen your mind. However, try not to have large amounts after 2 p.m., as the caffeine may interfere with the sleep.

AHAs list of BP measuring mistakes. Any of these errors may elevate your BP reading by several points (even as much as 10 points, in some cases), although they are generally not additive.

1. Having a full bladder. An uncomfortably full bladder might increase your reading.
2. Having no support for your back or feet. Slouching or dangling your feet when sitting can increase your reading. Make sure you sit in a chair with your back supported and feet flat on the floor or a footstool. At home, dont sit on a sofa or reclining chair.
3. Sitting with crossed legs. Crossing your legs squeezes the large veins in your legs, which may raise the reading slightly.
4. Not supporting your arm.  Your arm should be totally relaxed so your biceps (upper arm) muscle isnt contracted. Be sure to position your arm on a chair or counter, so that the blood pressure cuff is level with your heart. Also, dont clench your fist.
5. Wrapping the cuff over clothing. Depending on the thickness of the fabric, putting a cuff over clothing can boost the reading by quite a bit. Wear a short-sleeved shirt (along with easily removable layers, if youre chilly in the doctors office) so the cuff is placed on your bare arm.
6. Using a cuff thats not the correct size. Many people need a large-sized cuff. Using one thats too small will be uncomfortable and may elevate your pressure by several points. Note that models with upper-arm cuffs are more reliable than those that fit on the wrist.
7. Engaging in conversation. Chatting during the measurement — or even actively listening — can boost blood pressure.

The US FDA has approved a device intended to treat acute coronary artery perforations, or tears in the blood vessels of the heart. The PK Papyrus Covered Coronary Stent System is the first device approved by the FDA for this indication in 17 years.

US FDA has found an additional "unexpected impurity" in three lots of Torrent Pharmaceuticals recalled valsartan drug. On Thursday, the FDA said that three lots of the drugs were contaminated with a second impurity, N-Nitrosodiethylamine, or NDEA, which is also a suspected human carcinogen… (CNN)

Tired of the high drug costs and shortages of lifesaving generic drugs, major hospitals and hospital systems in the United States, including the Mayo Clinic, have come together to create Civica Rx, a not-for-profit generic drug company.

An ambitious project to clean up the oceans plastic pollution got underway over the weekend as members of The Ocean Cleanup project began towing their system out to sea. If it works as expected, theyll try to take a bite out of the Great Pacific Garbage Patch -- a huge collection of floating trash thats three times the size of France, or about double the size of Texas. The Great Pacific Garbage Patch is the nickname for an area between Hawaii and California, where plastic and other human-made litter and debris accumulate, according to the National Oceanic and Atmospheric Administration… (CNN)

What is the extent of information to be disclosed in the consent? (Dr KK Aggarwal and Advocate Ira Gupta) The 3 Judges Constitution Bench of Hon’ble Supreme Court of India in the landmark judgment titled as “Samira Kohli versus Prabha Manchanda, AIR 2008 SC 1385” has held that:

“32. We may now summarize principles relating to consent as follows:

(ii) The adequate information to be furnished by the doctor (or a member of his team) who treats the patient, should enable the patient to make a balanced judgment as to whether he should submit himself to the particular treatment as to whether he should submit himself to the particular treatment or not. This means that the Doctor should disclose (a) nature and procedure of the treatment and its purpose, benefits and effect; (b) alternatives if any available; (c) an outline of the substantial risks; and (d) adverse consequences of refusing treatment. But there is no need to explain remote or theoretical risks involved, which may frighten or confuse a patient and result in refusal of consent for the necessary treatment. Similarly, there is no need to explain the remote or theoretical risks of refusal to take treatment which may persuade a patient to undergo a fanciful or unnecessary treatment. A balance should be achieved between the need for disclosing necessary and adequate information and at the same time avoid the possibility of the patient being deterred from agreeing to a necessary treatment or offering to undergo an unnecessary treatment.

(v) The nature and extent of information to be furnished by the doctor to the patient to secure the consent need not be of the stringent and high degree mentioned in Canterbury but should be of the extent which is accepted as normal and proper by a body of medical men skilled and experienced in the particular field. It will depend upon the physical and mental condition of the patient, the nature of treatment, and the risk and consequences attached to the treatment.”

Thus, the nature and extent of information to be furnished by the doctor should be of the extent which is normal for medical men skilled and experienced in the particular field.

The doctor is required to furnish such adequate information so as to enable the patient to make a balanced judgment about his/her treatment/surgery. For this, the Doctor should disclose:

1. nature and procedure of the treatment and its purpose, benefits and effect;
2. alternatives if any available;
3. an outline of the substantial risks; and
4. adverse consequences of refusing treatment

Tobacco harm reduction: The London-based Royal College of Physicians states “Although it is not possible to precisely quantify the long-term health risks associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure" (Royal College of Physicians (London), Nicotine without smoke: tobacco harm reduction. 28 April 2016)

One in five men and one in six women worldwide, develop cancer during their lifetime, and one in eight men and one in 11 women die from it, IARC’s (International Agency for Research on Cancer) Global Cancer Observatory says, in its first report since 2012.

Doctors being asked to ditch Latin and use plain English. The Academy of Medical Royal Colleges says too often correspondence contains complex medical jargon rather than plain and simple English. Using the phrase "twice daily" to explain the dosing of a medicine is better than the Latin abbreviation "bd", for example. The Please Write to Me initiative, led by Dr Hugh Rayner, a kidney specialist, is aimed mainly at doctors working in outpatient clinics, although it is best practice for all clinicians who need to write clinical letters... (BBC UK)

The best way to use food as energy is to pay attention to the glycemic index, which measures how quickly sugar from food is absorbed into your bloodstream. Refined carbs with a high glycemic index increase blood sugar levels to provide a quick jolt of energy. But the insulin pumped into the  blood in order to control this sudden spike often leads to an equally sudden drop in blood sugar levels (sugar crash), which makes one feel even more tired. Eating foods with a low glycemic index can provide a slow and steady energy boost. The best choices are foods that rank from zero to 69 on the glycemic index scale.

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

President HCFI