Morning MEDtalks with Dr KK Aggarwal 26^th September 2018

Dear Colleague

Here are two links for videos to watch. Share them with your colleagues and friends.

1. Vedic Health - A Dialogue with Ashwini Kumar Choubey https://www.youtube.com/watch?v=wdorsM5IZTQ
2. TEDx Video: Doctor-patient relationship https://www.youtube.com/watch?v=i9ml1vKK2DQ

Delhi diphtheria death toll rises to 20. As many as 19 children have died of diphtheria at a municipal hospital in north-west Delhi, taking the death toll in the city to 20, according to a North Delhi Municipal Corporation report issued Monday. Diphtheria is a contagious bacterial infection which affects mucous membranes of the throat and nose. While 19 children died at the North Corporation-run Maharishi Valmiki Infectious Diseases Hospital, one child died at the Delhi government-run Lok Nayak Hospital. “From September 6-24, there have been 157 admissions, of which 128 were from UP. Rest of the cases are from Haryana and Delhi,” a senior North civic body official said (HT).

Diphtheria is caused by the bacterium Corynebacterium diphtheria that affects the throat and upper airways, which causes sore throat like symptoms and difficulty in breathing initially. If left untreated, the infection causes production of a toxin that can damage the body’s peripheral nerves and other important organs. According to the World Health Organisation (WHO), the disease can be fatal in 5-10% cases. Globally, the cases of diphtheria have declined from nearly 1 lakh in 1980 to closer to 9,000 cases in 2017. But the decrease has stalled over the past decade, with India a key drive.

Longer sleep duration is associated with uncontrolled BP. People with hypertension who slept 9–10 hours on workdays and ≥10 hours on non-workdays were found to be more likely to have unsatisfactory BP control than those who slept for 5–9 hours. The association between a longer sleep duration (≥10 hours) and unsatisfactory BP control was more pronounced among women aged 65–70 years, with BMI ≥ 24 kg/m2. The study examined the association between sleep duration on workdays or non-workdays and unsatisfactory BP control (systolic BP of ≥140 mm Hg or diastolic BP of ≥90 mm Hg) in more than 4000 hypertensive patients (Journal of the American Society of Hypertension, October 2018).

People for the Ethical Treatment of Animals (PETA): Dr John Pawlowski, MD, PhD, from Harvard Medical School has written to Medical Council of India to ensure that postgraduate medical students receive the best training possible by fully replacing cruel and deadly classroom use of animals with cutting-edge simulation technology, which, he states, is "academically superior, widely available, and more cost-effective".

Globally an estimated 237 million men and 46 million women suffer from alcohol-use disorders with the highest prevalence among men and women in the European region (14.8% and 3.5%) and the Region of Americas (11.5% and 5.1%). Alcohol-use disorders are more common in high-income countries (WHO). 

A “surge in financing and investments” is needed to achieve the 2030 Agenda, the United Nations plan of action agreed by Member States, to transform the world, the Secretary-General said at the opening of the High Level Meeting on Financing the 2030 Agenda, at which he launched his Strategy to support Financing the 2030 Agenda. The financing needs of the 2030 Agenda, said Mr. Guterres, are immense, in the order of between $5 and $7 trillion per year… (UN)

This can happen in Seattle also: Dozens of frozen embryos were mistakenly destroyed at the University of Washington Medical Center in Seattle. Tina Mankowski, director of strategic communications for UW Medicine, confirmed that 31 patients were affected and that the destruction happened in 2014. The mistake was not known publicly, however, until one of the couples recently filed a complaint for damages. According to their attorney, "When these embryos are developed, they’re like extensions of themselves.” She said her clients felt their frozen embryos were “living beings.”

Clinical practice guidelines for heart failure diagnosis and treatment: National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand

1. A 12-lead ECG is recommended in patients with suspected or new diagnosis of heart failure to assess cardiac rhythm, QRS duration, and underlying conditions such as myocardial ischemia or LV hypertrophy.
2. A chest x-ray is recommended in patients with suspected or new diagnosis of heart failure to help identify pulmonary congestion and alternative cardiac or noncardiac causes of symptoms.
3. Transthoracic echocardiography (TTE) should be considered in patients with heart failure with reduced ejection fraction (HFrEF) 3 to 6 months after the start of optimal medical therapy or if there has been a change in clinical status, to assess appropriateness of other treatments such as device therapy (e.g., implantable cardioverter defibrillator [ICD] or cardiac resynchronization therapy [CRT]).
4. Invasive coronary angiography should be considered in patients with heart failure associated with refractory angina, resuscitated cardiac arrest, sustained ventricular arrhythmias, or evidence of ischemic heart disease to determine the need for coronary revascularization.
5. Monitor peripheral arterial oxygen saturation in patients with acute heart failure.
6. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are recommended for patients with type 2 diabetes associated with heart disease and insufficient glycemic control despite metformin.

Dr KK Aggarwal

Padma Shri Awardee

President Elect CMAAO

President HCFI