Morning MEDtalks with Dr KK Aggarwal 16^th November 2018

‘Make healthy choices’ to prevent and manage chronic diabetes, says WHO. The global prevalence of adult diabetes has nearly quadrupled since 1980, the World Health Organization (WHO) said on Wednesday on the World Diabetes Day, with the call to “eat healthily, be physically active and avoid excessive weight gain.” Diabetes is a major cause of blindness, kidney failure, heart attack, stroke and lower limb amputation,” said WHO, noting that about 422 million adults have the disease – a number that has been increasing steadily over the last three decades. WHO Spokesperson Fadela Chaib said that was largely due to changes in lifestyle: “We are eating more heavy foods, full of fat and sugar; we are less physically active; and we have a more sedentary way of living.”

A set of guiding principles from an American Medical Association council on assessing the competency of senior/late career physicians failed to gain adoption at the AMAs interim meeting in National Harbor, Maryland in the US. In a floor vote of 281-222 on Tuesday, delegates sent the report back to the Council on Medical Education, which issued the guiding principles. Some hospitals and health systems already require competency testing by older physicians, but there are currently no standards for these tests. In committee discussions Sunday, Marlys Witte, MD, a delegate of the Organized Medical Staff section, questioned how one major benefit of aging “wisdom” could be measured… (Medpage Today).

Record number of tick-borne diseases reported in US in 2017: New data from the Centers for Disease Control and Prevention (CDC) show tickborne diseases are again on the rise. In 2017, state and local health departments reported a record number of cases of tickborne disease to CDC.  Cases of Lyme disease, anaplasmosis/ehrlichiosis, spotted fever rickettsiosis (including Rocky Mountain spotted fever), babesiosis, tularemia, and Powassan virus disease all increased—from 48,610 cases in 2016 to 59,349 cases in 2017. These 2017 data capture only a fraction of the number of people with tickborne illnesses. Under-reporting of all tickborne diseases is common, so the number of people actually infected is much higher. While the reason for this increase is unclear, a number of factors can affect tick numbers each year, including temperature, rainfall, humidity, and host populations such as mice and other animals … (CDC)

Steps to protect against tickborne diseases (CDC)

1. Using Environmental Protection Agency (EPA)-registered insect repellents containing DEET, picaridin, IR3535, Oil of Lemon Eucalyptus (OLE), para-menthane-diol (PMD), or 2-undecanone. Always follow product instructions.
2. Treating clothing and gear with products containing 0.5% permethrin. Permethrin can be used to treat boots, clothing and camping gear and remain protective through several washings.
3. Checking your body and clothing for ticks upon return from potentially tick-infested areas, including your own backyard. Use a hand-held or full-length mirror to view all parts of your body. Place tick-infested clothes in a dryer on high heat for at least 10 minutes to kill ticks on dry clothing after you come indoors.
4. Showering soon after being outdoors. Showering within two hours of coming indoors has been shown to reduce your risk of getting Lyme disease and may be effective in reducing the risk of other tickborne diseases. Showering may help wash off unattached ticks and is a good time to do a tick check.

Londons low-emission zone ineffective in improving child lung health, suggest a new annual cross-sectional study published November 14, 2018 in The Lancet. Within Londons LEZ, a smaller lung volume in children was associated with higher annual air pollutant exposures. There was no evidence of a reduction in the proportion of children with small lungs over this period, despite small improvements in air quality in highly polluted urban areas during the implementation of Londons LEZ, which are areas with a daily charge for vehicles that do not meet emission requirements were introduced in 2008 and have led to small improvements in nitrogen dioxide and nitrogen oxide levels, found in diesel emissions

Evidence suggests viral association for acute flaccid myelitis (AFM), says CDC. On Tuesday, it said 99% of children with confirmed AFM had experienced a viral illness with symptoms such as fever and cough about three to 10 days before the onset of paralysis. The CDC also seems to be getting closer to determining a cause of the disease. According to the new report, "Clinical, laboratory, and epidemiologic evidence to date suggest a viral association." (CNN)

The American Thoracic Society (ATS) has expressed grave concern and disappointment in the FDA’s decision to approve over-the-counter epinephrine (Primatene Mist HFA) for consumer use to treat asthma in a press communication dated Nov. 12, 2018. FDA’s decision contradicts existing and established clinical practice guidelines.  Several expert panels have produced evidence-based recommendations on the treatment of patients with asthma.  None of these guidelines recommend the use of inhaled epinephrine to treat asthma.  The National Asthma Education and Prevention Program (NAEPP), an expert panel convened by the National Institutes of Health recommends against the use of epinephrine for treating asthma exacerbations, stating:

1. Drugs of choice for acute bronchospasm: Inhaled route has faster onset, fewer adverse effects, and is more effective than systemic routes.
2. The less beta2-selective agents such as epinephrine, isoproterenol, metaproterenol and isoetharine ) are not recommended due to their potential for excessive cardiac stimulation, especially in high doses.”

By approving an over-the-counter epinephrine product to treat asthma, the FDA is endorsing a contra-indicated treatment for asthma.  The FDA should know that our patients deserve better.

Violent crime in a city has been linked to increased blood pressure (BP) for its residents, including those who live in relatively low-crime areas in a population-based study of more than 53,000 adults in Chicago, Illinois, between May 2014 and August 2016, presented at the recent American Heart Association (AHA) Scientific Sessions 2018 in Chicago. Overall, the areas with lower crime rates had fewer patients with elevated BP than areas with higher crime rates; 22.5% vs 36.5%, respectively (Medscape).

Video to watch: TEDx Video: Doctor-patient relationship www.youtube(dot)com/ watch?v=i9ml1vKK2DQ

Dr KK Aggarwal

Padma Shri Awardee

President Elect CMAAO

President Heart Care Foundation of India