Morning Medtalks with Dr KK Aggarwal

Morning Health Talk :

New Delhi, May 07, 2018 :

Clinical

• The Centers for Disease Control and Prevention experts say a new report shows diseases transmitted through ticks, mosquitoes and fleas have more than tripled. Deer tick bites cause Lyme disease.
• Adults and children should consume a maximum of 10 percent of their daily calories in the form of saturated fat such as meat and butter and one percent from trans fats to reduce the risk of heart disease, the World Health Organization said on Friday. The recommendations complement other WHO guidelines including limiting intake of free sugars and sodium.
•  Dear Dr. Aggarwal: I came across your webpage because you mentioned “norovirus” in a recent post. Two years ago, I noticed that regional diets high in high-molybdenum foods were correlated with lower “morning sickness” severity. Soon after, my sister was infected with a stomach virus and decided to take a molybdenum supplement–in the form of molybdenum glycinate–to see if it could help with the nausea. She and I were both surprised when it averted the expected vomiting completely. Since then, over 80 people, including toddlers, have experienced similar, often very dramatic relief from norovirus-type gastroenteritis symptoms. Thus I believe it to be a real treatment and not just a placebo.
• In places like India where molybdenum intake is relatively high–lentils have about the highest molybdenum content of all foods–I think that the molybdenum is partially relieving viral gastroenteritis symptoms and allowing carriers to more effectively pass on viruses. Your reminder to practice good handwashing hygiene is quite essential. Catherine Taylor, BS, JD, Colorado Springs, CO, USA
• The U.S. Food and Drug Administration approved Tafinlar and Mekinist, administered together, for the treatment of anaplastic thyroid cancer that cannot be removed by surgery or has spread to other parts of the body (metastatic), and has a type of abnormal gene, BRAF V600E (BRAF V600E mutation-positive).
• Melatonin, a hormone produced by the pineal gland that regulates sleep and wakefulness, appears to be efficacious for acute procedural anxiety when administered sublingually. Exogenous melatonin has been used for treatment of jetlag and circadian rhythm sleep disorders.
• Video observation of a laparoscopic procedure allows the patient to view live video images of the procedure on a monitor, providing the same view that the physician has through the laparoscope. Video observation for the purpose of anxiety reduction has not been tested in patients with acute procedural anxiety. A trial was conducted of video observation for 81 women undergoing colposcopy. The trial found that, compared with a control condition, video observation reduced anxiety and pain among women undergoing a diagnostic colposcopy but not among women undergoing colposcopy that included laser treatment. (Patient Educ Couns. 2004;55(2):247)
• US FDA dealt a setback to the developers of the experimental medicine stannsoporfin for newborns who cannot quickly clear bilirubin and thus risk developing jaundice, by a 21-3 vote recommending rejection of manufacturer Mallinckrodt’s application for approval of the drug.

Fatty Liver

Give vitamin E at a dose of 400 international units/day for patients with advanced fibrosis on biopsy who do not have diabetes or coronary artery disease

American Association for the Study of Liver Diseases recommends a higher dose of vitamin E (800 mg daily) as first-line pharmacotherapy for nondiabetic patients with biopsy-proven NASH (not just advanced fibrosis).

The largest randomized trial included in the meta-analysis (Pioglitazone versus Vitamin E versus Placebo for the Treatment of Nondiabetic Patients with NASH; PIVENS) did suggest a benefit with vitamin E.

AMR

WHO-recommended ‘five moments for hand hygiene’

1. Wash their hands using an alcohol-based product for 20-30 seconds, or soap and water for 40-60 seconds, before touching a patient, before clean/aseptic procedures, after bodily fluid exposure, after touching a patient, and after touching patient surroundings.
2. Facility-based infection prevention and control leaders should seize every opportunity to champion the importance of good hand hygiene.
3. Make hand hygiene a key quality monitoring indicator.
4. Patient advocacy groups should continue to insist on the value of hand hygiene as a good in itself, as well as a way to drive down the occurrence of sepsis.
5. Mnistries of health from across the Region should implement the 2017 World Health Assembly resolution on sepsis, which makes improving the prevention, diagnosis and management of sepsis a critical imperative.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI