Morning MEDtalks with Dr KK Aggarwal

New Delhi, September 07, 2018

American College of Gastroenterology H. pylori new treatment consensus clinical guideline

Antibiotic selection: There is increased resistance to clarithromycin, and traditional triple therapy (clarithromycin + amoxicillin + proton pump inhibitors [PPIS]) should not be prescribed unless the rates of clarithromycin resistance are known to be < 15%. We should not use clarithromycin triple therapy.

What should be the first-line therapy then?

• Quadruple therapy: Clarithromycin (500 mg), amoxicillin (1 g), metronidazole (500 mg) and a PPI, all given twice a day, or
• Bismuth subsalicylate (2 tablets four times a day), metronidazole (500 mg three or four times a day), tetracycline (500 mg four times a day), and a PPI (twice a day). Patients on this regimen will need to be informed about bismuth-related stool darkening, or
• Triple therapy with levofloxacin (500 mg once a day), amoxicillin (1 g twice a day), and a PPI (twice a day) is an alternative but not recommended as the best initial option.

Treatment duration: Recommended duration of treatment is 14 days

Salvage therapy for persistent Helicobacter pylori infection

• Avoid antibiotics previously used
• Bismuth-based quadruple therapy or levofloxacin triple therapy are accepted salvage regimens.

Sleep is important for all, but it is even more important for children. Research from Harvard Medical School and other institutions indicates that inadequate sleep can lead to obesity, behavioral and developmental problems and depression in kids and young adults. But due to the increased prevalence of technology such as cell phones, tablets and computers, and an increased emphasis on time-consuming extracurricular activities, students today are staying up later.

Intensive BP control increases risk of serious falls and syncope. The effect of BP lowering with antihypertensive medications and lower BP targets remains a significant concern for adverse events including falls, which are a concern, especially in the elderly patients. In a study published August 23, 2018 in the American Journal of Preventive Medicine, both minimum and mean systolic blood pressure less than 110 mmHg among treated hypertensive patients were associated with greater chances of serious falls and syncope. The chances of falls and syncope were more than twofold higher in those with any minimum systolic BP less than 110 mmHg, whereas they were nearly 50% higher among patients with mean systolic BP less than 110 mmHg. These differences were similar and persisted regardless of age (<65 and ≥65 years). The study recommends frequent monitoring of BP and also consider low BP threshold for medication modification.

CDC guideline for children with mild traumatic brain injury (mTBI) includes five key practice-changing recommendations:

1. Do not routinely image pediatric patients to diagnose mTBI.
2. Use validated, age-appropriate symptom scales to diagnose mTBI.
3. Assess for risk factors for prolonged recovery, including history of mTBI or other brain injury, severe symptom presentation immediately after the injury, and personal characteristics and family history (such as learning difficulties and family and social stressors).
4. Provide patients and their parents/caregivers with instructions on returning to activity customized to their symptoms.
5. Counsel patients and their parents/caregivers to return gradually to non-sports activities after no more than a 2-3 days of rest.

The sensitive words mental health experts say you should stop using in a conversation. Terms such as nutter, lunatic, psycho, schizo, deranged, mad and mental patient should be avoided even when not used maliciously, according to Everymind Director Jaelea Skehan. Using the word schizophrenic to denote duality such as a “schizophrenic economy” to describe rapid fiscal movements was also potentially damaging.

Johnson and Johnson to pay 30 lakh compensation but what about Kellogg’s in US? US Federal health officials are warning consumers to stay away from all Honey Smacks cereal, which is likely behind a multi-state salmonella outbreak that has sickened 130 people. Kellogg’s voluntarily recalled Honey Smacks in June, citing possible salmonella contamination. But the CDC announced on Tuesday that at least 30 people from 19 states have become ill since mid-July, suggesting that contaminated products may still be in people’s homes or on store shelves.

Children conceived through assisted reproductive technologies (ART) may be at an increased risk of developing arterial hypertension early in life, among other cardiovascular complications. ART adolescents were found to have both a higher systolic and diastolic BP vs controls born of natural conception at 119/71 mmHg versus 115/69, respectively. Eight of the ART adolescents reached the criteria for the diagnosis of arterial hypertension of more than 130/80 mmHg (September 3, 2018 in the Journal of the American College of Cardiology).

Three-quarters of patients seeking bariatric surgery prefer the term “person with obesity” to “obese person”. Among a selection of terms used for patients with a body mass index (BMI) ≥30, study participants favored people-first language, rating “person with elevated BMI” highest (5.3 out of 7), followed by “person with obesity” and “person with excess weight” (4.9 and 4.7, respectively), reported Rebecca Pearl, PhD, and colleagues from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia in JAMA Surgery.

More than 10% of children in the US have been diagnosed with attention deficit hyperactivity disorder(ADHD), which is a significant increase during the past 20 years, according to researchers from the University of Iowa who recently conducted a study and published the results in JAMA.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI