Morning MedTalks with Dr KK Aggarwal

Morning Health Talk

New Delhi,May 27, 2018 :

Nipah Breaking News: Tests have ruled out bats being behind the spread of the Nipah virus that took 12 lives in Kerala’s Kozhikode and Malappuram districts. The samples sent to Bhopal included those taken from bats found in the house of disease victim Moosa in the worse-affected Perambara village.

UAE asked its citizens to put off unnecessary travel to Kerala where a Nipah virus outbreak has claimed 12 lives. India has also reportedly procured 50 doses of antibody from Australia, which will help in fighting the virus.

Practice changing up-to-date: For hemodynamically stable patients with ventricular tachycardia in electrical storm (three or more episodes of sustained VT within 24 hours), in addition to amiodarane co-administer propranolol.

In a randomized, double-blind study of patients with ICD and electrical storm in which all patients received IV amiodarone and were randomized to propranolol (40 mg every 6 hours) or metoprolol (50 mg every 6 hours) for the first 48 hours, VT terminated significantly earlier in patients receiving propranolol (3 hours versus 18 hours). Patients receiving propranolol also had lower rates of ICD shocks during the ICU stay and shorter hospitalizations. ( J Am Coll Cardiol 2018; 71:1897.)

AMR

• Watch this video: https://www.youtube.com/watch?time_continue=53&v=ZlOudtkiAyQ
• Antibiotic resistant UTIs are on the rise: In a WHO report  released earlier this year, scientists found rates above 25 to 50 per cent of resistance to antibiotics commonly used to treat UTIs. They’re most often caused by the bacteria E. coli, and if left untreated could cause complications as serious as kidney damage and sepsis.

Quinolones, resistance to this class may be indicative of resistance to one of the last available oral treatment options, particularly in low-resources settings.

Health professionals may prescribe colistin or carbapenem for severe infections. They’re administered via IV and can cause side effects ranging from diarrhea, nausea, vomiting and skin rash to liver injury. However, even these are losing their potency over E. coli. Researchers note that they have found colistin-resistant E. coli in food animals in China.

A report published by the British government in 2016 revealed that humans are to blame for the excess of antibiotics in our bodies through their overuse in agriculture, over-the-counter medications and spill-off from medical waste.

According to the 2017 Canadian Antimicrobial Resistance Surveillance System report, family physicians were responsible for 65 per cent of all antibiotics prescribed to patients in 2016; among the most common was amoxicillin, a drug used to treat genito-urinary system infections.

Same year, one-million kilograms of antimicrobials were distributed for sale for use in animals by the Canadian Animal Health Institute member companies, of which 99 per cent were used for food-producing animals.

How to prevent UTIs

·      Drink plenty of water

·      Drink cranberry juice

·      Wipe from front to back after using the toilet

·      Empty your bladder after sex

·      Avoid potentially irritating feminine products

·      Switch up your birth control

Clinical

• The US FDA has approved the Xience Sierra (Abbott) everolimus-eluting coronary stent, the newest generation of Xience stent. Design innovations include a thinner profile, increased flexibility, increased lengths, and smaller diameters. The stent is not likely to be introduced in India.
• ICMR has sought help from Australia, where an antibody against the virus was found to be effective in tests.
• DMA delegation led by Dr. Ashwani Goyal, Dr. Girish Tyagi, Dr. Harish Gupta, Dr G.S. Grewal, Dr. Kamal Parwal, Dr. B.B. Wadhwa, Dr. Sunil Singhal & others met Hon’ble Ministers Dr. Harshvradhan, Dr. Mahesh Sharma, & Chief Secretary Mr. Anshu Prakash regarding BMW management rules & harassment of doctors. They very keenly considered issues presented by DMA & assured all possible help regarding this issue. Instructions passed on to local authorities for not taking any coercive actions till matter is resolved by environment ministry.
• Your partner’s BMI can predict your risk of developing diabetes. Men are particularly more prone to developing the metabolic disease if their wife is obese (University of Copenhagen and Aarhus University in Denmark) .

Wellness     

• Overweight or obesity is a cause of at least 12 cancers, as follows: liver, ovarian, prostate (advanced), stomach (cardia), oropharyngeal, colorectal, breast (postmenopausal), gallbladder, kidney, esophageal adenocarcinoma, pancreatic, and endometrial.  (American Institute for Cancer Research)

MCI

• The Supreme Court on Friday agreed to suggestions that the vacant post-graduate seats in private unaided medical colleges could be filled up as per the order of merit in the All-India National Eligibility cum Entrance Test (NEET) list. MCI said that almost 41.95% of post-graduate medical seats for the academic year 2018-2019 in private unaided medical colleges in the state were vacant. Additional Solicitor General (ASG) Pinky Anand, who appeared for the Centre, suggested to the bench that “a similar dispensation can be followed in other states, if they so desire, while ensuring that the cut-off date of May 31, 2018 is strictly adhered to”. “We agree with this suggestion,” the bench said and disposed of the plea filed by the Uttar Pradesh Unaided Medical Colleges Welfare Association.

One Health: CPR in Dogs

Dogs less than 14 Kg

1. Lay the dog on a flat surface with his/her right side against the surface.

2. Cup your palms and hold the dog with one palm on either side above the heart region. (On the dog’s side about 2 inches from the front leg).

3. Compress the chest for one inch to one-quarter or one-third the width of the chest for a count of one and then let go for a count of one. You will do compressions at a rate of 100 compressions in a minute.

4. If you are alone, breathe into the dog’s nose once for every five compressions that are done. If two persons are available, give artificial respiration once every two or three compressions are done.

5. Continue with the CPR and rescue breathing until the dog begins breathing on its own and the pulse becomes steady.

Dogs > 14 Kg

1. Lay the dog on a flat surface with his/her right side against the surface. (You will need to stand towards the dog’s back.)

2. Put one of your palms on the dog’s rib cage, near the heart region, and put your other palm on top of it.

3. Without bending both the elbows, press the rib cage in a downward motion.

4. Compress the chest for one-quarter to one-third the width of the chest for a count of one and then let go for a count of one. You will do compressions at a rate of 80 compressions per minute.

5. Close the muzzle with your hand before beginning artificial respiration. If only one person is available, breathe into the dog’s nose once for every five compressions that are done. If two persons are available, give rescue breaths once for every two compressions that are done.

6. Continue performing CPR until the dog begins to breathe and has a steady pulse.

The difference we see between smaller dogs and bigger dogs is that we may need to use two hands to compress a larger dog’s chest. The rate of compressions is also slightly slower for the larger dog.

Any dog that has needed rescue breathing or CPR needs to be seen by a veterinarian as soon as possible. (muskogeephoenix.com)

NIPAH Update

Health Ministry issues advisory on Nipah virus

1. Avoid consuming raw date palm sap or toddy, half-eaten fruits from the ground and refrain from entering into abandoned wells and eat only washed fruits.
2. Handling of bodies of those who died due to the disease should be done in accordance with the government advisory and that during this emotional moment traditional rituals and practices may need to be modified to prevent the exposure of family members to the disease.
3. Nipah virus which commonly affects animals such as bats, pigs, dogs, horses, etc. can spread from animals to humans and can sometimes cause serious illness among humans.
4. Spread of Nipah virus to humans may occur after close contact with other Nipah infected people, infected bats, or infected pigs. Bat secretions laden with virus can infect people during fruit tree climbing, eating/handling contaminated fallen fruits or consuming raw date palm sap/juice or toddy
5. Human-to-human infection can occur from close contact with persons affected with Nipah at home while providing care or close contact and in hospital setting if appropriate personal protective equipments are not used
6. People who are exposed to areas inhabited by fruit bats/ articles contaminated by secretions such as unused wells, fruit orchards, etc. are likely to be at higher risk of infections.
7.  Persons with direct contact with sick pigs or their contaminated tissues, persons in close contact with a Nipah virus affected deceased during burial or cremation rituals or health care workers having direct contact with probable or confrmed cases without using standard precautionary measures are also at a high risk of developing the infection.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI