Sunday 31 July 2016

Monsoon fever can be deceptive

Monsoon fever can be deceptive

New Delhi, July 31, 2016Fever during the monsoon season in India can be deceptive as malaria, viruses causing dengue, chikungunya and jaundice, and bacteria causing typhoid can all produce fever in this season, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA.

Following are the Dos and Don’ts to follow if you have fever in the monsoon season:
  1. No antibiotic should be started unless a diagnosis of typhoid is confirmed.
  2. Cough, eye redness and nasal discharge can also be present in viral disorders.
  3.  In dengue, one may have pain with the eye movement.
  4.  In chikungunya, patients may have fever, rashes and joint pains. The joint pains will typically increase on compression of the wrist joint.
  5. Malaria fever may present with chills and rigors, with no toxemia in between the fever episodes.
  6. In jaundice, fever normally disappears by the time jaundice appears clinically.
  7. In typhoid, patient looks toxic and the pulse rate may be relatively low compared to the fever.
  8. Fever medicines like aspirin should not be given in monsoon season as many fevers may have low platelet counts.
  9. Most viral disorders are self–limiting and resolve within a week.
  10.  In most monsoon related viral disorders, treatment is adequate hydration.
  11. Fever in the setting of chronic medical disease should not be ignored and shown to the doctors at the earliest.

Monsoon season is the time to give our child a de–worming tablet

Monsoon season is the time to give our child a de–worming tablet New Delhi, July 30, 2016: During the monsoons, most of the worms in the soil come up to the surface and infect the vegetables. The associated humidity also leads to more breeding of house flies and mosquitoes.
It is thus important to ensure that all fruits and vegetables, are washed thoroughly with clean water and if needed Potassium Permanganate is added to them during the monsoon season to prevent illnesses, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA.
Round worms are normally present in the soil and good sanitation is required to prevent their fecal contamination, which is often impossible in the monsoon season. Washing hands before meals and drinking boiled water can reduce the risk of round worm infection; but, in the India scenario, the same may not be possible.
The easiest way is to give your child a de–worming tablet 3–4 times in a year.
Treatment of school-going children with single dose of de–worming tablet every 3–4 months has been advocated in many countries. In a study conducted in Zanzibar, a single dose of mebandazole tablet given three times a year reduced round worm infection by 97%.

AAP updates guidelines for fetal alcohol spectrum disorders

AAP updates guidelines for fetal alcohol spectrum disorders The American Academy of Pediatrics (AAP) has updated guidelines to diagnose fetal alcohol spectrum disorders, published online July 27, 2016 in the journal Pediatrics. The new guidelines recommend evaluation of maternal alcohol consumption and that she should be interviewed carefully. Begin with more general questions about the child's health and then narrowing the focus to alcohol during and before pregnancy. The definition of alcohol exposure may include at least 6 drinks per week during at least 2 weeks of pregnancy, or at least 3 drinks per occasion on 2 or more occasions. Facial features should be evaluated. A positive result includes 2 of the following 3 criteria: short palpebral fissures, smooth philtrum, and thin vermilion border of the upper lip. If either facial features or maternal alcohol intake are positive, a neuropsychology evaluation is recommended. The guidelines also include a time line of the emergence of different developmental deficits, giving information on what to look for in infants, toddlers, and school-age children (Source: Medscape)

Saturday 30 July 2016

All diabetics must get regular eye checkup’s done

All diabetics must get regular eye checkup’s done New Delhi, July 29, 2016: The vast majority of diabetic patients who develop diabetic retinopathy (eye involvement) have no symptoms until the very late stages (by which time it may be too late for effective treatment). Because the rate of progression may be rapid, therapy can be beneficial for both symptom amelioration as well as reduction in the rate of disease progression, it is important to screen patients with diabetes regularly for the development of retinal disease. The eyes carry important early clues to heart disease, signaling damage to tiny blood vessels long before symptoms start to show elsewhere, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Diabetic people with retinopathy are more likely to die of heart disease over the next 12 years than those without it. As per a study from the University of Sydney and the University of Melbourne in Australia and the National University of Singapore, people with retinopathy are nearly twice as likely to die of heart disease as people without it. People with these changes in the eyes may be getting a first warning that damage is occurring in their arteries, and work to lower cholesterol and blood pressure. Patients with retinopathy have a greater risk of incident cardiovascular disease (CVD) events, including heart attack, stroke, revascularization, and CVD death, compared with those without retinopathy.

ASCO issues first Clinical Practice Guidelines for chronic pain in adult cancer survivor

ASCO issues first Clinical Practice Guidelines for chronic pain in adult cancer survivor

Dr K K Aggarwal The American Society of Clinical Oncology (ASCO) has release the first guidelines on management of chronic pain in adult cancer survivors. Published online July 25, 2016 in the Journal of Clinical Oncology, these recommendations were developed by an expert panel with multidisciplinary representation, who used a systematic review of RCTs (1996 to 2015), observational studies and clinical experience to formulate the guidelines. Some key recommendations in the new guidelines include the following: • Patients should be screened for pain at each encounter. • Clinicians should conduct an initial comprehensive pain assessment to explore the multidimensional nature of pain - pain descriptors, associated distress, functional impact, and related physical, psychological, social, and spiritual factors). • Clinicians should be aware of chronic pain syndromes resulting from cancer treatments, the prevalence of these syndromes, risk factors for individual patients, and appropriate treatment options. • Evaluate and monitor for recurrent disease, second malignancy, or late-onset treatment effects in patients with new-onset pain. • Patient and family/caregivers should be involved in all aspects of pain assessment and management. • Non opioid analgesics like NSAIDs, acetaminophen and adjuvant analgesics including selected antidepressants and selected anticonvulsants may be prescribed to relieve chronic pain if there are no contraindications and after assessment of the risks of adverse effects of pharmacologic therapies. Topical analgesics may also be prescribed. • A trial of opioids may be prescribed in carefully selected cancer survivors with chronic pain who do not respond to more conservative management and who continue to experience pain-related distress or functional impairment. Assess risks of adverse effects of opioids used for pain management. Taper the dose, if they are no longer needed to avoid abstinence syndrome. • Clinicians should clearly understand terminology such as tolerance, dependence, abuse, and addiction as it relates to the use of opioids for pain control and should incorporate universal precautions to minimize abuse, addiction, and adverse consequences. • Clinicians should understand pertinent laws and regulations regarding the prescribing of controlled substances. • Non pharmacologic therapies such as physical therapy, occupational therapy, cognitive-behavioral therapy, distraction, mindfulness, acupuncture, transcutaneous electrical nerve stimulation may be recommended.

Friday 29 July 2016

Hepatitis C may spell trouble for the heart

Hepatitis C may spell trouble for the heart This World Hepatitis Day, awareness needs to be created on the causes and effects of Hepatitis as also strategies for prevention and getting the right vaccination for this disease. New Delhi, July 28, 2016: Currently, around the world, about 400 million people are living with viral hepatitis, a liver disease responsible for the death of more people than that caused by HIV, malaria, and tuberculosis. Every year, about 1.4 million die of hepatitis, a figure that is shocking because hepatitis can be prevented! In the World Health Assembly 2014, 194 governments adopted a resolution to promote global action to prevent, diagnose, and treat viral hepatitis. A global strategy has been created by the World Health Organization to eliminate hepatitis B and C. This will be put forward for adoption during the World Health Assembly in 2016. While it is true that people infected with Hepatitis C are at a risk for liver damage, the infection may also spell trouble for the heart, according to a study. The study provides strong evidence suggesting that Hepatitis C can lead to cardiovascular damage. "People chronically infected with Hepatitis C are more likely to harbor abnormal fat-and-calcium plaques inside their arteries. This is known as atherosclerosis, a precursor to heart attacks and strokes. While it is not known exactly how the infection leads to the growth of artery-clogging plaque, the evidence is strong enough to look out for cardiac symptoms in people with Hepatitis C. It is important to look for signs of liver disease in people with Hepatitis C, but at the same time, physicians should also check the cardiac risk profile regularly. Annual cardiac examinations, including cholesterol and glucose testing, blood pressure checks, and assessment of lifestyle habits would also be helpful," said Padma Shri Awardee Dr. KK Aggarwal – President Heart Care Foundation of India and Honorary Secretary General IMA. The Hepatitis C virus is a bloodborne virus leading to an infection with severity range lasting few weeks and sometimes becoming a lifelong condition. The infection can occur through unsafe needle injection practices, inadequate sterilization of medical equipment, and the transfusion of unscreened blood and blood products. Infected people develop liver cirrhosis or liver cancer. Though it is possible to cure 90% of the infections through antiviral medicines, there is no vaccine for Hepatitis C. "Those with higher levels of circulating Hepatitis C virus in their blood have 50% more chance of having clogged arteries. If the infection is poorly controlled, it can lead to inflammation throughout the body thus fuelling blood vessel damage and resulting in heart problems. Hepatitis C is a manageable condition without any severe impact on health provided the diagnosis and treatment are done at the right time. It is essential that a person at risk discusses their case openly with a doctor and finds out the best ways to mitigate the effects of the infection on the liver and the cardiovascular system,” Dr Aggarwal added. It is important to maintain a healthy blood pressure and blood fat ratio to prevent heart disease. However, there is more work to be done if a person has Hepatitis C. Efforts should be made to minimize Hepatitis C viral load. Some steps to be taken include: • Abstaining from alcohol (as it causes the virus to flare-up) • Combating the illness with antiviral combination therapy (approximately half of those infected can conquer the virus) • Keeping cells healthy with antioxidants It is imperative to find ways to control the infection rather than letting Hepatitis C dictate the future of your heart. Follow suggestions from your physician to reduce the risk of coronary artery disease. Additionally, inhibiting the Hepatitis C virus will be beneficial for both the liver and heart

Even one hour of daily activity reduces health risks from prolonged sitting

Even one hour of daily activity reduces health risks from prolonged sitting A meta-analysis of 16 trials involving more than 1 million men and women has yet again found in favor of physical activity as against a sedentary lifestyle, as reported in a study published online 27th July 2016 in The Lancet. This is the first meta-analysis to use a harmonized approach to directly compare mortality between people with different levels of sitting time and physical activity. According to the study, prolonged sitting enhances all-cause mortality, with most deaths being due to cardiovascular disease and cancer (breast, colon, and colorectal). And, high levels of moderate intensity physical activity, about 60–75 min per day, may eliminate mortality risk associated with prolonged sitting time, but not the high risk associated with high TV-viewing time. • Daily sitting time was not associated with increased all-cause mortality in those in the most active quartile of physical activity. • Compared with the referent (<4 h of sitting per day and highest quartile of physical activity [>35•5 MET-h per week]), there was no increased risk of mortality during follow-up in those who sat for >8 h/day but who also reported >35•5 MET-h per week of activity. • Those who sat the least (<4 h/day) and were in the lowest activity quartile (<2•5 MET-h per week) had a significantly higher risk of dying during follow-up. These are results that may have significant implication for hundreds of office workers, who have sedentary jobs and have to sit for long hours at their work place … that it is important to be physically active, even if it is for only an hour in a day. Brisk walking is the simplest and most inexpensive form of exercise.

Thursday 28 July 2016

The benefits of oranges and lemons for those with high BP

The benefits of oranges and lemons for those with high BP
New Delhi, July 27, 2016: Increasing levels of potassium in the diet may lower a person's risk of developing high blood pressure and may decrease blood pressure in people who already have high blood pressure said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. A healthy intake of potassium is one reason why vegetarians and isolated populations have a very low incidence of heart disease. In isolated societies consuming diets low in sodium and high in fruits and vegetables, and which therefore have high levels of potassium, hypertension affects only 1 percent of the population. In contrast, in industrialized societies, where people consume diets high in processed foods and large amounts of dietary sodium, 1 in 3 persons have hypertension. The typical urban Indian diet contains about double the sodium and half the potassium that is currently recommended in dietary guidelines. The American Heart Association recommends intake of 4.7 grams per day of potassium. An increase in potassium with a decrease in sodium is probably the most important dietary choice (after weight loss) that should be implemented to reduce cardiovascular disease. Diets containing at least 500 to 1,000 milligrams magnesium daily and more than 800 milligrams of calcium daily may help lower blood pressure and the risk of developing high blood pressure, reports a study in Journal of Clinical Hypertension.

Hepatitis B is a more dangerous infection than HIV

HIV and Viral hepatitis
Hepatitis B is a more dangerous infection than HIV

Dr K K Aggarwal
  • Viral hepatitis and HIV coinfection is a common problem and challenge to the treating clinician.
  • People with HIV who are coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV) are at increased risk for serious, life-threatening health complications.
  • All people living with HIV should be tested for Hepatitis B and C infections.
  • HIV and viral hepatitis coinfection can complicate the management of HIV infection.
  • Progression of liver disease is faster in individuals with HIV and viral hepatitis coinfection; also, they may not respond as well to treatment.
  • Hepatitis B is preventable; hepatitis B vaccination is recommended for high-risk people or those living with HIV who have tested negative for HBV.
  • Give Hepatitis B vaccine to all unvaccinated persons after exposure to blood. If the exposed blood is positive for HBV and the exposed person is unvaccinated, treatment with hepatitis B immune globulin is recommended.
  • HIV, HBV and HCV have similar routes of transmission. They spread by contact with infected body fluids such as blood, semen and vaginal fluid, or from a mother to her baby during pregnancy or delivery. Because of these shared routes of transmission, people at risk for HIV infection are also at risk for HBV or HCV infection. Of these, hepatitis B is more infectious.
  • Hepatitis B virus gets transmitted by percutaneous and mucosal exposures and human bites.
  • Hepatitis B can also be transmitted by fomites such as finger stick blood sugar check, multi dose medication vials, jet gun injectors, and endoscopes.  Hepatitis B virus can survive on counter tops for up to 7 days and remain capable of causing infection.
  • Any scratch, cut and wound should be cleaned with soap and water and covered with a waterproof dressing or plaster. Expressing fluid by squeezing the wound will not reduce the risk of blood borne infection.
  • Blood spills from someone with hepatitis B should be cleaned up with appropriate infection control procedures e.g. wearing gloves, and using an appropriate cleaning product for the surface, such as diluted bleach or detergent and warm water.
  • Transmission of hepatitis C virus can occur from infected fluid splashes to the conjunctiva. Hepatitis C virus can survive on environmental surfaces for up to 16 hours.

Wednesday 27 July 2016

Obsessively yours: Signs That You May Have OCD New Delhi, July 26, 2016: Obsessive–compulsive disorder (OCD) is a disabling and potentially chronic anxiety disorder and is characterized by anxiety–provoking intrusive thoughts and repetitive behaviors, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Obsessions may consist of aggressive thoughts and impulses, fears of contamination by germs or dirt, or fears of harm befalling someone. Compulsions such as washing, checking, or counting are rituals whose purpose is to neutralize or reverse the fears. OCD occurs in 2 to 3 percent of the population. People with OCD have uncontrolled thoughts that compel them to develop habits or rituals to ease their anxiousness. The Anxiety Disorders Association of America offers this list of potential warning signs of OCD: • Persistent irrational fears or concerns, commonly about being dirty or getting sick. • Obsessing about things being in order or arranged a certain way. • Being afraid that your thoughts or actions will cause harm to you or someone else. • Hoarding objects with no value. • Irrational doubts or fears that you will harm someone else. • Impulsively and repeatedly cleaning your body or your home. • Repeatedly checking something, such as if the doors are locked, appliances are unplugged or the stove is turned off. • Habits such as repeatedly saying a word or a name, or walking in the same place or in the same way. • Constantly re–living conversations, repeating words or counting.

Today is World Head & Neck Cancer Day

Today is World Head & Neck Cancer Day Dear Colleague We are all aware that Head-Neck Cancer is among the most common cancers in the Indian subcontinent. Head and Neck Squamous Cell Carcinoma (HNSCC) with a global incidence of over 500,000 cases and 200,000 deaths annually is the leading cause of mortality and disability in many parts of the world. In India also it accounts for nearly 1.5 lakh cases every year. It mainly affects people in the productive age group, yet most of this mortality and morbidity is preventable. The burden of HNSCC is putting a strain on our national health care systems and impoverishing individuals, families and society. The International Federation of Head & Neck Oncologic Societies (IFHNOS) has declared to observe 27th July as "World Head & Neck Cancer Day (WHNCD)" to draw the world’s attention on effective care and control of HNSCC, for all to work together and also to reduce use of Tobacco- the most prevalent but preventable cause of Head & Neck Cancer. The move is supported by many Head Neck Societies around the globe, numerous Governments, UICC and civil society organizations. IFHNOS is a global organization established through cooperation of national and regional Societies and Organizations in the Specialty of Head and Neck Surgery and Oncology with membership from national and regional multidisciplinary organizations, representing 65 countries. The purpose of the Federation is to provide a common platform for Specialists in the field of Head and Neck Cancer to interact in professional matters of mutual interest. IFHNOS declared 27th July as World Head & Neck Cancer Day on the occasion of its 5th World Congress in New York on 27th July 2014, the largest gathering of Head and Neck Cancer specialists in history. Oral Cancers are often associated with smoking and alcohol use, however, oropharyngeal cancers (cancer of back or base of tongue and tonsils are associated with human papilloma virus and marijuana use as well as smoking and alcohol use. WHNCD targets two areas: • Advocacy for strengthening health care system and introduce community-based approaches for awareness, risks, prevention and early detection of HNSCC. • Enhance expertise of physicians by upgrading their knowledge and skills through CME programs. WHNCD activities can be :- o Educating the physicians on early diagnosis, current treatment paradigms and frontiers in research in Head and Neck Cancer o Awareness programs for the general public. o Free screening for Head and Neck cancers. o Interaction with cancer survivors and their families. o Interaction with government and policy makers. Involvement of newspaper and electronic media, other NGOs and Government representatives in the programs will give wide publicity and spread awareness too. IMA supports this International movement to increase awareness, promote education & training in early diagnosis and treatment of this imminently preventable cancer. (Contributions from Dr Dilip Kumar Acharya, Chairman-IMA National Cancer & Tobacco Control Committee)

The safe limit of alcohol varies from one country to another

The safe limit of alcohol varies from one country to another New Delhi, July 25th, 2016: One to two drinks a day for women, and two to four drinks a day in men, are inversely related to mortality. This was stated by Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. The definition of a "standard drink" varies in different countries. A standard drink in the US is approximately 12 to 14 g alcohol. In Great Britain, a standard drink is 8 g alcohol. In Japan, it is 19.75 g and in India is 10 grams of alcohol. The blood serum tests: AST (SGOT), ALT (SGPT), and gamma-glutamyl transferase (GGT) are often abnormal in alcoholic liver disease. The most common pattern of abnormalities is a disproportionate elevation of serum AST (SGOT) compared to ALT (SGPT). This ratio is usually greater than 2.0, a value that is rarely seen in other forms of liver disease. The absolute values of serum AST and ALT are almost always less than 500 IU/L (and typically less than 300 IU/L). Higher levels should raise the suspicion of concurrent liver injury due to viral or ischemic hepatitis or acetaminophen use, even at therapeutic doses. Alcoholic liver damage can range from asymptomatic fatty liver to alcoholic hepatitis to end–stage liver failure with jaundice, coagulopathy, and encephalopathy. Many alcoholics first become symptomatic only when severe, life–threatening liver disease is already present. Even at this stage, abstinence can result in a significant reversal in some patients. Alcohol can lead to a variety of histopathologic changes in the liver ranging from steatosis to cirrhosis. Steatosis, alcoholic hepatitis, and possibly cirrhosis are reversible. A high prevalence (25 to 65 percent) of hepatitis C virus infection has been recognised in alcoholics, which can greatly accelerate fibrosis and associated morbidity. These patients tend to have more severe disease, decreased survival, and an increased risk of hepatocellular carcinoma. Fatty liver, or alcoholic steatosis, can occur within hours after a large alcohol binge.

Tuesday 26 July 2016

Bacterial infections linked to occurrence of manic episodes

Bacterial infections linked to occurrence of manic episodes

Dr KK Aggarwal
Individuals who are hospitalized with acute mania have a considerably higher rate of bacterial infections, as evident by the recent prescription of antimicrobial agents, says a new study published 17th July, 2016 in the journal Bipolar Disorders. Researchers analyzed recent prescription of systemic antimicrobial medications and the site of presumed bacterial infection in 234 individuals hospitalized for acute mania in either as inpatient or a day hospital. Patients hospitalized for other psychiatric disorders (n=368) vs controls (n=555) were also evaluated. • Patients hospitalized with acute mania had a substantially increased rate of recent antimicrobial prescription, defined as exposure within 3 days of ascertainment. • Overall, 7.7% individuals hospitalized for acute mania were prescribed antibiotics vs 1.3% controls. • Antibiotic prescription was associated with being on an inpatient unit vs being in the day hospital, and having increased mania symptom severity but not with other clinical ratings, demographic variables, or psychiatric medications. • The recent antibiotic prescription did not have any association with hospitalization for other psychiatric disorders. The urinary tract was the most common site of infection in women, while the respiratory tract and mucosal surfaces were the most common sites in men. Though the results did not show any cause and effect association, the authors suggest that the prevention and effective treatment of bacterial infections may be important interventions for the management of individuals with mania.

Monday 25 July 2016

Sexual activity in patients with cardiovascular disease

Sexual activity in patients with cardiovascular disease New Delhi, July 23, 2016: “Heart patients and paralysis survivors can resume usual sexual activity as soon as they feel that they are ready and comfortable with the idea”, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. After recovery from a heart attack or stroke, patients may feel depressed, which is normal, and in 85% of cases it goes away within three months. If a person can walk one kilometre or climb two flights of stairs without any discomfort in the chest or breathlessness, he or she can resume normal sexual activity without any cardiac risk. The first-onset of erectile dysfunction after the age of 40 may be an indication of underlying coronary blockages. Penile blockages go hand in hand with blockages in the channels supplying blood to the heart. Viagra-like drugs are a boon for heart patients as they can improve blood circulation to the male penile organ helping men perform better in bed. However, patients on nitrates must not consume any such drug as a combination of Nitrate and Viagra like drugs can drastically lower one’s blood pressure and prove to be fatal. Heart patients who are unstable, have not had a relationship with their partner for years or are not mentally ready should not indulge in sexual activity with their parnet while using Viagra-like drugs without medical supervision. Any unaccustomed exercise, in patients with underlying coronary blockages that may be silent, can precipitate a heart attack and sudden cardiac death.

CDC & AAP update recommendations for infants with Zika virus infection

CDC & AAP update recommendations for infants with Zika virus infection

Dr K K Aggarwal

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) and have updated recommendations for the clinical evaluation and management of infants suspected of having Zika infection and those who have congenital Zika virus infection. These recommendations followed an expert level meet on July 21 to discuss revisions to the last CDC recommendations, released in February 2016.

The three main areas touched were evaluation of infants with suspected or confirmed congenital Zika virus infection, outpatient care and follow-up for symptomatic infants with congenital Zika virus infection, and outpatient care and follow-up for infants without apparent abnormalities at birth.

Infants suspected to have congenital Zika infection

·         Infection is considered to be possible or confirmed if infant PCR or IgM testing results are positive (final recommendations on this awaited).
·         A comprehensive physical examination should include careful head circumference measurement and assessment of length, weight, and gestational age; and evaluation for neurologic abnormalities, dysmorphic features, liver or spleen enlargement and the presence of rash or other skin lesions.
·         A hearing screen per universal screening and a cranial ultrasound should be done before discharge.
·         The infant should be examined within a month of birth by a pediatric ophthalmologist.
·         A complete blood count to check for thrombocytopenia should be done.

Symptomatic infants with congenital Zika infection

·         Standard precautions should be followed when handling body fluids.
·         Lab work should include CBC and a complete metabolic panel including liver function tests (LFTs).
·         Careful assessment of head circumference, length, and weight at birth, monthly until age 6 months, and then as required. Head circumference in infants with severe microcephaly should be measured from the glabella to the point of the occipital bone. But, one must remember that the head size may be normal in infants with congenital Zika infection.
·         Ophthalmology and hearing screen before discharge; repeat hearing screen at 4 to 6 months of age if normal at birth. If normal ophthalmology screening at birth, it should be repeated at age 3 months, including retinal exam.
·         Head USG before discharge; CT and MRI as needed.
·         Follow up every month; these infants should receive regularly scheduled immunizations. Pertussis-containing immunizations are not contraindicated in children with central nervous system malformations, but uncontrolled seizures may be a precaution for vaccines containing pertussis.
·         Developmental screening at each visit; complete neurological exam to be done at 1 and 2 months and as necessary thereafter.
·         Screen for central hypopituitarism/hypothalamic dysfunction
·         These infants should be under the care of multidisciplinary team.

 (Source: Medscape)

Frequent travel can double one’s risk of blood clots

Frequent travel can double one’s risk of blood clots New Delhi, July 24, 2016: Long distance travelers periodically should move around and stretch their legs, and drink plenty of water to stay hydrated, saidPadma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Long–distance travel can lead to potentially fatal blood clots in some people –– showing that the risk grows with the length of the trip. Certain people are at increased risk of blood clots, including cancer patients, people who have recently had major surgery such as a joint replacement, and women on birth control pills. In general, travel is associated with a nearly three-fold increase in the risk of venous thromboembolism (blood clots that form in the veins), often in the legs. If such a clot dislodges and travels to the lungs, it can cause a potentially fatal condition called pulmonary embolism. A combination of factors including dehydration and hours of sitting in cramped conditions explains why some people develop blood clots. A review, published in the Annals of Internal Medicine, analyzed 14 studies involving more than 4,000 cases of venous thromboembolism and found that travelers had a nearly three–fold higher risk of blood clots than non–travelers. The risk climbed along with the duration of the trip –– rising 18 percent for every two hours of any type of travel, and by 26 percent for every two hours of air travel. But there is no reason for panic, because the absolute risk to any one traveler is still low. People who travel long distances should be aware of the risk of blood clots and learn to recognize the symptoms. Symptoms of a blood clot in the leg include pain, warmth, swelling and redness in the limb. If the clot travels to the lungs, it may cause sudden shortness of breath, chest pain or a cough that produces blood.

Strong evidence that alcohol causes cancer at seven sites in the body

Strong evidence that alcohol causes cancer at seven sites in the body

Dr K K Aggarwal There is strong epidemiological evidence that alcohol causes cancer at seven sites in the body and probably others, says a new study in the latest issue of the journal Addiction reported 21st July, 2016. These sites include oropharynx, larynx, esophagus, liver, colon, rectum and female breast. A "dose-response relationship" between alcohol and cancer was observed for all these cancers, where the increase in cancer risk with increased average consumption is monotonic, either linear or exponential, without evidence of threshold of effect. The beverage type did not appear to influence any variation. The strength of the association with alcohol varies by site of the cancer, being particularly strong for mouth, pharynx and esophagus (relative risk in the range of 4–7 for ≥ 50 g of alcohol per day compared with no drinking) and less so for colorectal cancer, liver and breast cancer (relative risk approximately 1.5 for ≥ 50 g/day). Alcohol-attributable cancers at these sites were estimated to make up 5.8% of all cancer deaths globally. These conclusions are based on comprehensive reviews undertaken in the last decade by the World Cancer Research Fund and American Institute for Cancer Research, the International Agency for Research on Cancer, the Global Burden of Disease Alcohol Group including a comprehensive dose–response meta-analysis published last year in the British Journal of cancer. In the study, Jennie Connor, Dept. of Preventive and Social Medicine, University of Otago, New Zealand from New Zealand attempted to clarify the strength of the evidence for alcohol as a cause of cancer, and the meaning of cause in this context. Even without complete knowledge of biological mechanisms, the authors observed, the epidemiological evidence can support the judgment that alcohol causes cancer of these seven sites.

Saturday 23 July 2016

Living alone after heart attack can be risky

Living alone after heart attack can be risky New Delhi, July 22, 2016: "Living alone after a heart attack increases the chances of death in the next four years," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Citing a recent study published in the American Journal of Cardiology, he further added that the chances of death one year after a heart attack was roughly the same for individuals living alone compared to those living with someone else. However, patients who lived alone had 35% greater risk of death at four years after the heart attack. Social support greatly influences the outcome of an illness. It not only enhances physical health but also mental health. Family support, including that of their friends, helps these patients to recover and lead a good quality life. Lack of social support in people who live alone hampers their recovery. They do not have the assistance they need to take their medicines, the motivation to follow the prescribed exercise regime, and keep up with follow-up visits to their doctor.

Revisiting Dengue

Revisiting Dengue

Dr K K Aggarwal

  • Dengue is a mosquito-borne viral infection transmitted by female Aedes aegypti mosquito.
  • Dengue is a notifiable disease. All healthcare providers are required to notify every dengue case to local authorities i.e. District Health Officer/CMO of the district concerned and Municipal Health Officer of the Municipal Corporation/Municipality concerned every week (daily during transmission period) in prescribed format.
  • There are four different serotypes of dengue virus: Den 1, Den 2, Den 3 and Den 4. A person can have dengue 4 times during his lifetime.
  • Infection from one serotype produces lifelong immunity only for that particular serotype.
  • The second dengue infection is usually more severe than the first one.
  • The four dengue-related illnesses are: Undifferentiated fever, dengue fever, dengue hemorrhagic fever, dengue shock syndrome.
  • The main symptoms of dengue are high fever, severe headache, backache, joint pains, nausea and vomiting, eye pain and rash.
  • Retro-orbital pain presenting as pain in the eyes or pressure on eye movement is characteristic of dengue-related fever.
  • Dengue hemorrhagic fever is the more severe form of dengue fever.
  • A patient can be declared as probable case of dengue only on the basis of RDT technique of testing by using NS1 or IgM (not IgG).
  • IgM blood test may take 5 days to become positive.
  • The critical period is during defervescence - transition from the febrile to the afebrile stage - and usually occurs after the 3rd day of illness. Often people insist on a discharge from the hospital when the fever is over or do not want to get admitted once the fever is over.
  • The two dangerous clinical signs are falling systolic (upper) blood pressure and fall in pulse pressure.
  • Platelet transfusion is not required unless platelet count is less than 10,000 or there is presence of spontaneous bleeding.
  • A platelet count of less than one lakh signifies dengue hemorrhagic fever or dengue shock syndrome.
  • Remember the Formula of 20 to identify high risk patients:
o    Rise in pulse by 20
o    Fall in upper blood pressure by more than 20
o    Rise in hematocrit by more than 20 percent
o    Rapid fall in platelets to less than 20,000
o    More than 20 hemorrhagic spots on the arm in one inch after tourniquet test
o    Difference between upper and lower blood pressure is less than 20

Start fluid replacement at 20 ml/kg/hour immediately in such patients, and shift to nearest medical center for observation. 
·         The best way to reduce chances of getting the infection is to eliminate the places where the mosquito breeds. Plastic containers, buckets, drums etc. that hold water in and around the home should be kept covered or discarded properly. Outdoors, water containers like pet and animal water containers, flower planter dishes should be emptied and scrub cleaned at least once a week.

Friday 22 July 2016

IMA & HCFI stand for AIDS control and hold a webcast on the latest innovations in the prevention, treatment and care regime

IMA & HCFI stand for AIDS control and hold a webcast on the latest innovations in the prevention, treatment and care regime New Delhi, 21st July, 2016: As per India HIV estimation 2015 report, there are nearly 21 lakhs HIV positive people in our country out of which a huge population is not even aware of their condition. These appalling figures substantiate the fact that India has the third largest number of people living with HIV in the world. In India, the prevalence of HIV positive among pregnant ladies is 0.11%, 2% among commercial female sex workers (FSW), 4% among male sex workers (MSW) and 11% among Intravenous drug users. The need for raising awareness about the available diagnostic procedures and the treatments for AIDS is a matter of prime importance in our country. Stressing on the urgent need to eliminate the social stigma around the disease, the IMA and Heart Care Foundation of India organised a webcast today. The expert faculty for the same consisted of Dr P S Nayyer, Consultant Physician, BSAH, Former Addl, Project Director, Delhi State AIDS Control Society, Dr. VK Monga, Dean, IMA CGPand Padma Shri Awardee Dr KK Aggarwal – President HCFI & Honorary Secretary General IMA. Speaking about the same, Padma Shri Awardee Dr KK Aggarwal – President HCFI & Honorary Secretary General IMA said, "Not many people are aware that the diagnosis and treatment of HIV positive patients are free in India. One can just walk into any Govt. centre and get herself/himself checked. Now when someone is diagnosed with Tuberculosis, it has become advisable to get him/her tested for HIV too. It is true vice versa. Earlier the better is what is being practiced in the HIV treatment module now. Earlier people used to wait for the symptoms to appear but now action is taken fast so as to bring more and more number of HIV patients under treatment. Healthcare workers if struck by any needle injury and all rape victims should undergo Post-exposure prophylaxis (PEP). Those who indulge in high risk sexual activity and do not want to take protection should undergo PEP on a continuous basis.” Adding to this, Dr P S Nayyer, Consultant Physician, BSAH, Former Addl, Project Director, Delhi State AIDA Control Society said, ”The diagnosis of AIDS cannot be based on a single test. If one test is positive, repeat tests need to be done. Safe sexual practices and safe blood transfusion are the key. For Intravenous drug users, safe needle exchange programmes are there which entail single use and safe needle practice. There has been lot of advancements in the Antenatal and perinatal strategies to prevent mother-to-child transmission of HIV infection. It should be known that mother-to-child HIV transmission is 100% controllable, preventable and curable. HIV should not be considered a stigma. It is a chronic manageable disease like Hepatitis B and C. In terms of transmission, Hepatitis B virus is more transmissible than HIV. Hepatitis C now is curable and thus, there is a hope that HIV will also be curable. ” A few points discussed in the webcast include 1. India has nearly 21 lakh HIV positive patients 2. Diagnosis and treatment of AIDS are free in India 3. Earlier the better is the new mantra for HIV treatment 4. Diagnosis is not based on a single test. If 1 test is +ve, repeat tests need to be done. 5. Safe sexual practice is the key 6. Mother to child HIV transmission is 100% preventable, controllable and curable 7. HIV is no more a stigma; it is a chronic manageable disease like Hepatitis B and C 8. Hepatitis C is now curable and there is hope that AIDS too will also be curable

WHO encourages countries to act now to reduce deaths from viral hepatitis

WHO encourages countries to act now to reduce deaths from viral hepatitis

Dr K K Aggarwal Ahead of World Hepatitis Day falling on 28th July 2016, WHO is urging countries to take rapid action to improve knowledge about the disease, and to increase access to testing and treatment services. Today, only 1 in 20 people with viral hepatitis know they have it. And just 1 in 100 with the disease is being treated. Around the world 400 million people are infected with hepatitis B and C, more than 10 times the number of people living with HIV. An estimated 1.45 million people died of the disease in 2013 – up from less than a million in 1990. “The world has ignored hepatitis at its peril,” said Dr Margaret Chan, WHO Director-General. “It is time to mobilize a global response to hepatitis on the scale similar to that generated to fight other communicable diseases like HIV/AIDS and tuberculosis.” In May 2016, at the World Health Assembly, 194 governments adopted the first ever Global Health Sector Strategy on viral hepatitis and agreed to the first-ever global targets. The strategy includes a target to treat 8 million persons for hepatitis B or C by 2020. The longer term aim is to reduce new viral hepatitis infections by 90% and to reduce the number of deaths due to viral hepatitis by 65% by 2030 from 2016 figures. As of 2014, 184 countries vaccinate infants against hepatitis B as part of their vaccination schedules and 82% of children in these states received the hepatitis B vaccine. This is a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B. (Source: WHO, 20 July 2016)

IMA & HCFI congratulate leading policy expert Mr Rajendra Pratap Gupta on his appointment as an advisor to the Union Health Minister

IMA & HCFI congratulate leading policy expert Mr Rajendra Pratap Gupta on his appointment as an advisor to the Union Health Minister New Delhi, 20th July 2016: Leading public policy expert and global healthcare leader, Mr. Rajendra Pratap Gupta, has been appointed as an advisor to the Union Minister for Health & Family Welfare. He is currently a member of the Central Council of Health & Family Welfare, the apex advisory body of the Ministry for Health and Family Welfare. Congratulating his achievement, Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) & Honorary Secretary General Indian Medical Association (IMA) said, “Mr. Rajendra Gupta has made innumerable contributions to public policy, innovation and healthcare over the past decade. With over two decades of experience as a policy leader, economist and healthcare expert, Mr Gupta is likely to bring a fresh and practical perspective to the ministry. We are hopeful he will play an instrumental role in helping streamlining the sector and help address the major gaps that exist in the healthcare system today.” Sources in the ministry acknowledged that they have been seeking his advice for many years on various issues, and his joining the ministry will be of immense help to them. Gupta brings with him the rare quality of being a visionary along with his uncanny knack for executing plans in a record time. His colleagues know him for being a tough task- master, who is credited for turning around IMS Health in Nepal in three months, turning around the Medicine Shoppe operations in India and other consumer brands in a short time. He was featured as ‘Thought leader of the year’ three years in a row, felicitated as the ‘Global healthcare leader’ of the year in 2012 by the Sherriff of Los Angeles, and featured amongst the ‘25 living legends of healthcare in India’ in 2016. In 2007, he quit full time CEO role and started focusing on public policy and he is credited with championing the cause of healthcare reforms. He is the founder president of the Disease Management Association of India (DMAI), the only not-for-profit organisation in India having a special consultative status with the United Nations – ECOSEC. In 2010, the Government of Chhattisgarh incorporated his health reforms recommendations in their plans. The erstwhile Planning Commission would seek his inputs on key initiatives. Recently, Gupta has also authored a healthcare best- seller, ‘Healthcare reforms in India – Making up for lost decades’, published by Elsevier. He has served as a board member and advisor across the globe. He is the only Indian to serve as a board member for two terms on the Care Continuum Alliance, USA (Formerly , Disease Management Association of America) - amongst the largest healthcare not-for-profits in the United States. He has also served on the global agenda council of the World Economic Forum, and has been invited by United Nations, World Health Organization and International Telecommunications Union (ITU), besides others

Eat more of healthy unsaturated fats to reduce risk of type 2 diabetes

Eat more of healthy unsaturated fats to reduce risk of type 2 diabetes Results of a systematic review and meta-analysis of randomized controlled feeding trials published July 19, 2016 in PLoS Medicine indicate that substituting dietary carbohydrates with saturated fat does not have a favorable effect on blood glucose. While, substituting carbohydrate and saturated fat with a diet rich in unsaturated fats (monounsaturated and polyunsaturated fats) led to better control of blood sugar. And, compared to carbohydrates, saturated fats or MUFA, the most consistent favorable effects were observed with PUFA as evident by the improved glycemia, insulin resistance and insulin secretion capacity. The trial summarized findings of 102 randomized controlled trials, which included 4,660 participants. · Replacing 5% energy from carbohydrate with saturated fats had no significant effect on fasting, but lowered fasting insulin. · Replacing carbohydrate with MUFA lowered HbA1c, 2 h post-challenge insulin and homeostasis model assessment for insulin resistance (HOMA-IR). · Replacing carbohydrate with PUFA significantly lowered A1c and fasting insulin. · Replacing saturated fats with PUFA significantly lowered glucose, A1c, C-peptide, and HOMA. Major organizations recommend replacing saturated fats with MUFA or PUFA, mainly to improve lipid profiles rather than glucose-insulin metrics, for the primary and secondary prevention of diabetes. These findings suggest that eating more unsaturated fats in place of carbohydrates or saturated fats may improve glycemic control and focusing on PUFA in particular may have additional benefits on insulin secretion capacity.

Tuesday 19 July 2016

Postmenopausal women should get their insulin levels checked

Postmenopausal women should get their insulin levels checked New Delhi, July 18, 2016: "All postmenopausal women should try to keep insulin at normal levels through weight loss, regular exercise, and other methods," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Postmenopausal women with elevated insulin levels are at a higher risk of developing breast cancer. As per a report published in the International Journal of Cancer from Researchers at Albert Einstein College of Medicine of Yeshiva University in New York City, there is a strong association between elevated insulin levels in the blood and increased risk of breast cancer. The researchers examined data gathered from 5,450 women who took part in the Women’s Health Initiative (WHI) and found that women with insulin levels in the highest third were twice as likely to develop breast cancer as women in the bottom third. The link between elevated insulin levels and breast cancer was stronger for thin women than for obese women, as they tend to have higher insulin levels. This finding is potentially important because it indicates that in postmenopausal women, insulin may be a risk factor for breast cancer that is independent of obesity.

Postmenopausal women should get their insulin levels checked

Postmenopausal women should get their insulin levels checked New Delhi, July 18, 2016: "All postmenopausal women should try to keep insulin at normal levels through weight loss, regular exercise, and other methods," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Postmenopausal women with elevated insulin levels are at a higher risk of developing breast cancer. As per a report published in the International Journal of Cancer from Researchers at Albert Einstein College of Medicine of Yeshiva University in New York City, there is a strong association between elevated insulin levels in the blood and increased risk of breast cancer. The researchers examined data gathered from 5,450 women who took part in the Women’s Health Initiative (WHI) and found that women with insulin levels in the highest third were twice as likely to develop breast cancer as women in the bottom third. The link between elevated insulin levels and breast cancer was stronger for thin women than for obese women, as they tend to have higher insulin levels. This finding is potentially important because it indicates that in postmenopausal women, insulin may be a risk factor for breast cancer that is independent of obesity.

India is yaws, maternal/ neonatal tetanus/ Polio / Guinea Worm/ Small Pox free.

India is yaws, maternal/ neonatal tetanus/ Polio / Guinea Worm/ Small Pox free.

Dr K K Aggarwal

This is the strength of Modern Medicine. 1. In May 2016 WHO certified India yaws-free. India is the first country under the 2012 WHO neglected tropical diseases (NTD) roadmap to eliminate yaws, a disease known to affect the most underserved population. It is said ‘where the road ends, yaws begins’. 2. Until a few decades ago the country reported 150 000 to 200 000 neonatal tetanus cases annually. After India’s success in MNTE (maternal and neonatal tetanus elimination), Indonesia was validated for the same on 18 May this year. With this the entire WHO South-East Asia Region has achieved elimination of maternal and neonatal tetanus. WHO SEAR is the second WHO region, after European Region, to achieve MNTE. Indonesia and Timor-Leste are now the only remaining countries with yaws transmission in the WHO South-East Asia Region. 3. India is already Polio free 4. Guinea Worm disease free in February 2000 5. Smallpox free

India is yaws, maternal/ neonatal tetanus/ Polio / Guinea Worm/ Small Pox free.

India is yaws, maternal/ neonatal tetanus/ Polio / Guinea Worm/ Small Pox free.

Dr K K Aggarwal

This is the strength of Modern Medicine. 1. In May 2016 WHO certified India yaws-free. India is the first country under the 2012 WHO neglected tropical diseases (NTD) roadmap to eliminate yaws, a disease known to affect the most underserved population. It is said ‘where the road ends, yaws begins’. 2. Until a few decades ago the country reported 150 000 to 200 000 neonatal tetanus cases annually. After India’s success in MNTE (maternal and neonatal tetanus elimination), Indonesia was validated for the same on 18 May this year. With this the entire WHO South-East Asia Region has achieved elimination of maternal and neonatal tetanus. WHO SEAR is the second WHO region, after European Region, to achieve MNTE. Indonesia and Timor-Leste are now the only remaining countries with yaws transmission in the WHO South-East Asia Region. 3. India is already Polio free 4. Guinea Worm disease free in February 2000 5. Smallpox free

Monday 18 July 2016

Too much salt damages blood vessels and cause high BP

Too much salt damages blood vessels and cause high BP New Delhi, July 17, 2016: "Eating a high-salt diet for several years is associated with markers of blood vessel damage like high uric acid and presence of albumin in the urine. People with any of these markers of blood vessel damage, with a high-salt diet are more likely to develop high blood pressure," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA.
The study published in the American Heart Association journal Circulation analysed the association between sodium consumption and blood levels of uric acid and albumin in the urine — both markers of blood vessel damage — in participants not taking high blood pressure medicine. Higher sodium intake was associated with increasing levels of uric acid and albumin over time. The higher the levels of these markers, the greater the risk of developing hypertension, if dietary salt intake was high.
Compared with participants eating the least amount of sodium (2.2 grams a day), those eating the most (6.2 grams mg/d) were 21% more likely to develop high blood pressure.
Those who had high uric acid levels and ate the most salt were 32% more likely to develop high blood pressure while those with high urine albumin levels and highest salt intake were 86% more likely to develop high blood pressure.
A high-salt diet is believed to be responsible for 20% to 40% of all cases of high blood pressure.

10 risk factors associated with 90% risk of stroke globally

10 risk factors associated with 90% risk of stroke globally

Dr K K Aggarwal Researchers from McMaster University, Canada have found that 10 potentially modifiable risk factors are collectively associated with about 90% of strokes, 91·5% for ischemic stroke, 87·1% for intracerebral hemorrhage, worldwide in each major region of the world, among ethnic groups, in men and women, and in all ages. The following 10 risk factors were found to be significantly associated with 90% of the risk of stroke: 1. High blood pressure 2. Smoking 3. Waist-to-hip ratio (abdominal obesity) 4. Diet 5. Physical activity 6. Lipids 7. Diabetes mellitus 8. Alcohol intake 9. Stress and depression 10. Heart disorders Hypertension was more associated with intracerebral hemorrhage than with ischemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischemic stroke. The international case-control INTERSTROKE study investigated global and regional effects of potentially modifiable risk factors associated with acute stroke was conducted in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. The findings of the study are published online 15 July 2016 in The Lancet.

Sunday 17 July 2016

Burnout syndrome: A Critical Care Societies Collaborative call-to-action statement

Burnout syndrome: A Critical Care Societies Collaborative call-to-action statement Critical care health care professionals have one of the highest rates of burnout syndrome (BOS), compared with other health care professionals, according to a Critical Care Societies Collaborative call-to-action statement published in the July 2016 issue of the journal Chest. The statement has categorized risk factors by personal characteristics, organizational factors, quality of working relationships and exposure to end-of-life issues and calls for healthy ICU work environments that ultimately improve patients’ quality of care. The Critical Care Societies Collaborative (CCSC) comprises four major US professional and scientific societies: the American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society, and the Society of Critical Care Medicine. The statement reviews the diagnostic criteria, prevalence, causative factors and consequences of BOS along with potential interventions that may be used to prevent and treat BOS. • BOS occurs due to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. • The outcomes include increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. • BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. • Being self-critical, engaging in unhelpful coping strategies, sleep deprivation and a work-life imbalance have been identified as some of the personal traits associated with BOS. • Other personal risk factors associated with BOS are idealism, perfectionism and overcommitment, qualities that are often found in the best and most productive employees. • Critical care health-care professionals and their friends and family should be able to recognize the features of BOS and each critical care health-care professional should be personally responsible for managing their own BOS symptoms and related consequences • ICU teams should improve their ability to function as a group, respect each other, and reduce triggers of BOS. • ICU leaders should implement programs that identify and manage employees with BOS. • Hospitals should provide assistance programs for employees with (or at risk for) BOS and other psychological disorders such as PTSD. • Hospitals or clinical practices should consider limiting the number of consecutive days that a critical care health-care professional works, while promoting healthy sleep habits and the importance of sleep recovery. • Professional societies should educate and inform their members about BOS and other psychological disorders that impair the mental and physical health of their members, reduce the quality of care of their patients, and may deter trainees from entering their specific field.

Do not take drugs with juices

Do not take drugs with juices New Delhi, July 16, 2016: "Grapefruit juice can reduce the absorption of certain medications. Other common juices, including orange and apple, may limit the body’s absorption of drugs, compromising their effectiveness," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Quoting Dr David Bailey from the University of Western Ontario, Canada, Dr Aggarwal said that grapefruit juice markedly reduces the amount of drug that gets into the bloodstream. As per the American Academy of Family Physicians, doctors traditionally warn against drinking grapefruit juice if you’re taking certain medications for high cholesterol, high blood pressure, and heart rhythm problems. Research has shown that grapefruit juice, as well as orange and apple juice, can lower the body’s absorption of some drugs like anti-cancer drug Etopophos, beta-blockers like Atenolol, and anti-transplant rejection drug cyclosporine and antibiotics, including ciprofloxacin, levofloxacin, and itraconazole. Healthy volunteers who took the allergy drug fexofenadine with grapefruit juice absorbed only half the amount of the drug, compared with volunteers who took the medicine with water. Substances in the juices affect the absorption of drugs. Some chemicals block a drug uptake transporter, reducing drug absorption; other chemicals block a drug metabolizing enzyme that normally breaks down the drugs. In general, it’s safest to take medication with water. A glass is better than a sip. It helps dissolve the tablet. Cool water is better than hot because your stomach empties cool water faster, sending the medication on its way to the small intestine and finally the blood stream.

Do not take drugs with juices

Do not take drugs with juices New Delhi, July 16, 2016: "Grapefruit juice can reduce the absorption of certain medications. Other common juices, including orange and apple, may limit the body’s absorption of drugs, compromising their effectiveness," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Quoting Dr David Bailey from the University of Western Ontario, Canada, Dr Aggarwal said that grapefruit juice markedly reduces the amount of drug that gets into the bloodstream. As per the American Academy of Family Physicians, doctors traditionally warn against drinking grapefruit juice if you’re taking certain medications for high cholesterol, high blood pressure, and heart rhythm problems. Research has shown that grapefruit juice, as well as orange and apple juice, can lower the body’s absorption of some drugs like anti-cancer drug Etopophos, beta-blockers like Atenolol, and anti-transplant rejection drug cyclosporine and antibiotics, including ciprofloxacin, levofloxacin, and itraconazole. Healthy volunteers who took the allergy drug fexofenadine with grapefruit juice absorbed only half the amount of the drug, compared with volunteers who took the medicine with water. Substances in the juices affect the absorption of drugs. Some chemicals block a drug uptake transporter, reducing drug absorption; other chemicals block a drug metabolizing enzyme that normally breaks down the drugs. In general, it’s safest to take medication with water. A glass is better than a sip. It helps dissolve the tablet. Cool water is better than hot because your stomach empties cool water faster, sending the medication on its way to the small intestine and finally the blood stream.