Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 3 rd April, 2019

Morning Medtalks With Dr KK

1. Regular savings bank accounts require customers to maintain a certain average monthly balance (AMB). Leading lenders such as State Bank of India (SBI), HDFC Bank and ICICI Bank have fixed their monthly average balance requirements according to the location of a customers account in urban, metro, semi-urban and rural areas. Banks also charge a penalty from customers who fail to maintain an average monthly balance in their savings account. The penalty varies on factors such as the location of branch.

2. AFM is a condition associated with a recent infection, including those caused by polioviruses or non-polio enteroviruses, that causes sudden muscle paralysis. Polioviruses were once the major causes of AFM but now account for almost no cases because polio is nearly eradicated worldwide. There is no vaccine to prevent non-polio AFM, and no specific treatment is currently available to cure the condition. However, evidence indicates that early intensive physical therapy, which has helped patients with polio improve, may benefit other AFM patients, and should be considered as early as possible for children with AFM symptoms, according to the authors.

3. Adults who are regular drinkers and have had paroxysmal or persistent atrial fibrillation (AF) may cut their chances of AF recurrence by almost half if they stop drinking, or at least substantially lower their alcohol intake, suggests a small randomized trial. (Alcohol- AF)

4. More early research into a possible male contraceptive pill has been presented here at ENDO 2019: The Endocrine Society Annual Meeting. "Our results suggest that this pill, a modified testosterone which combines two hormonal activities in one, will decrease sperm production while preserving libido," said Christina Wang, MD, of the Clinical and Translational Science Institute at the Los Angeles Biomed Research Institute (LA BioMed), Torrance, California, who presented the findings of the small brief study here during a press conference.

5. Australian EXTEND studyL whether tPA is superior to placebo in the time window between 4.5 and 9 hours. The decision to randomize patients was based on perfusion imaging, using either CT or MRI perfusion. The study randomized 225 patients, and the endpoint was modified Rankin 0 or 1, which is a good outcome. This was achieved in 35% of patients with tPA compared with 29% on placebo, and this translates to an adjusted risk ratio of 1.44 at 90 days. The mortality was 12% with tPA whereas it was 9% with placebo, which was not significantly different. As you would expect, the rate of symptomatic hemorrhage was higher with tPA, at 6% versus 1%. If we take all of the evidence from the past 2 or 3 years, both on thrombectomy and tPA, we will no longer consider patients by a fixed time window. I think the decision about whether to choose tPA or thrombectomy basically depends on functional imaging, either with perfusion CT or perfusion and diffusion-weighted imaging on MRI.

Screening of ovarian cancer

1. A screening protocol for ovarian cancer should have a positive predictive value of at least 10 percent (that is, no more than nine healthy women with false-positive screens would undergo unnecessary procedures for each case of ovarian cancer detected)

2. Survival for ovarian cancer is much improved in early stage disease.

3. Most ovarian cancers have spread beyond the ovary at the time of diagnosis.

4. The strongest known risk factor for ovarian cancer is a family history.

5. CA 125, is elevated in 50 to 90 percent of women with early ovarian cancer but also can be elevated in numerous other conditions.

6. One should NOT screen with CA 125 in average-risk women

7. Serial measurements of CA 125 are important

8. Transvaginal ultrasonography as a sole screening intervention is not recommended

9. There is no recommendation to screen average-risk women for ovarian cancer

10. An ovarian symptom index: positive in women who report pelvic or abdominal pain, bloating, increased abdominal size, difficulty eating, or early satiety occurring more than 12 times a month, with symptoms present for less than one year.

Breaking Research Colchicine may help prevent obesity-related type 2 diabetes

colchicine, a drug used to treat the arthritic condition gout, could potentially reduce complications accompanying metabolic syndrome according to researchers at the National Institutes of Health. Their study appears in Diabetes, Endocrinology, and Metabolism.

System-wide inflammation that occurs in obesity plays a role in the development of type 2 diabetes. In the current study, researchers led by Jack A. Yanovski, M.D., Ph.D., of NIHs Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) randomly assigned 21 study participants to received colchicine twice a day for 3 months, while 19 participants received a placebo. Colchicine suppresses a multi-protein complex called NLRP3, which triggers the inflammation seen in obesity.

Researchers looked at several measures that reflect how well insulin works in the body to clear sugar from the blood (insulin resistance). There was no difference between the two groups in insulin resistance determined by one measure of insulin use (the frequently sampled, insulin-modified intravenous glucose tolerance test). However, the colchicine group showed improvement on the Homeostatic Model Assessment of Insulin Resistance test, which also estimates how much insulin is needed to keep blood sugar at a normal level while fasting. Those in the colchicine group also scored lower on a blood test of C-reactive protein and other tests that indicate inflammation.

Colchicine can prevent the development of type 2 diabetes in people with metabolic syndrome.

Dated: 3rd April, 2019

Current Temperature Status and Warning for next five days

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 01 April to 0830 hrs IST 02 April, 2019)

Heat Wave:

Yesterday, heat wave conditions observed at isolated pockets over Saurashtra & Kutch, Marathawada, East Madhya Pradesh and Chhattisgarh (Annexure 1 & 2).

Maximum Temperature

Maximum temperatures were markedly above normal (5.1C or more) at most places over Jammu & Kashmir; appreciably above normal (3.1C to 5.0C) at many places over Himachal Pradesh; at a few places over Saurashtra & Kutch, Rayalseema and Tamilnadu & Puducherry; at isolated places over West Rajasthan, Gujarat Region, Marathawada and Telangana. They were above normal (1.6C to 3.0C) at most places over East Rajasthan, West Madhya Pradesh and Vidarbha; at many places over Madhya Maharashtra and Kerala; at a few places over East Madhya Pradesh and Konkan & Goa; at isolated places over Jharkhand, Coastal Andhra Pradesh and Coastal Karnataka. Yesterday, the highest maximum temperature of 43.4C was recorded at Chandrapur (Vidarbha) over the country (Annexure 1 & 2).

Temperatures Recorded at 1430 Hours IST of Today, the 02 nd April, 2019

  • Akola(Vidarbha) recorded a maximum temperature of 42.1C (Annexure 3).
  • Temperatures recorded at 1430 hours IST of today have risen by 1-3C at most places over Jammu & Kashmir, Bihar and Assam & Meghalaya; at a few places over West Bengal & Sikkim and Odisha and one or two pockets of Punjab, Rajasthan, Saurashtra & Kutch, Coastal Andhra Pradesh and Madhya Pradesh( Annexure 4).

  • Faster acting nicotine consumption is cardiac safe

    The faster-acting nicotine replacement therapies (NRTs) include nicotine mouth spray, nicotine inhalers, nicotine nasal spray, nicotine nasal spray and nicotine sublingual tablet. Here is a brief overview of each.
    Nicotine mouth spray:It delivers 1 mg nicotine per spray. Used as 1 to 2 sprays when craving occurs, up to 4 sprays per hour. Side effects occurring frequently with the oral spray include hiccups (occurring in more than 55% of those treated in one trial, throat irritation, and nausea (Eur Respir J. 2012;40:548)....read more

    Does my patient have hyponatremia?

    Hyponatremia or sodium (Na) < 135 mEq/L represents a relative excess of water in relation to Na. Hyponatremia can be acute or chronic.

  • Acute: < 48 hours. Results from parenteral IV administration in postoperative patients (who have ADH hypersecretion associated with surgery) and from self-induced water intoxication (as in, for example, competitive runners, psychotic patients with extreme polydipsia and users of ecstasy)....read more

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