Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 9 th April, 2019

Morning Medtalks With Dr KK

1. A new paper in the New England Journal of Medicine offers a blueprint for how doctors can use artificial intelligence to help them diagnose diseases. The authors outline the benefits of machine learning to reduce physician error and streamline the health care system. They also highlight the challenges of using AI in medicine — cautioning that even machines can't be perfect.

2. Ketamine's rapid antidepressant effects and its recent approvalby the US Food and Drug Administration (FDA) has clinicians and patients alike buzzing with excitement.

3. The U.S. Surgeon General's office estimates that more than 20 million people have a substance use disorder.

4. In a long-term prospective study of more than 8000 British civil servants followed for almost 25 years, investigators found no significant association between following a healthier diet in midlife and a lower risk for incident dementia or cognitive decline.

Tele-prescriptions may lead to overuse of antibiotics

NIH: children are more likely to be overprescribed antibiotics for colds, sinus infections and sore throats during telemedicine visits than during in-person visits to primary care providers or urgent care facilities, suggests a study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health. The study, conducted by Kristin Ray, M.D., of the University of Pittsburgh School of Medicine and colleagues, appears in Pediatrics.

Many companies offer visits in which patients can connect with physicians outside of their primary care practice through audio-video conferencing, often on their cell phones or personal devices. The researchers compared antibiotic prescribing practices from the billing data of 4,604 telemedicine visits, 38,408 urgent care visits, and 485,201 primary care visits for children up to 17 years old with respiratory infections. They found that children were more likely to receive prescriptions for antibiotics during telemedicine visits (52), compared to urgent care visits (42%) and visits with primary care providers (31 percent).

Physicians providing telemedicine visits may overprescribe antibiotics because they cannot closely examine patients or perform tests, potentially limiting their ability to distinguish between bacterial and viral infections.

Blue light from electronic devices and risk of macular degeneration and blindness

[Harvard News Letter excerpts]: Blue light is visible light between 400 and 450 nanometers (nm) in frequency on the visible light spectrum. This type of light is perceived as blue in color. Blue light may be present even when light is perceived as white or another color. Blue light is of concern because it has more energy per photon of light than other colors in the visible spectrum, i.e. green or red light. Blue light, at high enough doses, is therefore more likely to cause damage when absorbed by various cells in our body.

But the amount of blue light from electronic devices, including smartphones, tablets, LCD TVs, and laptop computers, is not harmful to the retina or any other part of the eye.

Most incandescent light sources, like sunlight, have a broad spectrum of light. However, light emitting diodes (LEDs) produce relatively narrow peaks of light that are crafted by the manufacturer. This allows light from LEDs to be perceived as almost indistinguishable from white light, or daylight. White LEDs may actually emit more blue light than traditional light sources, even though the blue light might not be perceived by the user. This blue light is unlikely to pose a physical hazard to the retina. But it may stimulate the circadian clock more than traditional light sources, keeping you awake, disrupting sleep, or having other effects on your circadian rhythm.

The screens of modern electronic devices rely on LED technology. Typical screens have individually controlled red, green, and blue LEDs tightly packed together in a full-color device. However, it is the bright white-light LEDs, which backlight the displays in smartphones, tablets, and laptop computers, that produce the greatest amount of blue light.

Recent iPhones have a maximum brightness of around 625 candelas per square meter (cd/m2). Many retail stores have an ambient illumination twice as great. Sun yields an ambient illumination more than 10 times greater.

High-intensity blue light from any source is potentially hazardous to the eye. Industry sources of blue light are purposely filtered or shielded to protect users. However, it may be harmful to look directly at many high-power consumer LEDs simply because they are very bright. These include “military grade” flashlights and other handheld lights.

Although an LED bulb and an incandescent lamp might both be rated at the same brightness, the light energy from the LED might come from a source the size of the head of a pin compared to the significantly larger surface of the incandescent source. Looking directly at the point of the LED is dangerous for the very same reason it is unwise to look directly at the sun in the sky.

The current evidence does not support the use of blue light-blocking lenses to protect the health of the retina. Blue light from electronic devices is not going to increase the risk of macular degeneration or harm any other part of the eye. However, the use of these devices may disrupt sleep or disturb other aspects of your health or circadian rhythm.

"Unbeatable" superbug fungus Candida Auris sickens hundreds across the US

(excerpts cbs news) A drug-resistant superbug fungus, Candida auris, has sickened nearly 600 people across the United States in recent years, including more than 300 patients in New York State, the Centers for Disease Control and Prevention reported. The fungus which preys on people with weakened immune systems, can be deadly. As of the end of February, a total of 587 cases had been confirmed across the country, most of them in New York State, where there were 309 cases. Illinois had 144 confirmed cases and New Jersey had 104.

In 2016, the United States Centers for Disease Control and Prevention (CDC) and Public Health England (PHE) issued warnings about the emergence of a multidrug-resistant Candida species, C. auris.

Smptoms of the fungus may be difficult to detect because patients are often already sick and only a lab test can identify the superbug. Candida auris can cause different types of infections, including bloodstream infection, wound infection, and ear infection. People who recently had surgery, live in nursing homes, or who have breathing tubes, feeding tubes or central venous catheters appear to be at highest risk.

30 – 60% of people with C. auris infections have died. However, many of these people had other serious illnesses that also increased their risk of death. While most Candida auris infections are treatable with antifungal medications, it's concerned that some have proven to be resistant to all three main classes of antifungal medications. In this situation, multiple antifungal medications at high doses may be needed to treat the infection.

In patients with candidemia or invasive candidiasis caused by C. auris one should start initial therapy with an echinocandin. C. auris is often resistant to azoles. Because C. auris can develop resistance quickly, patients receiving antifungal therapy should be monitored carefully with follow-up cultures. If the patient does not respond clinically to an echinocandin or has persistent candidemia for >5 days, the patient can be switched to a lipid formulation of amphotericin B 5 mg/kg IV daily.

Given concerns about resistance and transmission of C. auris in health care facilities, there are special infection control precautions for patients who are colonized or infected with C. auris.

Dated: 8th 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 07 April to 0830 hrs IST 08 April, 2019)

Heat Wave:

Yesterday, heat wave conditions were observed in many parts over West Rajasthan and in some parts over East Rajasthan (Annexure 1 & 2).

Maximum Temperature

Maximum temperatures were markedly above normal (5.1°C or more) at many places over Jammu & Kashmir and West Rajasthan; at a few places over East Rajasthan; at isolated places over Haryana, Chandigarh & Delhi; appreciably above normal (3.1°C to 5.0°C) at many places over Himachal Pradesh and West Madhya Pradesh; at a few places over Punjab, East Madhya Pradesh, Marathwada, Vidarbha, Gujarat region and Coastal Karnataka; at isolated places over Saurashtra & Kutch, Chhattisgarh and Rayalaseema; above normal (1.6°C to 3.0°C) at many places over Kerala; at a few places over South Interior Karnataka, Coastal Andhra Pradesh, Lakshadweep and Tamilnadu & Puducherry; at isolated places over Konkan & Goa, North Interior Karnataka and Andaman & Nicobar Islands. Yesterday, the highest maximum temperature of 44.0°C was recorded at Khargone (West Madhya Pradesh) over the country (Annexure 1 & 2).

Temperatures Recorded at 1430 Hours IST of Today, the 08th April, 2019

  • Bramhapuri (Vidarbha) recorded a maximum temperature of 42.8°C (Annexure 3).
  • Temperatures recorded at 1430 hours IST of today have risen by 1-3°C at most places over Assam & Meghalaya; at many places over East Uttar Pradesh; at a few places over Bihar and at one or two pockets over West Madhya Pradesh, Gujarat region, Konkan & Goa and Sub Himalayan West Bengal & Sikkim (Annexure 4).

  • Guidelines for doctors on sexual boundaries

    Here are few excerpts from the guidelines on Sexual boundaries from the Indian Psychiatry Society Task Force and The Bangalore Declaration Group, which have been put on the Medical Council of India website.
    1. "It is the ethical duty of all doctors to ensure effective care for their patients. This would mean that their own conduct should in no way harm their patient. Sexual relationships between doctors and patients invariably harm both the patient and the doctor. Trust, which is central to an effective doctor patient relationship, is inevitably damaged. In view of the power gradient that invariably exists in the doctor patient relationship, the onus is on the doctor to ensure he or she does not enter into a romantic or sexual relationship with a patient.....read more

    New drug: Solriamfetol improves excessive daytime sleepiness

    A new drug, solriamfetol (75, 150, or 300mg) improved wakefulness on the Maintenance of Wakefulness Test (MWT) and reduced excessive sleepiness on the Epworth Sleepiness Scale (ESS) over a 12-week treatment period when compared with placebo in patients with narcolepsy published in the March 2019 issue of Annals of Neurology.
    These improvements were observed in the first week of the study itself and were maintained for the 12 weeks of the study indicating that there was no apparent tolerance to the drug over the study period.....read more


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