Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 10 th April, 2019

Morning Medtalks With Dr KK

1. CDC estimates that, during 2012-2015, over 9 million Americans tried to quit smoking cigarettes because of the campaign and over half a million quit for good.

2. In India nicotine products are not covered in COTPA and hence is a non tobacco product.

3. WHO Tobacco free Initiative: Electronic cigarettes (e-cigarettes) or electronic nicotine delivery systems: GENEVA - Electronic nicotine delivery systems (ENDS), of which electronic cigarettes are the most common prototype, are devices that do not burn or use tobacco leaves but instead vaporise a solution the user then inhales. The main constituents of the solution, in addition to nicotine when nicotine is present, are propylene glycol, with or without glycerol and flavouring agents.

4. The estimated number of malaria deaths in 2017, at 435 000, remained virtually unchanged over the previous year.

5. Johnson (J&J) Pvt. Ltd on Monday, it challenged a central government order to pay a compensation of ?65 lakh and ?74 lakh respectively to two patients affected by its faulty hip implants. The company told the Delhi high court it was willing to pay only ?25 lakh each to the patients.

FDA: 1st two-drug complete regimen for HIV

The U.S. FDA approved dolutegravir and lamivudine, as a complete regimen for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults with no antiretroviral treatment history and with no known or suspected substitutions associated with resistance to the individual components of the drug. This is the first FDA-approved two-drug, fixed-dose, complete regimen for HIV-infected adults who have never received treatment for HIV.

Currently, the standard of care for patients who have never been treated is a three-drug regimen. With this approval, patients who have never been treated have the option of taking a two-drug regimen in a single tablet while eliminating additional toxicity and potential drug interactions from a third drug.

Patients infected with both HIV and hepatitis B should add additional treatment for their hepatitis B or consider a different drug regimen.

Kids living near major roads at higher risk of developmental delays, NIH study suggests

NIH Excerpts: Young children who live close to a major roadway are twice as likely to score lower on tests of communications skills, compared to those who live farther away from a major roadway, according to an analysis by researchers at the National Institutes of Health and the University of California, Merced. Moreover, children born to women exposed during pregnancy to higher-than-normal levels of traffic-related pollutants — ultra-fine airborne particles and ozone — had a small but significantly higher likelihood of developmental delays during infancy and early childhood. The study appears in Environmental Research.

It may be prudent to minimize exposure to air pollution during pregnancy, infancy, and early childhood—all key periods for brain development.

Pauline Mendola, Ph.D., an investigator in the Division of Intramural Population Health Research at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the study’s senior author said previous studies have linked exposure to common air pollutants in pregnancy to low birthweight, preterm birth and stillbirth. A few studies have found a higher risk of autism and of lower cognitive functioning in children living near freeways, but results of studies about how prenatal and early childhood exposure to air pollution might affect development have been inconsistent.

The researchers analyzed data from the Upstate KIDS Study. They matched the addresses of 5,825 study participants to a roadway data set, calculating the distance of each address to the nearest major roadway. For each participant, they matched home address, mother’s work address during pregnancy, and address of the child’s day care location to an Environmental Protection Agency data set (link is external) for estimating air pollution levels. From 8 months to 36 months of age, the children were screened every four to six months with the Ages and Stages Questionnaire, a validated screening measure evaluating five domains of child development: fine motor skills, large motor skills, communication, personal social functioning and problem-solving ability.

Compared to children living more than half a mile from a major roadway, children living from roughly 164 feet to .3 miles from a major roadway were twice as likely to have failed at least one screen of the communications domain.

The researchers also estimated exposures to ozone (link is external) and fine inhalable particles (PM2.5 (link is external)), two pollutants produced by car traffic. Fine inhalable particles are 30 times smaller than the width of a human hair, can pass through the lungs’ defenses, and are absorbed directly into the bloodstream.

Prenatal exposure to elevated PM2.5 led to a 1.6 to 2.7% higher risk of failing any developmental domain, while higher ozone exposure led to a .7 to 1.7% higher risk of failing a developmental domain. In contrast, higher postnatal exposure to ozone was linked to a 3.3% higher risk of failing most domains of the developmental screen at 8 months, a 17.7% higher risk of overall screening failure at 24 months, and a 7.6% higher risk of overall screening failure at 30 months.

Metformin Prevents Type 2 Diabetes Over 15 Years

Metformin continues to reduce the likelihood of developing type 2 diabetesamong those at high risk for it over 15 years, particularly among those with higher baseline glycemia and women with a history of gestational diabetes mellitus (GDM).

Findings from the long-term follow-up of participants in the landmark Diabetes Prevention Program (DPP) were recently published online in Diabetes Care by the DPP Research Group.

The diabetes prevention benefit of metformin was seen in both relative and absolute risk reduction and regardless of whether the diagnosis was made by oral glucose tolerance testing, fasting blood glucose, or HbA1c (which was analyzed post-hoc as HbA1c wasn't recommended for diagnosing diabetes when DPP started).

Metformin remains this incredibly safe, inexpensive, that's well-tolerated by most patients and it's really one of the few drugs in the world that makes sense for diabetes prevention.

Moreover, the current analysis identified two groups of high-risk patients who experienced even greater risk reduction with metformin: those with blood glucose measures on the higher glycemic end of the "prediabetes" ranges and women with a history of GDM.

Use of metformin for diabetes prevention is off-label and because it's been off-patent for more than a decade it's unlikely that any pharmaceutical company would seek the indication.

"Superbug"...moving from bacteria to fungus

The fungus, Candida auris is an emerging “superbug” and is fast becoming a global health threat.
The CDC has added drug-resistant C. auris to a list of germs, which are considered as "urgent threats."
C. auris has been reported from South Korea, India, Pakistan, Kuwait, Israel, Oman, South Africa, Colombia, Venezuela, the United States, Canada, and Europe, including the United Kingdom, Norway, Germany and Spain (Clin Microbiol Rev. 2017;31(1). pii: e00029-17). A total of 617 cases have been reported in the US till March 29, 2019.....read more

Aim to achieve mucosal healing when treating patients with ulcerative colitis

The American College of Gastroenterology has updated its guidelines on diagnosis and management of ulcerative colitis in adults. These guidelines have been published in the March 2019 issue of the American Journal of Gastroenterology Some key recommendations include:....read more


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