Editor in Chief Dr KK Aggarwal, Padma Shri Awardee


Dated: 16 th April, 2019

Morning Medtalks with Dr KK

1. Cardiogenic shock survival rates jumped after FDA approval of the Impella percutaneous heart pump, Abiomed's quality assurance database showed. (Diagnostic and Interventional Cardiology)

2. Low adherence to oral anticoagulation in atrial fibrillation was highlighted along with growing evidence on the risk-benefit ratio of left atrial appendage occlusion in a review article in Mayo Clinic Proceedings.

3. Five risk factors in diabetes: elevated hemoglobin A1C, elevated LDL cholesterol, albuminuria, smoking, and elevated blood pressure.


When you should suspect C. auris?

  • If the patient is from ICU or high-dependency area

  • Transferred from another hospital after a long stay

  • Multiple intervention & prior antifungal exposure in any patient

  • If one identifies in a commercial system -Candida haemulonii, C. famata,C. guilliermondii, C. lusitaniae, C. parapsilosis, Rhodotorulaglutinis, Candida sake, Saccharomyces cerevisiae

  • If the Candida appears to be resistant to fluconazole & high MIC to voriconazole Notification

Whenever there is a suspected or confirmed case of C. auris infection or C. auriscolonization in the hospital, the details should be notified toProf.ArunalokeChakrabarti, Professor and Head, Mycology Reference Laboratory, Department of Medical Microbiology, PGIMER, Chandigarh.


Toilet Training

The child should sit on the toilet shortly after a meal, for 5 to 10 minutes, two to three times per day.

Toilet sitting episodes should occur at the same time each day and be timed with a timer or stopwatch

The routine should be followed every day, particularly during times of transition (eg, holidays, vacations, or weekends

The child's adherence to the program should be encouraged with positive reinforcers rather than negative reinforcers (criticism or punishment).

For children whose feet do not touch the floor sitting on a regular toilet seat, it is helpful to use a stool for foot support.

A foot support that raises the knees above the level of the hips can help relax the pelvic floor, and is particularly helpful for a child who tends to withhold stool.


Specifics vs general: Ask for specific test and not the complete panel of tests to reduce treatment costs

Evidence-based medicine has become the norm today. Laboratory tests are now greatly relied upon in the diagnosis of a condition, its treatment and follow up.
Most often, we ask for liver function tests (LFTs), kidney function tests (KFTs) or a lipid profile as a whole, for instance, without mentioning the specific test/s in the panel. This is the general practice and it is done quite possibly to avoid legal consequences
In lipid profile, total cholesterol or high-density lipoprotein (HDL) cholesterol may be the only tests required. If HDL is low, then triglyceride (TG) level is high. High TGs indicate serum lipemia.....read more


Some key facts about levothyroxine use for hypothyroid patients

Levothyroxine is routinely used as the primary form of thyroid hormone replacement in the management of hypothyroidism. It is absorbed in the small intestine; bioavailability in the euthyroid person is 70-80%.

  • Peak absorption is achieved at approximately 2 hours after oral ingestion; this can be delayed to 3-4 hours if it is ingested simultaneously with interfering medications, supplements, or some foods/drinks.....read more


eSpiritual

The lips of truth shall be recognized for ever, a lying tongue is but for a moment