Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 27 th March, 2019

Morning Medtalks with dr KK

1. New European guidelines supporting the use of multiparametric MRI before performing a prostate biopsy.

2. Fast MRI can detect clinically significant prostate cancers with a similar degree of specificity to multiplane, multiparametric or standard biparametric approaches

3. Society gives doctors the ability to prescribe medicines, to examine patients in intimate ways (which would not be allowed unless it was in the context of medicine), and to do a fair amount of self-regulation of the profession itself in terms of getting rid of bad apples.

4. A report in the BMJ in 2017 found GPs and their staff are increasingly facing violence, harassment and threatening behaviour in their surgeries. It found, in the space of a year, a 9% rise across the UK in the overall number of crimes committed at GP surgeries and health centres. There were 1974 in 2015-2016 compared with 2147 in 2016-17. The report showed an increase in assaults, harassment and a 90% rise in public order offences like threatening behaviour.

5. GPs can remove a patient from their practice list immediately if the person is violent, aggressive or behaves in a way that makes the GP fear for their safety or the safety of their staff.

Five Eye Emergencies That Need Quick Referral to Specialist

1. Traumatic Retinal Detachment: typically don't cause pain unless the patient has experienced a direct blow to the eye. The extent of visual loss will depend on whether the macula is attached. The prognosis is better if the macula is on.

2. Central Retinal Artery Occlusion: The characteristic finding of a central retinal artery occlusion is the cherry-red spot in the middle of the retina. The rest of the retina is milky white with narrowed arteries. It is a painless cause of profound visual loss. If you're hypertensive or have had emboli or an irregular heartbeat and you're flipping clots, they can travel to the eye and block off blood vessels

3. Ischemic Optic Neuropathy: Patients with ischemic optic neuropathy will have a chalky white swollen optic nerve with blurred disc margins and cotton wool spots, which indicate infarction of the retina. Typically, patients will suddenly lose vision in one or both eyes.

4. Ruptured Globe: Any full-thickness injury to the cornea, sclera, or both is considered an open globe injury.

5. Bacterial Ulcer: require most urgent referral. The patient will have severe pain and experience some loss of vision. No topical antibiotics should be given until the organism has been isolated. [ Excerpts from Medscape articl]

Screening test for endothelial function

Brachial artery ultrasound is a commonly used and widely accepted method to evaluate the peripheral macrovascular endothelial function.
Inflating the blood pressure cuff at suprasystolic pressures for 5 minutes occludes the upper arm proximal to the ultrasound measurement. When this occlusion is released, endothelial-dependent, nitric oxide NO-driven, flow-mediated dilation (FMD) of the brachial artery occurs due to an increase in shear stress. Both diameter and blood velocity are measured before and after occlusion at the end of the diastole. The results are reported as a percent change from baseline.....read more

Postmenopausal women at high risk of fractures should be treated for osteoporosis

Osteoporosis is often a silent disease and is responsible for minimal trauma fractures in the hip, spine and ribs later in life. In contrast to senile osteoporosis, osteoporosis occurs much more in the spine in postmenopausal osteoporosis, which is a cancellous bone. In senile osteoporosis, bones are 50-50, cancellous as well as cortical. Osteoporosis occurs both in the spine and hip. The commonest fractures in osteoporosis are spine fractures in postmenopausal women followed by fractures in hip and wrist....read more


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