Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 29 th March, 2019

Morning Medtalks With Dr KK

1. All institutions conducting biomedical and health research are now required to have an ethics committee, according to the new rules specified by the Indian Council of Medical Research (ICMR). These committees have to be constituted in line with the ICMR's National Ethical Guidelines for Biomedical and Health Research Involving Human Participants, 2017. The idea is to “safeguard the safety, rights and welfare of research participants”.

2. The United States will follow suit with the World Health Organization's recommendation for artesunate as a first-line treatment for severe malaria, starting April 1. Clinical studies have shown that IV artesunate is safe, well tolerated and can be administered to infants, children, and pregnant women in their second and third trimesters, as well as during lactation, according to the CDC. In the first trimester of pregnancy, the benefits of IV artesunate treatment outweigh the risk of death and poor outcomes due to severe malaria.

3. How you can reverse MCI; Certain types of medications can cause memory problems. Your doctor may be able to offer you a different drug therapy that won’t affect your memory. Depression is also linked to MCI. It may be possible to alleviate symptoms of MCI by treating the depression.

4. FDA Approves Device for Treating Moderate-to-Severe Chronic Heart Failure: The US Food and Drug Administration (FDA) has approved the Optimizer Smart system for treating patients with chronic, moderate-to-severe heart failure who are not suited for treatment with other heart failure devices such as cardiac resynchronisation therapy to restore a normal timing pattern of the heartbeat.

The FDA gave the device a Breakthrough Device designation because it treats a life-threatening disease and addresses an unmet medical need in patients who fail to get adequate benefits from standard treatments and have no alternative treatment options.

Potassium and CKD

Most talk about reducing sodium in patients' diets, but now the shift is to increase potassium intake and change the potassium-to-sodium ratio to be much healthier.

Plant-based diets contain sources of potassium which has many benefits but can be fatal for people with kidney disease if the level of potassium in their blood spikes, a condition known as hyperkalemia.

In the United States, more than 3 million patients are living with hyperkalemia. People with such conditions as CKD or heart failure are at highest risk for hyperkalemia.

Some individuals whose kidneys are not functioning properly and are not able to remove excess potassium, may not be able to maintain a plant-based diet because of the risk for hyperkalemia.

One should eat a diet that contains at least 4700 mg of potassium per day if you have normal, healthy functioning kidneys.

However, most people with moderate to severe CKD or acute kidney injury should eat less than 2000 mg of potassium per day.

New data support an individualized approach to potassium restrictions, indicating that some individuals may be able to tolerate more potassium in their diet despite CKD, especially when the source of the potassium is factored in.

Consumption of fresh fruits and vegetables may be better tolerated and cause less risk for hyperkalemia than meats and processed foods.

With the new potassium binders, there may be opportunities to consume more fresh fruits and vegetables, even in people with CKD.

CKD and Phosphorus

The phosphorus in foods consumed on a plant-based diet is less readily absorbed than phosphorus from animal sources.

Patients who consume primarily meat products have an increased risk for hyperphosphatemia. It takes us back to focusing on plant-based diets and utilizing them as a way of managing urine phosphorus excretion.

Certain potassium-containing foods (nuts, legumes, beans, and dairy products) also contain phosphorus. Phosphorus occurs in two forms: organic (as phosphates) and inorganic (as salts).

In general, organic phosphorus is naturally found in food, whereas inorganic phosphorus salts are added to foods for purposes of moisture retention, longer shelf life, and enhanced flavor. The absorption of phosphorus from the plant-based foods that contain organic phosphorus (and potassium) is less than 50%, owing to the phytic acid content. Organic phosphorus in plant-based foods is mostly in the storage form of phytates or phytic acid, and humans do not possess the enzyme required to degrade phytates or phytic acid; thus, the bioavailability of phosphorus from plant-based sources is low. Therefore, although high in phosphorus, plant-based foods do not significantly contribute to serum phosphorus levels compared with inorganic phosphorus from food additives and phosphorus from animal-based sources, which contribute significantly to serum phosphorus levels.

Because of the importance of avoiding high serum phosphorus levels, patients on dialysis are required to take phosphate binders. These binders contribute to the high pill burden experienced by people on dialysis and can contribute to constipation, which in term reduces fecal excretion of potassium. A diet that is plant-based and high in organic phosphorus-containing and potassium-containing foods could ultimately contribute to a reduced daily pill burden, owing to the reduced phosphorus bioavailability and lack of significant contribution to serum phosphorus levels.

Dated: 29 th March, 2019

Current Temperature Status and Warning for next five days

HHeat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 27 March to 0830 hrs IST 28 March, 2019)

Heat Wave:

•Yesterday, Heat wave conditions observed at one or two pockets over Saurashtra & Kutch (Annexure 1 & 2).

Maximum Temperatures

• Maximum temperatures were markedly above normal (5.1°C or more) at a few places over Jammu & Kashmir; at isolated places over Saurashtra & Kutch; appreciably above normal (3.1°C to 5.0°C) at a few places over Madhya Maharashtra; at isolated places Kerala; above normal (1.6°C to 3.0°C) at most places over West Rajasthan, Gujarat Region, Vidarbha, Marathwada and Rayalaseema; at many places over South Interior Karnataka and Lakshadweep; at a few places over Assam & Meghalaya, Uttarakhand, West Madhya Pradesh, Telangana, Tamilnadu & Pudducherry and at isolated places over Konkan & Goa. Yesterday, the highest maximum temperature of 42.2°C was recorded at Amraoti (Vidarbha) over the country (Annexure 1 & 2).

Temperatures Recorded at 1430 Hours IST of Today, the 28 th March, 2019

•Sholapur (Madhya Maharashtra) recorded a maximum temperature of 41.4°C (Annexure 3).

•Temperatures recorded at 1430 hours IST of today have risen by 3-5°C at many places over East Rajasthan and at one or two pockets of Delhi and Assam & Meghalaya; risen by 1- 3°C at most places Jammu & Kashmir, Himachal Pradesh, Uttarakhand, West Rajasthan, Madhya Pradesh, Uttar Pradesh and West Bengal & Sikkim; at a few places Bihar, Jharkhand, North Interior Karnataka, Madhya Maharashtra and Odisha and one or two pockets of Tamilnadu, Coastal Andhra Pradesh, Gujarat, Vidarbha, Marathwada and Kerala( Annexure 4).

Hon'ble Delhi High Court directs social restaurant to provide wholesome meals and sanitary napkins to children of 10 orphanages and 10 foster care homes

In a yet another exemplary move, on 27th March, 2019 the Hon'ble Delhi High Court has directed Impresario Entertainment and Hospitality, owner of the 'SOCIAL' restaurant chain, to provide wholesome meals to children in ten orphanages and ten foster care homes in Delhi for two years
The restaurant chain will continue providing one meal per day to the children lodged in these centres until the expenditure incurred by it becomes equal to the punitive costs of Rs 20 lakh imposed on it by the Court....read more

Adolescent psychotic experiences linked to air pollution

The adverse impact of air pollution on heart and lungs are well established. Air pollution has now emerged as a major environmental risk factor for health.
Here is another adverse impact of air pollution.
A study of more than 2000 UK-born children says that adolescents exposed to high levels of outdoor air pollution were more likely to report psychotic experiences; though, this is not a cause and effect association. ...read more


Ganesha, the Stress Management Guru