Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 30 th March, 2019

Morning Medtalks With Dr KK

1. AS per a British study a high-sensitivity cardiac troponin 1 (hs-cTnI) assay to diagnose myocardial infarction (MI) may lead to overdiagnosis with resulting inappropriate therapies. [University Hospital Southampton]

2. US FDA is proposing a rule for breast cancer screenings that would require doctors to give women more information about the risks associated with dense breasts. FDA wants doctors to ensure patients understand how dense breasts, which don't have a lot of fatty tissue, can skew the accuracy of mammograms and present a higher risk of developing breast cancer later in life. About 12 percent of all women are diagnosed with breast cancer at some point in their life.

3. Given that more than half of women over the age of 40 in the U.S. have dense breasts, helping to ensure patient access to information about the impact that breast density and other factors can have on the risk for developing breast cancer is an important part of a comprehensive breast health strategy

4. Mammograms are considered the best way to detect breast cancer. However, they're not as reliable in dense breasts, characterized as those with not as much fat and more fibrous or glandular tissue, according to the American Cancer Society. Dense tissue makes it harder for doctors to see cancer, meaning the tests can be less accurate.

5. Mammograms of dense breasts ... can be difficult to interpret because the dense tissue can obscure signs of breast cancer and lower the sensitivity of the image

6. Dense breasts have also been identified as a risk factor for developing breast cancer.

7. There are 314 confirmed cases of measles in 15 states, with six states reporting measles outbreaks as per US CDC. The situation is severe enough in New York's Rockland County, a suburb of New York City, that an emergency was declared effective today with 155 confirmed cases. Emergency include anyone less than 18 years of age who is unvaccinated against the measles barred from public places until this declaration expires in 30 days or until they receive the measles-mumps-rubella vaccination.

8. The US FDA has approved oral testosterone undecanoate to treat men with hypogonadism resulting from Klinefelter syndrome or tumors that have damaged the pituitary gland.

9. ARBs are recommended for the treatment of hypertension, heart failure, and chronic kidney disease, with more than 61 million prescriptions written for valsartan, losartan, and irbesartan in the United States in 2016.

10.Ongoing US FDA recalls — all in generic ARB-containing products — began last July when the probable carcinogen N-nitrosodimethylamine (NDMA) was detected in the valsartan active pharmaceutical ingredient (API) supplied by Zhejiang Huahai Pharmaceuticals (ZHP), Linhai, China. Within months, the rolling recalls had extended to irbesartan- and losartan-containing products. A second probable carcinogen, N-nitrosodiethylamine (NDEA), was identified last fall and a third, N-nitroso-N-methyl-4-aminobutyric acid (NMBA), only last month.

11.Statin muscle-related adverse events are relatively uncommon. Myalgias and myopathy occur with a frequency of 2 to 11 percent. However, severe myonecrosis and clinical rhabdomyolysis are much rarer (0.5 percent and less than 0.1 percent, respectively). Patients can experience statin-induced myalgias without an elevation in serum creatine kinase (CK) concentration.

12.The risk of muscle injury is substantially higher when taking a statin that is extensively metabolized by cytochrome P450 3A4 (CYP3A4; lovastatin, simvastatin, atorvastatin) together with a drug that interferes with CYP3A4.

13. Pravastatin, fluvastatin, rosuvastatin, and pitavastatin are preferred when given to a patient receiving another drug that is a strong inhibitor of CYP3A4.

14. Grapefruit juice inhibits CYP3A4; however, daily consumption of 8 oz or less of grapefruit juice or one-half of a grapefruit or less is unlikely to increase the risk of an adverse interaction or muscle injury.

15. Enhanced susceptibility to statin-associated myopathy occurs in patients with acute or chronic renal failure, obstructive liver disease, and hypothyroidism.

16. Muscle symptoms and/or signs usually begin within weeks to months after starting statins. Myalgias, weakness, and serum CK concentrations usually return to normal over days to weeks after drug discontinuation.

From "Formula of 80" to "Section 80": Invest wisely for a healthy future

India is the midst of an epidemic of lifestyle diseases or noncommunicable diseases (NCDs) such as type 2 diabetes, hypertension, heart disease, obesity, the genesis of which lies in an unhealthy lifestyle.

All the major lifestyle disorders or NCDs share common lifestyle-related risk factors like physical inactivity, unhealthy diet, tobacco and excess alcohol intake, which are modifiable. Hence, patients should be advised a common lifestyle that will prevent all lifestyle disorders and not just one.

I have devised a ‘Formula of 80’, which I teach all my patients to maintain a healthy lifestyle. I have chosen the number 80 as common to all risk factors - as most recommendations are to keep the values below 90 - so that it is easy for patients to remember.

Here is my Formula of 80 to live up to the age of 80.

•Keep lower BP, LDL ‘bad’ cholesterol levels, resting heart rate, fasting sugar and abdominal girth levelsall less than 80.

•Walk 80 minutes a day, brisk walk 80 min a week with a speed of 80 steps (at least) per minute

•Eat less and not more than 80 gm or ml of caloric food each meal.

•Observe cereal fast 80 days in a year.

•Do not smoke or be ready to shell out Rs. 80,000/- for treatment.

•Do not drink alcohol; if you do, do not consume more than 80 ml per day for men (50% for women) or 80 grams per week. Ten grams of alcohol is present in 30 ml or 1 oz of 80 proof liquor.

•If you are a heart patient, consider 80 mg aspirin and 80 mg atorvastatin a day.

•Keep kidney and lung functions more than 80%.

•Avoid exposure to PM 2.5 and PM 10 levels < 90 mcg/m3.

•Avoid exposure to >80 dB of noise.

•Take vitamin D through sunlight 80 days in a year.

•Do 80 cycles of pranayama (parasympathetic breathing) in a day with a speed of 4 per minute.

•Spend 80 minutes with yourself every day (relaxation, meditation, helping others etc.).

Health has been defined by the WHO as “not just the absence of disease, but a state of complete physical, mental and social well-being”.

This means that “the social contexts of health and disease” including socioeconomic status also influence our health.

Stress is one such factor that has an adverse impact on health and well-being. Excessive stress can interfere with your productivity and performance, impact your physical and emotional health and also affect relationships and domestic life.

Financial insecurity can be stressful for the body and the mind.

It physically hurts to be economically insecure, concluded a study published in April 2016 in the journal Psychological Science (Psychol Sci. 2016 Apr;27(4):443-54). Those who reported extremely stressful money or work-related events were at greater risk of metabolic syndrome (Diabetes Care. 2010 Feb;33(2):378-84)

Yet another study published in August 2013 in the journal Social Science & Medicine observed that “high financial debt relative to available assets is associated with higher perceived stress and depression, worse self-reported general health, and higher diastolic blood pressure” (Soc Sci Med. 2013 Aug; 91: 94–100).

People often try to cope with stress by adopting unhealthy behaviors such as overeating or eating unhealthy food, substance or alcohol abuse, tobacco use, social withdrawal; they skip exercise. All these behaviours are linked to lifestyle diseases. Hence, stress is recognized as a risk factor for NCDs.....read more

ADA issues updates to its 2019 Standards of Medical Care in Diabetes

The American Diabetes Association (ADA) has issued three important updates to its 2019 Standards of Medical Care in Diabetes based on recently published literature. These updates principally focus on people with cardiovascular disease and diabetes, and for those with chronic kidney disease (CKD) and diabetes.
The latest updates published March 27, 2019 are as follows:...read more


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