adminMorning Health Talk
New Delhi, April 23, 2018:
Clinical
In a study, in Lancet of over 600,000 drinkers in 19 high-income nations without a history of heart disease weekly consumption of > 100 grams of alcohol ( 30 ml is 10 grams) increased the risk of stroke, heart failure, fatal hypertensive disease and fatal aortic aneurysm. Excessive drinking did appear to reduce the risk of nonfatal heart attacks, but that benefit is more than wiped out by the more serious consequences.
The paper estimates a 40-year-old drinking four units (one unit is 15 grams) a day above the guidelines has roughly two years’ lower life expectancy. This works out at about an hour per day. So it’s as if each unit above guidelines is taking, on average, about 15 minutes of life, about the same as a cigarette.
A study in JAMA Dermatology has demonstrated that young adult men with acne are more likely to have insulin resistance and higher fasting plasma glucose levels than men of the same age without acne.
Sudden death
Acute triggers: In addition to the presence of the underlying disorders of structural heart disease, superimposed triggers include ischemia, electrolyte disturbances (hypokalemia and hypomagnesemia), the proarrhythmic effect of some antiarrhythmic drugs, autonomic nervous system activation, and psychosocial factors. SCA can result from commotio cordis in which VF is precipitated by direct trauma over precordium.
Warning symptoms may precede in a large number of patients, but symptoms may be unrecognized or minimized by patients. n a community-based study of 839 patients with SCA between 2002 and 2012 in whom symptom assessment could be ascertained (either from the surviving patient or from family members, witnesses at the scene of the event, or medical records from the four weeks leading up to the event), 430 patients (51 percent) were identified as having warning symptoms within four weeks preceding SCA. Eighty percent of patients experienced symptoms at least one hour before SCA, with 34 percent having symptoms more than 24 hours before SCA. Chest pain (46 percent) and dyspnea (18 percent) were the most common symptoms, with women more likely to have experienced dyspnea than chest pain (31 versus 24 percent). Patients with symptoms concerning for cardiac disease, particularly new or unstable symptoms, should seek prompt medical care for potentially life-saving evaluation and treatment.
Bag-mask ventilation versus endotracheal intubation for out-of-hospital cardiac arrest: Bag-mask ventilation remains the preferred pre-hospital approach to airway management for cardiac arrest patients. [JAMA. 2018;319(8):779]
AMR
A seven-day course of antibiotic treatment for Gram-negative bacteraemia (GNB) was shown to offer similar patient outcomes as a 14-day course, according to research presented at the 28th European Congress of Clinical Microbiology and Infectious Diseases.
As per ICMR Antimicrobial Resistance Surveillance Network January 2017-December 2017 the commonest species of CoNS are S.haemolyticus and S. epidermidis with the former demonstrating significantly higher levels of drug resistance (MRSH 86.6%, MRSE 61%). Both these species were isolated mostly from blood followed by pus (Coagulase-negative staphylococci)
Polymyxin B and colistin (polymyxin E) are bactericidal drugs that disrupt the outer cell membrane of gram-negative rods and are primarily used for infections with multidrug-resistant Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii. Do not routinely use polymyxin B or colistin for gram-negative pneumonia routinely.
Vedic Medicine
There is a difference between chautha and baithak during mourning. In a baithak which happens daily people come and meet the grieved family for few minutes by turn. In chautha on the other hand people in large number gather and listen to the common prayer. Gathered people are all in a phase of sympathetic overactivity and the only way to shift to parasympathetic mode is by listening to chanting of parasympathetic songs. These songs are based on “Alap’ or vowels and reduces respiratory rate. Most songs chant Rama Rama and not Krishna Krishna. Hey Ram, is typically chanted at the time of death to relieve the miseries.
Medicolegal
The Centre has given its nod to an ordinance to amend the existing Protection of Children from Sexual Offences Act (POCSO) Act, allowing courts to award death penalty to those convicted of raping minors
Public health
1 thumb tip = 1 teaspoon of peanut butter, butter, or sugar; 1 finger = 1 oz. of cheese; 1 fist = 1 cup cereal, pasta, or vegetables; 1 handful = 1 oz. of nuts or pretzels and 1 palm = 3 oz. of meat, fish, or poultry
