Bacterial infections linked to occurrence of manic episodes

Bacterial infections linked to occurrence of manic episodes

Dr KK Aggarwal
Individuals who are hospitalized with acute mania have a considerably higher rate of bacterial infections, as evident by the recent prescription of antimicrobial agents, says a new study published 17th July, 2016 in the journal Bipolar Disorders. Researchers analyzed recent prescription of systemic antimicrobial medications and the site of presumed bacterial infection in 234 individuals hospitalized for acute mania in either as inpatient or a day hospital. Patients hospitalized for other psychiatric disorders (n=368) vs controls (n=555) were also evaluated. • Patients hospitalized with acute mania had a substantially increased rate of recent antimicrobial prescription, defined as exposure within 3 days of ascertainment. • Overall, 7.7% individuals hospitalized for acute mania were prescribed antibiotics vs 1.3% controls. • Antibiotic prescription was associated with being on an inpatient unit vs being in the day hospital, and having increased mania symptom severity but not with other clinical ratings, demographic variables, or psychiatric medications. • The recent antibiotic prescription did not have any association with hospitalization for other psychiatric disorders. The urinary tract was the most common site of infection in women, while the respiratory tract and mucosal surfaces were the most common sites in men. Though the results did not show any cause and effect association, the authors suggest that the prevention and effective treatment of bacterial infections may be important interventions for the management of individuals with mania.

Revisiting Dengue

Revisiting Dengue

Dr K K Aggarwal

• Dengue is a mosquito-borne viral infection transmitted by female Aedes aegypti mosquito.
• Dengue is a notifiable disease. All healthcare providers are required to notify every dengue case to local authorities i.e. District Health Officer/CMO of the district concerned and Municipal Health Officer of the Municipal Corporation/Municipality concerned every week (daily during transmission period) in prescribed format.
• There are four different serotypes of dengue virus: Den 1, Den 2, Den 3 and Den 4. A person can have dengue 4 times during his lifetime.
• Infection from one serotype produces lifelong immunity only for that particular serotype.
• The second dengue infection is usually more severe than the first one.
• The four dengue-related illnesses are: Undifferentiated fever, dengue fever, dengue hemorrhagic fever, dengue shock syndrome.
• The main symptoms of dengue are high fever, severe headache, backache, joint pains, nausea and vomiting, eye pain and rash.
• Retro-orbital pain presenting as pain in the eyes or pressure on eye movement is characteristic of dengue-related fever.
• Dengue hemorrhagic fever is the more severe form of dengue fever.
• A patient can be declared as probable case of dengue only on the basis of RDT technique of testing by using NS1 or IgM (not IgG).
• IgM blood test may take 5 days to become positive.

• The critical period is during defervescence - transition from the febrile to the afebrile stage - and usually occurs after the 3rd day of illness. Often people insist on a discharge from the hospital when the fever is over or do not want to get admitted once the fever is over.
• The two dangerous clinical signs are falling systolic (upper) blood pressure and fall in pulse pressure.
• Platelet transfusion is not required unless platelet count is less than 10,000 or there is presence of spontaneous bleeding.
• A platelet count of less than one lakh signifies dengue hemorrhagic fever or dengue shock syndrome.
• Remember the Formula of 20 to identify high risk patients:

o    Rise in pulse by 20

o    Fall in upper blood pressure by more than 20

o    Rise in hematocrit by more than 20 percent

o    Rapid fall in platelets to less than 20,000

o    More than 20 hemorrhagic spots on the arm in one inch after tourniquet test

o    Difference between upper and lower blood pressure is less than 20

Start fluid replacement at 20 ml/kg/hour immediately in such patients, and shift to nearest medical center for observation. 

·         The best way to reduce chances of getting the infection is to eliminate the places where the mosquito breeds. Plastic containers, buckets, drums etc. that hold water in and around the home should be kept covered or discarded properly. Outdoors, water containers like pet and animal water containers, flower planter dishes should be emptied and scrub cleaned at least once a week.

Burnout syndrome: A Critical Care Societies Collaborative call-to-action statement

Burnout syndrome: A Critical Care Societies Collaborative call-to-action statement Critical care health care professionals have one of the highest rates of burnout syndrome (BOS), compared with other health care professionals, according to a Critical Care Societies Collaborative call-to-action statement published in the July 2016 issue of the journal Chest. The statement has categorized risk factors by personal characteristics, organizational factors, quality of working relationships and exposure to end-of-life issues and calls for healthy ICU work environments that ultimately improve patients’ quality of care. The Critical Care Societies Collaborative (CCSC) comprises four major US professional and scientific societies: the American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society, and the Society of Critical Care Medicine. The statement reviews the diagnostic criteria, prevalence, causative factors and consequences of BOS along with potential interventions that may be used to prevent and treat BOS. • BOS occurs due to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. • The outcomes include increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. • BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. • Being self-critical, engaging in unhelpful coping strategies, sleep deprivation and a work-life imbalance have been identified as some of the personal traits associated with BOS. • Other personal risk factors associated with BOS are idealism, perfectionism and overcommitment, qualities that are often found in the best and most productive employees. • Critical care health-care professionals and their friends and family should be able to recognize the features of BOS and each critical care health-care professional should be personally responsible for managing their own BOS symptoms and related consequences • ICU teams should improve their ability to function as a group, respect each other, and reduce triggers of BOS. • ICU leaders should implement programs that identify and manage employees with BOS. • Hospitals should provide assistance programs for employees with (or at risk for) BOS and other psychological disorders such as PTSD. • Hospitals or clinical practices should consider limiting the number of consecutive days that a critical care health-care professional works, while promoting healthy sleep habits and the importance of sleep recovery. • Professional societies should educate and inform their members about BOS and other psychological disorders that impair the mental and physical health of their members, reduce the quality of care of their patients, and may deter trainees from entering their specific field.

Updated HIV guidelines integrate treatment and prevention

Updated HIV guidelines integrate treatment and prevention

Dr K K Aggarwal

The International Antiviral Society-USA panel on antiretroviral (ARV) drug therapy for HIV infection has released updated recommendations, which for the first time, have integrated treatment and prevention. The guidelines say that ARVs remain the cornerstone of HIV treatment and prevention and when used effectively, currently available ARVs can sustain HIV suppression and can prevent new HIV infection. The guidelines “Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults2016 Recommendations of the International Antiviral Society–USA Panel” are published July 12, 2016 in JAMA. Some key recommendations are: • Antiretroviral therapy (ART) should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count. • The recommended optimal initial regimens include an integrase strand transfer inhibitor (InSTI) + 2 nucleoside reverse transcriptase inhibitors (NRTIs). Other effective regimens include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with 2 NRTIs. • ART should be started within the first 2 weeks after diagnosis for most acute opportunistic infections, with the possible exception of acute cryptococcal meningitis. • Reasons for switching therapy include convenience, tolerability, simplification, anticipation of potential new drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, or drug toxicities. • Laboratory assessments are recommended before treatment, and monitoring during treatment is recommended to assess response, adverse effects, and adherence. If ART is being initiated on the first clinic visit, all laboratory specimens should be drawn prior to the first dose of ART; resistance testing results should be used to modify the regimen as necessary. Recommended pre-ART tests include CD4 cell count, plasma HIV-1 RNA, serologies for hepatitis A, B, and C, serum chemistries, estimated creatinine clearance rate, complete blood cell count, urine glucose and protein, sexually transmitted infection screening, and fasting lipid profile. Genotypic testing for reverse transcriptase and protease resistance mutations is also recommended pre-ART. • Systematic monitoring of time to care linkage following initial HIV diagnosis, retention in care, ART adherence, and rates of viral suppression is recommended in all care settings. • Preexposure prophylaxis should be considered as part of an HIV prevention strategy for at-risk individuals. Daily, rather than intermittent, tenofovir disoproxil fumarate/emtricitabine is the recommended PrEP regimen. Detailed sexual, substance use, and medical histories are important for deciding whether to provide PrEP. • The guidelines recommend vaccination against hepatitis A and hepatitis B for those who are not immune and human papillomavirus vaccination. • Postexposure prophylaxis is recommended as soon as possible after exposure without waiting for confirmation of HIV serostatus of the source patient or results of HIV RNA or resistance testing. Postexposure prophylaxis regimens should be continued for 28 days, and HIV serostatus should be reassessed at 4 to 6 weeks, 3 months, and 6 months after exposure.

Eating more fruits and vegetables predict happiness and satisfaction with life

Eating more fruits and vegetables predict happiness and satisfaction with life

Dr K K Aggarwal

New research suggests that eating more fruits and vegetables can also increase levels of happiness later in life. In a study to be published in the American Journal of Public Health, researchers found that alterations in fruit and vegetable intake were predictive of later alterations in happiness and satisfaction with life. 

People who had been eating almost no fruits and vegetables and changed their diet to include fruits and vegetables per day experienced an increase in life satisfaction comparable to finding employment from an unemployed state. Their level of happiness increased incrementally for each extra daily portion of fruit and vegetables up to eight portions per day. The improvement in well-being was observed within 2 years of the study participants improving their diet.

The study examined food diaries of 12,385 randomly sampled Australian adults over 2007, 2009, and 2013 in the Household, Income, and Labour Dynamics in Australia Survey.

A collaboration between the University of Warwick, England and the University of Queensland, Australia, it is one of the first major scientific attempts to explore psychological well-being beyond the well-known finding that fruits and vegetables can reduce risk of diabetes, cancer and heart attacks. 

(Source: Science Daily)

New IDSA guidelines for the management of aspergillosis

New IDSA guidelines for the management of aspergillosis

Dr K K Aggarwal
Early diagnosis and treatment of the major forms of aspergillosis are the focus of a new practice guideline from the Infectious Diseases Society of America (IDSA). Some key recommendations are: • Hospitalized allogeneic hematopoietic stem cell transplant recipients should be placed in a protected environment to reduce mold exposure. These precautions can be reasonably applied to other highly immunocompromised patients at increased risk for invasive aspergillosis (IA), such as patients receiving induction/reinduction regimens for acute leukemia. • Until molecular tools are more widely used in clinical laboratories, tissue and fluid specimens be submitted in adequate quantities for simultaneous histopathologic/cytologic and culture examination. • Serum and BAL galactomannan (GM) is recommended as an accurate marker for the diagnosis of IA in adult and pediatric patients when used in certain patient subpopulations (hematologic malignancy, HSCT). • GM is not recommended for routine blood screening in patients receiving mold-active antifungal therapy or prophylaxis or for screening in solid organ transplant recipients or patients with chronic granulomatous disease (CGD) • A chest CT scan is recommended if there is clinical suspicion of invasive pulmonary aspergillosis (IPA). But routine use of contrast during CT chest is not recommended to screen for IPA. • Voriconazole is recommended for primary treatment of IPA; some high-risk patients may need combination therapy with voriconazole and echinocandin. Antifungal therapy for IPA should continue for at least 6 to 12 weeks. The new guidelines are published online June 29, 2016 in the journal Clinical Infectious Diseases.

Sedentary white-collar workers should consider walking meetings for better health

Sedentary white-collar workers should consider walking meetings for better health

Dr K K Aggarwal

Changing traditional seated meetings at work into a walking meeting increased the work-related physical activity levels of white-collar workers by 10 minutes, says a new study published in Preventing Chronic Disease, a journal of the Centres for Disease Control and Prevention (CDC).

The Walking Meeting (WaM) Pilot Study, Miami, 2015 examined opportunities to increase physical activity in the workplace among sedentary white-collar workers. Workers, mean age 39.8 years, who conducted weekly meetings in groups of 2 or 3 individuals from January 2015 to August 2015 were recruited for the study. The researchers developed a 7-item core component walking meeting protocol that included a safe 25- to 30-minute walking path on the university campus.

·         Set a time and place to meet before your WaM.

·         Create an agenda for your WaM.

·         To make the walk more comfortable, bring items such as water, sunglasses, and sunscreen. Wear comfortable shoes.

·         Have the group leader assign roles to each walking meeting group member. (i.e., time checker, note taker, path leader).

·         Follow the prescribed route.

·         Walk for 30 minutes minimum.

·         After the walking meeting, sit and conclude to wrap up meeting; take care of paperwork or other tasks that could not be accomplished during WaM.

Data analysis showed that walking meetings, a simple modification of traditional seated meetings, were not only well accepted by the study population, they were also easy to implement and feasible to conduct during regular working hours. Among the 8 participating groups, 7 completed both walking meetings. All groups walked from 30 to 40 minutes. The study found that the sit-and-conclude session and creating an agenda were the least frequently completed components.

The various health benefits of walking are well recognized. And, that a sedentary lifestyle has negative health effects is also well known. Physical activity is recommended for all ages.

White collar workers or people who have desk jobs spend most of their working hours sitting in chairs. Interventions such as this that encourage walking and physical activity in the workplace are needed to counter the negative health effects of sedentary behavior.

The body’s immunity reduces during the monsoon season

The body’s immunity reduces during the monsoon season New Delhi, July 4, 2016: After the hot summers, monsoons are welcomed by all. However, the monsoon season also means the onset of many diseases and reduced immunity. According to Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA, "The diseases associated with monsoon are malaria, dengue, Chikungunya, jaundice, and gastrointestinal infections like typhoid and cholera. Apart from these, viral infections like cold and cough are also common”.
Patients with Chikungunya typically have joint pain that is relieved by flexing the limbs. Dengue, if not adequately managed, can be fatal in 1% of the cases. Chikungunya, though not fatal, can cause chronic debilitating joint pains that can sometimes last for years. Management of dengue involves fluid resuscitation and not platelet resuscitation. If enough fluids are given, mortality can be reduced. The mortality period usually starts when the fever subsides. Misusing anti-fever medicines can precipitate bleeding in dengue patients.
The water that gets collected due to rain becomes a breeding ground for mosquitoes. As contamination of drinking water is common during monsoons, it is important to drink clean and pure water to prevent diarrhea and gastrointestinal infections.
Walking in dirty water during rainy season leads to numerous fungal infections, which affect the toes and nails. Diabetic patients should take special care of their feet and be aware of infections affecting the toes and nails. Feet should always be kept dry and clean. Avoid walking in dirty water. Keep shoes, socks, and raincoats dry and clean.
In the case of asthmatic patients, precautions should be taken to prevent dampness and growth of fungus (mould) in and around the house. Fumigation should also be avoided.
During this season, underground worms come to the surface and contaminate the surface vegetables. In the presence of weak digestive fire, this can cause gastric disturbances. It is because of this reason that community lunches and marriages are avoided in this season. It is better to eat light foods and consume barley, rice, and wheat. Water should be boiled before use. Eat warm food and add ginger and greens to your daily diet.