Food poisoning reported as one of the commonest disease outbreaks in India

Health Care, Heart Care Foundation of India, Medicine Comments Off

Hand washing and food hygiene play an important role in preventing this condition


New Delhi, 04 January 2018:
Recent government data has indicated food poisoning as one of the commonest outbreaks reported in India, next to acute diarrheal disease (ADD).

Statistics indicate that out of the 1,649 disease outbreaks reported till December 2017, 312 were due to ADD and 242 were that of food poisoning. The incidence is more in areas that have bulk production of food such as canteens, hostels, and wedding venues.

Food poisoning, also called food borne illness, is illness caused by eating contaminated food. Infectious organisms — including bacteria, viruses and parasites — or their toxins are the most common causes of food poisoning. Infectious organisms or their toxins can contaminate food at any point of processing or production. Contamination can also occur at home if food is incorrectly handled or cooked.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “Food-borne illnesses or food poisoning usually occurs due to eating food that is contaminated with bacteria or their toxins. Virus and parasites can also be cause food poisoning. People have known for long that raw meat, poultry and eggs can also harbor diseases causing microbes. But in recent years most outbreaks of food borne illnesses have been due to fresh fruits and vegetables. Food poisoning can cause abdominal pain, nausea, headache, fatigue, vomiting, diarrhea and dehydration. The most common serious complication of food poisoning is dehydration — a severe loss of water and essential salts and minerals. Symptoms may appear several hours to several days after eating tainted food. For example, Salmonella bacteria will cause illness 12 hours to 3 days after ingestion lasting about 4 to 7 days.”

It is important to differentiate poisoning due to preformed toxins or due to live organisms. While the first one will present within 6 hours and will have predominant vomiting the later will have predominant diarrhea and will present later.  Both may be self limiting requiring no antibiotics.

Pathogens can be found on almost all the food that humans eat. However, heat from cooking usually kills pathogens on food before it reaches our plate. Foods eaten raw are common sources of food poisoning because they don’t go through the cooking process.

Adding further, Dr Aggarwal, Vice President CMAAO, said, “Anyone can get food poisoning. However, certain groups are more at risk. This includes anyone with a suppressed immune system or an auto-immune disease, pregnant women, elderly individuals, and children. All these are categories of people with a weaker immunity and therefore, easily susceptible.”

  • Although the symptoms of food poisoning settle and disappear in about 48 hours, the following tips can help in coping with the condition.
  • Let your stomach settle. Stop eating and drinking for a few hours.
  • Try sucking on ice chips or taking small sips of water. When you’re urinating normally and your urine is clear and not dark, this means the body is hydrated enough.
  • Ease back into eating. Gradually begin to eat bland, low-fat, easy-to-digest foods, such as crackers, toast, bananas and rice. Stop eating if your nausea returns.
  • Avoid certain foods and substances until you’re feeling better. These include dairy products, caffeine, alcohol, nicotine, and fatty or highly seasoned foods.
  • Rest. The illness and dehydration can weaken and tire you.

WHO first-ever list of antibiotic-resistant

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A new study by researchers at Harvard University of all 48 million Americans aged 65 and older on Medicare found people were dying after just a single day of breathing air that met federal standards, but was somewhat dirty. The study was published Tuesday in JAMA. Environmental Protection Agency sets safety standards and if pollution is below that standard, everyone is safe but the same is not correct. There is no safe level of exposure to either pollutant.
Decades of research, big health schemes of the Delhi government– treatment for road and fire accident and acid attack victims, outsourcing of high-end diagnostic tests and sincluding a new study published December 26 in JAMA has failed to find substantial evidence that vitamins and supplements do any significant good.
Delhi LG gave a nod to threeurgeries. He has given a nod to the amendment in the Delhi Arogya Kosh (DAK), which would help pay for the free diagnostic tests and surgeries. LG, however, asked the government to maintain an income ceiling for the people who would be allowed to avail the benefits of the scheme “so that the resources of the government are used to help the poor and the needy and the poor are not crowded out by the well-to-do”. With recent cases of medical negligence and malpractices in private hospitals, the LG also urged the government to have a mechanism to penalize institutions in case of malpractice or even poor quality of services.
Nabarangpur: A district consumer forum has ordered a doctor of the Christian Hospital here to pay a compensation of Rs 20 lakh for “deficiency of service and medical negligence”, which left a pregnant woman paralysed on the lower part of her body (paraplegia), seven years ago. Sabina, a Bachelor of Physiotherapy was administered anesthesia as many as seven times by Dr Nag on May 19, 2010 while performing cesarean delivery, even though the latter was not qualified as MD (Anesthetist) and did so after her repeated refusal.
In a shocking case from Argentina, doctors accidentally tore off an infant’s head during a delivery. The incident occurred as they were trying to deliver a premature baby when the child got stuck inside.
WHO published its first ever list of antibiotic-resistant “priority pathogens” – a catalogue of 12 families of bacteria that pose the greatest threat to human health. The WHO list is divided into three categories according to the urgency of need for new antibiotics: critical, high and medium priority. The most critical group of all includes multidrug resistant bacteria that pose a particular threat in hospitals, nursing homes, and among patients whose care requires devices such as ventilators and blood catheters. They include Acinetobacter, Pseudomonas and various Enterobacteriaceae (including Klebsiella, E. coli, Serratia, and Proteus). They can cause severe and often deadly infections such as bloodstream infections and pneumonia. These bacteria have become resistant to a large number of antibiotics, including carbapenems and third generation cephalosporins – the best available antibiotics for treating multi-drug resistant bacteria. The second and third tiers in the list – the high and medium priority categories – contain other increasingly drug-resistant bacteria that cause more common diseases such as gonorrhea and food poisoning caused by salmonella.
Drugs banned in 2017:Fixed dose combinations of nimesulide + levocetirizine; fixed dose combinations of ofloxacin + ornidazole injection; fixed dose combinations of gemifloxacin + ambroxol; fixed dose combinations of glucosamine + ibuprofen and fixed dose combinations of etodolac + paracetamol.
In a new essay publishing 28 December in the open access journal PLos Biology, Kristofer Wollein Waldetoft and Sam P. Brown of Georgia Institute of Technology propose that development of alternative therapies for mild infections could help slow the development and spread of antibiotic resistance, thereby preserving the drugs effectiveness for use in severe infections.
Do not routinely administer prophylactic antibiotics in low-risk laparoscopic procedures:The use of prophylactic antibiotics in women undergoing gynecologic surgery is often inconsistent with published guidelines. Although the appropriate use of antibiotic prophylaxis for hysterectomy is high, antibiotics are increasingly being administered to women who are less likely to receive benefit. The potential results are significant resource use and facilitation of antimicrobial resistance.
Avoid the unaided removal of endometrial polyps without direct visualizationwhen hysteroscopic guidance is available and can be safely performed: Endometrial polyps are a common gynecologic disease. Though conservative management may be appropriate in some patients, hysteroscopic polypectomy is the mainstay of treatment. Removal without the aid of direct visualization should be avoided due to its low sensitivity and negative predictive value of successful removal compared to hysteroscopy and guided biopsy.
Dr KK Aggarwal

Padma Shri AwardeeVice President CMAAOGroup Editor-in-Chief IJCP Group

President Heart Care Foundation of India

Immediate Past National President IMA

New ACC/AHA guidelines: Treat high BP early at 130/80 mm Hg rather than 140/90

Health Care Comments Off
         Seventeen people across 13 states, including one person in New York, have been
affected by an E. coli diarrhea outbreak, according to the US Centers for Disease Control and
Prevention (CDC).
         What were the findings of the DUNE study (Meneghini et al) of achievement of
individualized glycated hemoglobin (HbA1c) targets of 7.0% to 7.5% after 12 weeks of
treatment with basal insulin in a real-world setting? The DUNE study had a large, real-world
population of patients either newly initiated on basal insulin or who had taken it for less than
12 months. Only 27.4% of patients achieved the individualized HbA1c set by their physician,
even though at 7.0% to 7.5% the targets were not stringent. This finding was consistent with
other real-world data and highlights the lack of effective titration of insulin in the real world. A
key finding was that participants who experienced symptomatic hypoglycemia were more
likely to achieve their HbA1c target than those who did not.
         A comparison of the 2016 US Preventive Services Task Force (USPSTF)
recommendations for statin therapy and the 2013 ACC/AHA Guideline on the treatment of
blood cholesterol to reduce atherosclerotic cardiovascular risk in adults, showed that more
patients would be recommended for statin therapy under the ACC/American Heart
Association (AHA) guidelines, according to a study published April 18 in JAMA. The 2013
ACC/AHA guidelines are based on an elevated 10-year risk of atherosclerotic cardiovascular
disease (ASCVD), while the 2016 USPSTF recommendations for primary prevention statin
therapy increased the estimated ASCVD risk threshold for patients (including those with
diabetes) and required the presence of at least one cardiovascular risk factor (i.e.,
hypertension, diabetes, dyslipidemia, or smoking), in addition to elevated risk.
         The ACC, with the American Heart Association (AHA) and the Heart Rhythm Society
(HRS), released the first guideline for the evaluation and management of patients with
syncope. The guideline was published March 9 in the Journal of the American College of
Cardiology.
o    If a patient faints, a physician should perform a detailed history and physical
examination during the initial evaluation. Using an electrocardiogram during this time
may be useful to determine the cause of fainting. People with serious medical conditions
that could be related to their fainting should be evaluated and/or treated at a hospital
after the initial assessment.
o    The guideline also explains that certain tests such as routine laboratory testing and
routine cardiac imaging may not be useful in evaluating these patients unless the unless
the patient has a suspected cardiac issue. Carotid artery or head imaging may not be
useful unless there is a specific reason why the patient needs to be evaluated further.
o    Depending on the reason for fainting, treatment options may include implantable
cardioverter-defibrillators (ICDs), beta-blockers or pacemakers. Patients who faint and
who also have certain types of heart issues should restrict their exercise, and athletes
who experience fainting should have a heart assessment done by an experienced health
care provider or specialist before returning to competitive sports. Heart rhythm
monitoring can be a good choice for patients with unexplained fainting who may have
intermittent heart rhythm issues that cause fainting.
         Patients with atrial fibrillation who are taking digoxin have an increased risk of death,
whether or not they have heart failure, compared with patients not taking the drug. This risk
increases with higher levels of digoxin in the bloodstream, according to research presented
from the ARTISTOTLE trial by Renato Lopes, MD, PhD, FACC, on March 19 at ACC.17, the
annual meeting of the American College of Cardiology (ACC) in Washington, DC.
         The addition of evolocumab, a PCSK9 inhibitor, to statin therapy over several years
significantly reduced cardiovascular morbidity and mortality in patients with clinically evident
atherosclerotic cardiovascular disease, according to results from the FOURIER trial presented
on Friday, March 17 during the first Late Breaking Clinical Trial session of ACC.17 in
Washington, DC and simultaneously published in the New England Journal of Medicine.
         Treatment with a sodium glucose cotransporter-2 inhibitor (SGLT-2i) was associated with
a marked reduction in hospitalization for heart failure vs treatment with other glucose-lowering
drugs, according to research presented by Mikhail Kosiborod, MD, FACC, on March 19 at
ACC.17 in Washington, DC.
         Catheter ablation improved outcomes for patients with atrial fibrillation (AFib) and left
ventricular dysfunction, compared to conventional drug treatment, based on results from the
CASTLE-AF trial presented on Aug. 27 at the ESC Congress 2017 in Barcelona.
         High blood pressure (BP) should be treated earlier with lifestyle changes and in some
patients with medication – at 130/80 mm Hg rather than 140/90 – based on new ACC/AHA
guidelines for the detection, prevention, management and treatment of high blood pressure.
o    The new guidelines – the first comprehensive set since 2003 – lower the definition
of high blood pressure to account for complications that can occur at lower numbers
and to allow for earlier intervention. The new definition will result in nearly half of the
U.S. adult population (46 percent) having high blood pressure, with the greatest
impact expected among younger people. Additionally, the prevalence of high blood
pressure is expected to triple among men under age 45, and double among women
under 45. However, only a small increase is expected in the number of adults
requiring antihypertensive medication.
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in- chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

         Seventeen people across 13 states, including one person in New York, have beenaffected by an E. coli diarrhea outbreak, according to the US Centers for Disease Control andPrevention (CDC).          What were the findings of the DUNE study (Meneghini et al) of achievement ofindividualized glycated hemoglobin (HbA1c) targets of 7.0% to 7.5% after 12 weeks oftreatment with basal insulin in a real-world setting? The DUNE study had a large, real-worldpopulation of patients either newly initiated on basal insulin or who had taken it for less than12 months. Only 27.4% of patients achieved the individualized HbA1c set by their physician,even though at 7.0% to 7.5% the targets were not stringent. This finding was consistent withother real-world data and highlights the lack of effective titration of insulin in the real world. Akey finding was that participants who experienced symptomatic hypoglycemia were morelikely to achieve their HbA1c target than those who did not.          A comparison of the 2016 US Preventive Services Task Force (USPSTF)recommendations for statin therapy and the 2013 ACC/AHA Guideline on the treatment ofblood cholesterol to reduce atherosclerotic cardiovascular risk in adults, showed that morepatients would be recommended for statin therapy under the ACC/American HeartAssociation (AHA) guidelines, according to a study published April 18 in JAMA. The 2013ACC/AHA guidelines are based on an elevated 10-year risk of atherosclerotic cardiovasculardisease (ASCVD), while the 2016 USPSTF recommendations for primary prevention statintherapy increased the estimated ASCVD risk threshold for patients (including those withdiabetes) and required the presence of at least one cardiovascular risk factor (i.e.,hypertension, diabetes, dyslipidemia, or smoking), in addition to elevated risk.          The ACC, with the American Heart Association (AHA) and the Heart Rhythm Society(HRS), released the first guideline for the evaluation and management of patients withsyncope. The guideline was published March 9 in the Journal of the American College ofCardiology. o    If a patient faints, a physician should perform a detailed history and physicalexamination during the initial evaluation. Using an electrocardiogram during this timemay be useful to determine the cause of fainting. People with serious medical conditionsthat could be related to their fainting should be evaluated and/or treated at a hospitalafter the initial assessment. o    The guideline also explains that certain tests such as routine laboratory testing androutine cardiac imaging may not be useful in evaluating these patients unless the unless
the patient has a suspected cardiac issue. Carotid artery or head imaging may not beuseful unless there is a specific reason why the patient needs to be evaluated further. o    Depending on the reason for fainting, treatment options may include implantablecardioverter-defibrillators (ICDs), beta-blockers or pacemakers. Patients who faint andwho also have certain types of heart issues should restrict their exercise, and athleteswho experience fainting should have a heart assessment done by an experienced healthcare provider or specialist before returning to competitive sports. Heart rhythmmonitoring can be a good choice for patients with unexplained fainting who may haveintermittent heart rhythm issues that cause fainting.
         Patients with atrial fibrillation who are taking digoxin have an increased risk of death,whether or not they have heart failure, compared with patients not taking the drug. This riskincreases with higher levels of digoxin in the bloodstream, according to research presentedfrom the ARTISTOTLE trial by Renato Lopes, MD, PhD, FACC, on March 19 at ACC.17, theannual meeting of the American College of Cardiology (ACC) in Washington, DC.          The addition of evolocumab, a PCSK9 inhibitor, to statin therapy over several yearssignificantly reduced cardiovascular morbidity and mortality in patients with clinically evidentatherosclerotic cardiovascular disease, according to results from the FOURIER trial presentedon Friday, March 17 during the first Late Breaking Clinical Trial session of ACC.17 inWashington, DC and simultaneously published in the New England Journal of Medicine.          Treatment with a sodium glucose cotransporter-2 inhibitor (SGLT-2i) was associated witha marked reduction in hospitalization for heart failure vs treatment with other glucose-loweringdrugs, according to research presented by Mikhail Kosiborod, MD, FACC, on March 19 at ACC.17 in Washington, DC.          Catheter ablation improved outcomes for patients with atrial fibrillation (AFib) and leftventricular dysfunction, compared to conventional drug treatment, based on results from theCASTLE-AF trial presented on Aug. 27 at the ESC Congress 2017 in Barcelona.          High blood pressure (BP) should be treated earlier with lifestyle changes and in somepatients with medication – at 130/80 mm Hg rather than 140/90 – based on new ACC/AHAguidelines for the detection, prevention, management and treatment of high blood pressure. o    The new guidelines – the first comprehensive set since 2003 – lower the definitionof high blood pressure to account for complications that can occur at lower numbersand to allow for earlier intervention. The new definition will result in nearly half of theU.S. adult population (46 percent) having high blood pressure, with the greatestimpact expected among younger people. Additionally, the prevalence of high bloodpressure is expected to triple among men under age 45, and double among women
under 45. However, only a small increase is expected in the number of adultsrequiring antihypertensive medication.
Dr KK AggarwalPadma Shri AwardeeVice President CMAAOGroup Editor-in- chief IJCP PublicationsPresident Heart Care Foundation of IndiaImmediate Past National President IMA