Loneliness and isolation are just two side effects of constant smartphone usage

Health Care, Heart Care Foundation of India, Social Health Community Comments Off

Take a social media holiday and keep phones away unless absolutely needed

New Delhi, 11th June 2018: Overuse of smartphones is akin to substance abuse and addiction, as per a recent study. People who use phones a lot seem to suffer from increased levels of feeling isolated, lonely, depressed and anxious. People who are extreme smartphone users constantly switch between activities and find it hard to focus. There is a need to create awareness that such an addiction can leave us with little time to relax and rejuvenate, particularly mentally.

Addiction to social media technology can have a negative effect on social connections. The accompanying loneliness is partly a consequence of replacing face-to-face interaction with a form of communication where body language and other signals cannot be interpreted.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “Push notifications, vibrations, and other alerts on our phones and computers make us feel compelled to look at them constantly. This, as per research, seems to trigger the same kind of neural pathways as during an imminent attack by a predator or in the face of some danger. This further means that our brain is constantly active and alert, albeit in a way that is not healthy for its functioning. We constantly seek that activity, and in the absence of it feel restless, agitated and lonely. There are certain other side effects of constant smartphone use. Ringxiety is the anxiety resulting due to not receiving a call in the last 30 minutes. It is present in the 30% of the mobile users. Phantom ringing is present in 20% to 30% of mobile users. You can feel that your phone is ringing but when you check, it is not.”

Smartphone is also a cause for parent-child conflict in 30% of the cases. Often children get up late and end up going to school unprepared. On an average, people spend 30 to 60 minutes in the bed playing with the smart phone before sleep.

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “Having access to so many different streams of information through gadgets has been found to decrease the brain’s grey matter density, which is responsible for cognition and emotional control. In this digital era, the key to good health should be moderation i.e. moderate use of technology. Most of us have become slaves to devices that were really meant to free us and give us more time to experience life and be with people. And we are leading our children in the same path as well.”

Some tips from HCFI
• Electronic curfew means not using any electronic gadgets 30 minutes before sleep.
• Facebook holiday: Take a Facebook holiday for 7 days every three months.
• Social media fast: Avoid use of social media once in a week for the entire day.
• Use your mobile phone only when mobile.
• Do not use computer for more than three hours in a day.
• Limit your mobile talk time to more than two hours in a day.
• Do not recharge your mobile battery more than once in a day.
• Mobile can also be a source of infection in the hospital setup; therefore, it is disinfected every day.

Metformin may now be safely used in patients with mild to moderate renal impairment

Health Care, Medicine Comments Off

Metformin is the first-line oral antidiabetic drug for most patients with type 2 diabetes mellitus.Its advantages are good glycemic control; it also does not cause hypoglycaemia weight gain. Metformin is eliminated by the kidneys; hence, its use in chronic kidney disease has been restricted. Lactic acidosis has been reported with the use of metformin, which occurs when metformin accumulates in conditions of acute or progressive renal failure, acute or progressive heart failure, acute pulmonary decompensation, sepsis, dehydration. A rare side effect, but has a high case fatality rate.

Metformin was earlier indicated for use in patients with kidney disease with eGFR >60 mL/min/1.73 m2. It was contraindicated when serum creatinine level was > 1.4 mg/dL in woman and 1.5 mg/dL in men, and eGFR < 60 mL/min.

Then in 2012, the Kidney Disease Outcomes Quality Initiative(K/DOQI)guidelines recommended that metformin may be used among patients with an eGFR >45mL/min/1.73 m2. And, it is to be avoided in patients in whom the eGFR is <30mL/min/1.73 m2because of an increased risk of lactic acidosis.

In 2016, in what can be termed as a practice changing update, the US FDA revised its labelling of metformin to indicate that it may now be safely used in patients with mild to moderate renal impairment (30 to 60 mL/min/1.73 m2) but not in patients with severe renal impairment (<30 mL/min/1.73 m2).The labelling changes include:

Obtain eGFR before initiating treatment with metformin.
Use of metformin in patients with an eGFR below 30 mL/minute/1.73 m2is an absolute contraindication.
Starting metformin in patients with an eGFR between 30-45 mL/minute/1.73 m2is not recommended.
Prescribe full dose in patients with eGFR ≥45mL/min.
In patients with no active kidney disease and an eGFR of 30 to 44mL/min, reduce metformin dose by half.Monitor kidney function frequently.
eGFR should be obtained at least annually in all patients on metformin. In patients at increased risk for the development of renal impairment such as the elderly, renal function should be assessed more frequently.
In patients taking metformin whose eGFR later falls below 45 mL/minute/1.73 m2, assess the benefits and risks of continuing treatment.If the eGFR later falls below 30 mL/minute/1.73 m2, then discontinue metformin.
Discontinue metformin at the time of / prior to an iodinated contrast imaging procedure in patients with an eGFR between 30 and 60 mL/minute/1.73 m2; in patients with a history of liver disease, alcoholism, or heart failure; or in patients who will be administered intra-arterial iodinated contrast. Re-evaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable.
(Source: Uptodate, US FDA)

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