Thursday, September 03, 2009

My Radio Talk on Big 92.7 FM

Just gave a talk on the common ear problems in children, including ear pain and infections and tips on ear cleaning, to the Chandigarh edition of BIG 92.7 FM.
Some photographs from the event, I enjoyed it.
I have been planning for an audioblog/ podcast, want to spread the word around - however unsure of the potential audience, and of course the time for the same ...
Any comments would be really appreciated

Wednesday, September 02, 2009

Influenza Vaccine - Now Available for season 2009 -2010 in India - FAQs

Influenza (also called "the flu") is a viral infection in the nose, throat and lungs. About 10 to 20 percent people get the flu each year. Some people get very sick. Tens of thousands die every year in India because of the flu and complications.

What are the Symptoms of FLU?

The flu may cause fever, cough, sore throat, a runny or a stuffy nose, headache, muscle aches and tiredness. Some people describe the flu as the worst cold of their life. If you get the flu, you should feel better after one or two weeks. But in some people, the flu leads to serious, even life-threatening diseases, like pneumonia. Some people are more likely to get the serious complications. A vaccine (the flu shot) is recommended for these high-risk people to protect them from the flu.

Who is at higher risk?

You have a higher risk of flu complications if you:

  • Less than 5 years age
  • Are 60 years of age or older
  • Are a doctor, nurse or working in a hospital
  • Have a lung problem, such as asthma or emphysema
  • Have Diabetes
  • Have a suppressed immune system
  • Have a problem with your kidneys
  • Have heart disease or other long-term health problems

If you are in any of these risk groups, you should get the flu vaccine every year.

Even if you're not at higher risk, you may want to get the flu vaccine so you don't get sick with the flu.

What is the flu vaccine?

The flu vaccine is an injection. It contains killed viruses. You can't get the flu from the vaccine because the viruses are dead. Instead, the vaccine protects you from the flu. When a "live" virus shows up, your defenses are ready. These defenses keep you from getting the flu. Because flu viruses change from year to year, you must get the shot each year to be protected.

When should I get the vaccine?

You should get the vaccine at the beginning of the flu season, sometime in September onwards. You can get the shot later in the year too, but because flu season usually begins in the winter months, it would be best to be protected before that time.

If I get a flu shot, can I still get the flu?

Yes. Even with a flu shot, you aren't 100 percent protected. Each year, the flu vaccine contains three different strains (kinds) of the virus. Depending on the strains used, the Flu vaccine is 70 to 90 percent effective in preventing the flu in healthy people under 65 years of age. If you're older than 65, the vaccine is less likely to prevent the flu. Even if you get the flu after the vaccine, your flu symptoms should be milder than if you didn't get the vaccine. You'll also be less likely to get complications from the flu.

Is the vaccine safe?

Yes. The flu vaccine is safe for all age groups over six months of age. There are very few side effects too. Your arm may be sore for a few days. You may have a fever, feel tired or have sore muscles for a short time. If you have a severe allergy to eggs, you shouldn't get the shot.

Do you take the FLU vaccine?

Yes, I have personally been taking the FLU vaccine for the last 3 years, ever since it was made available in India.

Will the vaccine be effective against swine flu?

As of now we do not really know, however we must remember that Seasonal Flu kills far more people than Swine Flu, and it is as serious a disease. For the high risk people mentioned above, taking this vaccine is a great way to reduce complications from this common disease.

Dr Gaurav Gupta

Child Specialist,

Charak Clinics, Phase VII, Mohali

91-172-5092585, 91-172-4663775

Friday, August 14, 2009

Some newborn frequently asked questions that I receive from parents

This is the response to a recent email I received from the excited and a bit apprehensive parents of a newly born
  1. Which medicine or any solution is best to stop the milk spit when a child drinks the milk and spit after drinking it ?

    In most cases, NONE. If the baby is gaining weight, then generally no medicine is recommended for REFLUX (spitting milk). A good burp and keeping the child's head elevated after feed, should help reasonably in most cases.
    Read more here
  2. Which medicine is best to control cold ?
    In most cases in small babies, just saline nasal drops (NASOCLEAR) are sufficient in treating a mild cold. If the child is irritable, CROCIN drops maybe used too.
  3. Which medicine is best to control cough ?
    Small babies less than 6 months old - NONE,
  4. Which medicine is best to control fever ?
    CROCIN - Dose is calculated as a simple formula, CROCIN DROPS upto 4 times / day, no. of drops = double the weight, for example 3 kg child = 6 drops, 4 kg child = 8 drops every time, AS NEEDED.
  5. Which medicine is best for control the loose motion ?
    SPORLAC / ECONORM packets 1 pkt twice a day mixed with 2 teaspoon of Expressed Breast milk OR boiled & cooled water / filter water.
  6. Which medicine is best for stomach ache ?
    COLIC AID drops 3-5 drops 3-4 times/ day
  7. How to recognize stomach ache ?
    Can be difficult, excessive crying without any specific cause, like a hungry, thirsty, excessively warm/ cold/ wet child, may all be attributed to stomach ache. Even a pediatrician may not really be sure about a stomach ache in many cases !
  8. What are the other useful tonics for baby's good health ?
    None needed for a healthy good weight baby. Only thing I would recommend - MOTHER'S MILK ONLY (nothing else) for the first 6 months of life
  9. What is the tip for shoulder ace ....some time some people says shoulder has moved or changed the place ( Kandha Utar jaana) ?
    No medical disease as far as modern medicine goes. If the child appears in pain due to any reason, you can give CROCIN
  10. What are the best powder for making child's health and intelligent ?
    None are proved to work, otherwise wouldn't we all be taking them ! EXCLUSIVE BREAST FEEDING for the first 6 months is the BEST gift that you can give to your baby.
Hope this helps :)

Wednesday, August 12, 2009

Swine Flu - A detailed Fact File with special reference to India

What are the symptoms?

Swine flu symptoms are similar to the symptoms of regular flu and include fever of over 100.4°F, fatigue, lack of appetite, and cold. Some people with swine flu have also reported runny nose, sore throat, nausea, vomiting and diarrhoea. Nearly everyone with flu has at least two of these symptoms.

So, how do you know if you have flu or just cold?

There is one clue: when you have the flu, you feel flu symptoms sooner than you would cold symptoms, and they come on with much greater intensity. With the flu, you may feel very weak and fatigued for up to 2 or 3 weeks. You'll have muscle aches and periods of chills and sweats as fever comes and goes. You may also have a stuffy or runny nose, headache, and sore throat.

Can I compare flu symptoms with cold symptoms?

Yes. The following chart can help you compare flu symptoms with cold symptoms. Use it to lean the differences and similarities between flu and cold symptoms. Then, if you get flu symptoms, call your doctor and ask about an antiviral drug.

Symptoms Cold Flu
Fever Rare Characteristic, high 100-102 degrees F); lasts 3-4 days
Headache Rare Prominent
General aches, pains Slight Usual; often severe
Fatigue, Weakness Quite mild Can last up to 2-3 weeks
Extreme Exhaustion Never Early and prominent
Stuffy Nose Common Sometimes
Chest Discomfort,
Mild to moderate; mild cough
Common; can become severe

You cannot confirm if you have swine flu just based on your symptoms. Like seasonal flu, pandemic swine flu can cause neurologic symptoms in children. These events are rare, but, as cases associated with seasonal flu have shown, they can be very severe and often fatal.

Doctors may offer a rapid flu test, but what you need to understand is a negative result doesn't necessarily mean you don't have the flu. Only lab tests can definitively show whether you've got swine flu. State health departments can do these tests.

What should you do immediately?

Those of you who have travelled from the affected countries in the past ten days and show symptoms swine flu like fever, cough, sore throat and difficulty in breathing should immediately contact the telephone number given below or visit the nearby Government Hospital.

Important contact numbers:
Outbreak Monitoring Cell (Control Room, NICD): 011-23921401

Websites: and
You can also contact a toll free number 2392 1401 at the National Institute of Communicable Disease

Contact number for each cities:
BIAL Swine Flu Center - 91-80-22001490

SDS TUBERCULOSIS & RAJIV GANDHI INSTITUTE OF CHEST DISEASES(Govt. of Karnataka), Hosur Road, Bangalore - 560029
Helpline No: 91-80-26631923

Communicable Disease Hospital, 87, T.H. Road, Tondiarpet, Chennai, Tamil Nadu

Govt. General and Chest Diseases Hospital, Erragadda , Hyderabad
Hospital Helpline Number - 040-23814939

Beliaghata Infectious Diseases Hospital, 57, Beliaghata Main Road, Kolkata

Kasturba Hospital, Arthur Road, Sane Guruji Marg, Mumbai 400011
Ph: 022- 23083901 / 23092458 / 23000889

New Delhi
Yellow Fever Quarantine Centre, Near AAI Residential Colony, New Delhi
Ph: 91-11-25652129

Influenza Ward, Ward no 5, Second Floor, New Building, RML Hospital, Delhi-1
RML- 91-11-24525211,23404328,23365525- Ext 4328

Source: Swine Flu India website

What is the treatment?

Antiviral drugs can be used to treat swine flu or to prevent infection with swine flu viruses. The anti-viral medicines oseltamivir (Tamiflu) and zanamivir (Relenza) are being used to treat people with swine flu. Antiviral drugs work by preventing the flu virus from reproducing. To be effective you need to take them within 48 hours of the symptoms beginning. These flu drugs can decrease the duration of the flu by 1 to 2 days if used within this early time period. These antivirals are usually given for a period of about 5-7 days. It's unclear whether these drugs can prevent complications of the flu. Tamiflu is approved for prevention and treatment in people 1 year old and older. Relenza is approved for treatment of people 7 years old and older and for prevention in people 5 years old and older. These medications must be prescribed by a health care professional.

Side effects: Side effects of antiviral drugs may include nervousness, poor concentration, nausea, and vomiting. Relenza is not recommended for people with a history of breathing problems, such as asthma, because it may cause a worsening of breathing problems. Discuss side effects with your doctor.

Self medication: Antibiotics are a no-no. Chances are that antibiotics will not help your flu symptoms. That's because flu, colds, and most sore throats and bronchitis are caused by viruses. In addition, taking antibiotics when you have a virus may do more harm than good. Taking antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment. Antibiotics only cure certain infections due to bacteria -- and if taken carelessly, you may get more serious health problems than you bargained for.

Is there a vaccine to treat swine flu virus?

No, there isn’t a vaccine yet. But vaccines are being made in large quantities. Clinical tests will begin in August 2009. Depending on how long federal officials wait for the results of these tests, tens of millions of doses of swine flu vaccine could be ready as soon as September 2009, with more vaccine becoming available each month thereafter. The first doses of vaccine likely will go to pregnant women and young children ages 6 months to 4 years, with older school kids to follow.

Source: Centres for Disease Control and Prevention (CDC), National Health Service, UK website, WebMD

Who is at risk?

Those who are more at risk from becoming seriously ill with swine flu are people with:

  • chronic (long-term) lung disease, including people who have had drug treatment for their asthma within the past three years,
  • chronic heart disease,
  • chronic kidney disease,
  • chronic liver disease,
  • chronic neurological disease (neurological disorders include motor neurone disease, Parkinson's disease and multiple sclerosis),
  • suppressed immune systems (whether caused by disease or treatment),
  • diabetes,
  • pregnant women,
  • people aged 65 or older, and
  • young children under five.
Source: National Health Service, UK website

How does it spread?

The new swine flu virus is highly contagious, that is it spreads from person to person. The virus is spread through the droplets that come out of the nose or mouth when someone coughs or sneezes. If someone coughs or sneezes and they do not cover it, those droplets can spread about one metre (3ft). If you are very nearby you might breathe them in.

Or, if someone coughs or sneezes into their hand, those droplets and the virus within them are easily transferred to surfaces that the person touches, such as door handles, hand rails, telephones and keyboards. If you touch these surfaces and touch your face, the virus can enter your system, and you can become infected.

Source: National Health Service, UK website

Can it be prevented?

Influenza antiviral drugs also can be used to prevent influenza when they are given to a person who is not ill, but who has been or may be near a person with swine influenza. When used to prevent the flu, antiviral drugs are about 70% to 90% effective. When used for prevention, the number of days that they should be used will vary depending on a person’s particular situation.

Follow this general procedure to reduce the risk of catching or spreading the virus, you should:

  • Cover your mouth and nose when coughing and sneezing, using a tissue
  • Throw the tissue away quickly and carefully
  • Wash your hands regularly with soap and water
  • Clean hard surfaces (like door handles and remote controls) frequently with a normal cleaning product
  • Keep away from others as much as possible. This is to keep from making others sick. Do not go to work or school while ill
  • Stay home for at least 24 hours after fever is gone, except to seek medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine.)
  • Drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated
  • Wear a facemask – if available and tolerable – when sharing common spaces with other household members to help prevent spreading the virus to others.
Source: CDC, National Health Service, UK website

Will it help to wear a mask?

Information on the effectiveness of facemasks and respirators for decreasing the risk of influenza infection in community settings is extremely limited. So, it is difficult to assess their potential effectiveness in decreasing the risk of Swine Flu virus transmission in these settings. However, a well-fitted, FDA-approved mask together with other preventive measures MAY reduce the risk of contracting the flu. Those who are sick or caring for someone who is ill should consider using a mask or respirator if leaving the house becomes necessary.

Source: CDC

What precautions should one take at home?

Two things - soap and water can reduce the chance of infection by 30 per cent. All you need to do is keep washing your hand with soap and water frequently. Wash hands frequently with soap and water or use alcohol-based hand cleaner when soap and water are not available. Avoid touching your eyes, nose and mouth

Eat healthy: Proteins are essential to help your body maintain and build strength. Lean meat, poultry, fish, legumes, dairy, eggs, and nuts and seeds are good sources of protein.

The Food and Drug Administration recommends that adults eat 50 grams of protein per day. Pregnant and nursing women need more. By eating foods high in protein, we also get the benefit of other healing nutrients such as vitamins B6 and B12, both of which contribute to a healthy immune system.

Vitamin B6 is widely available in foods, including protein foods such as turkey and beans as well as potatoes, spinach, and enriched cereal grains. Proteins such as meats, milk, and fish also contain vitamin B12, a powerful immune booster.

Minerals such as selenium and zinc work to keep the immune system strong. These minerals are found in protein rich foods such as beans, nuts, meat, and poultry.

Exercise: Regular exercise may help prevent the flu. According to recent findings, when moderate exercise is repeated on a near daily basis, there is a cumulative immune-enhancing effect. That is, your strong immune system can fight flu better. When you exercise, your white blood cells -- the blood cells that fight infections in the body -- travel through your body more quickly, fighting bacteria and viruses (such as flu) more efficiently. To maintain good health, experts recommend at least 30 minutes of aerobic activity such as walking, swimming, biking, or running each day.

Source: Flu India website, CDC, WebMD

What precautions should one take at schools?

  • Avoid close contact with people who are sick
  • People who are sick with an influenza-like illness should stay home and keep away from others as much as possible, including avoiding travel, for at least 24 hours after fever is gone except to get medical care or for other necessities. (Fever should be gone without the use of fever-reducing medicine). Cover your mouth and nose with a tissue when coughing or sneezing
  • Wash your hands often
  • Avoid touching your eyes, nose or mouth
Source: CDC

Is it safe to travel?

Avoid travelling unnecessarily. However, if you must travel, check how the country you're going to handles swine flu. Although, the WHO doesn't recommend travel restrictions, many countries have set up their own H1N1 policies, and some travellers have been screened or quarantined in other countries because of swine flu concerns.


Friday, August 07, 2009

The Indian Swine Flu Scare

Do we need to PANIC?

There is NEVER a need to PANIC. With the below mentioned common answers, you should be able to feel more confident about Swine Flu, especially in the Indian context. The media hype in this regard needs to be ignored.

So what are the common SWINE FLU SYMPTOMS?

The symptoms of swine flu are essentially indistinguishable from the familiar misery of seasonal flu: fever, coughing, sore throat, body aches, headache, sometimes vomiting and diarrhea. So which of us need to contact the doctor?
If you have traveled abroad to a country with a large number of Swine Flu cases in the last two weeks, and have Flu like symptoms.
If you have personally met someone who was later diagnosed to have Swine Flu in the last two weeks, & you have flu like symptoms.

Only under these circumstances do you need to worry about Swine Flu in India, at the present moment.

How can I prevent SWINE FLU?

Just like regular seasonal flu virus, the swine flu virus is thought to spread on droplets emitted by coughing and sneezing or deposited on hands and surfaces, then transferred to nose or mouth. Thus, practicing the usual precautions will help prevent its spread:

* Use a tissue when you cough or sneeze, and throw it away promptly. If you don’t have a tissue, cough into your sleeve.

* Wash your hands thoroughly and often, especially after sneezing or coughing, using soap and water or an alcohol rub. I personally use non alcoholic hand sanitizer by Himalaya Pharmaceuticals called Pure Hands, this is easily available with your local chemist shop. Any good hand sanitizer would do.

* Wipe surfaces like doorknobs using a regular cleaner.

* If you’re sick with flu-like symptoms, even if you don’t feel sick enough to go to the doctor, stay home from work or school to avoid giving the virus to someone else.

The most effective way to prevent Swine Flu is by STAYING at HOME, and by regular hand washing.
Please remember that as of now there is no vaccination (though one is likely to be available by the end of 2009 or sooner), antiviral medicines are generally not needed, and the disease is generally mild in most people.

When do I need to go to the Hospital?

If you have breathing problems, then you need to go the Emergency Room. Rest, Plenty of Warm Fluids, and mild OTC medications for Fever like Crocin, Brufen etc. should help you recover within 5-7 days.

Where can I get more information about Swine Flu in India?

Swine Flu India is the central website for all information and updates.
The Ministry of Health and Family Welfare has an information page for Swine Flu. This MS Word document supplied on the above page has contact information and details of the Control Rooms and Nodal Officers/Doctors for ALL states in India.

For Chandigarh J&K & Punjab, diagnostic facilities are available in PGI, Sector 12, Chandigarh.

Wednesday, May 20, 2009

What are the doctors / pediatricians reading ?

Here is what we doctors are reading in April 2009

Top 10 Most Read Articles by Pediatricians:
1. Rocket Fuel Chemical Found in Infant Formula
CDC scientists find perchlorate in samples of powdered infant formula.
2. A 5-Year-Old Boy With an Abnormal Left Eye
3. Adenoidectomy and Tonsillectomy Linked to Subsequent Overweight in Children
4. Clinical Assessment of the Crying Infant Should Guide Decision Making
5. US Declares Swine Flu Emergency
6. Cephalosporin Use in Treatment of Patients With Penicillin Allergies
7. Presentation, Prognosis, Treatment of Most Common Newborn Rashes Reviewed
8. Parenting Practices and ADHD
9. AHA Updates Advice on Strep Throat, Preventing Rheumatic Fever
10. Pacifier Use May Not Adversely Affect Breast-Feeding Duration or Exclusivity

Top 10 Most Read Articles by All Physicians:

1. Efalizumab Withdrawn From US Market
Efalizumab (Raptiva), used for the treatment of psoriasis, will no longer be available in the United States because of the risk for progressive multifocal leukoencephalopathy.
2. Hidden Malpractice Dangers in EMRs
3. The Case of the Missing Shaving Blade!
4. US Declares Swine Flu Emergency
5. Stimulus Package Could Convert More Physicians to EHRs
6. Dealing with the "Disruptive" Physician Colleague
7. A 5-Year-Old Boy With an Abnormal Left Eye
8. Progressive Neurologic Deterioration in a 23-Year-Old Man
9. WHO Raises Pandemic Level for Swine Flu, Mexican Death Toll Mounts
10. Less Is More: Simplified 4-Step Algorithm Improves BP Control

These articles are from Medscape from WebMD and may require free registration for viewing.
I specifically enjoyed tonsillectomy, crying infants, and newborn rashes amongst the articles for pediatricians, and the article on BP control among the physician read articles.

Monday, May 18, 2009

The Three C's of Medical Marketing

The other day I had a very interesting experience with a pharmaceutical company representative from a leading Indian Vaccine manufacturing company.
He came to me, and showed me a document, extracted from the WHO website, claiming that their Tetanus vaccine was the ONLY WHO approved Tetanus vaccine in India.
After looking at the document, I pointed out that the same document clearly showed that this was not true, and another older Indian Vaccine Company also had WHO approved Tetanus vaccine!
He coolly said, “Sir, but our vaccine is Air couriered to the destination, whilst there vaccine comes from Land Transport!”.
This was quite beside the point and I told him so. Similar misleading statements / outright lies have been made by other Medical Representatives.
At this point of time, I said, “ I believe that all Med Reps go to the same school, wherein you are told to change the topic / confuse the doctor as soon as you are caught out”.
He smiled and revealed a trade secret, he said, “Sir, it is the case of 3 C’s”.
What are these 3 C’s?
CONVINCE a Doctor.
If that does not work CONFUSE him.
And if that fails too, CORRUPT him, by offering incentives to him.
I found this amusing and worrying at the same time, like many truths, I suppose.
Is this how one of our most closely allied profession views us?
And more importantly, are they wrong?
Isn’t it we who have helped create this image?

Saturday, May 16, 2009

Reducing pain during vaccination - order of vaccines may make a difference too!

The commonest cause of induced pain in infants is due to multiple vaccines being given by the pediatrician.
This excellent study shows that infants given DTaP combination vaccine BEFORE the Pneumococcal Pneumonia vaccine, have less pain than those who are immunized in the reverse order.
Given the fact that both these vaccinations are being routinely administered by pediatricians in India, I think this is a really useful study that can change office practice.
I would be interested in knowing if this holds true for the normal DPT vaccine too. Also would this hold true if any other vaccine (like Inj Polio) is given separately too.
I guess that would have to wait for another study though!
As far as I am concerned, I would be giving the DTaP BEFORE any other vaccination if more than one injections are needed.

Sunday, May 03, 2009

All the brouhaha about swine flu

How important is Swine Flu really?

Is it likely to be a pandemic?

Is it going to kill millions of people like the infamous flu pandemic of 1918?

Unfortunately no one has the answers. Lots of speculations, guesses, and opinions. However a few regularly asked questions that have specific answers are what I am going to answer here, and provide a couple of excellent resources for self reading.

What are the symptoms of Swine Flu? Symptoms include at least 2 of the following:

  • Rhinorrhea or nasal congestion;

  • Sore throat;

  • Cough; and

  • Fever.

In addition, persons with swine flu may have other typical symptoms of influenza, including body aches, headache, chills, fatigue, and possibly diarrhea and vomiting.

Can you get this from eating cooked pork? No.

Can my pets get this? No.

Should I avoid traveling to swine flu affected areas at present ? Yes if you can avoid it.

Should I postpone my trip to US/ Mexico? It's too soon to know; follow travel-advisory information from the CDC closer to the event.

Will there be a vaccine? Work is under way to make a safe and effective vaccine that hopefully will be available by next flu season.

Is there enough medication? For those who may truly need it, yes, but most infected persons in the United States & worldwide (except Mexico) have not required intensive medical intervention.

What should I do to protect myself and my family? Take these everyday steps to protect your health:
  • Avoid touching your eyes, nose or mouth. Germs spread this way.

  • Try to avoid close contact with sick people.
    • Stay home if you are sick for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.
    • Is the nation/state/city prepared for a pandemic? Public health authorities are more prepared than ever before, supported with some (more is needed) government funding and shaped over time by events, including the 1918 flu disaster, 2001 anthrax attack, the ongoing threat of avian flu, and Hurricane Katrina. The global community, however, is far from ready.
Is it time to panic? It is never time to panic. While it's no surprise that a circulating, airborne, invisible virus causes anxiety for many, panic serves no useful role in public health.

I am planning to travel to USA, what should I do? Avoid it if possible, otherwise take regular precautions like washing hands, covering mouth and avoid crowded places and report to a doctor if you have flu like symptoms. Talk to your doctor about carrying Tamiflu as a preacutionary measure if traveling to an area with high incidence of Swine Flu.

Should I take prophylaxis with TAMIFLU if am traveling to the USA? Chemoprophylaxis is recommended for 7 days after the last known exposure to a confirmed case of swine influenza A (H1N1) virus. The CDC recommends that the following populations receive chemoprophylaxis:

  1. Household close contacts of a confirmed or suspected case who are at high risk for complications of influenza (persons with certain chronic medical conditions, elderly).

  2. School children who are at high risk for complications of influenza (persons with certain chronic medical conditions) who have had close contact (face-to-face) with a confirmed or suspected case.

  3. Travelers to Mexico who are at high risk for complications of influenza (persons with certain chronic medical conditions, elderly).

  4. Border workers (Mexico) who are at high risk for complications of influenza (persons with certain chronic medical conditions, elderly).

  5. Healthcare workers or public health workers who have had unprotected close contact with a person with confirmed swine influenza A (H1N1) virus infection during the infectious period. (Detailed guidance on this topic is available at

So the answer to that question is NO, if you are a healthy person traveling to USA, you may not take prophylaxis, because the risk of serious disease is virtually negligible.

What is the dose for Tamiflu? Tamiflu is NOT recommended for children less than 1 year. While a syrup form is available in the USA, I believe that none is available in India.
The dose is 2.5 mg/kg twice a day for treatment, while it is 2.5 mg/kg once a day for prophylaxis. For adults the dose is 75 mg once a day for prophylaxis and twice a day for treatment.

Here are a few excellent resources that will provide updated information about Swine Flu.

Medscape Resource Center for Clinicians

CDC Swine Flu Website


UPDATE: NEJM has created a new center of H1N1 virus, the one causing Swine Flu. You can get latest news about this here
NEJM H1N1 Influenza Center

Wednesday, April 29, 2009

Rotavirus presentation

This weekend I had a interesting presentation on Rotavirus presentation in our local IAP (Indian Academy of Pediatrics) meet of Pediatricians of Chandigarh, Panchkula & Mohali tri-city.

What is the rotavirus? Just the commonest cause of diarrhea in children, killing more than 1 lakh children in India alone!

You can get the entire presentation here. It was fun to read up this disease, since in office practice I tend to not get in a lot of academic reading about specific illnesses. While I am using the presently only available Rotavirus vaccine (Rotarix by GSK), there were still a few surprises for me. The large number of deaths worldwide caused by this virus were astounding, more so the fact (as you can read in the presentation ) that India has the largest number of deaths by far.

Since the presentation, I would probably be a bit more aggressive in suggesting this vaccine to affording parents with children under the age of 6 months. While the vaccination is at present slightly expensive (around INR 1,000 - 1,500 per dose), since it is imported and being marketed by a multinational, an Indian Rotavirus Vaccine is likely in the next few years, making a serious dent to the large number of preventable deaths due to rotavirus.

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Wednesday, April 15, 2009

A simple case of misdiagnosis .....

Being a doctor I always feel that there would be less chances of misdiagnosis in my case. I know the doctors, their reputation, and many are friends too. So this weekend when I developed pus in my tonsils, I first took a course of "mild" antibiotic Azithromycin. Since that did not work, I talked to an ENT specialist friend, and he recommended a course of Clindamycin, after having a look and saying that I had a lot of pus in both the tonsils. For those of you who have taken this medicine, you know the gastritis, loose motions etc. that are a part and parcel of taking it. However, I did take this as directed. However after 3 days of continuously missing my clinic practice due to fever, body aches and general malaise, I got a second opinion from another ENT specialist today. He had a look, and immediately exclaimed that this is a VIRAL tonsillopharyngitis, and it would recover faster with just a short course of oral steroids. No need for any antibiotics! This was amazing, and I am starting to feel better already :-)

I asked him and searched online for tips regarding how to differentiate the two conditions, since we do get a lot of purulent tonsillitis in my pediatric practice too.

While of course there are no hard and fast rules, generally viral tonsillitis would have small ulcers else where too, other than the tonsils, and the tonsils would not be angry red or enlarged. There would be more pain during speaking, and lots of malaise, but not very high fever nor toxic look in cases of children with viral tonsillitis. Small ulcerations on the other areas of the throat would be pathognomonic for viral tonsillitis, though in cases of doubt, a simple blood count would help differentiate the two conditions. Scratchy feeling in the throat, and other symptoms like cold, cough etc. are likely to occur. Generally the neck lymphnodes are not significantly enlarged nor painful in viral pharyngitis. Viral purulent tonsillitis is less common in children, and starts appearing in teenagers and older adults.

Strep tonsillitis is the most important differential between commonly occurring between 3-15 years age. Bacterial pharyngitis generally has higher fever, no flu like symptoms, and painful enlarged lymphnodes. There may be a petechial rash over the palate / uvula. Strep throat swabs are not easily available / routinely used in India at present, though this is likely to change, so immediate diagnosis is not possible, and antibiotics are generally given to everyone with purulent tonsillitis.

Well a lesson learnt about viral / bacterial tonsillopharyngitis, and that even simple conditions can be misdiagnosed leading to unnecessary suffering and missed work. While we do read about this, it really hits home when it happens to you I guess!

The other thing that I realized was that even for a "trivial" illness like tonsillitis, finding a better doctor can make such a difference, imagine how much difference it would make for serious and life threatening diseases?!