Friday, January 30, 2015

Chicken Pox vaccine now available after shortage for more than 6 months

After being conspicuously absent for the last 6 months or more, chicken pox vaccine is now finally available in India again.
This is good news for parents and pediatricians also, since the pediatricians kept on getting bombarded y anxious parents at every visit regarding the absence of this vaccine, and the reasons for the same!
The vaccine that has just become available is by Wockhardt Pharma and called BIOVAC V
As per IAP guidelines (Indian Academy of Pediatrics), 2 doses are recommended for Chicken Pox vaccination at 15 months and then a booster at 5 years.
If your child has not taken these 2 doses and has never had CP disease, this may be a good time to talk to your doctor about this vaccination.

Thursday, January 29, 2015

Swine flu claims 60 / 191 lives in India in Jan 2015

There has been a sudden surge in the number of swine flu cases and fatalities as a result across the country in January, compared to sporadic cases of the disease last year.
NEW DELHI: Swine flu has claimed 191 lives in the country in January alone with Telangana reporting the highest number of cases of people afflicted with the H1N1 virus followed by Delhi, the government said today.
The total number of cases of swine flu coming to light across India in January stood at 2,038.
Whiel Delhi saw 488 persons coming down with the disease with five deaths reported between January 1 to February 1 of this year, Telangana recorded 629 cases with 34 deaths.
In Gujarat, 309 persons contracted swine flu with the virus claiming 38 lives, said a senior health ministry official.
The Health Ministry data said that 205 swine flu cases were reported in Rajasthan, where the death toll from the virus stands at 49, while 73 cases have been noted in Maharasthra with 22 casualties.
Tamil Nadu witnessed 93 cases with seven lives claimed by the disease while Madhya Pradesh and Haryana reported 49 and 57 cases with the death toll in these states standing at 17 and eight, respectively.
Andhra Pradesh reported 33 cases, leading to four deaths. Sharing the details, Additional Secretary in the Health Ministry, Arun Panda, told reporters that, last year, 937 cases of swine flu were reported in the country leading to 238 deaths.
In 2012, there were 5,044 reported cases of swine flu, which claimed the lives of 405 people while in 2013, there were 5,253 cases and 699 deaths, he added.
Panda said that the present spurt is seasonal and all necessary assistance and support is being provided to the states to deal with the situation.
He said that the secretary of the ministry will hold a video conference with officials of the affected states tomorrow to discuss the measures to be taken to combat the disease.
"The frequency of advertisements of dos and don'ts will be increased and we will also request the states to come out with such advertisements in local newspapers and in local languages to spread awareness about the disease among the people," Panda said.

Saturday, January 17, 2015

What oral antibiotics can be safely used in newborn babies, and at what doses ?

Here is a list of oral antibiotics that can be used in newborn babies.
This is something that even I as a pediatrician get confused about, hence hopefully this will be a ready reckoner for the child specialist.

Please remember, we DO NOT WANT to give antibiotics to small babies, and so do NOT self medicate with these medicines.

Daily dosage
Amoxycillin20-40 mg/kg div. 8 hrly
Ampicillin50-100 mg/kg div 8 hrly
Cephalexin50 mg/kg div 6 hrly
Chloramphenicol< 14 days : 25 mg/kg div 8 hrly 
> 14 days : 50 mg/kg div. 6 hrly
Clindamycin 20 mg/kg div. 6 hrly
Cloxacillin > 2.5 kg : 50-100 mg/kg div. 6 hrly 
< 2.5 kg : 50 mg/kg div. 8 hrly
Erythromycin< 7 days : 20 mg/kg div. 12 hrly 
> 7 days : 20-40 mg/kg div. 6 hrly
Metronidazole25 mg/kg div. 12 hrly
Penicillin V50,000 U/kg div. 8 hrly


Friday, January 16, 2015

Achhe Din….Bure Din… the story of Asthma

By Dr Vikram Jaggi, Asthma & Allergy Specialist - posted at Docplexus forum
Life throws up good days and bad days – suddenly & unexpectedly. In the life of an asthmatic too there are good days and there are bad days. The last 30 to 40 days have been bad days ( bure din ) for most asthmatics in north India.
Let us try to understand why this has been so and try to learn some lessons from it.
Change of season, generally speaking, is a bad time for asthmatics. Many types of pollen and some types of fungal spores are more at the time of changing season. Kikkar or babul tree ( Prosopis julifora ) is one such example. More pollen means more asthma symptoms for pollen sensitized patients. Every 4-5 years there is a year when the pollen counts are exceptionally high. This year was one such year. Most patients suffered more this year.
Patients of asthma somehow assume that “coldness “or low temperatures have a bad influence on asthma. This may be true for some asthmatics. Many asthmatics experience some aggravation of asthma on breathing of very cold air, as happens in running in the open on a very cold day. But it is also true that many asthma patients actually improve when visiting very cold countries like Canada or Sweden. So coldness, per se, is not the main culprit.
Fog and Smog. These past few days have been very foggy. Does that aggravate asthma ? Yes it does. What’s the difference between fog and smog? To put things very simply :  fog is a high concentration of water vapor near the ground. Or in other words, Fog is a cloud in contact with the ground. Smog is high concentration of pollution near the ground. Smog can come from man-made sources like traffic and factories. Fog is a function of weather.
Fog is fog; smog is fog + smoke together.
We all have read in the newspapers recently that burning of crops in Punjab and Haryana is contributing to the smog. What is really happening ? Earlier, crops were cut by hand and sickle. This was done very near to the ground and only a very small stalk was left. Now most of the crops are cut by machines which cut at a greater height above the ground and hence a longer stalk is left behind. The farmers later set these on fie before the next crop is sown. The smoke from this activity, which has very high particulate matter content, travels long distances and adversly affects the asthma patients.

So what lessons can we learn from all this ?
1.      Be prepared. This will happen every year at this time.
2.      Be regular with your medication in anticipation. If required step up the dose.
3.      Restrict outdoor activities (morning walk) in these months between 5 to 10 AM.

Thursday, January 15, 2015

Can replacing Vitamin D improve asthma control in Adults?

JAMA. doi:10.1001/jama.2014.5052. Published online May 18, 2014. 
Vitamin D is known to be important when it comes to bone health and also in diseases where inflammation occurs, like asthma. Many people, including some of those with asthma, have low levels of vitamin D
Importance  In asthma and other diseases, vitamin D insufficiency is associated with adverse outcomes. It is not known if supplementing inhaled corticosteroids with oral vitamin D3 improves outcomes in patients with asthma and vitamin D insufficiency.
Objective  To evaluate if vitamin D supplementation would improve the clinical efficacy of inhaled corticosteroids in patients with symptomatic asthma and lower vitamin D levels.
Design, Setting, and Participants  The VIDA (Vitamin D Add-on Therapy Enhances Corticosteroid Responsiveness in Asthma) randomized, double-blind, parallel, placebo-controlled trial studying adult patients with symptomatic asthma and a serum 25-hydroxyvitamin D level of less than 30 ng/mL was conducted across 9 academic US medical centers in the National Heart, Lung, and Blood Institute’s AsthmaNet network, with enrollment starting in April 2011 and follow-up complete by January 2014. After a run-in period that included treatment with an inhaled corticosteroid, 408 patients were randomized.
Interventions  Oral vitamin D3 (100 000 IU once, then 4000 IU/d for 28 weeks; n = 201) or placebo (n = 207) was added to inhaled ciclesonide (320 µg/d). If asthma control was achieved after 12 weeks, ciclesonide was tapered to 160 µg/d for 8 weeks, then to 80 µg/d for 8 weeks if asthma control was maintained.
Main Outcomes and Measures  The primary outcome was time to first asthma treatment failure (a composite outcome of decline in lung function and increases in use of b-agonists, systemic corticosteroids, and health care).
Results  Treatment with vitamin D3 did not alter the rate of first treatment failure during 28 weeks (28% [95% CI, 21%-34%] with vitamin D3 vs 29% [95% CI, 23%-35%] with placebo; adjusted hazard ratio, 0.9 [95% CI, 0.6-1.3]). Of 14 prespecified secondary outcomes, 9 were analyzed, including asthma exacerbation; of those 9, the only statistically significant outcome was a small difference in the overall dose of ciclesonide required to maintain asthma control (111.3 µg/d [95% CI, 102.2-120.4 µg/d] in the vitamin D3 group vs 126.2 µg/d [95% CI, 117.2-135.3 µg/d] in the placebo group; difference of 14.9 µg/d [95% CI, 2.1-27.7 µg/d]).
Conclusions and Relevance  Vitamin D3 did not reduce the rate of first treatment failure or exacerbation in adults with persistent asthma and vitamin D insufficiency. These findings do not support a strategy of therapeutic vitamin D3 supplementation in patients with symptomatic asthma.
Comment: Vit D is being used for a lot of conditions as its deficiency has been found to be huge in Indian population (even though we are a tropical country with a lot of sunlight). The studies that have tried to see its effect in treating various medical conditions have unfortunately continued to be quite disappointing, suggesting that Vitamin D may not have a role in causing these illnesses but its low levels may just be associated with these medical conditions. More research would help resolve this question further.

Measles vaccines and risk of fever and seizures - JAMA Pediatrics article

JAMA Pediatr. doi:10.1001/jamapediatrics.2013.2745. Published online October 14, 2013.

Importance The first dose of live attenuated measles-containing vaccines is associated with an increased risk of febrile seizures 7 to 10 days following immunization among 12- to 23-month-old children. The combination measles, mumps, rubella, and varicella vaccine is associated with a 2-fold increased risk of febrile seizures 7 to 10 days following immunization compared with the separately administered measles, mumps, and rubella and varicella vaccines. It is unknown whether the magnitude of these increased risks depends on age at immunization.
Objective To examine the potential modifying effect of age on the risk of fever and seizures following immunization with measles-containing vaccines.
Design, Setting, and Participants Retrospective cohort study at 8 Vaccine Safety Datalink sites of a total of 840 348 children 12 to 23 months of age who had received a measles-containing vaccine from 2001 through 2011.
Exposures Any measles-containing vaccines and measles-containing vaccines by type.
Main Outcomes and Measures Fever and seizure events occurring during a 42-day postimmunization observation period.
Results In the analysis of any measles-containing vaccines, the increased risk of seizures during the 7- to 10-day risk interval, using the remainder of the observation period as the control interval, was significantly greater among older children (relative risk, 6.5; 95% CI, 5.3-8.1; attributable risk, 9.5 excess cases per 10 000 doses; 95% CI, 7.6-11.5) than among younger children (relative risk, 3.4; 95% CI, 3.0-3.9; attributable risk = 4.0 excess cases per 10 000 doses; 95% CI, 3.4-4.6). The relative risk of postimmunization fever was significantly greater among older children than among younger children; however, its attributable risk was not. In the analysis of vaccine type, measles, mumps, rubella, and varicella vaccine was associated with a 1.4-fold increase in the risk of fever and 2-fold increase in the risk of seizures compared with measles, mumps, and rubella vaccine administered with or without varicella vaccine in both younger and older children.
Conclusions and Relevance Measles-containing vaccines are associated with a lower increased risk of seizures when administered at 12 to 15 months of age. Findings of this study that focused on safety outcomes highlight the importance of timely immunization of children with the first dose of measles-containing vaccines.
© 2013 American Medical Association. 

Comment: With the MMRV vaccine likely to become available in India pretty soon in the next few months (mid 2015), any side-effects related to the use of this vaccine combination would become important. Since we use Measles at 9 months in India, we need to check for the potential side-effects of using this combination at 15 months. From the above study, it would appear that the chances of fever & seizures may be lower in this situation.

Tuesday, January 13, 2015

Four deaths due to Swine flu in Delhi, at least 1 case in Chandigarh

Delhi swine flu death toll climbs to four

NEW DELHI: The national capital on Monday recorded the fourth death due to swine flu with a 44-year-old woman from west Delhi succumbing to the H1N1 virus at a private hospital.

"The woman was undergoing treatment for various ailments and was detected with swine flu recently. She suffered from uncontrolled diabetes and breathlessness which further aggravated her condition. She was in an extremely critical condition," said Charan Singh, additional director in charge of public health, state health department.

Seven new cases were reported on Monday, taking the total figure to 50 so far this year.

The affected include an 18-year-old girl from Dakshinpuri undergoing treatment at Safdarjung, a 34-year-old woman from Brijpuri being treated at Lady Hardinge, a 45-year-old woman from Patel Nagar admitted at RML and a 59-year-old man from Laxmi Nagar at Holy Family hospital.

All of them tested positive for swine flu at the National Centre for Disease Control, Dr Singh said.

Others include a 37-year-old woman from Kirti Nagar, an 81-year-old from Defence Colony and a 19-year-old from Sidharth Extension. They are being treated in private hospitals.

Keeping in view the rising number of cases, the health department has procured 1,000 capsules of Tamiflu to combat the disease and would be stocking up on more medicines from time to time.

"We are closely monitoring the situation. All designated hospitals have been put on alert and directed to follow the standard operating procedure for treatment of swine flu," a senior official said. He said that health personnel from all districts have been sensitized about the standard procedures.
Tribune News Service
Chandigarh, January 8
A 40-year-old resident of Sector 38 was admitted to the GMSH, Sector 16, with the suspected H1N1 virus.
The patient is learnt to have travelled to New Delhi recently. Doctors suspect that she may have contracted the infection during her visit to New Delhi as many cases of swine flu have been reported from there and a death was also reported a week ago.
She was admitted to the isolated ward in GMSH-16 after she complained of prolonged flu symptoms at the flu screening OPD.
Her throat swab samples have been sent to the PGIMER virology lab for confirmation of swine flu. Reports will be obtained within two to three days.“ We are making all possible efforts to get to the source of infection in patients to ensure that the virus is not transmitted to other residents,” said UT Director Health Service (DHS), Dr VK Gagneja.
On Wednesday, a 20-year-old woman from Sector 42 had tested positive for swine flu. The woman was examined at Max hospital, Mohali, on Tuesday and after obtaining her report, the UT Health Department was informed about it. This was the first case of swine flu on the city this year. Immediately after the confirmation, she was quarantined at her residence.
Last year, three cases of swine flu were reported from different parts of the city. No deaths were reported from the city. Swine flu is an infection caused due to transmission of a deadly H1N1 virus. Prolonged flu, blood in sputum and fever are the common symptoms of the disease and it can prove to be fatal if undiagnosed for long.
Washing your hands often is an effective way of preventing the infection. And the disease is curable. Tamiflu, an oral medicine, cures swine flu. The medicine is available at all the three government hospitals, including the PGIMER, GMSH-16 and GMCH-32, free of cost. Private clinics and hospitals can get the medicine from the UT Health Department.
Comment: It is recommended that everyone at risk should consider taking the Swine Flu (H1N1) vaccination to prevent the chance of serious disease. Since this vaccination also has 2 other strains of Influenza virus, it can be useful in reducing the regular flu like fever cough & cold that occurs in winters and rainy seasons as well.

Four confirmed swine flu cases in Gurgaon, 1 dead.


GURGAON: Three days after a 45-year-old man from Jind died of swine flu at a private hospital in Gurgaon, the district health authorities on Monday confirmed four more H1N1 cases.

While one patient is admitted to a private hospital in Sector 51, two are undergoing home-based treatment and one has been discharged from another private hospital. "All the four cases have tested positive for H1N1," said chief medical officer of Civil Hospital, Pushpa Bishnoi.

Sources in Civil Hospital, Gurgaon, said three more cases were reported in the hospital on Sunday. "All these three patients are males and residents of Sheetla Colony near Sector 12. Their blood samples have been sent to a designated lab. So far, all three are suspected cases," said a doctor, on condition of anonymity. However, Bishnoi refused to confirm these three suspected cases from Sheetla Colony.

Keeping in mind the urgency, district health officials have become serious in their approach and called for maintaining an exclusive record of cases of cough, cold and viral fever.

"I have instructed the principal medical officer in Civil Hospital to maintain a separate record of influenza and viral fever cases. The patients will be screened in a separate room and a record of their contact details will be maintained. It will help us in keeping a tab on their condition. Every patient will be called after 48 hours so that we can prevent serious cases," Bishnoi said.

The cases of influenza and viral fever are also pouring in large numbers at private hospitals. In the last one week, more than 70% patients in three major private hospitals in Gurgaon comprised cases of viral fever and seasonal flu. The Civil Hospital has been receiving about 25 such cases a day.

The district officials are still clueless about the case of a 32-year-old woman from Faridabad, who was found positive for swine flu by a private lab on Thursday.

Friday, January 09, 2015

Doing better medical presentations

I do quite a few medical presentation, and I found this simple set of images very useful, hopefully you will too, especially the tips at the end ...

Please include attribution to with this graphic.
Medical PowerPoint Presentations

Thursday, January 08, 2015

A new highly accurate molecular point-of-care influenza test with 15 minutes reporting now available for doctors

A new point-of-care influenza test that yields highly accurate molecular results in less than 15 minutes can now be deployed in physician offices, the US Food and Drug Administration (FDA) announced today.
In June, the FDA approved the Alere i Influenza A & B Test(Alere Inc), but limited it to laboratories designated to perform tests of moderate and high complexity under federal regulations called the Clinical Laboratory Improvement Amendments (CLIA). Today, the agency issued a CLIA waiver for the test so it could be used in nontraditional laboratory sites such as physician offices, hospital emergency departments, and health department clinics.
It is the first CLIA waiver granted to a nucleic acid-based test.
The FDA based its decision on clinical study data showing that in comparison with a benchmark molecular test, the Alere i Influenza A & B Test proved highly accurate in identifying patients with or without influenza even though healthcare personnel who lacked lab training were using the device.
The test analyzes nasal swab samples to detect influenza A and B viral RNA. It can distinguish between influenza A and influenza B infections. According to the manufacturer, the test's sensitivity exceeds 90% for both viruses, substantially higher than that of older rapid influenza detection tests (RIDTs) that rely on enzyme immunoassay technology. Such RIDTs are known for a high rate of false negatives.
"Today's decision allows the first nucleic acid-based test to be available in clinical settings that previously could not use this technology," said Alberto Gutierrez, PhD, director of the Office of In Vitro Diagnostics and Radiological Health in the FDA's Center for Devices and Radiological Health, in a press release. "We expect many other simple and accurate tests using nucleic acid-based technology to be developed in the near future. Once cleared by FDA, such tests can allow health care professionals to receive test results more quickly to inform further diagnostic and treatment decisions."
The FDA noted that negative results obtained through the Alere i Influenza A & B Test do not rule out an influenza infection.
More information about today's announcement is available on the FDA website.

Monday, January 05, 2015

I am taking Levapil 500 mg (Levetiracetam) twice a day for Epilepsy, Can I Breast Feed my baby?

Q: I am taking Levapil 500 mg (Levetiracetam) twice a day for Epilepsy, Can I Breast Feed my baby? My doctor has advised that I continue BF, however I am worried for the health of my baby.
A: Breastfeeding (BF) your baby should be continued in this situation. The benefits of BF far outweigh any problems in this situation. In many studies taking doses of 1-3 gm/ day of Levetiracetam has been associated with low blood levels in the baby, and NO side-effects. 
Most authorities recommend continuing BF in this situation.
There is NO increased risk of epilepsy due to breast feeding the baby in this situation.