30/09/2015
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September 16 2015, Wednesday
eMedinewS
Managing wounds at home
Dr KK Aggarwal
A wound is a disruption of the normal structure and function of the skin.
Antibiotic therapy is not indicated in all the wounds and is reserved only for infected wounds.
It is important to keep blood sugar under control while managing a wound.
All wounds, which are contaminated or with foreign bodies, require debridement.
Irrigation of the wound is the best to reduce bacterial load and removing loose material.
Irrigation can be done with warm saline.
Principles of wound management are – scrub, clean and dress.
Scrubbing means that dressing should be done with clean hands, which requires proper scrubbing of the hands.
Would cleaning means that the wound should first be cleaned and finally after cleaning it requires a proper dressing.
Some wounds may require suturing, especially if the wound is less than 6 hours old.
In an accident if a finger is cut or a tooth is removed, one should preserve the finger or the tooth and take it to the nearest hospital along with the patient for reimplantation.
The best way to carry the amputated finger or uprooted tooth is to put them in a plastic bag and put that bag in a box containing ice.
Skin burns should be treated firstly by putting the area under the running water till the burning disappears.
In a patient with burns, the blister that forms should not be punctured.
Presence of pain is also a good sign and indicates that the burns are superficial.
IMA,IJCP,HCFI
eMedipics
IMA,IJCP,HCFI
Beneficiaries of Sameer Malik Heart Care Foundation Fund, tuesday meeting
News
Neurology
Low vitamin D levels are very common in older adults, especially African Americans and Hispanics, and are associated with accelerated decline in episodic memory and executive function, the two cognitive domains strongly associated with Alzheimer's disease dementia, suggests a new study published online September 14 in JAMA Neurology.
Anesthesiology
Surgery
A double-blind, phase 2 study of the investigational opioid TRV130 showed that it was superior to placebo in terms of reducing pain intensity in patients undergoing a bunionectomy, relieving pain within 5 minutes of administration and without causing serious adverse events. The results were presented at PAINWeek 2015.
Orthopedics
Geriatrics
Brief, daily bouts of hopping or jumping can strengthen hip bones and reduce the risk of fracture following a fall, suggests a new study of older men, published in the Journal of Bone and Mineral Research.
Obstetrics and Gynecology
Nocturnal enuresis in postmenopausal women may be associated with symptoms of obstructive sleep apnea (OSA), suggests data from the Women's Health Initiative (WHI) program, published online in Menopause.
Nutrition
New research suggests that people who think they are doing the right thing by choosing a diet beverage then do the wrong thing by snacking on sodium, sugar and high-carbohydrate goodies like cookies, ice cream, fries and pastries. The findings are published in the Journal of the Academy of Nutrition and Dietetics.
IMA,IJCP,HCFI
Cardiology eMedinewS
The US Food and Drug Administration (FDA) has approved the first implantable cardioverter defibrillator (ICD) that was designed to be used safely in patients who undergo MRI. The device (Evera MRI ICD) is a single- or dual-chamber ICD modified with changes to the firmware and hardware to make it compatible with an MRI scan.
A new study suggests that greater adherence to the American Heart Association's Life's Simple 7 in middle age is associated with a lower lifetime occurrence of heart failure and greater preservation of cardiac structure and function. The findings are published in The American Journal of Medicine.
Pediatrics eMedinewS
Pediatrics
Neurology/Psychiatry
A diagnosis of attention deficit hyperactivity disorder (ADHD) was associated with an almost 3-year delay in the diagnosis of Autism Spectrum Disorder (ASD) when compared with the age of diagnosis of children diagnosed with ASD alone, suggested a new study published online September 14 in Pediatrics.
Pediatrics
Cardiology
Three hours of uninterrupted sitting causes substantial disruption to vascular function in the legs in young girls, reported a study published in Experimental Physiology.
Pulmonary Embolism
The initial resuscitative therapy for patients with suspected pulmonary embolism (PE) should focus upon oxygenating and stabilizing the patient. The mainstay of therapy for patients with confirmed PE is anticoagulation, depending upon the risk of bleeding. Alternative treatments include thrombolysis, inferior vena cava filters and embolectomy.
Dr KK Spiritual Blog
Are we reborn as humans each time we die?
As per Vedic sciences, Hindu philosophy believes in rebirth unless your Sanchit and Prarabdha Karmas are totally exhausted.
It also believes in liberation in which once your past karmas debt is over, you do not take a rebirth.
On the other hand, Garuda Purana says that you can be reborn as animals, which means you can be born like a donkey or a dog. Vedic science, on the other hand, says that once you get a human body, you will either be liberated or only get another human body.
The message of Garuda Purana can be read and interpreted in a different perspective. In mythology humans have been linked to animal tendencies. For example, bull is linked to s*xual and non–s*xual desires, peacock to vanity etc. Probably, people who wrote Garuda Purana meant that if you do not live according to the Shastras, you will end up in getting another human body but with animal tendencies and behavior.
Wellness Blog
Caffeine–Alcohol combination in paralysis
A drug Caffeinol containing caffeine and alcohol may help stroke patients recover.
In a small study at Texas Health Science Center in Houston, 60% of stroke patients who were given the drug, had no or minimal disability when they were discharged from the hospital. In contrast, only 26% of stroke survivors given standard therapy with tissue plasminogen activator, or tPA, fared that well.
Caffeinol contains about as much caffeine as 5 to 7 cups of good, strong New Orleans coffee and the equivalent of two shots of alcohol.
The study involved 100 people who had suffered an ischemic stroke. All received intravenous tPA; 10 were also given an infusion of caffeinol. Caffeinol allows cells to tolerate reduced blood flow longer, thereby giving tPA a longer opportunity to do its action.
Will these findings be applicable to heart attack? Only time will tell as heart attack is also treated with tPA.
Beneficiaries of Sameer Malik Heart Care Foundation Fund
IMA,IJCP,HCFI
Make Sure
Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure of 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.
Dr Good Dr Bad
Situation: A patient with heart failure needed a beta blocker.
Dr. Bad: Start any beta blocker.
Dr. Good: Start metoprolol succinate.
Lesson: Only carvedilol, bisoprolol and metoprolol succinate are approved for heart failure.
(Copyright IJCP)
HCFI Videos
Scientific Awareness on Obesity Prevention in School Going Children
Scientific Awareness on Good Personal Hygiene Practices in School Going Children.
IJCP Book of Medical Records
www.ijcpbookofmedicalrecords.com/
IJCP’s ejournals
http://ebook.ijcpgroup.com/Indian-Journal-of-Clinical-Practice-February-2014.aspx
CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
Video of the Day
100 percent Training in CPR 10 of Delhi Police PCR Staff
Razia, SM Heart Care Foundation Fund, TOF
Pooja, SM Heart Care Foundation Fund, Post PDA
Azad Saini, SM Heart Care Foundation Fund, ASD
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh, SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
Press Release
Dengue 4 is less fatal: IMA
It’s not an epidemic yet: IMA
IMA today released dengue guidelines and said not to panic. The present serotype is less fatal than the one which caused dengue cases in 2013.
Addressing a press meet here, Dr A Marthanda Pillai National President Indian Medical Association (IMA) and Dr K K Aggarwal, Padma Shri Awardee and Honorary Secretary General IMA said that only suspected severe dengue cases need medical attention and admission. Most can be managed as OPD care. IMA said NO to platelet transfusion unless patient has active bleed and the platelet count is less than 10,000.
Platelet counts by machine readings are not reliable and can have an error of up to 40,000.
The reliable test is hematocrit and not platelet count. Most cases can be managed without testing by only measuring difference between upper and lower blood pressure. The pulse pressure should be kept over 40 mm Hg.
IMA also appealed to the public not to panic and not force doctors for hospital admission unless it is important. “Do not fill beds with patients not requiring admission. Make beds available for sever dengue cases,” added Dr Aggarwal.
Co-addressing the press Dr V K Monga and Dr R N Tandon from IMA said that most dengue patients can be managed with oral fluids. Unnecessary admissions and overcrowding of hospitals can lead to hospital-acquired infections.
New strain of dengue
Dengue normally is caused by four serotypes of the dengue virus: Den1, Den2, Den 3 and Den4. Serotypes 1 and 3 are less dangerous as compared to serotypes 2 and 4.
This year, serotypes 2 and 4 serotypes are prevalent.
As per AIIMS, the serotype 4 of the virus has emerged as the dominant type for the first time in the capital, along with dengue serotype 2.
Symptoms of type 4 dengue include fever with shock and a drop in platelets; type 2 causes a severe drop in platelets, hemorrhagic fever, organ failure and dengue shock syndrome.
Every strain carries the risks of hemorrhagic fever, but type 4 is less virulent than type 2. Risk of severe dengue is highest with the serotype 2 virus.
Barring stray cases in 2003, the type 4 strain of the virus has never been isolated in Delhi
Doctors were expecting the strain to change this year, given the large number of cases. Doctors were not expecting type 4 because it has never been actively circulating in Delhi.
When the dominant strain remains the same for a long period, a significant population develops immunity to it, and fewer patients are diagnosed with the virus. However, the type 4 strain had never shown a significant presence. A new serotype will always result in an epidemic-like situation.
Infection with one of the four serotypes of dengue virus (primary infection) provides lifelong immunity to infection with a virus of the same serotype. However, immunity to the other dengue serotypes is transient, and individuals can subsequently be infected with another dengue serotype (secondary infection). Subsequent infection with a second type increases the likelihood of serious illness.
The risk for severe dengue appears to decline with age, especially after age 11 years.
AIIMS lab is also suspecting a new serotype this year in addition. Is it Den 5? Researchers screening dengue viral samples found a virus collected during an outbreak in Malaysia's Sarawak state in 2007, which they suspected was different from the four original serotypes. They sequenced the virus and found that it is phylogenetically distinct from the other four types. Experiments found that monkey antibodies produced against the new type differ significantly from those resulting from the previously known dengue viruses. So far, dengue 5 has been linked to only one outbreak in humans.
In 1996, when an outbreak of the disease was reported in Delhi with over 10,000 cases, the relatively severe type 2 strain of the virus was identified as the most common serotype.
In 2003, when a sharp rise in dengue cases was again reported, type 3, a mild strain, emerged as the most common serotype.
In 2013, with over 5,500 cases, serotype 2 returned as the common strain in the capital.
Most dengue patients are not serious
Dengue is both preventable and manageable.
The risk of complications is in less than one percent of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided.
A platelet transfusion is not needed unless patient has active bleeding (other than petechiae) and platelet counts are less than 10,000.
Unnecessary platelet transfusion can cause more harm than good.
Classic dengue fever is an acute febrile illness accompanied by headache, retro orbital pain, and marked muscle and joint pains. Symptoms typically develop between 4 and 7 days after the bite of an infected mosquito. The incubation period may range from 3 to 14 days. Fever typically lasts for 5 to 7 days. The febrile period may also be followed by a period of marked fatigue that can last for days to weeks, especially in adults. Joint pain, body aches and rash are more common in females.
Most complications of dengue occur after the fever is over. The two days after the last episode of the fever are crucial and during this period, a patient should be encouraged to take plenty of oral fluids mixed with salt and sugar.
The main complication is leakage of capillaries and collection of blood outside the blood channels leading to intravascular dehydration. Giving fluids orally or by intravenous routes, if given at a proper time, can save fatal complications
Only these patients need hospitalization
The World Health Organization (WHO) guidelines recommend attention to clinical “warning signs” for severe dengue
Severe abdominal pain or tenderness
Persistent vomiting
Lethargy or restlessness
Abrupt change from fever to hypothermia
Bleeding
Pallor
Cold /clammy extremities
Liver enlargement on physical exam
Abnormal mental status
Early recognition
Dramatic plasma leakage often develops suddenly; therefore, substantial attention has been placed on early identification of patients at higher risk for shock and other complications.
The period of maximum risk for shock is between the 3rd and 7th day of illness. This tends to coincide with resolution of fever. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after defervescence.
An elevation of the hematocrit is an indication that plasma leakage has already occurred and that fluid repletion is urgently required.
Low platelet count usually precedes overt plasma leakage.
Mild elevations in serum SGOT and SGPT levels are common. But in severe dengue the levels are very high with SGOT > SGPT levels
A normal SGOT levels is a strong negative predictor of severe dengue even in the first three days of illness.
NS 1 antigen levels of >600 ng/mL suggest severe dengue.
Coexisting medical conditions, such as pregnancy, infancy, old age, obesity, diabetes mellitus, renal failure, and chronic hemolytic disease may increase the risk of severe dengue and/or complicate management. Referral for hospitalization is recommended for such patients, regardless of other findings
Additionally, hospitalization should be considered for patients who may have difficulties with outpatient follow-up or with timely self-referral should complications develop (e.g., patients who live alone or who live far from a healthcare facility without a reliable means of transport).
Patients with suspected dengue who do not have any of the above indicators probably can be safely managed as outpatients, as long as close clinical observation is assured. Daily outpatient visits may be needed to permit serial assessment of blood pressure, hematocrit, and platelet count.
Government may clarify: is it an epidemic?
Recent government circulars say: Postpone routine surgeries to accommodate dengue patients/ Postpone routine admissions/Make provision of extra beds/Do not refuse any patient who needs admission.
These all are done when an epidemic is announced.
In an epidemic, all cases are presumed to be dengue, no confirmatory testing are done, a triage announcement is done, clear cut directions are announce regarding which patients are to be admitted and which patients are not to be admitted.
Management of significant bleeding
Gastrointestinal bleeding, epistaxis, or menorrhagia in patients with severe dengue (and occasionally in patients with dengue fever) can be severe enough to require blood transfusion.
Blood replacement should be done with 5 mL/kg of packed red blood cells (or 10 mL/kg whole blood).
Platelet transfusions have not been shown to be effective at preventing or controlling hemorrhage but may be warranted in patients with severe thrombocytopenia (
www.indianmedicalassociation.info
