Monday, January 27, 2014

My 16 year old daughter has a KELOID on Rt Shoulder, what is the best treatment?

There are many treatment options 
What are the treatments for keloids?
The methods now available to treat keloids are:
·         Cortisone injections (intralesional steroids): These are safe and not very painful. Injections are usually given once per month until the maximum benefit is obtained. Injections are safe (very little steroid gets into the bloodstream) and usually help flatten keloids; however, steroid injections can also make the flattened keloid redder by stimulating the formation of more superficial blood vessels. (These can be treated using a laser; see below.) The keloid may look better after treatment than it looked to start with, but even the best results leave a mark that looks and feels quite different from the surrounding skin.
·         Surgery: This is risky, because cutting a keloid can trigger the formation of a similar or even larger keloid. Some surgeons achieve success by injecting steroids or applying pressure dressings to the wound site after cutting away the keloid. Radiation after surgical excision has also been used.
·         Laser: The pulsed-dye laser can be effective at flattening keloids and making them look less red. Treatment is safe and not very painful, but several treatment sessions may be needed. These may be costly, since such treatments are not generally covered by insurance plans.
·         Silicone sheets: This involves wearing a sheet of silicone gel on the affected area for several hours a day for weeks or months, which is hard to sustain. Results are variable. Some doctors claim similar success with compression dressings made from materials other than silicone.
·         Cryotherapy: Freezing keloids with liquid nitrogen may flatten them but often darkens the site of treatment.
·         Interferon: Interferons are proteins produced by the body's immune systems that help fight off viruses, bacteria, and other challenges. In recent studies, injections of interferon have shown promise in reducing the size of keloids, though it's not yet certain whether that effect will be lasting. Current research is underway using a variant of this method, applying topical imiquimod (Aldara), which stimulates the body to produce interferon.
·         Fluorouracil: Injections of this chemotherapy agent, alone or together with steroids, have been used as well for treatment of keloids.
·         Radiation: Some doctors have reported safe and effective use of radiation to treat keloids


In India, most doctors are using intralesional steroids as the first line treatment, I believe. Compression bandages with silica gel is also a good option given that it is almost free of any permanent side-effects and can be tried before other interventions. Talk to a reputable cosmetologist before finalizing your daughter's treatment.

Sunday, January 26, 2014

India Vaccine News - Chicken pox vaccine shortage likely to continue in India

At present we are facing a chronic shortage of Chicken Pox vaccines in India. Okavax (Sanofi) is not available at present, while Varilrix (GSK) has remained short for many months now, and is recently been made available. Varivax (VHB Pharma) is also running short, and supply issues are likely to remain in the near future. 
The situation has worsened partly because for the last couple of years, IAP (Indian Academy of Pediatrics), the parent body of Pediatricians in India has formulated new guidelines (in line with the US guidelines) of recommending a booster dose of Chicken Pox vaccine at 5 years (along with the MMR vaccine booster). You can get more information about the new guidelines on the IAP website here

Thursday, January 23, 2014

India vaccine news - New Indian Rotavirus vaccine Rotavac by Bharat Biotech to be launched soon

As per available information (personal communication) ROTAVAC - the long awaited fully indigenous Rotavirus vaccine (116 E, Live attenuated) created by teh team of Dr Suraj Bhan, AIIMS< new Delhi, will be launched by around April 2014 by Bharat Biotech.
The estimated price is likely to be around 500 Rs, which will be 50 % cheaper than the existing imported Rotavirus vaccines in the market.
Another huge advantage would be that we would finally have Indian studies that would clearly establish the efficacy in our children. 

Annually in India, rotavirus diarrhoea causes an estimated 122,000-153,000 deaths, 457,000 to 884,000 hospitalizations, and 2 million outpatient visits in children <5 2.0-3.4="" 41-72="" against="" age.="" annually="" billion="" costs="" diarrhoea.="" equivalent="" font="" in="" india="" interventions="" medical="" million="" nbsp="" of="" rotavirus="" rs="" specific="" spends="" such="" the="" to="" treat="" us="" use="" years="">as newly available vaccines, would help prevent much of this large disease and economic burden. Reference
The same vaccine will also be supplied to the Government of India at a price point of USD 1 according to sources.
This will open up the diarrhea vaccine market in much the same way Engerix vaccine opened up the Hepatitis B vaccine market in India, and would be a welcome development. 

India Vaccine News - Pentaxim vaccine shortage in India

In keeping with the global vaccine shortages that have become a part & parcel of the vaccine industry, PENTAXIM (5 in 1 painless DtaP with hib & IPV Combination vaccine - Sanofi Aventis) is at present out of stock in India.
The alternative options for parents / pediatricians are limited. Only 1 painless DTaP is brand is available at present (INFANRIX - GSK) and this can be mixed with Act - HIb (Sanofi Pasteur, as per personal communication / internal study of Sanofi). Injectable Polio (IPV) would need to be given separately.
Expected shortage to last till at least 1 month (15th to 20th feb 2014)

Saturday, January 11, 2014

What is the minimum age for giving Septran (Cotrimoxazole) in children?

Q: I have a 4 month old baby with Loose Motions. My pediatrician prescribed Bactrim / Septran, is it safe?

Ans. Yes, Cotrimoxazole (Bactrim, Septran, Septra etc.) is safe in children above 2 months age, and can be used in the dose of 8-10 mg/ kg/ day in 2 divided doses. Whether a 4 month old with diarrhea requires any antibiotics is another question altogether :)
If you have any further concerns, I would recommend that you discuss these with your pediatrician as well.
Read more here

Thursday, January 02, 2014

Parents question - I did not take Pneumonia vaccine for my baby at the right age, can I take it now?

Q. My baby Anurag is now 11 months old. My previous pediatrician in India did not recommend the Pneumonia vaccine, however the current Pediatrician (& my research online) seems to suggest that I should get it done. Can i take it now? If so, how many doses would be needed?

Ans. I would agree with your present pediatrician in giving the Pneumonia Vaccine to your 11 month old baby in India. The number of doses vary as per age. Taking any vaccine after the ideal age is referred to as "catch up" vaccination. Here is the recommendation for Pneumonia Vaccine for "Catch - up" Immunization.

For children 7 months through 5 years of age who have not received Pneumonia Vaccination, the following catch-up schedule should be used:
•Children 7 to 11 months of age should receive 3 doses. The first 2 doses should be at least 4 weeks apart with the third dose after the one-year birthday, separated by at least 2 months.
•Children 12 to 23 months of age should receive 2 doses at least two months apart.
•Children 24 months through 5 years of age (prior to the 6th birthday) should receive a single dose of PCV 13 (Prevenar) or 2 doses of PCV 10 (Synflorix).
So in this case, Anurag (11 month old) should receive 2 doses of the Pneumonia vaccine at a gap of 1 month, followed by a booster dose after another 2-3 months.