Monday, November 30, 2015

India introduces injectable polio vaccine in routine immunization TODAY

In the first phase, the injection will be introduced in six states: Assam, Bihar, Uttar Pradesh, Gujarat, Madhya Pradesh and Punjab. Photo: Pradeep Gaur/Mint
In the first phase, the injection will be introduced in six states: Assam, Bihar, Uttar Pradesh, Gujarat, Madhya Pradesh and Punjab. Photo: Pradeep Gaur/Mint
New Delhi: Babies getting their third dose of oral polio vaccine (OPV) will now also be administered an injection with inactivated polio vaccine (IPV), as part of India’s efforts to boost its polio immunization programme. IPV and OPV together can provide additional protection to a child.
India was certified polio-free on 27 March 2014, but the immunization programme continues in the country since two of its neighbours remain polio-endemic and due to the threat of vaccine-derived polio.
In the first phase, the injection will be introduced in six states: Assam, Bihar, Uttar Pradesh, Gujarat, Madhya Pradesh and Punjab.
“The last polio case was reported in India in 2011. But the risk is still there with the virus being active in Pakistan and Afghanistan. Hence, we are introducing IPV for double protection against polio,” said Union minister for health and family welfare J.P. Nadda, at an event to launch the vaccine. “By 2016 April, we will switch from trivalent to bivalent vaccine. We have to ensure that core and support systems work, along with a robust cold chain system and improved routine immunization,” added Nadda.
Trivalent vaccines protect against three strains of the polio virus while the bivalent variety protects against two. Immunization programmes the world over are switching to the bivalent vaccine since the third strain has been eradicated, and the trivalent vaccine could theoretically re-introduce it.
There are challenges that come with the introduction of the vaccine. IPV is an expensive vaccine and each dose costs around Rs.120 and unlike OPV, the IPV which is an injectable vaccine can only be given by trained health workers at vaccination sites. There are also issues of vaccine availability which the health ministry is trying to resolve.
“IPV is a key step towards global endgame strategy. It is a tough task to convince a population to continue with OPV after a country is declared polio-free and even harder to introduce IPV on top of that,” said Louis George Arsenault, country representative India, Unicef. “A lot of people doubted India could get polio-free, but it happened. We now look forward to a transition from OPV to IPV. If India can do it, so can the world,” he added.
IPV is not a new vaccine and was first used in 1955. Thirty countries have already introduced IPV in their national immunization schedule, while 126 countries including India will introduce IPV soon.

Wednesday, November 25, 2015

For all the mistakes, for the most part, doctors get it right. Remember that.

I have two refrigerators.
The full size, expensive version, sits in the usual location in the kitchen.  The small black one rests idly in the basement.  Excluding this morning, of course, when I dragged it up the steps and begrudgingly coaxed it back into action.  Let me explain.
Six months ago my old refrigerator started acting up.  Somewhere around year five, it’s motors groaned, its coolers moaned, and all the sudden the food started to smell.  So I called the repairman and hundreds of dollars later, it worked like a dream.
Until it didn’t.
The repairs held for all of a week.  I called the repairman back.  And we danced this dance a few more times.  In the meantime, I ran out to the local appliance store and bought a mini fridge to store my food.
I lived out of that little black fridge for weeks while workmen came and went.  Every time one problem was fixed, another popped up.  Eventually I bit the bullet, returned to the appliance store and bought a brand new, state of the art, full sized refrigerator to replace the old.
I happily returned the black fridge to the basement and thought little about it again.  For six months, my new appliance worked exactly the way it should.  The ice bucket was always full.  Each zone maintained the correct temperature.  I had separate drawers for the fruits, vegetables, and dairy.
I thought I was truly on the pathway to appliance nirvana when the unexpected happened.  I awoke one morning to fine a horrible sound coming from my brand new refrigerator.  Hours later it was dead.  My ice cream melted and my vegetables wilted.
I called a different repairmen who showed up promptly, and fixed the problem in short order.  Money well spent, or so I thought, until the exact same scenario played itself out forty-eight hours later.
Another trip to the basement, and the little black refrigerator has once again taken up residence in my kitchen.
This experience is nothing new.  I can’t count how many times a television has broken, and an iPad has malfunctioned, or a dishwasher latch has busted.  Each time I dutifully call an expert who sometimes gets the job done.  But often the repair unravels or the machine is deemed DOA and unable to be fixed.
This often makes me wonder why we expect so much out of our doctors.  The human body is far more complex than any electronic.  The number of moving parts measures in the millions.  And god knows how personal psychology plays into the range of pathology.
And for the most part, doctors get it right.  Eighty to ninety percent of the time.  Day after day, year after year.
I wish I could get this kind of service with my appliances.
Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of I Am Your Doctor: and This Is My Humble Opinion.

Monday, November 23, 2015

Misconception among patients about "Antibiotic Resistance" - a multi-country WHO survey highlights important facts !

Misconceptions about antibiotics and the health threat posed by antibiotic resistance are common around the world, according to findings from a multicountry survey from the World Health Organization (WHO) released today.
The survey, conducted online and in person, asked nearly 10,000 adults about use and knowledge of antibiotics and antibiotic resistance. It was conducted in 12 countries (two countries per WHO region): Barbados, China, Egypt, India, Indonesia, Mexico, Nigeria, the Russian Federation, Serbia, South Africa, Sudan, and Vietnam. Among the common misconceptions highlighted by the WHO:
  • Three quarters (76%) of respondents think antibiotic resistance happens when the body (not bacteria) becomes resistant to antibiotics.
  • Two thirds (66%) believe individuals are not at risk for a drug-resistant infection if they personally take their antibiotics as prescribed. Nearly half (44%) of respondents think antibiotic resistance is only a problem for people who take antibiotics regularly.
  • More than half (57%) of respondents think there is not much they can do to stop antibiotic resistance, and 64% believe the medical community will solve the problem before it becomes a serious threat.
  • Nearly two thirds (64%) say they know antibiotic resistance is an issue that could affect them and their families, but how it affects them and what they can do to address it are not well understood.
  • Nearly two thirds (64%) of respondents believe antibiotics can be used to treat viruses, and one third (32%) believe they can stop taking antibiotics when they feel better, rather than completing the prescribed course of treatment.
Source (needs free medscape registration)

Monday, November 16, 2015

Vaccine FAQs Indian parents - Spacing newborn vaccines

My daughter`s DOB is 28th-July-2015. Now She is due for OPV3 plus IPV3 plus DPT3 plus Hib3 plus Rotavirus3No. plus PCV3 on 20th -November-2015. All the due vaccination will give to one day or should I give her Rotavirus after 7 days, and PCV after 7 days. Pls recommend me.

I prefer to give all vaccines on the same day.
However, I do allow parents to help make the decision as per their beliefs.
I am sure she has been given the same vaccines together before as well, so this should not be an issue.


How To Learn From Your Patients - Dr Aniruddha Malpani

As medical students, we used to learn from our professors and from our medical textbooks. In clinical practice, we don't have professors to teach us anymore, which is why we need to learn by reading medical journals; attending conferences; and from our colleagues.
However, a very important source of learning which we often forget to take advantage of is our patients. All good doctors accept that they learn from their patients all the time. However, you do need to follow a process to maximise what you can learn from your patients.
Firstly, you need to be respectful , and understand that patients can be very valuable sources of knowledge , if you're willing to tap into them. Thus, it's possible to use patients as unpaid research assistants, ask them to look for information on the internet or do a PubMed search. Patients are extremely motivated. Some of them are extremely intelligent and have great business analysis skills, which they can apply to their medical problem as well . Ask them to share the information they learn by doing an internet search with you, so that together you can polish your skills - and theirs as well . You do need to guide them in the right direction , and provide them with feedback, so that the results of their search become progressively better.
Secondly, keep your heart and your ears open. There are lots  of inadvertent experiments which occur naturally in real life in clinical medicine. For example, some patients don't follow your instructions ; or forget what you tell them, in which case they end up doing something completely different; or they combine your treatment with alternative medicines.  These are clinical trial where n = 1. When this happens, they're scared and they don't tell you that they forgot to do what you told them; or that they did something completely different, as result of which we never learn from these encounters.  Sometimes, the outcomes of these variations is better than we would have expected. We need to treasure these exceptions and learn from them. If you keep your channels of communication open , and tell patients it's okay to make mistakes provided they share them with you, you may realize that even though the patient made a mistake, the outcome really wasn't bad at all - or perhaps was even better. You can learn from these first-hand experiences of your patients, and use these to tweak the treatment protocols which you offer.
Finally, smart patients will come up with clever hacks, and useful tips and tricks they use in order to manage their illness. When you see that a patient is doing a great job at taking care of himself, ask them what they are doing - and request them to share their experiences and expertise with you, so that you can teach your other patients as well !
Source (docplexus- requires free registration for doctors)

Tuesday, November 10, 2015

Vaccine FAQs - Can antibiotic be given to a child received DPT booster 24 hrs ago for Respiratory Tract Infection?

Q: Can antibiotic be given to a child received DPT booster 24 hrs ago for Respiratory Tract Infection?

A:  There is no interaction between any antibiotic and injectable vaccinations. The only possible exception could be oral Typhoid vaccine (not available in India at the present point of time). All presently available vaccines can be co-administered with antibiotics.

A new potential miracle cure for Leukemia - gene therapy saves an infant baby with untreatable leukemia

A new treatment that uses genetic manipulation to tailor genes and create modified immune cells programmed to seek out and destroy drug-resistant leukemia has been used in a hospital in the UK

A three-month-old baby girl diagnosed with an aggressive form of bone marrow cancer called acute lymphoblastic leukemia, given a cycle of chemotherapy, a bone marrow transplant, became a part of a clinical trial all before her first birthday- but cancer relapsed! As doctors knew the success rate for such aggressive form of this disease at this age is not more than 25%, doctors lost all hope and was preparing for her to perish. But doctors wanted to try one last option as they have heard about Dr. Waseem Qasim of University College London, who was working on a specific mode of gene therapy to treat cancer.
The therapy involved creating a modified immune cell with an ability to attack cancerous bone marrow cell and destroy them. This programs the T-cells to seek out and kill any cells with a protein called CD19 on their surface – which is found on the cells that cause acute lymphoblastic leukemia. This genetically modified T-cell was created by tools of “molecular scissor” called Transcription activator-like effector nucleases (TALENs) to modify a gene in CAR19 cells and converting it to Universal CAR19 (UCART19) cell line, those are meant to attack cancerous cells. In this course, the major problem remains with the recognition of those engineered cells as foreign by the host immune system. In leukemia patients, this is not a problem because they are given drugs that destroy their immune system. Except, one of these immunosuppressant drugs – an antibody – also destroys donor T-cells. So they also disabled a second gene in the donor T-cells, which made them invisible to the antibody.
The treatment consisted of 1ml of UCART19 cells delivered intravenously line in around 10 minutes. After the cells had been delivered, the patient spent in isolation to protect her from infections while her immune system was extremely weak. After patient showed up with signs of the immune response in the form of rashes etc, doctors became sure that the treatment is working and the patient is ready for another round of bone marrow transplant to replace her blood cells. Though much clinical evidence for the effectiveness of this therapy was not ready in the hand of researchers at that moment, but keeping in mind the pain and suffering of the baby they decided to try this therapy and it worked like wonder. She survived through the aggression of the disease and showed no symptom of relapse even after3 months of treatment. To the much hope of the baby’s family, when bags of chemo did not work, an ml of injection did the trick. Though it is too early to declare her to be cancer free but this success to counter the aggression of disease is monumental
This is only the second time that gene-edited cells have been used in people. The first ever trial involved modifying T-cells in people with HIV to make them more resistant to the virus.

Is routine home blood pressure monitoring really such a good idea? OR How much healthcare should be delegated to the patient?

occurred to me that this is a terrible idea.
In fact, it’s possibly the least beneficial thing for the general health of a population to have gained momentum in recent years. I’m not discussing cigarettes or e-cigarettes or low-yield cancer screening procedures. I’m not talking about diet drinks or sugary drinks.
I’m talking about home blood pressure monitoring.
It’s a terrible idea.
OK, I get it. The idea sounds benign. Buy your own cuff. Monitor your blood pressure at home. Why? Well, it might be high. And, we need data. Lots of it. So, monitor away.
Of course, it’s never really about an idea or its intention. It’s about results. And, how this concept currently gets implemented is the number one cause of preventable panic attacks in my area.
You think breast cancer screening is inflicting unnecessary angst on the general public? It’s nowhere even close to blood pressure monitoring. I’ve even found this practice to occasionally worsen the disease state of hypertension. Yes, it literally makes some people’s blood pressure get worse!
Very soon, I may give up recommending the idea to anyone. In fact, I currently tell more and more of my patients to check it less and less at home.
I’m really not trying to offend anyone involved with the patient empowerment movement. These are the people laser-focused on proving medicine’s paternalism has long been the problem with health care. They claim the “asymmetry of information” between the doctor and the patient must be eradicated. We must democratize medicine. Patient’s should own their medical data, be informed of all potential outcomes, and be equal participants in deciding upon medical therapies they know far less about.
And, let me tell you, I’m all for the dispersion of power. I’m fine with you believing this will improve your health. But, I just see so many people supporting this kind of thing who really have no clue what they are supporting.
Good intentions begone, what matters are results. And, the results of this ongoing home blood pressure project are a disaster.
I’m “on call” an average of 1 out of every 4 days all year long. People who aren’t in medicine really have no clue what it’s like to be on call. And, that’s okay. I have no clue what it’s like to be an astronaut. I just know that on many call nights, I’d rather be on the moon. Somewhere far away from call.
When I’m on call, I do my job. I manage emergencies that arise in my specialty at the hospitals nearby. I also take personal calls from patients who think they are having “emergencies” at home. These calls get patched into my phone from our office answering service.
If you are one of my patients, please don’t think that I don’t want you to call me when you need me. That’s why I’m on call, to help you in a time of need. Call me! But, just know that the human race is all over the place, and this is never more apparent than call nights.
I tell you more about my lifestyle in Finding Truth in Transparency, so I’m not going to repeat all of that here. But, I will tell you this. I drive a truck. Maybe, it’s outdated, but it has one light that comes on when it needs to be “serviced.” It doesn’t tell me what to do. It doesn’t tell me the radiator coolant needs flushing.
“Just bring her in,” it says.
And, for me, this seems to work fairly well.
You may presume monitoring blood pressure is an easy thing. Just give people a simple algorithm to follow that works. I haven’t found one. Doesn’t matter what I say in the office, the situation explodes out of control whenever people get home. Suspect the same thing would happen to me if I left the dealership with an air compressor.
I get calls frequently at 2 a.m. because, for whatever reason, the electronic home blood pressure monitor won’t turn on. People are literally stricken with panic, not sure what they should do.
I get calls in the middle of the night because someone without symptoms found his diastolic blood pressure (the bottom number) to be 45 mmHg. A neighbor told him that this number wasn’t compatible with life. Of note, this guy lived.
Patients frequently call after midnight with blood pressure readings to ask if they should go the emergency department. Who checks it then, you ask? On many nights, it seems like almost everyone. One person told me the insurance company instructed her to do it.
The first blood pressure may be 152/82 mmHg, which, not surprisingly, increases to 160/90 mmHg when checked five minutes later, and then increases again to 168/95 mmHg when checked a few minutes after that.
“What should I do?” people ask.
“Go to sleep,” I commonly say.
This movement has gotten out of control. I’m sure someone sitting behind medicine’s curtain of Oz will study this practice and find it to be helpful. I’m studying it now, and it’s not.
This post isn’t intended to provide medical advice. But, I’m just not certain there is much utility for an asymptomatic patient, feeling normal, to take a routine blood pressure before going to the bathroom in the middle of the night.
Yet, plenty of people think we need more of this patient participation and not less. Almost to the point that patients feel they are doing something wrong if they choose to be managed entirely by the discretion and expertise of a doctor, someone who (at this point) is still a human being capable of using judgement (despite a myriad of government mandates that appear less focused on incentivizing it).
Yes, we have apps on our phone that measure heart rate. The rhythm of our body is viewable on a watch. Consumers can now request any blood test they want to be drawn from a lab on the street corner.
And, I’m not against it. Just be ready for the consequences. They are coming. You think it will save doctor visits or drive more of them?
I’m not here to predict the future. The future of healt hcare will take care of itself.
I just think you’ll find that many things are better left for servicing at the dealership.

Rocky Bilhartz is a cardiologist and the author of Finding Truth in Transparency: Our Broken Healthcare System and How We Can Heal It. He can be reached at
Comment: While we in India are not there yet, but very soon these problems are going to surface in our country as well. Too much decision making in the hands of people is not necessarily going to reduce the cost/ burden of healthcare 

Friday, November 06, 2015

How to make your child healthier and happier in 30 seconds

Kids Should Read Whatever They Want, Whenever They Want

Time and again, I’ve come across scenes in novels where a young character is wandering around a library, whether personal or public, entranced by the endless possibilities offered by the books. These characters aren’t sure where to start, so they choose a book at random, and go from there.
Scenes like this occur in such works as A Tree Grows in BrooklynBlack BoyDirty River, and The Book Thief, suggesting that discovery through reading is a universal experience, one that enables readers to imagine other lives and other worlds. To me, it doesn’t get much better than that.
Which is why I will place no restrictions on my personal library when my kids learn how to read. With nearly a thousand physical books and scores of e-books, our house is almostgroaning under the weight of all those words. Poetry, fiction, history, biography, drama, anthologies: they’re all there on my bookshelves (and floors, and futons). They tell stories that are uplifting, disturbing, gruesome, inspiring, and hilarious. They reveal the kaleidoscopic diversity of human experience. They will show my kids that the world is an infinitely fascinating place.
But, some might say, you’d let your 8-year-old read Lolita? You’d let your 10-year-old readLady Chatterley’s LoverAnd anything by Emile Zola???
Yes, yes I would. You know why? Because I believe that you connect with books that you’re meant to connect with at a specific time. Reading Thomas Hardy, for instance, informed how I read Salinger and Faulkner, Morrison and Mann. I read voraciously, and my parents, who didn’t read much fiction themselves, left me alone with my literary choices. My mom listened for hours as I told her about the books I was reading, and while she lifted eyebrows and asked questions, she never told me I wasn’t allowed to read something. For that I’m eternally grateful.
This smörgåsbord of genres and time-periods and styles ultimately enriched my understanding of the world and my place in it. I realized through my reading that “the good old days” never really existed, that human nature never changes, and that I must keep an open mind if I wanted to keep on learning.
I bounced around between India and France, Israel and Alaska and South Africa and beyond, traveling in my mind and enjoying it especially because we never traveled much in real life. My family’s idea of a vacation was the ocean two hours away. Every. Single. Summer. I used books to explore places I couldn’t otherwise access, and built up a list of literary pilgrimages I wanted to make when I was older.
The key to having your kids’ reading be free-wheelin’ and unfettered but also informative is your availability to answer their questions and listen to them figure out what they’ve read. You won’t need to schedule specific times to have “Big Talks” about various issues because those issues will naturally come up in their reading. They’ll read Ralph Ellison and ask you about racism and injustice and identity; they’ll read Charlotte Perkins Gilman and ask about feminism and equality; they’ll read Dickens and Orwell and ask about poverty and surveillance and war. They’ll read histories of World War II and plays about apartheid and poems about faith or sexuality or despair. They’ll read graphic novels and comic books and libretti and screenplays. You’ll realize that answering their questions is a full-time job and that your books are making them really smart and thoughtful and pretty soon they’ll be outmaneuvering you in debates about when and for how long they can take the car and whether or not they can get a tattoo or dye their hair blue. But you’ll be proud of them.
I will admit, though, that there is one single book that, if I still had it in my library, I’d try to keep it out of my kids’ hands: American Psycho. It was assigned in my senior English course in college and you know what, I wish I could unread it. Look, if my kids found it elsewhere and read it, I couldn’t stop them. But I won’t be the one supplying it.
Anyway. You guys know how I feel about censorship and book-banning and mind-control bullshit, so this post should come as no surprise. Kids are more thoughtful than they’re sometimes given credit for, and they should be allowed to browse and sample and explore. Who cares if they don’t understand a book they read in 6th grade? They’ll read it again later, perhaps, and then all will be illuminated. After all, you can read the same book every three years and each time your life experiences will make you see the book differently.

So unleash your kids in your personal or public library and watch the magic happen.
Comment: Both me & my wife are voracious readers. However, unfortunately this appears to be a habit that is uncommon among the new generation, more so in India. We have gone through multiple Kindles already - even before they had first appeared in India. I would love our daughter Chandana to pick up any book and read. While she has been extremely fascinated by Dr Seuss books (courtesy my wife), she will probably read more as she grows beyond her 6 years age, I believe :)

Thursday, November 05, 2015

What are the COMMONEST food items that can trigger eczema (atopic dermatitis) in children ?

Here is what we recommend. Do the blood test for allergies. PHADIATOP/ ALATOP are the most renowned at the present point of time and easily available in big labs like Ranbaxy (SRL) and Lals Lab across India.
Then food avoidance is done as per tests is indicated. If tests are not possible or not helpful, the list of common foods to avoid include Milk, Egg, Peanut, Wheat, Soya, Shrimp and fish.
In India it is estimated that shrimp & fish allergy is likely less common.  

What is the right age for an Indian child to wear contact lens?

Wearing — and caring for — contact lenses is a serious responsibility and it takes some maturity to handle it well. Your child will need to remember to clean his contacts each time he wears them and wash his hands before he inserts them, or he could wind up with an eye infection or worse. And he may have to make important decisions about his lenses (such as when to take them out) without your help when he's away from home.

Many children are mature enough to handle the duties of wearing contacts at age 10. Consider what you know about your child: Does he remember to wash his hands before dinner and do other chores without being told? If so, he's probably mature enough to wear contacts. The bottom line is that your child must be motivated (the drive to wear them should come from him, not you) and responsible. Also keep in mind that a child of this age should wear contact lenses only as needed — while playing sports or for a special event, for example — rather than wearing them every day.
Comment: As per my wife, an ophthalmologist with significant pediatric experience, it would be useful to delay contact lens use till the child is at least 13 years old and is responsible enough to take care of the contact lens by themselves.