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Inflammatory bowel diseases-associated hepatobiliary disorders include: autoimmune hepatitis/ primary sclerosing cholangitis overlap syndrome, IgG4-associated cholangiopathy, primary biliary cholangitis, hepatic amyloidosis, granulomatous hepatitis, cholelithiasis, portal vein thrombosis and liver abscess. The spectrum of these manifestations varies according to the type of inflammatory bowel diseases. Successful therapy of EIM is essential for improving quality of life of patients with IBD. This slide set covers the common liver manifestations and its management.
Extra intestinal manifestations are common in patients with inflammatory bowel disease. These manifestations can affect different organ systems of a patients. The skin and the mucosa often affected as a result of inflammatory bowel disease. Common manifestations when this organ system is affected includes Erythema Nodosum, Pyoderma Gangrenosum, Sweet’s syndrome and Aphthous Stomatitis. Successful therapy of EIM is essential for improving quality of life of patients with IBD. This slide set covers the common skin manifestations and its management.
Pre-conception is the period during which many couples plan their pregnancy. Pre-conception care provides an opportunity to a couple to improve their health before trying for a baby. During this time, even the male partner needs to make lifestyle and diet changes such that they can help in conception.
Throughout the years there have been many cancer myths floating around. This article will help clear the myths related to cancer.
Infection during cancer, causes, sign and symptoms and tips for prevention are given in this patient education material in a simplified manner.
Among all body organs, eye manifests drug toxicity, second only to the liver. Ocular disorders occur not only from topical drugs, but also from their systemic administration. The current presentation gives a brief on the ocular manifestations of systemic medications and its management.
Hepatitis C virus (HCV) infection during pregnancy is an emerging problem. While not negatively affecting acute hepatitis, it may exacerbate chronic hepatitis and worsen liver function in woman with liver cirrhosis. The burden of HCV in pregnant women is largely underappreciated. New HCV antiviral regimens based on direct-acting antiviral agents without interferon have greatly expanded the pool of patients eligible for treatment and have dramatically improved treatment outcomes. This slide set discusses the management of hepatitis C infection in pregnancy.
Causes, signs and symptoms, prevention, diagnosis and treatment of liver cancer has been described in this article.
Basic understanding of cervical cancer including risk factors, symptoms, diagnosis and prevention is explained in this article.
Alcoholic liver disease includes a broad spectrum of entities from simple steatosis, acute alcoholic hepatitis with or without underlying cirrhosis, to hepatocellular carcinoma as a complication of cirrhosis. The approach to management of this condition along with the latest developments are covered in this slide set.
The Acetaminophen versus Ibuprofen in Children with Asthma (AVICA) was initiated to determine whether the use of acetaminophen vs. ibuprofen under clinical indication would result in higher morbidity related to asthma in children with mild persistent asthma. The findings revealed no differences in terms of the incidence of asthma exacerbations or asthma-related complications with the as-needed use of acetaminophen vs. ibuprofen over a period of 48 hours.
It is recognized that around 5-10% of patients with asthma have severe disease which remains inadequately controlled; despite high-dose ICS/LABA and additional controller medication if required. Due to the associated morbidity, these patients represent an important segment of asthma population. This slide set focuses on the identification, management and advances in severe asthma.
Air pollution is becoming a major risk factor for health problems and is also responsible for increased rates of cardiovascular and respiratory mortality. Lungs being the most vulnerable organ to the effects of pollution, people are experiencing high prevalence of respiratory symptoms due to exposure to air pollutants. This booklet is a general guide to the clinicians on the effects of pollutants on respiratory system on healthy individuals and vulnerable population & essential steps which can help in protecting against these harmful effects.
A nationally representative mortality survey that monitored 1.3 million households over a decade’s time was conducted in India to estimate the number of adult deaths from renal failure, and to determine the contribution of diabetes, hypertension and cardiovascular disease, along with changes over time. The survey confirmed renal failure to be a rising cause of premature deaths in adults. Moreover, diabetes was identified as the most robust predictor of death due to renal failure among the Indians.
Clinicians are required to assess abnormal liver chemistries on a daily basis. The most common liver tests done are serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase and bilirubin. This slide set discusses the new clinical guideline from the American College of Gastroenterology on the first recommendations in over a decade for the evaluation of abnormal liver chemistries. For the first time in a liver test guideline, the authors define a normal healthy serum ALT level based on gender and recommend that levels above this should be assessed.
The Global Initiative for MRSA Pneumonia (GLIMP) study, is an international, multicenter study aimed to determine the point prevalence and specific risk factors associated with MRSA infection in hospitalised patients with community-acquired pneumonia. The results of this study showed low prevalence of MRSA pneumonia, differing between countries and continents. The study also identified specific MRSA risk factors among community-dwelling patients hospitalised with pneumonia.
This study evaluated safety and efficacy of dapsone gel 5%, in treatment of acne when used in combination with adapalene gel 0.1% or benzoyl peroxide gel 4% or moisturizer. The 12 week results showed that dapsone gel 5% in combination with either adapalene gel 0.1% or benzoyl peroxide gel 4% was safe and well tolerated in the treatment of acne vulgaris.
Beta-lactam Infusion in Severe Sepsis (BLISS) study is a prospective, two-centre, open labelled, randomized controlled trial of continuous infusion versus intermittent bolus dosing of beta-lactam antibiotics in critically ill patients with severe sepsis from ICUs in Malaysia. The study results reveal the most beneficial method of administration of beta-lactam antibiotics in critically ill patients with severe sepsis.
A study determining the efficacy and safety of Saccharomyces boulardii (SB) in the treatment of acute childhood rotavirus diarrhea in Indian setting demonstrated that twice daily oral administration of 250 mg SB for 5 days significantly shortened the diarrhea duration and the duration of hospitalization without any adverse effects. Thus, SB appears to be a safe and effective option for treating acute rotavirus diarrhea in a setting of developing country like India.
This presentation gives an overview of the link between allergic rhinitis and asthma, with results from a large scale survey (CARAS) determining the association between the two conditions in Indian patients.
The present study was conducted to assess the patient compliance factors like ease of use, confidence, satisfaction and preference with Revolizer, a novel dry powder inhaler in Indian healthy individuals and patients with asthma or COPD. The study concluded that Revolizer was an easy to use and preferred device in patients with asthma and COPD as well as healthy individuals having no previous experience of using inhalation devices. It scored high in terms of confidence and satisfaction in the patients and was highly preferred as it was easy to use and operate. It has the potential to become the device of choice for patients as well as the physicians.
The HOPE (The Heart Outcomes Prevention Evaluation)-3 study was conducted to evaluate the efficacy and safety of a combined LDL cholesterol lowering and BP lowering strategy vs. placebo for preventing major cardiovascular (CV) events in individuals without CVD but at intermediate-risk. Fixed doses of rosuvastatin (10 mg/day) and candesartan (16 mg/day) + hydrochlorothiazide (12.5 mg/day) significantly lowered the risk of CV events as compared to dual placebo during the 5.6 years of treatment in intermediate risk population with average lipid and BP levels but without CVD, indicating that lowering BP and LDL-C lowered the risk of CV events in intermediate-risk patients who do not have a history of CVD.
The Heart Outcomes Prevention Evaluation (HOPE)–3 trial was conducted to evaluate the long-term effects of rosuvastatin in intermediate-risk, multi-ethnic population without cardiovascular disease (CVD). Cholesterol lowering with low-dose rosuvastatin (10 mg/day) for a period of 5.6 years significantly lowered the risk of CV events in an intermediate-risk, multi-ethnic population without CVD and having lipid levels in normal range.
Gout is a form of arthritis characterized by sudden and severe episodes of pain, redness, stiffness and swelling of joints because of high levels of uric acid in the body. This patient education gives a comprehensive overview of gout, its symptoms, causes and treatment.
This study aimed at determining the impact of oral antidiabetic (OAD) pretreatment on clinical outcomes and health resource utilization among type-2 diabetes mellitus (T2DM) patients. OAD treatment modestly delayed the initiation of insulin therapy and lowered the total healthcare costs for hospitalizations, physician office visit and emergency department visit in the study subjects.
Influenza, commonly known as "the flu," is a highly contagious viral infection of the respiratory tract causing mild to severe illness. It affects all age groups; however, children are at higher risk than adults. Although, humans have been afflicted for more than a century with influenza, the overall awareness about the disease is undermined. Help the child’s parents know all about influenza, how it spreads, its symptoms, means of prevention, the importance of vaccination and the right selection from the available vaccines against influena.
Influenza (flu), is an acute respiratory viral illness that occurs as seasonal epidemic with higher attack rates in children. Also, children are the main disseminators of influenza in the community as they are in frequent contact with their family members. Help the family know all about influenza, its symptoms, means of prevention, the need for vaccination and the right choice from the available vaccines in order to protect oneself and their loved ones against influenza.
Glance through this referral recommendations that The American Academy of Pediatrics (AAP) has created in collaboration with Surgical Sections of the AAP. It is intended to assist general pediatricians in determining when and to whom to refer their patients for pediatric surgical specialty care.
The Atherosclerosis Risk in Communities (ARIC) study was conducted to determine the association of migraine (with or without aura) with ischemic stroke, and stroke subtypes. The study with a follow-up of 20 years revealed that late-middle-aged individuals having migraine with visual aura had a greater risk of cardioembolic stroke rather than that of lacunar or non-lacunar thrombotic stroke. Such an association was not evident amongst migraine patients without visual aura.
Menstruation is a natural process, yet it is not spoken about openly due to unnecessary embarrassment and shame. Good menstrual hygiene is crucial for the health, education, and dignity of girls and women. These slides talk about the taboos related to menstruation & the basic steps to be followed for effective menstrual hygiene.
This presentation encompasses information about all aspects of changes that take place in boys during and after puberty, including male reproductive system, physical and emotional changes and different concerns that boys might face.
The current trial was conducted to determine the efficacy and safety of a single-dose Russian-backbone live attenuated influenza virus (LAIV) vaccine in pediatric population of rural and urban regions of Bangladesh. The intranasal LAIV proved to be very effective in the study population and its use was associated with very few adverse events. Thus, integration of LAIV program in low-income countries like Bangladesh might diminish the burden of influenza illness.
The CARAS survey was conducted to assess the prevalence of allergic rhinitis in Indian asthmatic patients and to determine their inter-relationship. The survey showed a high prevalence of concomitant allergic rhinitis in Indian patients with asthma, especially in Southern region of India. A positive link was found between perennial allergic rhinitis and the severity of asthma. The results reinforced the need for early diagnosis and co-management of the two diseases.
The current study was conducted to compare the effectiveness and cost-effectiveness of two treatment approaches: treat-to-target (TTT) and benefit-based-tailored strategy (BTT) for the management of type-2 diabetes mellitus (T2DM) in five low-income and middle-income countries (India, China, Ghana, Mexico, South Africa). The BTT strategy provided superior protection against future cardiovascular events and microvascular events and was also cost-effective as compared to TTT strategy.
Non-Cardiac Chest Pain (NCCP) is a term used to describe chest pain that resembles heart pain (also called angina) in patients who do not have heart disease. As the heart and esophagus are in close proximity, the pain due to both organs takes the same path to the brain. Thus, it becomes difficult to distinguish between cardiac pain and esophageal pain. This slide set gives a brief overview of the differentiating factors between GERD and NCCP.
Diarrhoea is a leading cause of death in India usually during the rainy season. Ignoring it may prove hazardous to life. A person can be protected from diarrhoea by taking few preventive measures that are described here.
The Metered Dose Inhaler (MDI) is a device that delivers a specific and pre-metered amount of medication to the lungs, in the form of an aerosol spray that is inhaled by the patient. It consists of a canister of pressurized medication that fits into a plastic actuator sleeve and connects to the mouthpiece. The formulation in an MDI is made up of the drug and a liquefied gas propellant. Cipla MDIs are designed to deliver accurate dosing by employing the right formulation technology and using the most sophisticated metered dose valves, canisters and actuators. Detailed steps of usage and cleaning are shown here.
The revolizer is a novel DPI device, which is the result of a design and development programme to address the critical requirements of an ideal inhalation device. It provides accurate dosing and excellent lung deposition even at low inspiratory flow rates combined with ease of use. It provides an improved respirable fraction while adding style and modern design to give patients a revolution in inhalation therapy.
European Respiratory Society (ERS) conference was conducted on September 3-7, 2016 in London, United Kingdom. It is conducted every year to present a wealth of information on all aspects of respiratory health and disease as well as an innovative educational programme that drives standards in respiratory care. Highlights of the ERS 2016 emphasizes on role of drugs, risk factors, importance of devices and relevant therapy updates in asthma, COPD, lung cancer, and other pulmonary diseases. The highlights also covers the newer research on both therapy and drugs being investigated in pulmonary disease.
This presentation gives an overview on the involvement of cholinergic system in asthma and further discusses the use tiotropium as an add-on to ICS/LABA in asthma.
Influenza continues to remain one of the most severe respiratory infections causing annual seasonal epidemics. Among the various public health strategies in place to combat influenza, vaccination is the most cost-effective strategy. Currently, live attenuated influenza vaccine (LAIV), has been widely accepted for use in protecting healthy individuals; however, it is contraindicated in certain group of individuals. This patient screening questionnaire along with the information on LAIV will help the health care professionals to check for vaccine-eligible patients.
The diagnosis of urinary tract infection (UTI) is delayed in roughly 10% of the pediatric population due to lack of pyuria. This consequently delays the treatment. This study was conducted to determine various factors associated with absence of pyuria in symptomatic UTI patients with a positive urine culture. The findings revealed that pyuria might not be evident in children with UTIs due to certain pathogens such as Enterococcus and Klebsiella species and P aeruginosa. Hence, urinalysis and urine culture must be performed in all the pediatric patients suspected of having UTI.
The POSEIDON trial was planned to explore the point prevalence of symptoms and medical conditions for which a patient visits a primary health-care practitioner in India. Results showed that respiratory symptoms were the main reason for visits to a primary health-care practitioner and hypertension and obstructive airway diseases were the most common diagnoses.
Around 50% of women experience at least one episode of UTI at some point in their lifetime and recurrent UTI occur in about 20-40% of women. European Association of Urology (EAU) guidelines have suggested that, antimicrobial prophylaxis for prevention of rUTI should be considered only after counselling and behavioural modification has been attempted and when non-antimicrobial measures have been unsuccessful. Cranfit (a combination of cranberry and D-mannose) is one such non-antimicrobial solution that helps in promoting urinary tract health and reducing the frequency of UTIs. This slide set provides detailed information on the mechanism of action, clinical efficacy and safety studies as well as dosage and administration of cranberry and D-mannose.
Fungal infections of the skin are very common and include athlete's foot, jock itch, ringworm, and yeast infections. It can be easily acquired from the surroundings or from infected individuals. Here are few tips on how fungal infections can be avoided.
The world's first transparent Rotahaler™ is a dry powder inhaler (DPI). Rotahaler™ is used with Rotacaps, which is pre-metered single dose medication for inhalation. DPIs are breath-actuated devices and eliminate the need for co-ordination of actuation and inspiration. RotahalerTM is a simple to use device and its transparency provides visual confirmation to the patient that the drug has been inhaled. The user has to insert the Rotacap, twist the base of the Rotahaler, and then inhale.
Cefuroxime is a second-generation cephalosporin antibiotic. It is a broad-spectrum antibacterial agent with a favorable pharmacokinetic profile. This presentation highlights the pharmacology, efficacy and safety as well as dosage of cefuroxime in various approved indications.
Influenza, one of the most common infectious diseases, is an acute respiratory illness caused by influenza viruses. A country like India, apart from having a huge population, also faces challenges in influenza diagnosis and management; thus, annual vaccination would be an ideal and principal intervention for preventing influenza and reducing the public health impact of epidemics and pandemics. This article provides information on Trivalent live attenuated influenza vaccine (NASOVAC-S), Its usage and other relevant details that will be of interest to all healthcare professionals.
Urinary tract infections (UTIs) are one of the most common bacterial infections. Around 50% of women experience at least one episode of UTI at some point in their lifetime and recurrent UTI occur in about 20-40% of women. Fosfomycin is a broad-spectrum bactericidal antibiotic. It is recommended by the current EAU and IDSA guidelines as first-line antibiotic for empirical treatment of women with acute uncomplicated cystitis. Fosfomycin is the only antibacterial approved by US FDA as a single-dose therapy for acute uncomplicated cystitis. This presentation provides brief overview on the mechanism of action, unique features, clinical efficacy and safety studies, dosage and recommendations of fosfomycin in the treatment of acute uncomplicated cystitis.
Zerostat VT™ spacer is a unique static free transparent spacer with a valve mechanism which increases the drug fraction reaching the lungs. It acts as a reservoir where the actuated aerosol cloud can be held prior to inhalation and thus overcomes the actuation inhalation co-ordination. It has all the features which a spacer should ideally have i.e. static free, transparent, flow gate valve, shape of an aerosol plume and volume 250-300 ml. The time available for inhalation is prolonged by using polyamide, which is a static free material. The half – life of aerosol in the Zerostat VT™ spacer is 60 sec. Unidirectional flow from the holding chamber is achieved by using a one-way valve.
The European Association for the Study of Diabetes (EASD) annually conducts a scientific meeting for all clinicians involved in diabetes research or the delivery of diabetes care. This meeting has now become the largest international annual conference on diabetes worldwide. Selected abstracts from the 52nd Annual Meeting of EASD are compiled here.
Good personal hygiene is the first step to good health. But for women, it's also about taking care of the hygiene of their most intimate area – the vagina. Here is a list of important tips that will help in maintaining proper intimate hygiene.
Good personal hygiene is the first step to good health. But for women, it's also about taking care of the hygiene of their most intimate area – the vagina. These slides talk about the normal vaginal environment and pH, risk factors that can alter the pH, consequences of altered pH and a new lactic acid hygiene wash which can help maintain the normal vaginal pH and prevent infections.
Teriparatide has recently gained increasing popularity for the treatment of severe osteoporosis due to its unique mode of action. This presentation briefly covers the mode of action, dosage, contraindications and efficacy and safety of teriparatide in severe osteoporosis.
Asthma and COPD patients have many myths regarding the treatment and the inhaler use. Role of paramedic is very important to counsel and solve all the patient queries associated with the treatment regimen and inhaler use & maintenance. This would further help in improving the acceptance and adherence to the therapy. This booklet is a guide for paramedics, which would help them in learning how to use and maintain various inhaler devices; along with answers to common patient queries.
Patients of the STENO-2 trial were followed up for a period of 21.2 years to determine the potential long-term impact of 7.8 years of intensified multifactorial intervention in patients with type-2 diabetes mellitus (T2DM) and microalbuminuria. As per the findings, intensified, multifactorial, target-driven treatment reduced mortality and the risk of cardiovascular events in the study subjects.
Peptic ulcers are open sores that develop on the inside lining of stomach and the upper portion of small intestine. The most common symptom of a peptic ulcer is stomach pain. Most peptic ulcers are caused by infection with the bacteria Helicobacter pylori (H. pylori). Another common cause is the use of nonsteroidal anti-inflammatory drugs (NSAIDs).This patient education sheet provides information on peptic ulcer disease- its causes, risk factors, symptoms, complications, treatment options and prevention.
This study compared the efficacy of live attenuated influenza vaccine (LAIV) vs. inactivated influenza vaccine (IIV) in children and adolescents of the Hutterite community. Vaccinating children with LAIV did not provide better community protection against influenza virus as compared to IIV. LAIV did not provide any additional benefits over IIV.
Gastroesophageal reflux disease (GERD) is a disease which encompasses a wide range of symptoms for the patient. The diagnosis of GERD is often based on the patient’s history if the symptoms are typical. However, in case of atypical symptoms additional tests are required by the physician to confirm the diagnosis of GERD. This document gives a glance of the various diagnostic approaches for gastroesophageal reflux disease.
Gastroesophageal disease occurs when contents of the stomach back flow into the esophagus. Patients often experience a burning sensation in the chest known as heartburn. Majority of patients are relieved of symptoms through changes in diet and lifestyle. However, some of them may require medications. This patient education sheet provides information on GERD- its causes, symptoms, treatment, and long term complications.
SPRINT was conducted to compare the clinical benefits of intensive vs. standard systolic blood pressure (SBP) lowering in non-diabetic patients at high risk of cardiovascular (CV) disease. As per the results, SBP target <120 mm Hg vs. <140 mm Hg lowered the rates of fatal and nonfatal major CV events and death from any cause in the study subjects. Nevertheless, the incidence of adverse events was significantly high in the patients treated intensively.
CDC has recently released updated guidance for U.S. health care providers taking care of women in the reproductive age group with possible Zika virus exposure. It includes recommendations on counseling women and men with possible Zika virus exposure who are interested in conceiving.
This presentation discusses basics of inhalation therapy. It gives an overview and pros & cons of various types of inhalation devices - pMDI, spacer, DPIs, Autohaler and Nebulizer.
Presence of free radicals in the skin affect its cellular structures. It also depletes the natural reservoir of antioxidants in the skin which leads to the ageing of skin. Topical antioxidant therapy is preferred for the treatment of photoageing. VCX serum is a topical combination of antioxidants which aims at introducing these antioxidants directly to the skin. This booklet highlights the properties of each antioxidant and the rationale behind its combination.
Disseminated TB results from widespread blood borne dissemination of TB bacilli. This presentation includes causes and risk factors of disseminated tuberculosis. It also includes the management approach of ARDS with Disseminated Tuberculosis.
Analyzing the respiratory sounds is an important diagnostic process in children with respiratory symptoms. In this video, Dr. H. Paramesh emulates the various respiratory sounds in children and the several diagnosis which can be inferred from analyzing them.
Urinary tract infection (UTI) is an inflammatory response of urothelium to bacterial invasion. UTI is found to be more common in females and it is found that around 50% of healthy women suffer from UTI at some point of time in their life. The following slide set elaborates on the prevalence, pathophysiology and diagnosis of UTI. It also describes the clinical presentation and recommended antimicrobial therapy for the treatment of uncomplicated UTI.
Post-exposure prophylaxis (PEP) is the method of preventing exposures of HIV to blood and body fluids and it is considered to be the most important strategy for preventing occupationally acquired human immunodeficiency virus (HIV) infection. It refers to the prophylactic use of antiretrovirals to prevent establishment of HIV infection after an occupational exposure to HIV. PEP is majorly used for health care professionals who come in contact with blood or bloody fields in the hospital or laboratory. The current WHO guidelines recommends antiretroviral drug regimens and duration of prophylaxis post exposure of HIV in Health care professionals.
HIV is the strongest risk factor for developing tuberculosis (TB) disease in those with latent or new Mycobacterium tuberculosis infection. Prevention of TB is one of the most important measures needed to reduce morbidity and mortality among PLHIV. Isoniazid preventive therapy (IPT) has proved effective in reducing TB rates among HIV-infected patients. WHO recommends at least 36 months of isoniazid preventive therapy for adults and adolescents living with HIV, who have an unknown or positive tuberculin skin test status and among whom active TB disease has been safely ruled out. The fixed dose combination of Sulfamethoxazole (800mg) /Trimethoprim (160 mg) /Isoniazid (300 mg) /Pyridoxine (25 mg) can provide the overall protection from all the opportunistic infection including TB.
Many factors can impair asthma control. One which is frequently overlooked is Allergic Rhinitis (AR). Both AR and asthma are highly prevalent and often co-morbid conditions. In this talk, a renowned Chest Physician, Dr. PA. Mahesh from Mysore has explained in a very lucid manner with specific statistical data, on the link between AR and asthma and the strategies involved in the diagnosis and management of these two concurrent upper and lower airway diseases.
The first Indian physician-based survey which provides unique insights on how dyslipidemia is managed in routine clinical practice. This survey was presented as an oral presentation at APICON 2016, with Dr. G. S. Wander as the principal author.
This patient education article provides a brief overview on the incidence, causes, risk factors, types of urinary stones and symptoms, diagnosis as well as management of urinary stones with few dietary and lifestyle modifications for preventing urinary stone formation in a simple manner.
PrEP is the use of an antiretroviral medication by HIV-negative individuals to prevent them from acquiring HIV. These slides give an overview of the WHO and the Pre-exposure Prophylaxis for the Prevention of HIV Infection in the United States – 2014 Clinical Practice Guideline recommendation on PrEP for HIV negative individuals at substantial risk
This patient education leaflet provides a brief overview on the incidence, causes, risk factors, symptoms, diagnosis and treatment of urinary tract infection with few tips on preventing UTI in a simple manner.
Asthma is one of the most common respiratory diseases world-over and it affects people of all ages and more specifically children. As part of our initiative to keep Indian physicians abreast of the latest in asthma and its management, we have developed this Q and A series using questions received during a CME program - “Helping you Deliver in your Asthma Practice’’. This is the second issue of booklet which covers Q & A on treatment of asthma.
The American Diabetes Association (ADA) annually conducts a scientific meeting for all healthcare professionals involved in diabetes research or the delivery of diabetes care. Selected abstracts from the 76th Annual Meeting of ADA are compiled here.
This talk by Dr. Vikram Jaggi, an expert in the field of allergy, describes why Allergic Rhinitis (AR) should be considered as a serious condition in todays practice; the impact of AR on a patient’s QoL; how AR should be differentiated from common cold, as well as practical aspects in the diagnosis and management of the disease.
Asthma is one of the most common respiratory diseases world-over and it affects people of all ages and more specifically children. As part of our initiative to keep Indian physicians abreast of the latest in asthma and its management, we have developed this Q and A series using questions received during a CME program– “Helping you Deliver in your Asthma Practice’’. This is the first issue of booklet which covers Q & A on asthma pathophysiology, risk factors and diagnosis.
Allergic rhinitis is a very common disorder that affects people of all ages, however, peaking inthe teenage years. Considered innocuous, it is detrimental to health interms of the individual quality of life and also to the society in terms ofhampered individual productivity.This booklet attempts to elucidate the mechanisms behind the manifestation of the symptoms, the characteristics, the diagnosis and the treatment of allergic rhinitis
Inflammatory bowel disease is a chronic relapsing disorder that affects the digestive tract. It symptoms include, bloody diarrhea, abdominal pain, fever, painful urge to pass stools. This disease can be effectively managed through the use of anti-inflammatory medications.
Causes and prevention of constipation along with symptoms usually experienced in this condition have been listed in this booklet to help patients understand and deal with their situation.
While bisphosphonates reduce fracture risk over 3 to 5 years, the optimal duration of treatment is uncertain. This study suggest that almost all patients who have received six annual infusions of zoledronic acid can stop medication for up to 3 years with apparent maintenance of benefits.
The understanding of HBV infection is continuously improving and these advances are included in the APASL 2015 hepatitis B management guidelines. This slide set covers the latest recommendations from this guideline. Changes in recommendations are noted in natural history, screening, counselling, assessment of the stage of liver disease, choice and duration of treatment. Updates in the management of special situations like childhood, pregnancy, co-infections, renal impairment and pre-and post liver-transplant have been covered here.
The American Diabetes Association annually conducts a scientific conference for all health care professionals involved in diabetes research or the delivery of diabetes care. Selected abstracts from the ADA 75th Scientific Sessions, 2015 are compiled here.
The American Diabetes Association annually conducts a scientific conference for all health care professionals involved in diabetes research or the delivery of diabetes care. Selected abstracts from the ADA 75th Scientific Sessions, 2015 are compiled here.
Glance through this comprehensive overview of epidemiology, clinical manifestations, transmission, impact and diagnosis of one of the most common and contagious infectious disease – the seasonal influenza (flu).
Swine flu can be diagnosed only through test in a specialised laboratory by identifying the particular antigens associated with the virus type. Here is a list of 21 laboratories across India that are equipped to test H1N1 viruses.
With the scare of swine flu looming in our country and the death toll increasing, Indian Medical Association and subject experts have issued a joint statement on recommendations for influenza vaccination and preventive measures for health care workers and general public.
Swine Flu due to H1N1 virus is a contagious disease that can lead to hospitalization and even mortality if not treated timely. Government of India urges you to identify the flu symptoms and take the following actions to protect yourself and others from flu.
Ebola is a hot topic across the world, but with the flu season also in full swing, it’s important to know the difference between the two. Find out the difference between these two vastly different viral diseases that begins similarly but ends differently.
This presentation includes the detailed description about the mode of action, pharmacokinetics and clinical efficacy & safety of paracetamol injection: a well known analgesic agent indicated for the short-term treatment of moderate pain, especially following surgery; and, short-term treatment of fever.
The World Allergy Organization International Scientific Conference (WISC 2014) held in December 2014 at Brazil, threw some light on the latest updates in the field of allergy. Summarized here are a few abstracts on the latest in airway allergies; i.e. asthma and allergic rhinitis. A large number of abstracts focused on Indian data on the prevalence of asthma and allergic rhinitis, as well as aeroallergens in India.
Allergic rhinitis is a contributing factor in 60% to 80% of patients with chronic sinusitis. Both these diseases have a significant impact on patients quality of life and is associated with illness related productivity loss in the workplace. Therefore, the relationship between allergic rhinitis and rhinosinusitis is a relevant issue; and this booklet reviews this link between the two diseases suggesting an appropriate approach for its management in clinical practice.
Carbapenems are preferred as an empirical therapy for the treatment of serious infections since last two decades, and still holds its position in current antibacterial armamentarium. But, as the treatment of resistant pathogens becomes difficult and very few new antimicrobial agents are available after development of carbapenem resistance, the best approach is to optimize the currently available antimicrobials. This set of slides highlights the rationale behind the optimization of carbapenem therapy by using the 3D approach: Right Dose, Right Duration and Right Drug combination.
A quick glance at the facts and myths regarding Ebola virus disease will help combat fear and clear confusion.
Here is an overview of the reasons why deriving an optimum therapy for Ebola Virus Disease has been so difficult and the treatment approaches available for Ebola Virus Disease including therapeutic approaches as well as vaccines being used in the current outbreak.
Sunscreens have become an indispensable part of every person’s skin care routine. But there are many myths about the use of sunscreen. This leaflet includes few myths and facts about sunscreens.
The European Association for the Study of Diabetes annually conducts a scientific meeting for all healthcare professionals involved in diabetes research or the delivery of diabetes care. Selected abstracts from the 50th Annual Meeting of EASD are compiled here.
The caregivers of a dementia patient are faced with many challenges when taking care of the patients. This short presentation gives a brief on dementia and tips to the caregivers on how to manage various aspects viz. feeding, clothing, sleep schedules etc.
The American Diabetes Association annually conducts a scientific conference for all health care professionals involved in diabetes research or the delivery of diabetes care. Selected abstracts from the ADA 74th Scientific Sessions, 2014 are compiled here.
The American Diabetes Association annually conducts a scientific conference for all health care professionals involved in diabetes research or the delivery of diabetes care. Selected abstracts from the ADA 74th Scientific Sessions, 2014 are compiled here.
Chronic pancreatitis (CP) is described as an ongoing inflammatory condition of the pancreas specified by irreversible morphologic damages resulting in pancreatic exocrine and endocrine insufficiency. Medical, endoscopic and surgical treatment of CP should aim at control of symptoms, prevention of progression of the disease and correction of complications. The following slide-set reviews the etiology, pathogenesis, diagnosis and management of CP.
Physician update (issue 3) takes you through the recent news & information related to Urinary Tract Infections (UTI) followed by the various criteria’s for defining UTI events, risk factors as well as the journey through the management of complicated and uncomplicated UTI in adults.
Muscle cramps of varied severity and frequency are common in patients with liver disease and are associated with a significant decrease in the health-related quality of life (QoL). Muscle cramps has not been acknowledged to be of sufficient importance and its treatment in general and in liver patients still remains empirical. The clinical features, pathophysiology and therapeutic approach to cramps in patients with liver disease has been covered here.
Acute pancreatitis is an inflammatory disease characterized by acute abdominal pain of varying severity and associated with extensive morbidity and mortality. The increased incidence of pancreatitis, coupled with new treatment options, poses a challenge in its management for the physicians. The following slide-set reviews the etiology, pathogenesis, diagnosis and management of acute pancreatitis.
This book is a compilation of key abstracts from the posters presented at 24th ECCMID, held at Barcelona, Spain.
This slide set summarizes the key 2014 clinical practice recommendations of the American Diabetes Association (ADA) on the screening, diagnosis and management of diabetes and its complications.
The 70th Annual meeting of the American Academy of Allergy Asthma and Immunology Conference 2014 was held in Boston, USA from 28th February to 4th March 2014. Interesting abstracts in the field of asthma and allergies from the conference have been compiled in this proceedings.
This antibiotic reckoner presents the information on the approved dosage and indications of various antibiotics commonly used in the clinical practice. It also provides the details of antibiotic concentrations attained in different body tissues. This booklet is intended for use by healthcare providers who treat diverse infections.
Irritable Bowel Syndrome is a functional disorder of the digestive system. Although it’s prevalence in India is lower as compared to the western countries, it is still one of the most common disease managed by gastroenterologists. Within these slides, the diagnosis, management and treatment of this condition is covered.
This newsletter summarizes the 2012 IDSA guidelines and discusses the management and the recommendations regarding antibiotic choices and dosing. The guidelines are intended for use by healthcare providers who care for adult and paediatric patients with group A streptococcal pharyngitis.
Nails are not only an important aspect of the external appearance; they are also mirrors of internal health. This booklet highlights examples of fingernail and toenail abnormalities that can provide clues to underlying systemic diseases
Healthy hair is not only a pleasure to behold; it is pleasing to person who has it. Healthy looking hair is a sign of excellent general health. This leaflet highlights few tips for healthy hair.
A compilation of the highlights of important presentations and clinical trials discussed at the recent Annual Scientific Sessions Meeting of the American Heart Association (AHA) held at Texas in November, 2013.
The European Respiratory Society's (ERS) Scientific Conference was held in Barcelona, Spain from 7th to 11th September 2013. Presented here are the key abstracts in the field of asthma, COPD, pulmonary infections, sleep apnoea and PAH.
This poster provides information on the sites and types of urinary stones as well as the different treatment options available for the management of urinary stones in a simple manner.
In India, hypertension has reached epidemic proportions and as per the latest estimates, one in 3 adults in India has hypertension. This slide set mainly discusses the prevalence, risk factors and recommendations from the Indian Guidelines on Hypertension – III, published in 2013.
Back pain is a common problem that affects most people at some point in their life. This leaflet provides simple guidelines to keep back in good shape to avoid back pain and is available in English & Hindi.
Simple dietary changes can help control Gout, a disease characterized by excess uric acid in blood. This leaflet provides information on the foods to be eaten and to be avoided in patients suffering from Gout, and is available in English & Hindi.
Clostridium difficile associated diarrhoea (CDAD) is an important cause of nosocomial morbidity and mortality and has heightened clinicians’ awareness of CDAD in the recent past emphasizing the importance of early recognition and its appropriate treatment. A quick algorithm on management of CDAD may help to guide the therapy.
This booklet emphasizes that patients with DFI should be evaluated for an ischaemic foot, and the employment of multidisciplinary foot teams improves outcomes. Clinicians and healthcare organizations should attempt to monitor, and thereby improve, their outcomes and processes in caring for DFI.
This factfile is designed to serve as quick reference guide, providing clinically relevant information on Pulmigen such as the efficacy and safety, use in children, mode of administration, place in therapy and advantages it offers.
Highlights of the World Allergy Organization (WAO) International Scientific Conference 2012 Presented here are key abstracts from the recently concluded WAO International Scientific Conference held at Hyderabad, India.
ID Week 2012 conference was held from October 17-21 at San Diego with the theme—Advancing Science, Improving Care. The conference highlighted the recent therapy approaches in prevention, diagnosis, treatment, and epidemiology of infectious diseases.
This booklet summarizes the IDSA 2012 Guidelines on Acute Bacterial Rhinosinusitis which addresses key issues, including an algorithm for the subsequent management, based on the risk assessment for antimicrobial resistance and evolution of clinical responses.
The artesunate plus mefloquine combination is one of the five WHO recommended ACT’s for uncomplicated malaria. It is indicated for the treatment of multidrug resistant falciparum infection. This monograph provides insights into the clinical efficacy and safety of artesunate plus mefloquine administered as a fixed-dose combination.
Indigestion, a common problem faced by individuals is often a reason for a visit to a doctor. Treating this condition often needs a fair amount of counseling along with medication to give the patient effective relief. This booklet has been designed as an aid for counseling of this condition and has different sections that deal with the various aspects of indigestion the patient faces. Facts have been provided in a lucid and simple manner to help patients.
This booklet gives overview on diagnosis & management of urological infections and provides information on recommendations for antimicrobial therapy for treatment as well as prophylaxis.
A compilation of key studies presented at the AHA 2012 Scientific Sessions
This patient education booklet is designed to provide useful information to patients diagnosed with hepatitis B with the goal of helping them and their caregivers understand and manage this disease. The information supplied here is presented in the form of answers to commonly asked questions regarding the disease, symptoms, diagnosis, and treatment.
This slide set takes a physician through prevalence and hazards of smoking and smokeless tobacco especially in India. NRT as a form of providing nicotine, mechanism of action of NRT, studies on efficacy and safety of NRT.
It explains the causes, risk factors, symptoms and treatment options for angina, as well as the various do’s and don’t’s in a patient-friendly language. This patient education is available in 3 languages – English, Hindi and Marathi.
This algorithm outlines the approach for diagnosis and treatment of uncomplicated malaria when microscopy results are available within 24 hours and when microscopy results are not available within 24 hours.
This presentation discusses the hidden facts of PUO.
<h1 class="csv-title">Practice Enhancer<br />Diagnosis and Treatment of Malaria in India</h1><h2 class="csv-header"><a name="1">Introduction</a></h2><div class="content"><p>Malaria is a major public health problem in India, accounting for sizeable morbidity, mortality and economic loss. Around 1.5 million confirmed cases are reported annually by the National Vector-Borne Disease Control Programme (NVBDCP), of which 40-50% are due to <em>Plasmodium falciparum (P falciparum)</em>. Malaria is curable if effective treatment is started early. Delay in treatment may lead to serious consequences, including death. Prompt and effective treatment is also important for controlling the transmission of malaria.</p></div><p><a href="/sites/default/files/csv_images/CPM-0IDOP0499-1.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-1.jpg" /></a></p><div class="content"><p>In the past, chloroquine was effective for treating nearly all cases of malaria. In recent studies, chloroquine-resistant P. falciparum malaria has been observed with increasing frequency across the country. The continued treatment of such cases with chloroquine is probably one of the factors responsible for the increased proportion of <em>P falciparum</em> relative to <em>Plasmodium vivax (P. vivax)</em>.</p></div><h2 class="csv-header"><a name="2">Clinical Features</a></h2><div class="content"><p>Fever is the cardinal symptom of malaria. It can be intermittent, with or without periodicity, or continuous. Many cases have chills and rigors. There may be accompanying headache, myalgia, arthralgia, anorexia, nausea and vomiting. The symptoms of malaria can be non-specific and mimic other diseases like viral infections, enteric fever, etc.</p><p>Malaria must be considered in patients residing in endemic areas and presenting with the above symptoms. It should also be suspected in those patients who have recently visited an endemic area.</p><p>Malaria is known to mimic the signs and symptoms of many common infectious diseases; therefore, other causes should also be suspected and investigated in the presence of the following manifestations:</p></div><div class="bullet_list"><ul><li>Runny nose, cough and other signs of respiratory infection</li><li>Diarrhoea/dysentery</li><li>Burning micturition and/or lower abdominal pain</li><li>Skin rash/infections</li><li>Abscess</li><li>Painful swelling of joints</li><li>Ear discharge</li><li>Lymphadenopathy</li></ul></div><h3 class="csv-subheader">Manifestations of Severe Malaria</h3><div class="content"><p>Severe manifestations can develop in <em>P. falciparum</em> infection over a span of time as short as 12-24 hours and may lead to death, if not treated promptly and adequately. Severe malaria is characterized by one or more of the following features:</p></div><div class="bullet_list"><ul><li>Impaired consciousness/coma</li><li>Repeated generalized convulsions</li><li>Renal failure (serum creatinine >3 mg/dL)</li><li>Jaundice (serum bilirubin >3 mg/dL)</li><li>Severe anaemia (haemoglobin <5 g/dL)</li><li>Pulmonary oedema/acute respiratory distress syndrome</li><li>Hypoglycaemia (plasma glucose <40 mg/dL)</li><li>Metabolic acidosis</li><li>Circulatory collapse/shock (systolic blood pressure <80 mm Hg; <70 mm Hg in children)</li><li>Abnormal bleeding and disseminated intravascular coagulation (DIC)</li><li>Haemoglobinuria</li><li>Hyperthermia (temperature > 104 F)</li><li>Hyperparasitaemia (>5% parasitized red blood corpuscles (RBCs) in low endemic areas and >10% in hyperendemic areas)</li></ul></div><div class="content"><p>Foetal and maternal complications are more common in pregnancy with severe malaria; therefore, they need prompt attention.</p></div><h2 class="csv-header"><a name="3">Diagnosis</a></h2><div class="content"><p>All clinically suspected malaria cases should be investigated immediately by microscopic examination of blood films and/or the Rapid Diagnostic Test (RDT).</p><p><h3 class="csv-subheader">Microscopic examination of blood films</h3><br />Microscopy of stained thick and thin blood smears remains the gold standard for a definitive diagnosis of malaria.</p><p>The advantages of microscopy are as follows:</p></div><div class="bullet_list"><ul><li>The sensitivity is high, so it is possible to detect malarial parasites at low densities. It also helps to quantify the parasite load.</li><li>It is possible to distinguish the various species of malarial parasites and their different stages.</li></ul></div><div class="content"><p>Microscopic evidence may be negative for asexual parasites in patients with severe infections due to sequestration and partial treatment. Efforts should be made to confirm these cases by RDT or repeat microscopy. However, if the symptoms clearly point to severe malaria and there is no alternative explanation, such a case should be treated accordingly.</p></div><h3 class="csv-subheader">Rapid Diagnostic Test</h3><div class="content"><p>Rapid Diagnostic Tests (RDTs) are based on the detection of circulating parasite antigens. Several types of RDTs are available. Some of them can only detect <em>P. falciparum</em>, while others can detect other parasite species also. The latter kits are expensive and temperature-sensitive. These kits are especially useful at locations where microscopy results are not obtainable within 24 hours of sample collection.</p></div><p><a href="/sites/default/files/csv_images/CPM-0IDOP0499-2.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-2.jpg" /></a></p><p>Note: It should be noted that Pf <em>(P. falciparum)</em> Histidine rich protein 2 (HRP2) based kits may show positive results up to 3 weeks of successful treatment.</p><h2 class="csv-header"><a name="4">Aims of Malaria Treatment</a></h2><div class="bullet_list"><ul><li>Complete cure</li><li>Prevention of progression of uncomplicated malaria to severe disease</li><li>Prevention of deaths</li><li>Interruption of transmission</li><li>Minimizing the risk of selection and the spread of drug-resistant parasites</li></ul></div><h2 class="csv-header"><a name="5">Referral to a Specialist / Hospital</a></h2><div class="content"><p>Once diagnosis of malaria is confirmed, appropriate antimalarial treatment should be initiated immediately. While uncomplicated malaria can be managed at home, severe malaria needs special care at a hospital. Danger signs of severe malaria should be looked for and if any of these are noted, the patient should be referred to a specialist/hospital.</p></div><h3 class="csv-subheader">How to Recognize the Danger Signs?</h3><p><b>Ask</b></p><div class="bullet_list"><ul><li>Is the patient unable to drink?</li><li>Has the patient had convulsions?</li><li>Does the patient vomit repeatedly?</li><li>How much urine does the patient pass? Very little? None at all? Is it dark?</li></ul></div><p><b>Look</b></p><div class="bullet_list"><ul><li>Is the patient abnormally sleepy, difficult to wake, or confused?</li><li>Does the patient have anaemia?</li><li>Does the patient have severe dehydration? (Look for sudden weight loss, loose skin, sunken eyes, dry mouth.)</li><li>Is the patient unable to stand or sit?</li></ul></div><div class="content"><p><b>If the answer to any of these questions is yes, the patient has severe febrile disease, probably severe malaria. The patient's life is in danger. Urgent treatment is needed at a clinic or hospital to save the patient's life.</b></p><p>Give the first dose of antimalarial treatment. Then, refer the patient to the nearest clinic or hospital. Write a referral note to go with the patient; include details of what has been observed and what treatment has been given and when.</p></div><h2 class="csv-header"><a name="6">General Management of Uncomplicated Malaria</a></h2><div class="bullet_list"><ul><li>Avoid starting treatment on an empty stomach. The first dose should be given under observation. The dose should be repeated if vomiting occurs within 30 minutes.</li><li>The patient should report back if there is no improvement after 48 hours or if the situation deteriorates.</li><li>The patient should also be examined for concomitant illnesses.</li></ul></div><h2 class="csv-header"><a name="7">Treatment of Uncomplicated Malaria</a></h2><div class="content"><p>All fever cases diagnosed as malaria by RDT or microscopy should promptly be given effective treatment.</p></div><h3 class="csv-subheader">Treatment of <em>P. Vivax</em> Cases</h3><div class="content"><p>Positive <em>P. vivax</em> cases should be treated with chloroquine in the full therapeutic dose of 25 mg/kg divided over 3 days. Vivax malaria relapses due to the presence of hypnozoites in the liver. The relapse rate in vivax malaria in India is around 30%. For its prevention, primaquine may be given at a dose of 0.25 mg/kg daily for 14 days under supervision.</p></div><p><a href="/sites/default/files/csv_images/CPM-0IDOP0499-3.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-3.jpg" /></a></p><div class="content"><p><em>Primaquine</em> is contraindicated in G6PD-deficient patients, infants and pregnant women. Caution should be exercised before administering primaquine in areas known to have a high prevalence of G6PD deficiency; therefore, such deficiency should be tested for if facilities are available. Primaquine can lead to haemolysis in G6PD deficiency. The patient should be advised to stop primaquine immediately if he or she develops symptoms like dark-coloured urine, yellow conjunctiva, bluish discolouration of the lips, abdominal pain, nausea, vomiting, etc., and report to the doctor immediately.</p></div><div class="table-header">Table 1: Chloroquine for <em>P. vivax</em> and <em>P. falciparum</em> cases in areas considered to be chloroquine-sensitive</div><p><a href="/sites/default/files/csv_images/CPM-0IDOP0499-4.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-4.jpg" /></a></p><p>Note: Each tablet contains 150mg base</p><div class="table-header">Table 2: Primaquine for <em>P. vivax</em> (daily dosage for 14 days)</div><p><a href="/sites/default/files/csv_images/CPM-0IDOP0499-5.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-5.jpg" /></a></p><p>Note: Tablets available in 2.5 mg, 7.5 mg and 15 mg strengths</p><h3 class="csv-subheader">Treatment of <em>P. Falciparum</em> Cases</h3><div class="bullet_list"><ul><li>The treatment of <em>P. falciparum</em> malaria is based on areas identified as chloroquine- resistant/sensitive. Artemisinin Combination Therapy (ACT) should be given in resistant areas whereas chloroquine can be used in sensitive areas.</li><li>ACT consists of an artemisinin derivative combined with a long-acting antimalarial (amodiaquine, lumefantrine, mefloquine, or sulfadoxine-pyrimethamine [SP]).</li><li>The ACT used in the national malaria programme in India is artesunate + SP. Presently, the artemether + lumefantrine fixed-dose combination and a combination of artesunate + mefloquine are also available in the country. Other ACTs which will be registered and authorized for marketing in India may be used as alternatives.</li><li>Artemisinin derivatives must never be administered as monotherapy for uncomplicated malaria. These rapidly acting drugs, if used alone, can lead to the development of parasite resistance.</li><li>ACTs should be given only to confirmed <em>P. falciparum</em> cases found positive by microscopy or RDT.</li><li>According to the current World Health Organization (WHO) guidelines, ACTs can be given in the second and third trimester of pregnancy. The recommended treatment in the first trimester of pregnancy is quinine.</li></ul></div><h3 class="csv-subheader">Indications for Treatment with Act</h3><div class="content"><p><b>Areas which qualify for ACT</b></p></div><div class="bullet_list"><ul><li>High <em>P. falciparum</em>-endemic districts in the seven northeastern states, and Andhra Pradesh, Chhattisgarh, Jharkhand, Madhya Pradesh and Orissa (see annexure).</li><li>Other chloroquine-resistant PHCs and clusters of blocks surrounding identified drug-resistant foci.</li></ul></div><div class="content"><p><b>Individual cases who qualify for ACT</b></p></div><div class="bullet_list"><ul><li>Patients with a history of travel to the districts/areas identified for the use of ACT per the Guidelines for Diagnosis and Treatment of Malaria in India, 2009 (see annexure).</li><li>No clinical or parasitological response to a full dose of chloroquine within 72 hours of starting the therapy.</li></ul></div><div class="table-header">Table 3: ACT (Artesunate + SP) dosage schedule for <em>P. falciparum</em> cases in chloroquine-resistant areas</div><p><a href="/sites/default/files/csv_images/CPM-0IDOP0499-6.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-6.jpg" /></a></p><div class="footer_note">AS: Artesunate 50 mg; SP: Sulfadoxine 500 mg + Pyrimethamine 25 mg</div><div class="table-header">Table 4: Primaquine for <em>P. falciparum</em> (single dose on first day)</div><p><a href="/sites/default/files/csv_images/CPM-0IDOP0499-7.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-7.jpg" /></a></p><p>Note: Tablets available in 2.5 mg, 7.5 mg and 15 mg strengths</p><h3 class="csv-subheader">Treatment of Mixed Infections</h3><div class="content"><p>Mixed infections with <em>P. falciparum</em> should be treated as falciparum malaria.</p></div><h3 class="csv-subheader">Treatment Based on Clinical Criteria Without Laboratory Confirmation</h3><div class="content"><p>All efforts should be made to diagnose malaria either by microscopy or RDT. However, special circumstances should be addressed as mentioned below:</p><p><b>Line of treatment, if RDT is negative and a microscopy result cannot be obtained within 24 hours</b></p><p>If RDT for only <em>P. falciparum</em> is used, negative cases showing signs and symptoms of malaria without any other obvious cause for fever should be considered as "clinical malaria" and be treated with chloroquine in the full therapeutic dose of 25 mg/kg body weight over 3 days. If a slide result is obtained later, the treatment should be adjusted according to species.</p></div><p><a href="/sites/default/files/csv_images/CPM-0IDOP0499-8.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-8.jpg" /></a></p><div class="content"><p><b>Line of treatment, if neither RDT nor microscopy is available</b><br />"Clinical malaria" cases should be treated with chloroquine in the full therapeutic dose.</p></div><h2 class="csv-header"><a name="8">Algorithm for the Diagnosis and Treatment of Malaria</a></h2><div class="table-header">Where microscopy result is available within 24 hours</div><p><a href="/sites/default/files/csv_images/CPM-0IDOP0499-9.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-9.jpg" /></a></p><div class="table-header">Where microscopy result is not available within 24 hours</div><p><a href="/sites/default/files/csv_images/CPM-0IDOP0499-10.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-10.jpg" /></a></p><div class="footer_note">* Look for other causes of fever; repeat blood slide examination after an appropriate interval.<br />** In districts/areas identified for the use of ACT as per the Guidelines for Diagnosis and Treatment of Malaria in India, 2009 (see annexure).<br /><em>Pf: P falciparum; Pv: P. vivax;</em> PQ: Primaquine; CQ: Chloroquine</div><h2 class="csv-header"><a name="9">Treatment of Severe Malaria</a></h2><div class="content"><p>For the management of severe malaria, health facilities should be equipped with the following:</p></div><div class="bullet_list"><ul><li>Parenteral antimalarials, antibiotics, anticonvulsants, antipyretics</li><li>Intravenous (I.V.) infusion equipment and fluids</li><li>Special nursing for patients in coma</li><li>Blood transfusion facilities</li><li>Well-equipped laboratory</li><li>Oxygen</li></ul></div><div class="content"><p>If the above are not available, the patient must be referred without delay to a facility where they are available.</p></div><h3 class="csv-subheader">Specific Antimalarial Treatment</h3><div class="bullet_list"><ul><li><b>Severe malaria is an emergency and treatment should be given promptly.</b></li><li><b>Parenteral artemisinin derivatives or quinine should be used, irrespective of chloroquine sensitivity.</b></li></ul></div><div class="content"><p><b>Artesunate:</b> 2.4 mg/kg I.V. or intramuscular (I.M.), given on admission (time = 0), then at 12 hours and 24 hours, and, then, once a day (care should be taken to dilute the artesunate powder in the 5% sodium bi-carbonate provided in the pack).</p></div><div class="content"><p><b>Quinine: </b>20 mg quinine salt/kg on admission (I.V. infusion in 5% dextrose/dextrose saline over a period of 4 hours) followed by a maintenance dose of 10 mg/kg, 8-hourly; infusion rate should not exceed 5 mg/kg per hour. Loading dose of 20 mg/kg should not be given if the patient has already received quinine.</p></div><p><b>Never Give a Bolus Injection of Quinine.</b></p><div class="content"><p>If parenteral quinine therapy needs to be continued beyond 48 hours, the dose should be reduced to 7 mg/kg, 8-hourly.</p></div><div class="bullet_list"><ul><li><b>Artemether:</b> 3.2 mg/kg I.M. given on admission; then, 1.6 mg/kg per day.</li><li><b>αβ Arteether:</b> 150 mg I.M. daily for 3 days in adults only (not recommended for children).</li></ul></div><div class="bullet_list"><ul><li><b>Once the patient can take oral therapy, further follow up treatment should be as below:</b></li><li>Patients receiving parenteral quinine should be treated with oral quinine 10 mg/kg three times a day to complete a course of 7 days, along with doxycycline 3 mg/kg per day for 7 days.</li></ul></div><p>Note: Doxycycline is contraindicated in pregnant women, and children below 8 years of age; instead, clindamycin 10 mg / kg body weight, 12-hourly for 7 days, should be used.</p><div class="bullet_list"><ul><li>Patients receiving artemisinin derivatives should get the full course of oral ACT. However, ACT containing mefloquine should be avoided in cerebral malaria due to neuropsychiatric complications.<ul><li><b>Intravenous (I.V.) preparations should be preferred over intramuscular (I.M.) preparations.</b></li><li><b>In the first trimester of pregnancy, parenteral quinine is the drug of choice.</b> However, if quinine is not available, artemisinin derivatives may be given to save the life of the mother. In the second and third trimester, parenteral artemisinin derivatives are preferred.</li></ul></li></ul></div><h2 class="csv-header"><a name="10">Severe Malaria Caused by <em>P. Vivax</em></a></h2><div class="content"><p>In recent years, increased attention has been drawn to severe malaria caused by <em>P. vivax</em>. Some cases have been reported in India, and there is reason to fear that this problem will become more common in the coming years. Severe malaria caused by <em>P. vivax</em> should be treated like severe <em>P. falciparum</em> malaria.</p></div><h2 class="csv-header"><a name="11">Chemoprophylaxis</a></h2><div class="content"><p>Chemoprophylaxis is recommended for travellers, migrant labourers and military personnel exposed to malaria in highly endemic areas. Use of personal protection measures like insecticide-treated bed nets should be encouraged for pregnant women and other vulnerable populations.</p></div><div class="bullet_list"><ul><li><b>For short-term chemoprophylaxis (less than 6 weeks) Doxycycline:</b> 100 mg daily in adults and 1.5 mg/kg for children more than 8 years old. The drug should be started 2 days before travel and continued for 4 weeks after leaving the malarious area.</li></ul></div><p>Note: Doxycycline is contraindicated in pregnant women, and children less than 8 years old.</p><div class="bullet_list"><ul><li><b>For long-term chemoprophylaxis (more than 6 weeks) Mefloquine:</b> 5 mg/kg body weight (up to 250 mg) weekly and should be administered 2 weeks before travel, during stay, and continued for 4 weeks after leaving the area.</li></ul></div><p>Note: Mefloquine is contraindicated in cases with a history of convulsions, neuropsychiatric problems and cardiac conditions.</p><h2 class="csv-header"><a name="12">Reference</a></h2><p><em>1 .Guidelines for Diagnosis and Treatment of Malaria in India, 2009. </em><br /><em>2. http://apps.who.int/malaria/docs/healthworkers/healthworkers.htm.</em><br /><em>Last accessed on 06/08/09.</em></p><h2 class="csv-header"><a name="13">Annexure</a></h2><div class="content"><p>Districts/Areas identified for use of ACT Combination (AS+SP) for treatment of Pf malaria</p></div><p><a href="/sites/default/files/csv_images/CPM-0IDOP0499-11.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-11.jpg" /></a><a href="/sites/default/files/csv_images/CPM-0IDOP0499-12.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-12.jpg" /></a><a href="/sites/default/files/csv_images/CPM-0IDOP0499-13.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-13.jpg" /></a><a href="/sites/default/files/csv_images/CPM-0IDOP0499-14.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-14.jpg" /></a><a href="/sites/default/files/csv_images/CPM-0IDOP0499-15.jpg" target="_blank"><img class="content_image" src="/sites/default/files/csv_images/CPM-0IDOP0499-15.jpg" /></a></p>
This booklet is intended as a quick reference guide to all physicians to provide some pointers on how he/she can help an asthmatic patient enjoy his/her vacation safely.
Paracetamol has the advantage of being the only non-opioid analgesic available in oral, rectal and now intravenous formulations. The intravenous route is especially advantageous in postsurgical situations when oral (e.g. infections with severe fever or vomiting) or rectal (e.g. high variability in uptake and bioavailability) routes are not suitable or effective, or patients have contraindications to the administration of NSAIDs or opioid analgesics. This booklet covers intravenous paracetamol in details with the pharmacokinetics, probable mode of action, indications, contraindications, warnings and precautions.
Choice of a first-line hepatitis B drug should take into account antiviral potency, safety and risk of antiviral resistance. The ideal therapy should be safe, effective and associated with a sustained and durable response. This booklet outlines the principles of initiating anti-hepatitis B virus therapy in treatment-naive patients.
Good hand hygiene, the simple task of cleaning hands at the right time and in the right way by any health care worker is essential for patient care. Here is an illustrative practice guideline on hand hygiene adapted from ‘WHO Guidelines on Hand Hygiene in Health Care, 2009’.
