Guidelines Updated for Administration of Combination MMRV Vaccine

The updated ACIP recommendation now reads as follows: "Combination MMRV vaccine is approved for use among healthy children aged 12 months – 12 years. MMRV vaccine is indicated for simultaneous vaccination against measles, mumps, rubella, and varicella. ACIP does not express a preference for use of MMRV vaccine over separate injections of equivalent component vaccines (i.e., MMR vaccine and varicella vaccine)."

The ACIP also advocated that a work group be convened for in-depth analysis of data regarding the increased risk for febrile seizures after the first dose of MMRV vaccine. On the basis of these findings and other information that becomes available, the CDC, FDA, and ACIP will consider future policy options, communicate updates, and implement further necessary actions.

If you want to read it in details, please visit the following website at the address given below.
http://www.medscape.com/viewarticle/571507
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Dr Marwah

Computerization in CGHS

Computerization in CGHS

Kidwai Nagar CGHS dispensary was fully computerised on 10 march 2008.
Chemist is not making any entry in the indent submitted by the dispensary since 11th march 2008.
How is he supplying the indent to the dispensary? Probably he is following the old system.
He is not supplying the medicines in the morning. If  he is fined for the delay, he starts misbehaving.


CGHS / NIC server was very slow since morning today. Its very difficult to work in the dispensary.
NIC should do something about server, otherwise it will be a big failure.

NIC bosses should come and work one full day in the dispensary. Then they will realize the
problems faced by the public as well as Doctors working in the dispensary.


Dr Marwah

Computerisation In CGHS

Kidwai Nagar dispensary is computerised since 10th march 2008.
On 15th march 321 patients attended the dispensary.

Main problems are :

1. Net is very slow.
2. NIC server is slow and around 11.00 am either it is very slow or could not be contacted.
3. Chemist / MSD authority could be issued from the computer but the report can not be generated.
4. More over Chemist / MSD authority are not serial numbered.
5. Permission software for investigation and treatment from private recognised hospital is incomplete.
6. Some items are shown in the inventory but they could not be issued.
7. Previously indented items if repeated are shown without any choice of selecting as indented/ chemist authority / MSD authority.
8. Pharmacist cannot find when the patient has drawn the medicine before .
9. There should be special module for the pharmacist distributing the local purchase medicines.
10. Linux and Mozila browser are outdated and need to be updated. NIC people are not able to do it in spite of repeated request.

Solutions

• CGHS should install their own server or NIC should upgrade their server.
• MTNL connection should be 512 kb connection.
• There should be a special module for the pharmacist distributing the local purchase medicines.
• RAM may be increased to 1 GB.
• Linux and Mozila browser may be updated.
• NIC should modify the software keeping  above points in view.
• Provisions should be made so that reports in different formats  could  be generated

Dr Marwah

Proton Pump Inhibitors

Guidelines on the use of Proton Pump Inhibitors (PPI) in the Treatment of Dyspepsia

1.1 In patients with documented duodenal or gastric ulcers, a treatment strategy of testing for Helicobacter pylori and, where positive, eradicating the infection is recommended. Long-term acid-suppressing therapy should not be used. Those patients who are H.pylori negative or remain symptomatic after eradication therapy should be treated as described in1.6

1.2 For patients with a documented non-steroidal anti-inflammatory drug (NSAID)-induced ulcer, who must unavoidably continue with NSAID therapy (e.g. those with severe rheumatoid arthritis), an acid suppressor, usually a proton pump inhibitor (PPI), should be prescribed. After the ulcer has healed, the patient, where possible, should be stepped down to a maintenance dose of the acid suppressor.
1.2 Patients who have severe gastro-oesophageal reflux disorder (GORD) symptoms or who have a proven pathology (e.g. oesophageal ulceration, Barrett's oesophagus) should be treated with a healing dose of a PPI until symptoms have been controlled. After that has been achieved, the dose should be stepped down to the lowest dose that maintains control of symptoms. A regular maintenance low dose of most PPIs will prevent recurrent GORD symptoms in 70-80% of patients and should be used in preference to the higher healing dose. Where necessary, should symptoms re-appear, the higher dose should be recommenced. In complicated oesophagitis (stricture, ulcer, haemorrhage), the full dose should be maintained. Patients with mild GORD symptoms and/or those who do not have a proven pathology can frequently be managed by alternative therapies (at least in the first instance) including antacids, alginates, or H2RAs (H2 receptor antagonists).
1.3 Patients diagnosed with non-ulcer dyspepsia (NUD) may have symptoms caused by different aetiologies and should not be routinely treated with PPIs. Should the symptoms appear to be acid-related, an antacid or the lowest dose of an acid suppressor to control symptoms should be prescribed. If they do not appear to be acid-related, an alternative therapeutic strategy should be employed.
1.5 Patients presenting in general practice with mild symptoms of dyspepsia may be treated on either a "step-up" or a "step-down" basis. Neither group should normally be treated with PPIs on a long-term basis without a confirmed clinical diagnosis being made.
1.6 In circumstances where it is appropriate to use a PPI and where healing is required, the optimal dose to achieve this should be prescribed initially. Once healing has been achieved, or for conditions where it is not required, the lowest dose of the PPI that provides effective symptom relief should be used.
1.7 The least expensive appropriate PPI should be used.

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Dr Marwah

Anti-leprosy day 30th January

The martyrdom day of Mahatma Gandhi (30th January) is observed as Anti-leprosy day throughout the world. It is also called "International Anti-leprosy day".
Mahatma Gandhi's cherished dream of a leprosy-eliminated India has come true. Thanks to the support of the various NGOs, national and international bodies along with the Government machinery, the number of leprosy cases has come down from 40 lakhs in 1982 to less than 1 lakh today. Since the Prevalance Rate has come down to less than 1 per 10,000 population in India, the govt. has declared that leprosy has been eliminated.
Leprosy is completely curable today. An air-borne disease caused by mycobacterium leprae, leprosy was a scourge to humanity and it had a lot of misconceptions. Leprosy is a socio-medical problem. Though the number of leprosy cases has come down, the stigma still prevails. A lot need to be done with regard to rehabilitation of persons affected with leprosy (PALs).
India as eliminated leprosy but still we have to eradicate the disease from our country which would be possible by increasing the awareness regarding the // transmission of the bacteria and the treatment regimen to be followed for treating the disease.
World Health Organization is playing a great role in eradication of Leprosy through its free worldwide distribution of Multi-drug Treatment drugs, which is supplied as blister drug packets to India.

Dr Marwah

Happy New Year 2008

Fulfillment in the New Year

Here's to the outgoing year, 2007:
May the good times live on in our memories,
and may we learn lessons from the troubling times
that will make us stronger and better than ever.

Here's to 2008:
For each and every one of you,
may it be filled with significant steps
toward the fulfillment of your fondest wishes.

In this coming new year,
let us focus on our goals and work toward our dreams,
and yet (smile)
let's all try to go with the flow a little more
and stress a little less.

And most important,
(wave glass around to encompass the whole group)
here's to all of you.
Appreciate yourselves and each other in the new year
as I appreciate all of you now.
Let's focus on each other's good points
and choose to overlook minor annoyances
to create mutual happiness and contentment in 2008.

Here's to 2008 (raise glass): Enjoy the journey!

By Joanna Fuchs

Happy New Year 2008
Dr Marwah

World AIDS Day themes, The AIDS red ribbon and What can You do to support World AIDS Day?

World AIDS Day themes over the years have included:

• 2007 - Stop AIDS; Keep the Promise - Leadership

• 2006 - Stop AIDS; Keep the Promise - Accountability

• 2005 - Stop AIDS; Keep the Promise

• 2004 - Women, Girls, HIV and AIDS

• 2003 - Stigma & Discrimination

• 2002 - Stigma & Discrimination

• 2001 - I care. Do you?

• 2000 - AIDS : Men make a difference

• 1999 - Listen, Learn, Live: World AIDS Campaign with Children & Young People

• 1998 - Force for Change: World AIDS Campaign With Young People

• 1997 - Children Living in a World with AIDS

• 1996 - One World, One Hope

• 1995 - Shared Rights, Shared Responsibilities

• 1994 - AIDS & the Family

• 1993 - Act

• 1992 - Community Commitment

• 1991 - Sharing the Challenge

• 1990 - Women & AIDS

• 1989 - Youth

• 1988 - Communication

To learn more about what is happening around the world, or to list any events that you may be holding locally this World AIDS Day, please visit the WAC's events calendar.

The AIDS red ribbon

The red ribbon is an international symbol of AIDS awareness that is worn by people all year round and particularly around World AIDS Day to demonstrate care and concern about HIV and AIDS, and to remind others of the need for their support and commitment.

The red ribbon started as a "grass roots" effort; as a result there is no one official AIDS ribbon manufacturer, and many people make their own. It's easily done - just use some ordinary red ribbon and a safety pin!

What can You do to support World AIDS Day?

There are many ways in which you can support World AIDS Day. For example:

• Raise awareness of HIV and AIDS in your area

• Wear a red ribbon and ask others to do the same

• Sign up as a supporter of the Stop AIDS in Children campaign

• Protect yourself and your partners - this is the first and best way to stop the spread of HIV

• If you are worried - get tested

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Dr Marwah