Swine Flu guidelines from India

On 14 th august, Friday night, after facing flake for the past two weeks on the bungled handling of Swine Flu epidemic in India, the government has come up with a better set of guidelines.The new guidelines allow ALL doctors to treat for Swine Flu (Believe it or not, earlier only designated hospitals and doctors  < and no other doctor> could treat Swine flu!!) The guidelines were finalized after a five-hour meeting chaired by Health and Family Welfare Minister Ghulam Nabi Azad.

The patients have been categorized as follows:

* Category A: Patients with mild fever plus cough/sore throat with or without body ache, headache, diarrhoea and vomiting. They do not require Oseltamivir and should be treated for the symptoms mentioned above. The patients should be monitored for their progress and reassessed after 24 to 48 hours by the doctor. No testing of the patient for H1N1 is required. Patients should confine themselves at home and avoid mixing with the public and high risk members in the family.

I agree with this

* Category B: (i) In addition to all the signs and symptoms of Category A, if the patient has high grade fever and severe sore throat, he/she may require home isolation and Oseltamivir; (ii) In addition to all the signs and symptoms of Category A, individuals having one or more of the following high risk conditions shall be treated with Oseltamivir: children under five, pregnant women, those above 65 years, those with lung diseases, heart disease, liver disease, kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS; Patients on long term cortisone therapy. No H1N1 tests are required for Category-B (i) and (ii). Such patients should confine themselves at home and avoid mixing with the public and high-risk members in the family.

I think all such cases be tested for H1N1, and antiviral therapy started without delay

* Category C: In addition to the symptoms of Categories A and B, if the patient has one or more of the following: breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nails; irritability among small children, refusal to accept feed; worsening of underlying chronic conditions. Such patients require testing, immediate hospitalisation and treatment.(

All such patients should be started on antivirals without even waiting for test results!!, its already late!

)

During the meeting, various guidelines and protocols developed by the World Health Organisation, Geneva, the Centre for Disease Prevention and Control, Atlanta, United States, and the National Health Service, United Kingdom, were also discussed.The death toll has already reached 26 today, and is rising exponentially. Hope these guidelines help, but i really think its too little too late.

Related articles

• Inside the Fight Against a Flu Pandemic – TIME (time.com)
• Swine flu deaths go up in India (news.bbc.co.uk)

Physiology of Propofol in drug Abuse

Is Propofol, or Diprivan what Michael Jackson Used for ( Drug) Abuse ?

According to Cherilyn Lee, a registered nurse who operates a Los Angeles-based nutritional counseling business, in California, “Jackson was complaining of insomnia and pleaded for her to get him some (Diprivan)”. Other reports claim Propofol was recovered from his residence. This conversation reportedly occurred in April of this year. Preliminary reports say that M.J died of cardiac arrest, which is within the possible effects of unmonitored Diprivan use. (A rapid bolus injection can result in undesirable cardiorespiratory depression including hypotension, apnea, airway obstruction, and oxygen desaturation.)

Diprivan is a general anesthetic, used to start or maintain anesthesia during certain surgeries, tests, or procedures. It is available in a white vial of 20, 50 and 100 ml (containing 10mg/ml.).Most adults require 2 to 2.5 mg/kg of the drug ( approx. 10 ml). DIPRIVAN Injectable Emulsion is an IV sedative-hypnotic agent and can cause potentiation of other narcotic drugs and benzodiazepines when used together. The most common side-effects include Change in mood or emotions; dizziness; drowsiness; lack of coordination. It is given intravenously, usually within the operation theater or in a clinic. It has a rapid onset of action ( less than 1 min) and short duration of action (approximately 10 min but is dose dependent).It has direct cardiodepressant effects, leading to decreased blood pressure and heart rate in higher doses. Its actions causing decreased heart rate and respiratory rate mean that use of propofol is done only under continuous monitoring of vital signs.Diprivan is not meant for use in pediatrics and elderly population since its safety has not been established in these populations. Prolonged use of propofol results in accumulation of the drug in body tissue and increases the duration of action as well as chances of overdose.

Rarely, Cases of death due to propofol have been discussed in medical literature. All these cases have occured in hospital settings only.It is definitely not meant for home use and this is the first time I have heard of Diprivan being used as a drug of abuse outside hospital settings.

Euphoria, sexual hallucinations and disinhibition have been described on recovery of propofol anaesthesia. These effects could explain the recreational use of the drug. Moreover, several experimental studies strongly suggest the potential for abuse and dependence on propofol,and few cases of abuse and dependency have been described, mostly in medical professionals. As propofol is generally not recognized as a substance of abuse, and because of its safe profile, it is important to remember that rare adverse reactions of propofol could produce death in a context of abuse, even at therapeutic dose range, in the absence of ventilatory and medical assistance.

British Journal of Anaesthesia 2006 97(2):268; doi:10.1093/bja/ael168

The male foreskin is dangerous- Circumcision protects .

Health information politicized

Doesn’t the public have the right to know that male circumcision protects against HIV?

In 2007, the ethical landscape surrounding medical male circumcision (MC) suddenly lurched and shifted when the World Health Organization and UNAIDS declared unequivocally that the `efficacy of male circumcision in reducing female to male transmission of HIV has been proven beyond reasonable doubt.The male foreskin has been shown to have a high number of cells that were targeted by the HIV virus

Interestingly, evidence that MC had medical benefits has been mounting for more than 20 years. Not only does the procedure reduce the risk of HIV infection, it also has been shown  to

• prevent urinary tract infections,

• sexually transmitted diseases, and

• penile and prostate cancers.

Researchers have even found that MC reduces the risk of cervical cancer in current female partners . In spite of that growing list of medical benefits, the issue has hovered just below the radar screen until several large randomised controlled studies from Africa showed that circumcision offered a 60% to 70% protective effect against the heterosexual acquisition of HIV. The evidence was so compelling that three of the studies were stopped early, on the recommendation of Data Safety and Monitoring Boards

The Government of India has been reluctant to approach an issue that promises to be controversial among conservative Hindus. MC is
considered a marker of religious identity since Muslims routinely circumcise their male children, and Hindus do not. It has been
suggested that at times, circumcision status may even have been used to identify people`s religious affiliation during communal riots. Popular wisdom holds that even the mention of MC in some communities will trigger sectarian violence. Predictably, some opponents have argued that the greater good of society must be protected by withholding information about MC from the population.

This is a joke, surely?

They wont tell the benefits of circumcision because they want to use it to identify Muslims?

Related articles:

• Circumcision protects against 2 common sexually transmitted diseases: studies
• Call for higher circumcision rate
• The kindest cut?
• Gardasil Debate Shifts As Merck Pushes For Use In Boys, Men

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