After Iran, it is India’s turn to report  totally resistant strain of tuberculosis.

The report published in Clinical Infectious Diseases journal on Dec 21, 2011 by Dr Udwadia  et al and comes from Hinduja hospital and medical center in Mahim, Mumbai, reported four cases of this strain.

The strain is called Totally Drug Resistant (TDR).

That makes it resistant to every known drug and it is untreatable.

In 2009, Iran had reported 15 cases of totally drug resistant tubercular bacteria

Recently Times of India reported that number of patients tested positve for TDR has risen to 12.

Tuberculosis already kills 1000 people per day in India with emergence of new strain it has become deadlier.

TB is also one of the world’s worst killers.

Poor case management, protracted course of treatement, poor nutrition and buid and poor patient compliance are known factors that lead to emergence of resistant strains.

Earlier the known strains were Multi Drug Resistant (MDR) and Extremly Drug Resistant (XDR).Last year WHO predicted that there would be 2 million MDR or XDR cases in the word by 2012.

Now we face the problem of now total drug resistant strain.

Over last twenty years, there has been increased use of negative pressure pumps in order to seal wound dressings and remove edema, or fluid buildup and in turn enhance wound healing.

Smith & Nephew’s new device PICO is a single-use negative pressure wound therapy system has been cleared by FDA and offers advantages to clinicians and patients both.

The website mentions

Clinicians can be confident that the PICO system is providing NPWT safely and effectively in a wide range of wounds and care settings. The PICO system is indicated for chronic, acute and traumatic wounds, subacute and dehisced wounds, partial-thickness burns, ulcers (such as diabetic or pressure), flaps and grafts, and closed surgical incisions. The PICO system is as easy to apply as a conventional wound dressing, reducing the need for the staff time, intensive training and administrative paperwork associated with traditional NPWT.

For the patient, the PICO system’s one-button pump is easy-to-use and its small size and silent operation provide a discreet, unobtrusive way to carry on daily life with NPWT. The disposable device works with a revolutionary dressing technology that manages fluids, eliminating the need for bulky canisters. The system can be worn on a wound up to a week, depending on the level of exudates. Its gentle silicone wound contact layer helps minimize pain at a dressing change.

For the Payer, the PICO system is more affordable than traditional NPWT, and can significantly reduce therapy costs associated with traditional NPWT. The PICO system is available off-the-shelf and therefore may reduce the occurrence of delayed hospital discharges.

Here are videos on the product

Visit website on PICO

Med Care Tips wishes all its readers a very very happy new year. May it bring health and prosperity.

Take care.

Ingredients

• 3 1/4 cups chicken breast, cooked, cubed, and skinless
• 1/4 cup celery, chopped
• 1 Tbsp lemon juice
• 1/2 tsp onion powder
• 1/8 tsp salt [Omit to reduce sodium]
• 3 Tbsp mayonnaise, low-fat

How  To Make?

1. Bake chicken, cut into cubes, and refrigerate.
2. In a large bowl combine rest of ingredients, add chilled chicken and mix well.
3. Makes 5 servings

Serving Size

3/4 cup

Per Serving:

• Calories: 176
• Total Fat: 6 g
• Saturated Fat: 2 g
• Cholesterol: 77 mg
• Sodium: 179 mg [120 mg if without salt]
• Protein: 27 g
• Carbohydrate: 2 g
• Calcium: 16 mg
• Magnesium: 25 mg
• Potassium: 236 mg
• Fiber: 0 g

Courtesy:http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/recipes.html

Following is a clinical photograph of a diabetic person’s ankle with a non healing ulcer. The person had poor diabetes control

Ulcer Over Ankle Medial Aspect

With control of diabetes and surgical toileting, the wound healed.

The United States Food and Drug Administration has approved once-daily dosing for darunavir boosted with ritonavir for use in adult patients with HIV with no resistance to the protease inhibitor.

Source: Medscape Daily News

Nao gastric tubing is used for many purposes which may be to provide the feed in patients who for any reasons could not be fed through the mouth or to aspirate the gastric content as in poisoning  or during neck surgery for better localization of the esophagus.

While the process needs to be individualzed in every patient, I thought it is good have a video explaining the basics in insertion of nasogastric tube.

See my note at the end after you finish your video.

Click here to view the embedded video.

Note

The position of the Ryle’s tube can also be confirmed by auscultating the stomach by placing the stethoscope over the area below xiphisternum.

A syringe would push air through the outer end of the tube and a loud audible air entry is heard by the stethoscpoe.

A new study published in Sleep has suggested that loud snoring and sleep difficulties may predict development of the metabolic syndrome, a key risk factor for cardiovascular disease.

The study included  812 participants in the community-based Heart Strategies Concentrating on Risk Evaluation study. Two thirds of participants were women, and 36% were African American.

During 3-year follow-up, metabolic syndrome was diagnosed in 14% of participants. Significant predictors of development of the metabolic syndrome were difficulty falling asleep, unrefreshing sleep, difficulty staying asleep, or frequent awakening from sleep.

Loud snoring was associated with more than twice the risk for the development of the metabolic syndrome. The study limitations were cross-sectional nature of the AHI assessment and smaller sample.

Sleep. 2010;33:1633-1640. Abstract

A new analysis has shown that patients older than 80 years with acute ischemic stroke perform better when treated with intravenous thrombolytic therapy than when left untreated.

It further stresses that the older patients would derive similar benefits from thrombolytic therapy as younger patients and are not at significantly greater risk for intracranial bleeding.

The study used data from of Treatment in Stroke–International Stroke Thrombolysis Registry (SITS-ISTR) and the Virtual International Stroke Trials Archive (VISTA). The study was published online November 24 in the British Medical Journal.

About 30% of acute stroke occurs in people older than 80 years.

Their analysis was based on 23,334 stroke patients who underwent thrombolysis with alteplase at an average of 145 minutes after stroke onset and 6166 stroke patients who did not receive alteplase. Patients were divided into 2 groups — those older than 80 years and those 80 years and younger.

BMJ. Online Nov,ember 24, 2010.

Short course chemotherapy is the treatment of TB using a combination of new antitubercular drugs in a fixed regime for a set duration. These regimes have shortened the duration of treatment of TB from the 12-18 months of old regimes using streptomycin, isoniazid, thiacetazone or PAS to 6-9 months.

These new regimes with nearly 100 percent cure rates are much more potent than the older regimes and fewer relapses are reported with them. Their potency, shorter duration of treatment and fewer relapse rates make them a very cost effective treatment of choice for TB.

The regimes essentially consist of treating TB in two phases.

Initial intensive phase (for rapid killing)

Several drugs are given in the initial intensive phase to rapidly reduce the bacillary population in the tubercular lesion. This results in the destruction of drug resistant mutants in the bacterial population and prevents their selective proliferation. In addition, the rapid killing also results in very early sputum conversion, which dramatically reduces the risk of transmission of infection.

A tubercular lesion has four different types of bacilli:

Group 1: Rapidly growing, active bacilli (most bacilli in the lesion belong to this group)

Group 2: Those in the acidic environment inside cells and in cavitary walls.

Group 3: Semidormant bacilli which show occasional spurts in growth (mostly responsible for relapses)

Group 4: Few dormant bacilli. (no drug is yet available against this group)

Each of the 4 drugs used in the initial intensive phase acts on different populations in the tubercular lesion.

Isoniazid kills 90 percent of all bacilli during the first few days. It is most active against group 1. Rifampicin is not only most effective against group (3), but also acts on group 1.

Pyrazinamide acts on group 2.

Ethambutol or streptomycin are added to the regime to prevent emergence of MDR strains of Mycobacterium tuberculosis in countries like India, where the prevalence of initial bacterial resistance is high.

This potent combination of drugs rapidly decimates the bacillary population which results in the virtual treated by a combination of these drugs become smear negative by the end of two months.

Continuation phase (to prevent relapse)

The rapid decrease in the population also ensures elimination of drug resistant strains. That is why ethambutol or streptomycin, are withdrawn at the end of 2 months. In addition, in the first 2 months pyrazinamide has destroyed the intracellular and extracellular bacilli in acidic pH, against which it acts specifically. It has no further role and is also withdrawn at the end of 2 months.

A small population of intermittently multiplying bacilli still remains in the lesin at the end of the intensive phase. This population is responsible for relapses. A protracted treatment with sterilizing drugs that act specifically against these bacilli is necessary to prevent relapses.

Isoniazid and rifampicin are continued for four months in the continuation phase. They are very potent bactericidal drugs and continue to destroy bacilli. In addition, rifampicin continues to destroy semidormant, intermittently multiplying bacilli which cause relapses.

Currently available standard daily short course chemotherapy regimes

1. Six months duration: (2+4)

• 2 EHRZ/ 4HR
• 2 SHRZ/ 4HR
• 2 HRZ/ 4HR

2. Nine months duration (2+7)

• 2 SHR/ 7 HR
• 2 HER/ 7 HR

E: ethambutol, S: streptomycin, H: Isoniazid, R: rifampicin, Z: pyrazinamide

Prefix numerals indicate the number of months for which the drugs have to be given.