A lecture by Dr Vinod Nikhra at Conference on Swine Flu, organised by Health Department, South Delhi Municipal Corporation at Civic Centre, Delhi on 05 February 2015.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
In the last 42 days, Six deaths and 421 cases of swine flu have been reported from 28 districts of the state. Here's what you need to know about the disease.
What is swine flu?How swine flu presents?How to diagnose swine flu?How to treat swine flu? What are the vaccines for swine flu?How to prevent from getting swine flu?
Hello friends i am BSc Nursing intern.This presentation of mine covers almost each and every aspect related to swine flu.Hope it will help you to increase your knowledge regarding the topic.Looking forward to your feedback.Thank you
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
In the last 42 days, Six deaths and 421 cases of swine flu have been reported from 28 districts of the state. Here's what you need to know about the disease.
What is swine flu?How swine flu presents?How to diagnose swine flu?How to treat swine flu? What are the vaccines for swine flu?How to prevent from getting swine flu?
Hello friends i am BSc Nursing intern.This presentation of mine covers almost each and every aspect related to swine flu.Hope it will help you to increase your knowledge regarding the topic.Looking forward to your feedback.Thank you
A cardiologists perspective to current scenario in light of corona pandemic in india and world wide. cardiac procedures , heart disease , aceinhibitors , arni , heart failure , troponin, nt probnp
Swine flu is a respiratory disease. It is caused by the influenza viruses that infect the respiratory tract of pigs. It can lead to symptoms such as a barking cough, decreased appetite, nasal secretions, and listless behaviour; the virus can be transmitted to humans. The Swine flu vaccination or H1N1 vaccination is crucial to provide immunity against swine flu.
Human Longevity - Concepts and Options - Vinod Nikhra - 08 Dec 2023.pdfVinod Nikhra
Wonderful advances in the field of medical science make possible to slow down aging process and live a long and healthy life. Here, I share with you, the facts and visions more eloquent than imaginations and amazing thoughts amounting to reality-pregnant-early-morning dreams.
It may seem, but the presentation is not a fiction. Neither it is a bundle of concocted myths. Based on current state of scientific knowledge and gerontological research, it aims to provide answers to aging and longevity.
Therefore, you are requested to read on. After all, the theme, ageing slowly and living longer, is of a prime interest to all of us.
The gut microbial dysbiosis its fallouts and therapeutic potential of gut mic...Vinod Nikhra
My Keynote Talk at the
6th International Conference on Diabetes Treatment and Research
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Revisiting Caloric Restriction as Therapeutic Strategy for MetS, T2DM and Obe...Vinod Nikhra
OVERNUTRITION AND ADIPOSITY: Overnutrition contributes to chronic energy surplus leading to adiposity, IR, MetS and obesity with its fallouts including increased oxidative stress, altered glucose, fat and protein metabolism, and altered skeletal muscle mitochondrial function.
REDOX BALANCE AND THIOREDOXIN SYSTEM: The cellular redox balance is regulated by activity of several antioxidant systems including TXN system. TNX is a key player in regulation of glucose homeostasis and lipid metabolism. The overexpression of TXNIP in T2DM, MetS and obese subjects is associated with metabolic abnormalities including apoptosis of β-cells, decreased insulin sensitivity and energy expenditure. The reduced oxidative capacity of skeletal muscle leads to accumulation of IMTG and affects mitochondrial function. TXNIP influences metabolic regulation mainly through insulin release from β-cells, glucose production from liver and glucose uptake in peripheral tissues. In addition, it acts as a nutrient sensor in discrete regions of brain.
EFECTS OF CR ON METABOLIC HOMEOSTASIS: CR is a potentially effective therapeutic strategy to improve adiposity and insulin sensitivity at tissue level. CR associated weight loss decreases IMTG and improves mitochondrial function in skeletal myocytes. The decrease in adipose mass, oxidative stress and inflammation lead to downregulation of TXNIP, eliminating its inhibitory effect on glycolysis, glucose transporters, insulin receptors and receptor substrate, insulin-stimulated Akt activation and PI3K.
CONCLUSION - NOVEL ADDITIVES TO POLYPHARMACY: The CR consistently leads to improved cardiometabolic outcomes and exerts beneficial effects on every organ system. Yet, CR is difficult to implement in practice for multiple reasons. Still, the focus on CR is important within a specific disease context to clearly delineate underlying mechanisms and exploit the research to achieve therapeutic goals. TXNIP is a potential therapeutic target. Anti-diabetic agents like metformin, GLP-1 agonists and CRMs like resveratrol inhibit TXNIP expression. Verapamil – a calcium channel blocker, tranilast - a tryptophan metabolite and allopurinol reduce TXNIP levels in vivo and in vitro studies. Lowering TXNIP levels halts β-cells apoptosis. On a cautious note, the loss of TXNIP may have serious consequences as TXNIP expression is required for maintaining normal fasting glycaemia and TXNIP being a tumour suppressor, its loss is associated with increased incidence of cancer.
Aberrancy in CNS Signals and Other Factors Related to Altered Homeostasis, ...Vinod Nikhra
INTRODUCTION - ‘THE OBESE-OBESE WORLD’: The obesity and metabolic syndrome (MetS) are a global epidemic of such magnitude that the today’s health scenario can be summed up as the ‘Obese-obese World’*. Obesity and MetS deteriorate quality of life and alter course of various chronic diseases, and on their own, are risk factors for diabetes, hypertension, cardiovascular disease and stroke, neurological degenerative diseases and cancers. Modern day lifestyle drives for excess calorie intake, comparatively reduced energy expenditure and storage of surplus energy in adipose tissue, an accentuated evolutionary need to fill body nutrients stores, leading to obesity, appended by pathophysiological alterations termed MetS.
CNS REGULATION OF ENERGY INTAKE: Specialised neurons in hypothalamus and brainstem primarily regulate energy homeostasis, food intake and body weight, and integrate multiple peripheral metabolic inputs, such as nutrients, gut-derived hormones, and adiposity-related signals. There are several neuropeptides involved, including melanin concentrating hormone (MCH) and the orexins. An abnormal alteration in ghrelin and leptin levels can lead to weight gain and Obesity. Increase in adipose tissue leads to overproduction of leptin and hypothalamus becoming resistant to leptin action. The reward circuitry involves interactions between several systems including opioids, endocannabinoids, serotonin and dopamine. The obese individuals appear to have abnormalities in dopaminergic activity, and an imbalance in the brain circuits promoting reward seeking and those governing cognitive control leads to an overriding stimulus to feeding, even in the absence of an energy deficit. Dorsal striatum is hyperactive in obese and may contribute aberrancy of satiety signals. The genetics involving various mutations contributes up to 70% towards a person's vulnerability to obesity.
REGULATION OF ENERGY EXPENDITURE: Energy is consumed in processes of physical activity, basal metabolism, and adaptive thermogenesis, which are modulated by brain, especially hypothalamic melanocortin system. Brown adipose tissue (BAT) plays a major role in thermogenesis. Central regulation of BAT thermogenesis is dependent on sympathetic outflow to BAT. Norepinephrine released from sympathetic nerve terminals binds to β3-adrenergic receptors on adipocytes in BAT to promote enhanced thermogenesis. In addition, many hormonal and nutrient signals, such as glucose, insulin, leptin and GLP-1 also influence sympathetic outflow to BAT.
CONCLUSION - FALLOUTS OF NEUROSIGNAL ABERRANCY: The obese subjects with BMI > 30 show atrophy in the frontal lobes, anterior cingulate gyrus, hippocampus, and thalamus. MetS affects various cognitive domains including executive functioning, processing speed, and overall intellectual functioning. There is impaired vascular reactivity, endothelial dysfunction, neuro-inflammation, oxidative stress and altered brain metabolism.
Guest Lecture at University of Delhi - The Entangled Relationship between Dia...Vinod Nikhra
The talk at Ramjas College, University of Delhi on 18th Feb 2015. It highlights the latest issues in biological and molecular research which link overweight/obesity with diabetes, metabolic syndrome and aging.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
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Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
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Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
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The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
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According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
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India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...
Clinical management guidelines for swine flu at civic centre on 5 feb2015
1. Clinical Management
Guidelines for
SWINE FLU ( H1N1)
.
Dr. Vinod Nikhra
M.D., ICCN, PGCHM, FIMSA,
Fellow Royal Society of Medicine
Hindu Rao Hospital, Delhi
Civic Centre 05.02.2015
2. Our Set Up at HRH
Sample Collection Facility
Swine Flu Ward
4. Guidelines for Sample Collection
• Sample Type: Throat Swab or Nasal Swab
• Collection: You will need PPE kit, N95 mask, Viral media, Swab stick
• Transportation of Specimens
Sample for Real time-PCR (polymerase chain reaction) for H1N1
should taken:
1. If the patient has a severe or progressive disease in both high risk
and other groups with warning signs
2. There is cluster of cases
3. High risk individuals with ILI
5. Guidelines on Categorization of
Influenza A - H1N1 Cases for Testing and Treatment
• Category A:
Mild fever plus cough/ sore throat. A mild illness.
Do not require anti-viaral medication, i.e., Oseltamivir (Fluvir or Tamiflu). No
need of Testing for H1N1. No need of hospital admission. Should be confined at
home and asked to observe precautions.
• Category B:
(i) Cat. B1: Moderate S/Ss. Treatment strategy same like Cat. A. No testing for
H1N1 is required.
(ii) Cat. B2: Those with high risk; They should be treated with Oseltamivir.
• Category C:
S/S of a severe disease. Breathlessness, chest pain, altered consciousness, fall in
BP, blood tinged sputum, peripheral cyanosis. In children with ILI having
somnolence, high and persistent febrile state, not accepting feeds, shortness of
breath, convulsions.
The Cat. C patients require immediate hospitalization and treatment.
7. High Risk Groups for Complications of H1N1
• Pregnant women
• Infant and Children below 5 years
• Elderly >65 years
• Patients with COPD/chronic resp disease, CAD,
Chronic neurological disease which impairs breathing
or clearance of secretions, CRF, DM, haemoglobin-
pathies, or immunocompromised (on steroids and
such drugs, cancers, HIV).
8. Care of a
Suspected or Confirmed Case of H1N1
• As per the National Guidelines, a confirmed H1N1 case has
to be treated:
At Home, or
In the Hospital Setting
Depending on:
Clinical presentation and presence of complications
For this, the Respiratory Disease Activity is to be
monitored.
Special emphasis if the patient belongs to high risk group
9. Guidelines for the Patient Care at Home
• Dos:
1. Wear mask
2. Wash hands frequently
3. Observe cough etiquettes
4. Stay at home and avoid going into the community
5. Take the prescribed treatment
6. Self monitor health and report to hospital in case S/S
worsen.
10. Guidelines for the Patient Care at Home ..2
• Don’ts:
1. Smoke
2. Close contact with others
3. Touching of eyes, nose or mouth
• Alerts:
1. Persistent fever
2. Difficulty in breathing
3. Blood tinged sputum
4. Alteration of sensorium
5. Exacerbation of S/S of associated comorbidities
6. In case of children: irritability, not accepting orally, vomiting, fast
breathing, seizures, etc.
11. Management of H1N1 Patients admitted in Hospital
Treatment decisions involve:
1. Complications of influenza
2. Worsening of pre-existing illness
3. High risk groups
4. Tools to assess Resp. status:
• X Ray Chest
• CURB65 A scoring tool for deciding the action to be taken
0-1: Treat as an outpatient
2-3: Consider a short stay in hospital or monitor carefully as an outpatient
4-5: Requires hospitalization with consideration for respiratory support.
• CRB65 The CRB-65 tool has been simplified by taking SBP,
and omitting DBP.
Thus, risk class 1 for those with score 0,
Risk class 2 for those with Score 1-2
Risk class 3 for those with 3-4.
Patients in risk class 1 would be ideal candidates for ambulatory treatment in the absence of any severe
comorbidity.
CURB-65
Signs Points
Confusion 1
BUN>7 mmol/l 1
Respiratory rate>=30 1
SBP<90mmHg,
DBP=<60mmHg
1
Age>=65 1
CALCULATE TOTAL SCORE --
12. Warning Signs for Severe Disease
• Dyspnoea
• ALI (Acute lung injury) – Pneumonia
• Hypoxia (pO2 <60mmHg, SaO2 <90%)
• Hypercapnia
• Persistent fever
• Hypotension
• Acidosis
• Altered mental status
• Septic shock
13. Predictors of Severe Disease
• Clinical and radiological signs of LRTI
• Exacerbation of underlying disease
• Shock and multi-organ involvement
• CNS complications
• Higher CURB65 / CRB65 score
• Signs of secondary bacterial infection
• Signs of respiratory compromise / poor oxygenation
14. Treatment of Indoor H1N1 Patient
• ABC: Care about Airway, Breathing and Circulation
• Supplemental Oxygen and Respiratory support
including mechanical ventilation
• Antipyretics (avoid aspirin), Bronchodilators,
Decongestants (avoid steroids), Treat Complications
like shock, bacterial infection
• Nutritional supplementation and rehydration
• Stress ulcer prophylaxis
• Other supportive treatment.
15. Anti-Viral Treatment
• Anti-viral treatment should be started in ILI in high risk group
and in case of Severe and progressive illness
• Oseltamivir (a neuraminidase) is the primary drug. Adv.: oral
administration and a higher lung availability.
• Dose schedule:
Adult: 75 mg twice daily for 5 days
Children: <15 Kg – 30 mg twice daily
15-23 Kg – 45 mg twice daily
23 to less than 40 Kg – 60 mg twice daily
40 Kg or more – 75 mg twice daily
Infants: <3m – 12mg BD; 3-5m – 20mg BD; 6-11 m – 25 mg BD
16. Anti-viral Tt: Side Effects and Toxicity
OSELTAMIVIR:
• Nausea and vomiting
• Allergic reaction, skin rash, facial swelling
• Hepatitis
• Various neuropsychiatric adverse effects
ZANAMIVIR:
Given by inhalation. For the treatment in those of 7 years or older. Not
recommended for individuals with underlying respiratory disease. SIDE
EFFECTS: headaches, diarrhea, nausea, cough, vomiting, disturbance in
temperature regulation, and dizziness. NOT AVAILABLE.
DRUGS TO BE AVOIDED: Steroids and Aspirin.
17. Respiratory Support
Non-invasive Ventilation (NIV):
NIV is a modality that supports breathing without the need for intubation
or surgical airway. It is a popular method of adult respiratory support in the
emergency and indoor wards and the intensive care unit (ICU), and is
particularly helpful in the care of paediatric patients.
It avoids the adverse effects of invasive ventilation, and has the added
advantage of patient comfort. It delivers ventilator support without the
placement of an artificial airway. Useful in milder cases where Pt. is
conscious
NIV can be (i) Negative pressure ventilation (NPV) or (ii) Non-invasive
positive pressure ventilation (NIPPV). NIPPV includes continuous positive
airway pressure (CPAP) and bilevel positive airway pressure (BiPAP).
18. NIV will benefit patients with PaO2/FiO2 > 200 and those with
APACHE II <6.
APACHE II (Acute Physiology and Chronic Health Evaluation II) is a
severity-of-disease classification system, designed to measure the
severity of disease for adult patients admitted in ICU. It is applied
within 24 hours of admission of a patient to ICU: an integer score
from 0 to 71 is computed based on several measurements; higher
scores correspond to more severe disease and a higher risk of death.
Weaning from NIV is associated with a reduced mortality and lower
incidence of ventilator-associated pneumonia.
Respiratory Support ..2
19. Respiratory Support ..3
Invasive Mechanical Ventilation:
It will ensure adequate oxygen therapy, tidal volume 5-7 ml/kg
PBWPEEP to achieve adequate oxygenation. Invasive ventilation
is a method to mechanically assist or replace spontaneous
breathing. It involves an endotracheal tube or a tracheostomy
tube. Respiration is assisted by a ventilator or an Ambu bag.
The mechanical ventilation can be Positive Pressure Ventilation
(where air is pushed into the trachea) or Negative Pressure
Ventilation (where air is sucked into the lungs).
Mechanical ventilation is indicated when the spontaneous
ventilation is inadequate.
Ventilatory Treatment of each patient need to be individualised.