Will India import P1 polio from Pakistan?

Health Care, Medicine, Social Health Community 1,169 Comments

India is on high alert against the deadly polio P1 virus coming from Pakistan Indian health ministry has asked the Punjab government to mandatorily vaccinate all children aged 0-5 years coming Pakistan for the next four months.

Pakistan till now has recorded 84 cases of polio of which 83 are of the P1 strain, a deadly dangerous since it travels faster and infects more people.

Polio also has re-entered China after a gap of 10 years with polio virus imported from Pakistan.  China’s last indigenous case was in 1994, and it’s very last case – imported that time from India – was in 1999. After the recent outbreak, the Chinese government has decided to immunize 4.5 million children.

India has reported just one case. Last case was reported on January 13 in West Bengal. Punjab has been polio free since 2009.

Do not ignore yellow plaques on the eyelids

Health Care, Medicine 358 Comments

Xanthelasma are soft, cholesterol-filled plaques that develop under the skin, usually on or around the eyelids and most often near the nose. They occur mainly in middle-aged and older adults and in women more often than in men. They are always benign and rarely impair vision. But they can be a sign of hyperlipidemia — elevated blood-fat levels in 50% of the people.

The presence of xanthelasma on the eyelids is an independent predictor of future heart blockages. In a large prospective study By Dr Anne Tybjærg-Hansen, of Rigshospitalet in Copenhagen published in BMJ during a mean follow-up of 22 years, adults participating in a long-term Danish heart study who had xanthelasmata at baseline had an adjusted hazard ratio for acute heart attack of 1.48. In the study those with the eyelid lesions had lower levels of apolipoprotein A1 and HDL cholesterol as against those who had arcus corneae they had higher levels of lipoprotein (a).

The plaques are especially common in people with inherited disorders of low-density lipoprotein (LDL) metabolism. They occur in 75% of older people with familial hypercholesterolemia (very high cholesterol levels) and in 10% of people with high levels of apolipoprotein B.

Treating any underlying lipid condition may reduce the size of xanthelasma. If no lipid abnormality is present then xanthelasma is largely a cosmetic problem.

There are several ways to remove xanthelasma. These include cryotherapy (freezing the lesions with liquid nitrogen), laser ablation, surgical excision, electrodesiccation (destruction of the lesion with an electric needle), and chemical cauterization (application of a topical agent such as trichloroacetic acid to dissolve the plaques).

Take home message

  • All patients with xanthelasmas should get lipid profile done.
  • Look for low HDL and low Apo A1 levels.
  • Look of high Apo B levels.
  • Get LP(a) levels it will usually be normal.

Anti-nausea drug ondansetron linked to arrhythmias

Health Care, Medicine 519 Comments

Ondansetron can trigger dangerous and possibly lethal changes in heart rhythms as per FDA warning. It can cause prolongation of the QT interval in ECG which can lead to an abnormal and potentially fatal heart rhythm, including Torsade de Pointes,” the FDA said.

Patients at greatest risk include those with “underlying heart conditions, such as congenital long QT syndrome, [and] those who are predisposed to low levels of potassium and magnesium in the blood” as well as patients who are taking other medications also associated with QT prolongation.

Ondansetron is a 5-HT3 serotonin receptor antagonist, commonly prescribed to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, and surgery.

The FDA label recommend ECG monitoring in certain patients including those with hypokalemia or hypomagnesemia, congestive heart failure, bradyarrhythmias, and in patients who are taking other medications that increase the risk of QT.

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