CURRENT MEDICAL JOURNAL

CONTINUING MEDICAL EDUCATION (CME) PROGRAMME
ISSN-NO - 0972-2203

RECENT ADVANCES IN PANCREATIC TRANSPLANTATION
- BUDS NURTURED WITH TENDER
CARE BLOSSOM TO FULL POTENTIAL

Prof. S. Chhabra,
Head, Deptt. of Obs & Gynae,
MGIMS, Sevagram, Wardha.

Adolescence is a transitional period which is vulnerable to behavioral and sexual disorders and these have far reaching consequences.These disorders vary considerably because of the economic status, environment (especially cultural milieu), peer effect, substance abuse, education and many other factors. The numbers may vary but teenage pregnancies, abortions, childbirths etc. are a global problem. Teenage births are roughly 10% of the total births and 15 million mothers are unwed. An obstetrician must know the possible hazards and delivery complications because in teenage there is lack of knowledge of reproductive life, non-access to contraception, unprotected sex and vulnerability to abuse. So, adolescents are at high risk of unwanted pregnancies. Awareness amongst the adolescents, families as well as health providers is essential for preventive, promotive and rehabilitative health of adolescents. Reproductive disorders in youth are influenced by myriad of factors, operating at different levels including individual, family, community and so on. Counselling on development, sexuality and contraception is essential.

DISASTER MANAGEMENT PLAN
Dr. V. Kaushal,
AP, Deptt. of Pharmacology,  
DMC & Hospital, Ludhiana.

The maternal physiological changes, which occur during pregnancy have significant effect on many aspects of maternal drug handling. So, during the treatment of any disorder, the family physician should use caution while prescribing the drugs. Every clinician should be aware of basic principles of teratogenecity. It is wise to avoid all drugs during pregnancy unless compelling reasons exist for their use, regardless of the fact whether the drug is considered safe or presumed to be safe. However, some of the drugs such as aspirin, paracetamol, cephalosporins, corticosteroids, penicillins, heparin, sulfonamides, phenothiazines, alpha methyl dopa, erythromycin, insulin, isoniazid, chloroquine and nystatin can be safely used, if deemed necessary. All anti-cancer drugs, carbamazepine, phenytoin, trimethadione, paramethadione, diethylstilboestrol, ethanol, tetracycline and retinoids should be avoided during pregnancy. Use of over-the-counter medications should be discouraged. If considered necessary, the safest drug should be recommended for the shortest duration at smallest dose adequate for appropriate therapeutic response.

OCCUPATIONAL ASTHMA
Prof. A. K. Janmeja,
Dr. Suman K. Dass,
Deptt. of Chest Diseases & Tuberculosis,
GMC and Hospital, Chandigarh.,

Asthma exclusively attributable to working environment is known as occupational asthma. Nearly 5-10% of adult asthma is actually due to work place exposures. However, in different occupations the disease prevalence is different and may range from 5%-50%. Atopy, tobacco smoking and preexisting airway hyperresponsiveness are predisposing factors as in usual form of bronchial asthma. Both immunologic and non-immunologic mechanisms are involved in its pathophysiology. Clinical signs and symptoms are similar to usual asthma, however, they are commonly encountered after working shifts in the evenings/nights. Improvements of symptoms occurs at weekends or during longer breaks. The diagnosis of OA is made by keeping high index of suspicion amongst adult asthmatics. Two things are prerequisite for diagnosis of OA i.e. the diagnosis of asthma itself and to establish that some occupational agent is causing it. Treatment involves removal of causal exposure and close medical follow up. Once diagnosis is confirmed, it is the duty of treating physician to do proper counselling of patient for compensation according to the law of land.

TAMSULOSIN
THE FIRST PROSTATE-SELECTIVE
ALPHA 1A-ADRENOCEPTOR ANTAGONIST
- CLINICALLY PREFFERRED DRUG FOR THE TREATMENT
OF SYMPTOMATIC BENIGN PROSTATIC HYPERTROPHY (BPH)

Dr. Kiran V. Barar
Associate Prof., Deptt. of Pharmacology,
RNT Medical College, Udaipur.

Benign enlargement of the prostate is a problem that can occur in men as they get older. Since the gland is located below the bladder, when it increases in size, creates pressure on the urethral passage, giving rise to many kinds of problems in urinating, such as-a need to urinate often, a weak stream, a feeling of not being able to empty the bladder completely, etc. etc. It is recently known that both urethral and prostatic tissue are rich in specific subtype of alpha1A-receptors i.e. alpha1A-adrenoceptors responsible for contraction of the smooth muscles there. If one could have a target-specific drug which blocks only these alpha1A-receptors leading to relaxation of these muscles, it will prove to be a boon to many a patient and will have to be a highly clinically selective agent with very few side effects. Tamsulosin HCl (Flomax) is such a new advancement to have specific antagonistic action on a alpha1A subtype of receptors. It helps relax the muscles in prostate and the opening of the bladder.

PANIC DISORDER-DIAGNOSIS AND MANAGEMENT
Dr. Lok Raj,
Prof. B.S. Chavan,
Deptt. of Psychiatry,
GMC & Hospital, Chandigarh.

Anxiety disorders are the commonest psychiatric disorders encountered in medical practice. Panic disorder is characterized by discrete episodes of acute anxiety occurring without any precipitating factor and lasting for a few minutes only. Panic disorder patients have very a high incidence of co-morbid conditions like depression, phobias, drug abuse, alcohol dependence and personality disorders. Antidepressants, particularly tricyclics are very effective in treating panic disorders. Benzo-diazepines, though effective, pose the threat of dependence. Non-pharmacological measures include cognitive behaviour therapy, psychodynamic psychotherapy and various relaxation techniques.

ROLE OF DIET IN DELAYING THE AGEING PROCESS
Ms. Manju Mathur,
Head, Deptt. of Dietetics,
GMC & Hospital,
Chandigarh.

People in general, fear aging*. Although each one of us desires to stay healthy and remain youthful throughout life, this can only be achieved if we are able to maintain health and prevent the onset of non-communicable chronic diseases. A combination of factors like sensible diet, exercise in moderation, regular habits and a positive attitude towards life is important for achieving this goal. It is also important to protect the immunity of the body by regular use of antioxidant vitamins and minerals and also to take care of the factors that may rob our body of the nutrition that it gets from a balanced diet. Besides this, regular exercise and a positive attitude towards life go a long way in maintaining health and delaying the aging process of the body.

PAIN IN THE UPPER LIMB- A DIAGNOSTIC ENIGMA
Prof. Raj Bahadur,
Dr. Sudhir Kumar,
Deptt. of Orthopedics,
GMC & Hospital, Chandigarh.

Pain in the upper limb is one of the commonest complaint for which patient seeks medical help. There is a long list of disorders that can cause pain in the upper limb. Only painstaking history and examination can help us in differentiating one condition from other. To pin-point the cause, it is also vital to have a thorough knowledge of anatomical features and the biomechanics of the upper limb. Investigations are valuable adjunct, which help us in confirming our diagnosis and planning treatment.

NEWER ANTIEPILEPTIC DRUGS
Dr.S.Balakrishnan,
Prof. P. Pandhi,
Deptt. of Pharmacology,
PGIMER, Chandigarh.

The presently available antiepileptic drugs (AEDs) i.e. phenobarbitone, phenytion, benzodiazepines, sodium valproate, carbamazepine, ethosuximde and trimethadone are associated with a number of shortcomings. They are not able to control seizures effectively in as many as 25% of the patients. Their dose related neurotoxicity, drug interactions and other side effects at times becomes major limitations in their clinical use. So these limitations with conventional AEDs highlighted the need for developing newer agents for treatment of epilepsy. There have been an increasing number of newer antiepileptics, which have recently flooded the market. Most of these have been rationally designed; either augmenting inhibitory neurotransmission or inhibiting excitatory neurotransmission. This article briefly describes the pharmacology of newer antiepileptics most of which are used as second or third line agents for refractory cases; especially as add-on to the conventional antiepileptics.

RETINOPATHY OF PREMATURITY - SCREENING & TREATMENT
Dr. Renu Sawhney,
Dr. Rajeev Gupta,
Prof. Sunandan Sood,
Deptt. of Ophthalmology,
GMC & Hospital, Chandigarh.

Retinopathy of prematurity (ROP) is a proliferative retinopathy which affects pre-term infants exposed to high ambient oxygen concentrations. The incompletely vascularised temporal retina of pre-term babies is particularly susceptible to oxygen damage. The incidence of ROP varies from 20-30% in premature infants. Untreated, ROP can progress to retinal detachment and can cause bilateral permanent blindness in the child. ROP is the largest cause of child blindness in USA and is also emerging as a major cause of child blindness in developing countries. The blinding complications of the disease prevented by early diagnosis and prompt treatment. All the premature babies with birth weight less than 1700 gm or period of gestation less than 36 weeks should be screened for presence of ROP. Treatment by either cryotherapy or laser photocoagulation is recommended in infants with threshold disease.