MANAGEMENT OF ACUTE UPPER GASTROINTESTINAL HEMORRHAGE
Prof. Luv Kakkar,
Acute upper gastrointestinal bleeding remains a common cause of visits to the Emergency Department, with an estimated incidence of about 100 per 1,00,000 hospitalizations and being associated to significant morbidity and mortality.

Acute upper GI bleeding spectrum is diverse and encompasses a plethora of clinical conditions, which include acid-peptic disease, variceal bleeding, erosive mucosal diseases, Mallory-Weiss tear and others
The basic principles of management of an acute upper gastrointestinal bleeding are the same. Immediate resuscitation to stabilize hemodynamic status, followed by identification of bleeding source and control of active bleeding as well as prevention of recurrent bleeding are the fundamental tenets of success.
 A variety of therapeutic modalities namely pharmacotherapy, endoscopic procedures like sclerotherapy, variceal ligation, angiographic embolizations and surgery are employed, either alone or in combination, depending upon the cause of bleeding, clinical status of the patient and availability of expertise to improve the success rate. Management of acute upper GI bleeding from ulcer and variceal bleeding is important for all concerned
 All these are often complementary to each other and require multi-speciality approach. Finally, strategies should be formulated to treat or eradicate the underlying disease for prevention of re-bleeding.

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ROUTES OF DRUG ADMINISTRATION
Prof. Rakesh C. Chaurasia,

The drugs are administered by three major routes i.e. enteral, parenteral and topical. The route depends upon various factors i.e. physical (solid, liquid and gas) and chemical (solubility, stability, pH, irritancy etc.).
The most common, convenient, non-invasive, safe and accepted mode is oral. By parenteral route, the drugs are directly administered into blood or body fluid to achieve maximum bioavailability, in a shorter period of time. Drug may also be applied on skin and mucous membrane for local effects.
Apart from intramuscular, intravenous and subcutaneous routes, the other routes available are the intra-dermal, intra-arterial, intracardiac, intra-peritoneal, intra-thecal, intra-articular, retrobulbar, intra-lesional etc. Sublingual, rectal and nasal routes are also used, commonly. Each route has its own advantages, disadvantages, indications and adverse effects
Many drugs can be administered orally as liquids, capsules, tablets or chewable tablets. Drugs injected by subcutaneous route are insulin, adrenaline, local anesthetics and some vaccines Overall, the choice of route depends on the drug properties, patient's requirements and acceptability. Some of the newer drug delivery systems available are the targeted delivery, prodrug, transdermal implants etc. In the present scenario, newer and special modes of drug delivery systems are being developed for better patient compliance. ]

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PHOTODERMATITIS
Prof. Jayakar Thomas,  

Photodermatitis is a group of skin diseases, caused by some toxic or allergic agents, effect of which is aggravated on exposure to sunlight. Main culprit for developing cutaneous reaction is ultraviolet (UV) radiation mainly of wavelength 200-400 nm (UVA, UVB and UVC). Classification is based on etio-pathogenesis i.e. exogenous photodermatitis and endogenous photodermatitis. Endogenous photodermatitis mainly includes various types of porphyrias. These show photosensitivity reactions upon sun exposure.

Patients having photodermatitis should be properly investigated for any topical or systemic exposure to chemicals or any underlying genetic or metabolic disorders. Photodermatitis is very distressing condition, as it hampers a patient's daily life, significantly.

Phototoxic reactions often resemble a sunburn, whereas the lesions of photoallergic reactions often resemble 'allergic contact dermatitis'.

Management mainly focuses on identification and avoidance of the offending agents, strict photoprotection by proper clothings and sunscreens. Appropriate topical or systemic therapy and avoidance of allergens as well as toxic agents are important in management. For short-term flares, short course of systemic cortico-steroids and topical soothing lotions, steroid creams etc. can be used.

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DIAGNOSIS OF REUMATOID ARTHRITIS
Prof. Kavita Krishna,  

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disorder that has various articular and extra-articular manifestations. Common presentation is pain in multiple joints, often symmetrical, accompanied by morning stiffness. In long standing cases, classical deformities are seen.

There is no single diagnostic test for RA and the treating physicians are often unable to differentiate between the various causes of polyarthritis. Diagnosis of RA rests on a good detailed history, supported by certain diagnostic tests. First and foremost, we have to see the duration and type of joints involved. Then, based on the pattern of involvement, alongwith ESR/CRP, we have to decide, if it is an inflammatory arthritis or not. Rheumatoid factor and anti-CCP positivity re-inforce the clinical diagnosis of RA.

ACR/EULAR classification criteria are instrumental in early RA. Imaging is to look for the erosions. Ultrasonography and other modes of imaging are for acute synovitis. Synovial fluid analysis should be performed only in selected cases.

The last two decades witnessed a tremendous development in the field of management with newer promising drugs entering the market, as a result of extensive research.

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AUTISM, (Pervasive developmental disorder/Asperger’s syndrome)
Prof. Supriya Hegde,  

Autism is a life-long developmental disorder without definite cause or treatment. There is a wide range of symptoms and intensity of this disability varies. There may be abnormal response to sight, hearing, smell, abnormal ways of responding to people, resisting changes in routine, physical overactivity or underactivity and tantrums.

Autism is a disorder of neural development, which is characterized by impaired social interaction and communication and by restricted as well as repetitive behaviour. Mostly thought, perception and attention are affected. Basically, the common factor is difficulty in communication, social skills and learning.

These signs mostly begin before a child is three years old. Autism affects information processing in the brain by altering nerve cells and the connection of their synapses. The process of alteration is not well understood.

Parents often notice signs in the first two years of their child's life. The signs usually develop gradually, but some autistic children first develop normally and then there is regression of attainment of milestones.

Early behavioural or cognitive intervention can help autistic children gain self-care, social and communication skills. Specialized interventions can be given to lead a more productive life. Special schools are helpful for children as well as for parents.

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LONG-HAUL AIR FLIGHTS AND ECONOMY CLASS SYNDROME (ECS)
Prof. Zuber Ahmed,  

Long distance air traveling has become increasingly common, because of commercial trades and availalability of improved skill. Economy Class Syndrome (ECS) is a condition of the circulatory system, which has been associated with flights in economy airline seats. It is known as "Venous Thromboembolism" or more commonly as "Deep Vein Thrombosis" (DVT). ECS can result in the formation of blood clots.

Prolonged immobility, dehydration and lack of precautionary measures are the high risk factors for the development of venous thrombo-embolism (VTE) during long-haul air flights.

To avoid the risk of developing Economy Class Syndrome (ECS), the air travellers should be made aware of it and advised to take sufficient liquids (avoiding alcoholic drinks and beer) during flights. They should be encouraged to have frequent strolls in the aisle and carry out certain yogic and breathing exercises. Such breathing exercises inflate the retracted ear drums and act as a simplified Valsalva manoeuvre in flights.

Pharmacological prophylaxis can be beneficial. Drugs like Aspirin (100 mg) or Clopidogrel (75 mg) or Furosemide (20 mg) in a single dose once a day, may be used conveniently, by oral route to decrease remotely, the chances of developing VTE. These drugs may be taken two days before and two days after the flight.

All those related to world travelling, should be made aware to take precautionary measures.