News and Views
Craniosynostosis is one of many problems where the pediatric population now and then visits a doctor, viz. a pediatrician, a neurosurgeon or a plastic surgeon. Unfortunately the incidence in India is not known when compared to the western literature. A Medline database search reveals less then thirty articles from India, most of them are anecdotal case reports whereas a similar search with the keyword ‘craniosynostosis’ reveals more then 4900 articles from the western world. The reason why we are far behind in numbers in this particular condition is either due to lack of awareness, ignorance or due to less emphasis on cosmetics when there are many more core issues to focus onto. They are also commonly passed off as positional skull abnormality due to head position that would get corrected with time. Even if reported, they present at a much older age when the results are not as good as in infants.
By definition, craniosynostosis is premature closure of skull sutures before the complete development of brain. It is either syndromic or non syndromic, the latter is more commonly encountered. There are hundreds of syndromes associated with craniosynostosis but the commoner ones are Crouzon’s, Apert’s, Pfeiffer and Saethre–Chotzen syndromes and they are autosomal dominant. The non syndromic ones are usually sporadic but one study quoted 6% of genetically–linked scaphocephaly.
Children with abnormally–shaped skulls are prey to great psychological trauma due to taunting from their peers. There are also reports of delayed poor cognitive performances or even raised intracranial pressure in these children. Lots of ocular abnormalities like squint, nystagmus or optic atrophy may occur when anterior sutures are involved. The common genes involved are FGRF 1 and 2 and TWIST genes though a huge list of genes are being associated with this condition.
The diagnosis is simple by clinical observation and skull radiographs. High definition 3D CT scan of skull aids in better planning but comes at the cost of radiation exposure to small babies which can better be avoided. The treatment is surgical by remodelling of skull bones and is done in neurosurgical and plastic surgery centers. Best results are obtained in infants less then 9 month, a relatively simple and safe surgery. So, the time has come to shed off the myth that craniosynostosis is just a cosmetic deformity and let the babies get treated in the right age by the right surgeon for the right results before it casts its ugly shadow with malfunctioning of the maldeveloped brain. (Dr Suchanda B, Neurosurgeon, firstname.lastname@example.org)
Children can now be prescribed the antihypertensive Benicar
In February this year, the FDA gave its nod to Benicar (olmesartan medoxomil) for the treatment of hypertension in children aged 6 to 16 years based on the results of a phase 3 study of Benicar in pediatric patients. It may be used as monotherapy or given in combination with other antihypertensive agents.
Breast cancer drug Tykerb now approved in combination as first–line therapy
The antineoplastic agent Tykerb (lapatinib) has been approved to be given in combination with with Femara (letrozole) as a first–line oral regimen for hormone-positive and human epidermal growth factor receptor 2 (Her–2)–positive advanced breast cancer in postmenopausal women who are candidates for whom hormonal therapy. In a double–blind, placebo–controlled study, women who were treated with this combination had a 5.2–month increase in median progression–free survival vs women treated with only letrozole.
An extended–release formulation of trazadone approved for adult depression
Based on the results of an 8–week, randomized, double–blind, 2–arm, multicenter study of patients with unipolar major depressive disorder (MDD), trazodone hydrochloride (Oleptro) has been FDA approved as an extended–release tablet for the treatment of MDD in adults. The tablet is to be given once–daily.
Prevent India 2010 (Dynamic Programme on Preventive Cardiology)
Date: March 13–14, 2010
Venue: Hotel Marriott Convention Centre, Hyderabad, Andhra Pradesh.
Quote of the Day
If we could all hear one another’s prayers, God might be relieved of some of his burdens. (Ashleigh Brilliant)
Meglitinides (nateglinide and repaglinide) increase insulin and pre formed insulin, are short acting and used in post prandial hyperglycemia
Public Forum (Press Release)
Obese people are more prone to heart failure
Obesity or extra body weight is a major risk factor for coronary artery disease and congestive heart failure.
Since obesity places increased burden on heart it is also associated with enlargement of heart, said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor, eMedinewS.
Obesity can lead to a large scale morbidity culminating in mortality in some cases.
Extra body weight also places a burden on the lungs by making breathing difficult.
It predisposes a person to a number of other illnesses including stiffness of joints, atherosclerosis (hardening of arteries), hypertension and gallstones especially in fat women.
Most of these conditions can be reversed if the patient sheds extra weight. But the loss in weight should be gradual and without any ups and downs. It must not rebound.
A person is said to be obese when he reaches a level more than 10 percent above his ideal body weight, which is the standard weight of a person depending on his or her height and the body frame.
The pot–belly obesity where the measurement of the waist is more than that of the hip, is more dangerous.
The body gains weight when the intake of calories exceeds what the body needs for physical activity and growth. The basic principle to lose weight is that one must consume fewer calories than one expends. In this context, "Walk more and eat less" has been recommended. Half an hour of cycling and a brisk walk every day can be helpful.
People should miss a meal a week. Obese people should avoid eating too many sweet, sour and salty things. They may eat more of bitter things like neem, karela and bel, and also ginger.
Question of the day
What are the foods and beverages that are better tolerated by IBS and IBD patients?
Water, ginger ale, sprite and gatorade
Soy milk or rice milk
Soy–or rice–based products
Plain pasta, plain noodles, white rice. No sauces or gravies
Potato: boiled or baked. No French fries
Breads: French, Italian, whole white, English muffins and white rolls
Plain fish, plain chicken, plain turkey or plain ham
Eggs: soft–boiled, poached
Cereals: Plain cornflakes, rice krispies, Cheerios; dry or with soymilk or rice milk.
Salads: lettuce, hard–boiled egg slices, oil and vinegar dressing
Cooked peas, carrots (avoid raw vegetables)
Margarine, jams, jellies, peanut butter.
In small amounts: apple sauce, cantaloupe, watermelon, honeydew melon, fruit cocktail, peaches, pears (canned, nondietetic).
(Suggested reading: MacDermott RP. Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet. Inflamm Bowel Dis 2007;13:91.)
eMedinewS Try this it Works
Put on a happy face
Blow up a latex exam glove and draw a happy face on it. Ask the parent to hold the balloon and move it from side to side to help you with the examination of the child.
Dr Good Dr Bad
A patient with acute heart attack was not fit for reperfusion therapy
Dr Bad: Start 60 mg prasugrel.
Dr Good: Chew 300 mg aspirin and 300 mg clopidogrel.
Lesson: For patients receiving no reperfusion therapy, start clopidogrel 300 mg as opposed to prasugrel.
Situation: A 4–year–old girl with rickets is unresponsive to high doses of vitamin D.
Reaction: Oh my God! Why didn’t you advise alfacalcidol?
Make sure to advise alfacalcidol in patients unresponsive to calcium/vitamin D therapy. Alfacalcidol, in numerous studies, has been found to be effective in refractory cases of rickets.
Direct Taxes Individual
Income tax slabs for resident woman taxpayers to be as follows:
Income upto Rs 1.9 lakh
Income above Rs 1.9 lakh and upto Rs. 5 lakh
Income above Rs.5 lakh and upto Rs. 8 lakh
Income above Rs. 8 lakh