Indian Academy of Pediatrics, · PDF filePediatric Seminar Hall, ... Probiotics Demystified Symposium ... the practical aspects of Management of Fluid and Electrolyte Imbalance in

Indian Academy of Pediatrics, MumbaiMonthly Newsletter, Vol.8, August 2014

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Hon. Secretary

Dr Sushant Mane

Hon. Treasurer

Dr Bela Verma

President

Dr Uday Pai

Contact : Indian Academy of Pediatrics, 92/4, Geeta Building, 1st Floor, Next to Chhagan Mitha Petrol Pump,Dr. B. Ambedkar Road, Rani Laxmibai Chowk (Sion Circle), Sion (E), Mumbai - 400 022.Email : [email protected] | [email protected] Telefax : +91-22-24045803

For Private Circulation onlyNot for Sale

FREEDOMIS A WONDERFUL FEELING

APPRECIATE IT !

IAP, MUMBAI

IAP Navi Mumbai IAP ThaneDr Bhanudas G Ranpise

Dr. Subhash RaoDr Ramesh S Aiyer

Dr Ramgopal R Chejara

IAP Kalyan/Karjat DombivaliDr Gurudutt BhatDr Mangesh Kasle

RESEARCH & ACADEMIC AFFAIRS COUNCIL

Dr M R Lokeshwar

TRUSTEES

EX - OFFICIO MEMBERS

EXECUTIVE BOARD MEMBERS

PresidentDr Uday Pai

Hon. TreasurerDr Bela Verma

Hon. SecretaryDr Sushant Mane

Past PresidentDr Sharat Menon

OFFICE BEARERS AND MEMBERS OF EXECUTIVE BOARD, 2014

Dr Bakul Jayant Parekh Dr Bharat Agarwal Dr Bipin Shah Dr P N Patnekar Dr Vijay Tuteja

Dr Mamta Manglani Dr Mukesh Agarwal Dr Kamlesh Shrivastava

Central IAP

Dr. Yewale Vijay N Dr. Mehta Pravin J Dr. Bakul Jayant ParekhPresident 2014 Hon. Secretary Hon. Treasurer

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Dr A D Rathod Dr Barkha Chawla Dr Mukesh Agarwal Dr Murlidhar Mahajan Dr Preetha Joshi Dr Vinay Joshi Dr Samir Dalwai

Dr Sandeep Bavdekar Dr Shruti Ghatalia Dr Sujata Kanhere Dr Sushma Malik Dr Sushma Save Dr Varsha Phadke Dr Yashwant Gabhale

Pediatric and Radiology Department (Pediatric-Radiology Meeting) of Nanavati Hospital.

1st Saturday of every month Time : 9 am to 10.30 am.

CT scan Department, Nanavati Hospital,

S V Road, Vile Parle West, Mumbai.

NO registration fee But COMPULSORY

Venue : Pediatric-Radiology Meeting Pediatricians are welcome.

Pl SMS Ms. Deepali : 9969412934

E mail : [email protected]

1Indian Academy of Pediatrics, Mumbai. Monthly Newsletter, 2014Vol.8, August

Monthly Meetings

7 Augustrth Thursday : North West Mumbai Pediatric Meeting

Venue Borivali Medical Brotherhood, Shri N. B. Chadwa Hall,

TPS Marg, Borivali West, Mumbai

Time 08.30 am to 10.00 am

:

:

Enquiries to Dr. Charu Suraiya 9820357632:

st th th th 1 , 8 , 15 , 22 August Friday : Clinical meetingsth, 29

Institute

B. J. Wadia hospital Dr S. Prabhu

J . J . Hospital Dr N. R. Sutay

K.E.M. Hospital Dr Mukesh Agarwal

B.Y. L . Nair hospital Dr Sandeep Bavdekar

LTMG hospital Dr Mamta Manglani

Head of department

th th th th 7 , 14 , 21 , 28 2014: Postgraduate Grand Rounds August

Pediatric Seminar Hall, Lokmanya Tilak Medical College, Sion

6:00 pm to 8:00 pm

Venue

Time

:

:

Contents

Monthly Meetings

Presidents Message

Word Power

NICE - II

MAHAPEDICON 2014 Announcement

Probiotics Demystified Symposium

Laughter Club

Gastroenteritis : Loose Ends Symposium

Understanding Rotavirus Disease And Prevention

Rational Antibiotic Practices (RAP) CME

The Pertussis Problem Symposium

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Respected Teachers, Colleagues, Friends and Well Wishers,

Dear Member,

Over the past few months we have been on a transforming journey.

We started our first wave of scientific focus on basic verticals. Our

focus now continues with more relevance to speciality. The next

wave will further narrow to carefully chosen super specialty needs

and subjects.

Please expect more scientific feast from the IAP Mumbai. The

trigger is driven by our fundamental belief that the very nature of the services and teaching, has

been constantly changing and will continue to change even more rapidly in the future. This will

challenge the fundamental premise of valuable scientific dissemination for better execution of

the existing way of pediatric practice.

IAP Mumbai aspires to be the positive disruptor of the new order in scientific services. Our

intent is to inject and infuse new value by moving to a new model where our fixed and rigid

ideas gets replaced by EBM, which finds an important place in next generation healthcare

delivery system..

It is opportune for us to have a refreshed identity that we will embrace EBM in our daily

practical approach to our little patients to provide the most advanced guidelines in our

approach to various issues. This re-energizes us to keep updating ourselves regularly for this

purpose.

We have initiated significant momentum and are exited about the future.I invite you to this

interesting journey and hope you stay engaged as we continue in this transformation.

PRESIDENT’S MESSAGE


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1) Bronchoplegia : Paralysis of the muscles of the walls of the bronchial tubes

2) Celioma : A tumor of the abdomen especially mesothelioma of the peritoneum

3) Desmopathy : Any disease of the ligaments4) Egilops : Perforating abscess at the inner canthus of the eye5) GALT : Gut Associated Lymphoid Tissue

WORD POWER


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For Details . www.mahapedicon2014.com | www.iapmumbai.org

Dr. Anil Raut

President - Mumbai IAP - 2014

MAHAPEDICON 2014 ANNOUNCEMENT


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MAHAPEDICON 2014 ANNOUNCEMENT

Dear IAPians,

It is with great pride and pleasure to announce , the Mumbai and Navi Mumbai branch are co-hosts to the prestigious Silver Jubilee " MAHAPEDICON 2014 ' to be held at the GRAND HYATT Hotel in Santacruz East , Mumbai.

This 25 th Mahapedicon will be held on 7th - 8 th- 9th November 2014. Please block these dates and register for the same.

Please find attached the brochure and details. You can also visit our website iapmumbai.org., mahapedicon2014.com

Our secretarait:

Organizing Secretary92/4, Geeta building, opposite Sion Bus depot,Near Chaggan Mitha Petrol Pump,Sion East, Mumbai 400022Tel. no. 022-24045803

stDetails for registration: ( Special Rates Applicable Till August 31 , 2014 )

REGISTRATION:IAP MEMBER : Rs. 5500NON IAP MEMBER : Rs. 8500Accompanying Member : Rs. 5500

ACCOMMODATION

DOUBLE SHARING PER PERSON FOR 2 nights/ 3 days all inclusive package: Rs. 9500TRIPLE SHARING PER PERSON FOR 2 nights / 3 days all inclusive package: Rs. 9000

Example:Registration IAP MEMBER + accommodation. ( double sharing ) = 5500 + 9500. = 15000Registration Non Member + accommodation.( double sharing ) = 8500 + 9500 = 18000Member + accompanying = 5500 + 5500= 11000Member + accompanying + accommodation= 11000 ( 5000 x 2 )+ 19000 ( 9500 + 9500 )= 30000

Multicity cheques in favour of " MAHAPEDICON 2014 " or online on mahapedicon2014.com

Contact : Dr. BAKUL PAREKH 09821212887 [email protected]. UDAY A. PAI 09820060171 [email protected]

[email protected]


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PROBIOTICS DEMYSTIFIED – 5th JULY 2014

A Scientific Symposia on “Probiotics Demystified” was successfully convened on 5th July 2014.

After a brief introduction by Dr. Uday Pai on Probiotics, International speaker Dr. Yvan Vandenplas

from Belgium, gave an interesting talk on “Global Guidelines in Diarrhea, 2014.” He highlighted

the beneficial effects of well researched probiotics – Lactobacillus rhamnosus GG and

Sacchromyces boulardii in acute infectious diarrhea and antibiotic associated diarrhea. This was followed by a panel discussion chaired by Dr. Yvan, Dr. Uday Pai, Dr.

Sridhar Ganapathy, Dr. Bela Verma and Dr. Gurudutt Bhatt.

The receptionist in the insurance company office had a bad habit of falling asleep on the reception desk despite much advice and reprimand. Finally, one bright officer put up a board on the reception table reading- “If you take insurance from us, you can sleep like this.”

Teacher: What are some products of the West India? Student: I don’t know madam..

Teacher: Ofcourse you know; Where do you get sugar from?

Student: We borrow it from our neighbours mam….

A woman received a report from the school- “Your little boy is very intelligent,but he spends too much time playing with girls. However, we are working on a plan to break him of the habit.” The mother signed the report and sent it back with a note- “Let me know if it works; and I will try out on his father.”

Doctor: Your husband needs absolute rest and quite surroundings; here are some sleeping pills. Patient’s Wife: When must I give them to him?Doctor: They are for you madam….

LAUGHTER CLUB


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GASTROENTERITIS – LOOSE ENDS : 20th JULY 2014

A scientific symposium on “Gastroenteritis – Loose Ends” was organised by the Mumbai IAP on the 20th of July 2014, as a part of the ORS Week Activities which are conducted every year from the 21st to 29th July. The symposium started at 10 am with “Introduction To Gastroenteritis – Current Scenario” which was elaborated by Dr. Sushant Mane, Assistant Professor & Incharge of Pediatric Pulmonology, Grant Medical College & Sir J.J. Group of Hospitals, Mumbai. This was followed by a very informative talk on the Menace of Gastroenteritis & its Prevention by Dr. P.G. Samdhani, Consultant Pediatrician at Jaslok & Breach Candy Hospitals and Ex-Honorary Professor at Grant Medical College & Sir J.J. Group of Hospitals. Dr. Bakul Parekh, Treasurer, Central IAP spoke on the practical aspects of Management of Fluid and Electrolyte Imbalance in gastroenteritis. This was followed by a discussion on various practical aspects of treating diarrhea with good interaction between the audience and the faculty. The symposium ended with lunch for the delegates & faculty.

PRESIDENT’S INSTALLATIONUNDERSTANDING ROTAVIRUS DISEASE AND PREVENTION


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IAP Mumbai had organized an International Speaker Program on 16th Jan 2014 with Dr. Timo Vesikari (renowned Rotavirus Expert from Finland) and honorable guest Dr. S.G. Kasi, along with moderator Dr. Uday Pai under the chairmanship of Dr. Vijay Tuteja

Key Presentation Points by Dr. Vesikari

ŸThe importance of anti-rotavirus (VP6) IgA antibody levels and opined that these can be best correlate of protection. He supported this with recent evidence of intracellular neutralization studies

ŸAdvantage of “multiple hits” mechanism that offers better protection on repeated dosing

ŸWhich is possible with multivalent vaccineReal world evidence of substantial and sustained impact on reduction of rotavirus disease burden in US and Finland with use of pentavalent rotavirus vaccine (Rv5).

ŸAge related association of rotavirus vaccine with intussusception and hence need for early vaccination

Key FAQs from the programBedside Investigation for Rotavirus DiarrheaQuestion by Dr Tuteja: Dr. Kasi, apart from the ELISA test confirming Rotavirus disease, is there anybedside investigation that you can use to confirm?

Kasi : There are some latex agglutination tests available but are not very reliable. Those are the only tests available for bedside testing. Ranbaxy was marketing it somewhere about 3 years back for about Rs. 300 per test. Not very reliable. Apart from ELISA more confirmative test is RTPCR.

Dr Uday Pai added: Yes, it’s a kit of 10 which comes for about 3850 but kit is only possible if you are going to use within 6 hours. So you have to have 10 patients to be tested for rotavirus at one time. Otherwise it is not cost effective

Dr Kasi added: This kit is not easily available.

Dr Uday Pai asked : Then you will still rely on the clinical presentation and seasonal presentation.

Dr Kasi: Please remember if you want to diagnose Rotavirus in the lab, it is only for research purpose. In your clinic it is going to be essentially clinical diagnosis.

Dr Pai added: You do not have much time. It really makes no sense.

Rotavirus + OPVQuestion by Dr Uday Pai: Dr. Kasi, I would like to ask two things which you pointed out on the slides. In one of the slide you said that as we go on vaccination, the protection is good. You also

PRESIDENT’S INSTALLATION

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had a slide stating that when it is given alongwith the oral polio vaccine there is little difference in the conversion of the immunity that was developed. Would you like to give a little more background to that particular slide?

Ans by Dr Kasi: Basically when you combine two live oral enteric vaccines, one is going tointerfere with the other. What my slide showed basically was that the comparison of OPV vs IPV. 6-10 week schedule versus 10 -14 week schedule. You will find that immunogenicity was better in the 10-14 weeks. Immunogenicity was also better where IPV was given versus OPV. This is what the basic in the slide showed.

If you see in our practice, I think, all of us definitely give OPV. Would then you would like to keeping a gap in the oral rotavirus vaccine and oral polio vaccine or would you even suggest togive it together? Dr. Timo also can comment.

Additional Remarks by Dr Vesikari: I would like to ask a question, we have some data from Dr. Kasi’s presentation on Indian data where we have an Indian study with three doses of vaccines and even with OPV and r esulting in 93 % immunogenicity which is excellent. SO you have data with RV5 showing that it can be given together with OPV.

So that I think you have a data from India showing that it can be given together and it is very true that biologically they interfere and e.g. there is some South African data with RV1 at 6 weeks together with OPV is disastrous or did not work at all. So it is very clear indication that interference is happening.

But again it is important to dig out the positive data and positive experience. Off course in private practice that it is possible to space the vaccination and it is possible to bring the child every two weeks so if you want you can do this if you want to avoid interference with OPV.

But one important remark is when vaccine in Indian study is given at 6, 10 and 14 weeks three doses these infants have already received the birth dose of OPV so the dose that is given at 6 weeks is not the first dose and then the interfering effect is less than if it is the real first OPV dose.

Question by Dr Uday Pai: We are still looking at 99% which is still following either or OPV with rest of the vaccines. Would that mean to recommend the spacing the rotavirus vaccine separately than OPV?

Dr Kasi: As far as I say, private practice is concerned, it is logically feasible to space it out, butif you are going to be introducing rotavirus vaccine in NIP – and this is definitely going to be thenext introduction in NIP after pentavalent vaccine, it is definitely going to be given along withOPV and I really don’t forsee much problems in that as I said, a little lower antibody does not translate to reduced effects.

Herd ImmunityQuestion Dr Uday Pai: Another important slide Dr. Timo Vesikeri showed that In Finland you have a very good coverage – 90% coverage of population. And you also said that because you have good coverage you also looked at Herd immunity. In our country we have 1% coverage as of now because it is only in private practice. Would you like to say that with 1% coverage what kind of Herd immunity can we expect?

UNDERSTANDING ROTAVIRUS DISEASE AND PREVENTION

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Dr Timo Vesikari: Zero.

Dr Uday Pai: So what is the level of coverage we should look at?

Dr Vesikari: In private practice the target is clearly the protection of individual. Private practice with 1% coverage, you can not have public health objectives like protection.

Dr Kasi: The herd effect also depends on the particular vaccines. If you take injectable polio in countries like Finland, they achieved almost irradication with 56% coverage. If you take pertussis vaccine, you need > 90% coverage for herd immunity. So it really depends upon the individual vaccines. So I don’t think we really have much data about Rotavirus vaccines and Herd Immunity.

Comment by Dr Uday Pai: See in our country oral vaccines by itself whether it is Polio or cholera or all oral vaccines by itself do not generate the immunity in every individual in population. That is one of the constraints which India is going to face.

Cut off dates of VaccinationQuestion by a doctor: What is the cut-off age for completing the three doses of vaccines? Highest age? Because information for vaccines is 24 weeks in one vaccine and one vaccine 32 weeks. Immunization schedule also mentions 6 weeks.

Dr Kasi: RV1 PI states that it has to be completed before 24 weeks of age. With RV5, it is 32 weeks. WHO has sort of simplified the things and both the vaccine, schedule should be completed by 32 weeks, and so does IAP

Schedule DeviationsQuestion by delegate doctor: If the first dose RV5 is given at 6 weeks and for the second or for the third dose, child comes after 3 months what would you advise.

Dr Kasi: If it is less than 32 weeks you can still give.

Question by doctor: On one hand, you are saying that there are no reports of intussusceptions then how do you suggest that?

Dr Kasi: I think your question is that after taking a break after first dose, what if the second or third dose is delayed to later age?

If you can complete the dose by 32 weeks for RV5 you are still in the safety zone. But if you can not complete it in 32 weeks it is better to leave it incomplete schedule rather than give the third dose after 32 weeks.

Dr.Tuteja summarized that : The guidance are very clearly given by both speakers. It has to be given early. It has to be given as early as 6 weeks. Do not wait beyond 32 weeks. Complete it before 32 weeks.

UNDERSTANDING ROTAVIRUS DISEASE AND PREVENTION

Rational Antibiotic Practices (RAP) – 6th July 2014

Resistance to antibiotics is one of the biggest public health challenges faced by this

century presently.Undeniably, a major cause of this increased anti-microbial resistance is the

misuse and overuse of antibiotics by we clinicians in our individual practices.To improvise the

concepts regarding the use of antibiotics in clinical practice, the Indian Academy of Pediatrics,

Mumbai along with Central IAP, had organised a one day CME on Rational Antibiotic

Practices (RAP) on the 6th of July 2014 at Grant Medical College Gymkhana, Marine Drive,

Mumbai.

The CME opened with registrations & breakfast for the delegates at 8.30 am in the

morning. The introduction was given by Dr. Bakul Parekh, Treasurer, Central IAP and the

National Co-ordinator for the RAP Module for Training of Trainers (TOT). Dr. Bakul also

gave a talk on “When to use Antibiotics”. This was followed by the talk on “How to choose an

Antibiotic” by Dr. Sushant Mane, Assistant Professor & Incharge of Pediatric Pulmonology at

Grant Medical College, J.J. Hospital, Mumbai. Dr. Sushma Save, Associate Professor of

Pediatrics at Nair Hospital, enlightened the audience on the various mechanisms & indications

of antibiotics in her lecture on “Know your Antibiotics”. The pharmacokinetics &

pharmacodynamics of antibiotics were superbly explained in his enthralling talk on “How to

use your Antibiotic” by Dr. Anand Shandilya, Consultant Pediatrician & a great teacher.Dr.

Kalpesh Date & Dr. Amin Kaba briefed the delegates on their wonderful topics of “Antibiotic

Monitoring” and “Changing Antibiotics – Escalation & Descalation” respectively. The last but

very important topic of “Preventing Antimicrobial Resistance” was highlighted by Dr. Bela

Verma, Associate Professor of Pediatrics at Grant Medical College, J.J. Hospital, Mumbai.

The expert panelists for the CME were Dr. Anand Shandilya, Dr. Bakul Parekh, Dr.

Uday Pai (Consultant Pediatrician & President, IAP Mumbai) and Dr. Supriya Amey (Clinical

Microbiologist at Fortis Hospitals, Mulund). They cleared the various doubts of the delegates

by their practical & expert opinions. The CME turned out to be a great academic success

ending with a delicious lunch.



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RATIONAL ANTIBIOTIC PRACTICES (RAP) - CME


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SYMPOSIUM : THE PERTUSSIS PROBLEM – 13th JULY 2014

A symposia on ‘The Pertussis Problem’ held on the 13th of July 2014 was an excellent

scientific discussion on the benefits of Whole Cell Pertussis Vaccine (wP) by Dr. Naveen

Thacker versus Acellular Pertussis Vaccine (aP) by Dr. Srinivas Kasi. An evidence based

comparison between aP and wP was presented by Dr. Shafi Kolhapure.

Current thought is to use DTwP for primary immunization. Use DTaP for Booster doses.

(DTwP if aP is not available). DTaP to pregnant women in 2nd or 3rd trimester. IAP

recommends one DTaP to adolescents. Every 5 year or 10 year booster not yet recommended.

IAP GEM COURSE - 28TH & 29TH JUNE 2014


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Documents

Indian Academy of Pediatrics, · PDF filePediatric Seminar Hall, ... Probiotics Demystified Symposium ... the practical aspects of Management of Fluid and Electrolyte Imbalance in