FROM A CLINICIAN'S BIOSCOPE

“Sir,please prescribe the medicines I am continuing”, is a standard request by the employees of organizations getting free treatment; be it an analgesic, vitamin, calcium or any other thing. I sometimes think, how these people will cope up after retirement. This is abuse of drugs to some extent. These people react violently when an advice to discontinue the drugs will be given.


Now, it has been found that chronic use of stomach acid suppressing drugs may be associated with overgrowth of intestinal bacteria. Those produce hydrogen and methane. There was speculation earlier, when proton pump inhibitor drugs were introduced for the purpose, that there is risk of benign adenoma formation in the stomach. Later on it was published that the apprehension may not be correct. But there is sufficient reason to believe that stomach acid suppression may cause an intestinal bacterial overgrowth. So, these group of drugs should be used judiciously. Those need these drugs, must not be denied. But, it should be improved in such a way that, there will be stomach acid suppression not to the extent that, it will promote intestinal bacterial overgrowth. This bacterial overgrowth may lead ti flatulence and may be, irritable bowel syndrome.

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clipped from www.medpagetoday.com SAN DIEGO -- Much as it aided the general population of smokers, varenicline (Chantix) helped patients with chronic obstructive pulmonary disease (COPD) quit too, a randomized trial showed. From weeks nine to 12 of treatment, 42.3% of those taking varenicline remained abstinent, compared with 8.8% of those taking placebo (P<0.001), Donald Tashkin, MD, of the University of California Los Angeles, reported at the American College of Chest Physicians meeting here. Varenicline and bupropion are the two first-line pharmacologic aids for smoking cessation recommended by the Department of Health and Human Services' Public Health Service in guidelines updated in 2008. There was one report of aggression in the varenicline group. Reports of anxiety, depression, depressed mood, and depressive symptoms were infrequent and similar in number between the two groups.

A common accidental injury, scald; is seen in women of India following spillage of hot liquid over body. The sufferers are mostly the housewives. Hot liquid may range from water to oil. It occurs following serving of hot tea, cooking fishes and while extracting excessive water from cooked rice etc.There may be simple redness to blister formation. It may get infected and consequent delay in healing.
As a first-aid measure, the hot liquid should be washed off with copious amount of tap water; the part be kept in water for at least 10 minutes. That will cool the part of body and give a soothing touch. Many times, this small step will prevent blister formation. I have seen people applying tooth paste in the hope of getting relief, which should not be performed. A silver sulphadiazine cream if available should be applied. The victim is to be shifted to a nearby hospital.
In the hospital, the percentage of scald is assessed in the same line as employed for burn; the rule of nine of Wallace. A replacement fluid, if required will be administered; an analgesic will be given as well as immunization against tetanus. A suitable antibiotic is prescribed.
The important aspect of treatment is dressing. An occlusive dressing is preferred over an open dressing. Blisters more than 2 cms. in diameter are to be de-roofed after cleaning the dirt, if any. A soothing antibacterial cream like silver sulphadiazine is to be applied, over that sterile paraffin soaked gouge is to be put along with a layer of sterile cotton, and the whole is to be bandaged. Dressing is changed at least after 3 to 4 days or if it is soaked with the fluid, whichever is earlier. The progress of wound healing is to be monitored carefully. If a deeper injury is noticed earlier or observed subsequently where scar formation is likely, a skin grafting should be contemplated. The skin grafting will prevent future contracture to develop, give a neat healing and good cosmesis.
Prevention of scald is better than treatment.

Amoebiasis is an infection by E. Histolytica. It is an unicellular protozoa. Amoebiasis is a world wide problem, but more serious in less developed counties. It has the potential to infect wide range of organs of body. It is transmitted through faeco-oral route, commonly through contaminated food and drinks. Vegetable crops irrigated by water contaminated with sewerage is a potent way of transmission.
It causes;

• Amoebic dysentery
• Non-dysenteric colitis
• amoebic appendicitis
• Amoebic liver abscess and hepatitis
• Splenic abscess
• Amoebiasis of skin
• Amoeboma of colon
• Encephalitis, sometimes.

The symptoms vary according to the site of infection. Important among these are amoeboma, liver involvement and encephalitis. Amoeboma confuses with cancer of colon. Liver and brain involvement in form of abscess formation and encephalitis respectively are life threatening.


A stool examination is by far the most common mode of diagnosing amoebiasis. The disease sometimes becomes very difficult to treat, and often prolongs to a chronic stage. Preventive measures are good. Thorough washing of raw eaten fruits and vegetables washes away the cysts. Washing fruits and raw eaten vegetables with diluted iodine, diluted acetic acid or full strength vinegar will destroy the cysts. Boiling drinking water destroys the cysts.