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Ivermectin, HCQ not part of ‘clinical management’ for adult Covid patients

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New Delhi, Sep 24: Two commonly used drugs Ivermectin and Hydroxychloroquine (HCQ) have been dropped from the revised clinical guidance for management of adult Covid 19 patients.

The All India Institute of Medical Sciences (AIIMS) and the Indian Council of Medical Research (ICMR) Covid-19 national task force has made the recommendation to drop the use of these two drugs in its revised guidelines.

The clinical guidance version dated May 19, 2021, prepared jointly by the AIIMS and ICMR — national task force for Covid-19 and the Joint Monitoring Group was reviewed on August 20, in the context of emerging evidence of Ivermactine and hydroxychloroquine. After review, the medicines were removed from the guidance document.

The reasons behind dropping Hydroxychloroquine also included no mortality benefit, increases the risk of address drug effect (ADE) when co-administered with Azithromycin.

“HCQ may be considered for removal from guideline, with recommendation to use with caution only in clinical trial setting (since there is some genuine uncertainty regarding the possible benefit for severe cases and in low dose). Many studies showing increased mortality risk (10/13) and low mortality benefit of HCQ(2/13). Considering evidence for increased ADE(6/13) , especially with azithromycin and only one study showed no increase in ADE(1/13),” said the revised guidelines for Covid management.

In the case of Ivermectin, it said, “Ivermectin may be considered for removal from guideline, with recommendation to use only in clinical trial setting until warranted by more conclusive large-scale randomized controlled trials due to the reason that many studies show mortality benefit, and no evidence for increased mortality. High risk of bias in many studies (especially with the ones showing benefit), level of certainty for mortality benefit is low.”

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Delhi hospital saves 2 patients who accidentally ingested sanitiser

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New Delhi, Oct 8: Two patients who accidentally ingested sanitiser mistaking it for water, rendering them unable to swallow food and water for months, were given a new lease of life after doctors at Fortis Hospital here performed an oesophageal reconstructive surgery.

A 24-year-old boy, hailing from Karnataka accidentally ingested sanitiser four months back. Treatment at local hospital inserted a pipe in his intestine and he was fed with liquids via the pipe.

On admission at Fortis Shalimar Bagh, he was found to have complete scarring and obstruction of the entire food pipe and portion of the small intestine and stomach. Doctors performed a reconstructive surgery, where a portion of his small and large intestine was used to create a new food pipe.

The surgery lasted for more than five hours post which the patient was kept under observation. The patient has recovered very well and is now able to eat normal food, said Dr Amit Javed, Director, Laparoscopic and Minimal Access Surgery, Fortis Hospital Vasant Kunj and Shalimar Bagh, in a statement.

In a separate case, a 20-year-old girl from Kashmir, also ingested sanitiser accidentally. She was even unable to swallow her saliva, and had become emaciated from malnutrition and lost a lot of weight.

Her survival was dependent on glucose which was being given to her intravenously.

The challenging surgery lasted for more than six hours as the patient suffered from severe burns and scarring in her throat and stricture (an abnormal tightening of the oesophagus) in her food pipe. Doctors reconstructed a new food passage by using a part of her stomach and intestine.

She has recovered well, the doctor said.

According to Javed, an oesophageal reconstructive surgery done by the laparoscopic technique can be a hope for patients with damaged food pipes.

“Corrosives are irritant substances which when ingested either intentionally or by accident results in severe burns of the oesophagus (food pipe) and the stomach. Early symptoms include difficulty in breathing, hoarseness of voice, mouth and throat pain, drooling of saliva, vomiting and abdominal pain. In severe cases, there can be perforation of the oesophagus and the stomach,” Javed explained.

However, as the acute injury heals, there are formation of strictures, which results in narrowing of the food passage and leads to obstruction. The unfortunate patient is unable to eat food and drink water. In severe cases, the patient is unable to swallow their own saliva.

The treatment involves initial sessions of endoscopic dilatations.

“In patients who have tight strictures, long length of strictures or in those where endoscopic dilatation is not successful, a surgery is done to create a new food pipe. This new food pipe can be reconstructed using either the stomach or portion of the large intestine. It is a complex surgery. We routinely perform this surgery by the laparoscopic technique which results in excellent functional results and very good cosmesis. The patient is able to eat and drink a normal diet,” Javed said.

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Gurugram: Notice to 11,311 households for larvae-breeding

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Gurugram, Oct 7: To prevent the outbreak of mosquito-borne diseases, the district Health Department in collaboration with the district administration examined over 22.70 lakh households and issued notices to 11,311 households where mosquito larvae were found.

Civil Surgeon Gurugram, Dr Virender Yadav said that so far 1,897 samples of dengue have been sent for testing in the district, out of which 83 dengue and two malaria patients have been confirmed.

Yadav informed that more than two lakh people have been tested so far. The team of the health department is also running a campaign for the prevention of mosquito-borne diseases.

“The team is carrying out anti-larva activities under which Temephos medicine is being sprayed at mosquito prone areas. Gambusia fish is very effective in preventing the breeding of mosquitoes, keeping this in mind the health department, in collaboration with the fisheries department, has put seeds of gambusia fish in 173 reservoirs located in the district,” Yadav said.

Health officials said for the prevention of mosquito-borne diseases in the district, area wise fogging is being done through 56 machines. They said for fogging, the helpline numbers of the Municipal Corporation Gurugram (MCG) can be contacted on 18001801817 and 0124-44055779.

Apart from this, free testing and treatment of dengue, malaria and chikungunya are available in Sector-31 Polyclinic and Sector-10 Civil Hospital.

Instructions have been given not to charge more than Rs 600 for NS-1 and LGI test for Chikungunya and Rs 1,000 for test for dengue. Action will be taken against the concerned hospitals for violating this,” said a health official.

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Gambusia fish to check mosquito-borne diseases in UP district

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Amroha (Uttar Pradesh), Oct 6: The Amroha district administration has decided to release 7,000 gambusia or mosquito fish in drains in the populated areas to check the spread of dengue and malaria.

According to Amroha chief medical officer Sanjay Agarwal, mosquito fish, generically known as Gambusia, eat larvae of dengue-breeding mosquitoes.

Health officials claim that these fishes will check the spread of viral fever in the district.

According to health department statistics, over 300 patients have been diagnosed with viral fever, 17 with malaria and 32 with dengue in the past one and half month.

The district administration is also carrying out a door-to-door survey to ask the people to drain out stagnant water from coolers, pots and other utensils.

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