CURRENT MEDICAL JOURNAL

CONTINUING MEDICAL EDUCATION (CME) PROGRAMME
ISSN-NO - 0972-2203

RECENT ADVANCES IN PANCREATIC TRANSPLANTATION
Dr. V.K.Bansal,
Dr. Kim Mammen,
Deptt. Of Urology and Transplant,
CMC and Hospital, Ludhiana.

Pancreatic transplantation is an increasingly common surgical procedure performed for the treatment of patients with type 1 diabetes mellitus. The goal is to abort or delay systemic complications of severe diabetes. Successful management of exocrine pancreatic secretions is the most critical aspect of pancreas transplantation (PTX) and is usually accomplished by either enteric or bladder drainage. Despite these advances, the surgical complication rate has remained unacceptably high and has precluded widespread application of this therapy to type 1 diabetes mellitus. The benefits of PTX must be weighed against the morbidity associated with the operative procedure and need for heavier long-term immunosuppression.

DISASTER MANAGEMENT PLAN
Dr. V. Kaushal,
Deputy Medical Superintendent,
Prof. A. K. Gupta,
Medical Superintendent,
PGIMER, Chandigarh.
GMC & Hospital,
Chandigarh.

Disaster Management is a major challenge to the society. Disaster can occur at any time, in any place and in any weather. It strikes with suddenness and brings lot of destruction of life and property. The objectives of the Disaster Management Plan is to prapare the institutional staff and to create awareness in the community (and amongst the NGOs). Every Hospital must have its well-prepared Hospital Disaster Management Plan. Every minute details especially regarding the bed space, linens, drugs and equipment, emergency blood bank, medical and nursing staff, food services, security, information services, water, elecricity etc. should be worked out. The disaster management plan should be simple, flexible, clear, concise and practised regularly.

OCCUPATIONAL ASTHMA
Prof. A. K. Janmeja,
Dr. Suman K. Dass,
Deptt. of Chest Diseases & Tuberculosis,
GMC and Hospital, Chandigarh.,

Asthma exclusively attributable to working environment is known as occupational asthma. Nearly 5-10% of adult asthma is actually due to work place exposures. However, in different occupations the disease prevalence is different and may range from 5%-50%. Atopy, tobacco smoking and preexisting airway hyperresponsiveness are predisposing factors as in usual form of bronchial asthma. Both immunologic and non-immunologic mechanisms are involved in its pathophysiology. Clinical signs and symptoms are similar to usual asthma, however, they are commonly encountered after working shifts in the evenings/nights. Improvements of symptoms occurs at weekends or during longer breaks. The diagnosis of OA is made by keeping high index of suspicion amongst adult asthmatics. Two things are prerequisite for diagnosis of OA i.e. the diagnosis of asthma itself and to establish that some occupational agent is causing it. Treatment involves removal of causal exposure and close medical follow up. Once diagnosis is confirmed, it is the duty of treating physician to do proper counselling of patient for compensation according to the law of land.

TAMSULOSIN
THE FIRST PROSTATE-SELECTIVE
ALPHA 1A-ADRENOCEPTOR ANTAGONIST
- CLINICALLY PREFFERRED DRUG FOR THE TREATMENT
OF SYMPTOMATIC BENIGN PROSTATIC HYPERTROPHY (BPH)

Dr. Kiran V. Barar
Associate Prof., Deptt. of Pharmacology,
RNT Medical College, Udaipur.

Benign enlargement of the prostate is a problem that can occur in men as they get older. Since the gland is located below the bladder, when it increases in size, creates pressure on the urethral passage, giving rise to many kinds of problems in urinating, such as-a need to urinate often, a weak stream, a feeling of not being able to empty the bladder completely, etc. etc. It is recently known that both urethral and prostatic tissue are rich in specific subtype of alpha1A-receptors i.e. alpha1A-adrenoceptors responsible for contraction of the smooth muscles there. If one could have a target-specific drug which blocks only these alpha1A-receptors leading to relaxation of these muscles, it will prove to be a boon to many a patient and will have to be a highly clinically selective agent with very few side effects. Tamsulosin HCl (Flomax) is such a new advancement to have specific antagonistic action on a alpha1A subtype of receptors. It helps relax the muscles in prostate and the opening of the bladder.

PANIC DISORDER-DIAGNOSIS AND MANAGEMENT
Dr. Lok Raj,
Prof. B.S. Chavan,
Deptt. of Psychiatry,
GMC & Hospital, Chandigarh.

Anxiety disorders are the commonest psychiatric disorders encountered in medical practice. Panic disorder is characterized by discrete episodes of acute anxiety occurring without any precipitating factor and lasting for a few minutes only. Panic disorder patients have very a high incidence of co-morbid conditions like depression, phobias, drug abuse, alcohol dependence and personality disorders. Antidepressants, particularly tricyclics are very effective in treating panic disorders. Benzo-diazepines, though effective, pose the threat of dependence. Non-pharmacological measures include cognitive behaviour therapy, psychodynamic psychotherapy and various relaxation techniques.

ROLE OF DIET IN DELAYING THE AGEING PROCESS
Ms. Manju Mathur,
Head, Deptt. of Dietetics,
GMC & Hospital,
Chandigarh.

People in general, fear aging*. Although each one of us desires to stay healthy and remain youthful throughout life, this can only be achieved if we are able to maintain health and prevent the onset of non-communicable chronic diseases. A combination of factors like sensible diet, exercise in moderation, regular habits and a positive attitude towards life is important for achieving this goal. It is also important to protect the immunity of the body by regular use of antioxidant vitamins and minerals and also to take care of the factors that may rob our body of the nutrition that it gets from a balanced diet. Besides this, regular exercise and a positive attitude towards life go a long way in maintaining health and delaying the aging process of the body.

PAIN IN THE UPPER LIMB- A DIAGNOSTIC ENIGMA
Prof. Raj Bahadur,
Dr. Sudhir Kumar,
Deptt. of Orthopedics,
GMC & Hospital, Chandigarh.

Pain in the upper limb is one of the commonest complaint for which patient seeks medical help. There is a long list of disorders that can cause pain in the upper limb. Only painstaking history and examination can help us in differentiating one condition from other. To pin-point the cause, it is also vital to have a thorough knowledge of anatomical features and the biomechanics of the upper limb. Investigations are valuable adjunct, which help us in confirming our diagnosis and planning treatment.

NEWER ANTIEPILEPTIC DRUGS
Dr.S.Balakrishnan,
Prof. P. Pandhi,
Deptt. of Pharmacology,
PGIMER, Chandigarh.

The presently available antiepileptic drugs (AEDs) i.e. phenobarbitone, phenytion, benzodiazepines, sodium valproate, carbamazepine, ethosuximde and trimethadone are associated with a number of shortcomings. They are not able to control seizures effectively in as many as 25% of the patients. Their dose related neurotoxicity, drug interactions and other side effects at times becomes major limitations in their clinical use. So these limitations with conventional AEDs highlighted the need for developing newer agents for treatment of epilepsy. There have been an increasing number of newer antiepileptics, which have recently flooded the market. Most of these have been rationally designed; either augmenting inhibitory neurotransmission or inhibiting excitatory neurotransmission. This article briefly describes the pharmacology of newer antiepileptics most of which are used as second or third line agents for refractory cases; especially as add-on to the conventional antiepileptics.

RETINOPATHY OF PREMATURITY - SCREENING & TREATMENT
Dr. Renu Sawhney,
Dr. Rajeev Gupta,
Prof. Sunandan Sood,
Deptt. of Ophthalmology,
GMC & Hospital, Chandigarh.

Retinopathy of prematurity (ROP) is a proliferative retinopathy which affects pre-term infants exposed to high ambient oxygen concentrations. The incompletely vascularised temporal retina of pre-term babies is particularly susceptible to oxygen damage. The incidence of ROP varies from 20-30% in premature infants. Untreated, ROP can progress to retinal detachment and can cause bilateral permanent blindness in the child. ROP is the largest cause of child blindness in USA and is also emerging as a major cause of child blindness in developing countries. The blinding complications of the disease prevented by early diagnosis and prompt treatment. All the premature babies with birth weight less than 1700 gm or period of gestation less than 36 weeks should be screened for presence of ROP. Treatment by either cryotherapy or laser photocoagulation is recommended in infants with threshold disease.