INDIAN MEDICAL ASSOCIATION, TAMIL NADU STATE BRANCH INDIAN MEDICAL ASSOCIATION, TAMIL NADU STATE BRANCH IMA ACADEMY OF MEDICAL SPECIALITIES TAMS BULLETIN-TAMIL NADU ACADEMY OF MEDICAL SPECIALITIES BULLETIN - FIRST TH 17 MARCH 2024 1
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State President Message -AMS Bulletin Dear Colleagues, Greetings I am very happy to learn about AMS IMA TNSB coming out with a Bulletin. I always believed that any organisation doing good work must have some kind of document, ideally Bulletin. IMA AMS TNSB has been very active and doing the great job of updating knowledge by way of conducting CME programme & courses, and this Bulletin would augment its services. Dr. V. Rajesh Babu, Dr. S. Jayaraman, & Dr Aadhaar Senthil Kumar have been very enthusiastic about this initiative & I wish them all the best. Jai Ho IMA Regards Dr. KM. Abul Hasan President, IMA TNSB Chairman, IMA JDN HQ 4
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TAMS BULLETIN IMA AMS TAMILNADU ACTIVITY REPORT OF DECEMBER 2023 Activity Report of IMA AMS TNSB for the month of December 2024. The team comprising of Dr. V. Rajesh Babu, Chairman IMA AMS, Dr. S. Jayaraman, Secretary IMA AMS, Dr. Aadhar Senthil Kumar, Joint Secretary IMA AMS for become the new office bearers of IMA AMS Tamil Nadu on 09/12/2023. The Team have conducted periodical review meeting of the IMA local branches of Tamil Nadu. We have done following activities:- 1) On 06.12. 2023 as per the Instruction from The National Board of Examinations in Medical Sciences (NBEMS). In order to spread awareness and impart training to non-medical personnel for administering CPR in a proper manner, an awareness programme was organized on 06/12/2023 from 9.30 am to 10.30 am for all non-medical Managers and all non-medical Staffs was conducted at Ganga Medical Centre and Hospitals Private Limited, Coimbatore .by Dr. V. Rajesh Babu, Chairman ,IMA-AMS , Tamil Nadu and Dr. R. Kannan. Totally 200 non-medical people were benefited. This programme was coordinated and advised to conduct LIVE programme.by NBEMS. 2). On 09.12.2023 Dr. V. Rajesh Babu, Installed as chairman., IMA-AMS Tamilnadu, and Dr. S. Jayaraman Installed as Secretary IMA-AMS and Dr. Aadhar Senthil Kumar Installed as Joint Secretary IMA-AMS Tamilnadu. After the installation the new office bearers gave a presentation about what are going to do in the next 2 years in IMA-AMS in Tamilnadu. 7
3). On 15.12.2023 Dr. V. Rajesh Babu IMA-AMS Secretary done a platform presentation in the form of video session on Craniotomy for Subacute subdural hematoma.,at the National Neuro Scientist Conference,NSICON-2023 AT Bhuvaneshwar, 4). On 19.12.2023 IMA-AMS Tamilnadu along with Tamilnadu Association of Neurological surgeons conducted National Epilepsy day CME in the zoom platform from 7.00 pm - 10.00 pm . Dr. K. Malcolm Jeyaraj gave a talk on Intractable Epilepsy, Dr. V. Rohit gave a talk on antero medial temporal lobectomy, it was well attended by 420 participants. 8
IMA AMS TAMILNADU ACTIVITY REPORT OF JANUARY 2024 1. IMA AMS ,Tamil Nadu conducted 1st monthly webinar on 4th January Thursday from 3 pm to 6 pm with Dr. N. Arun, gave talk on ConstipationTips&Tricks to solve the problem, Dr. C. Palanivelu was the moderator, Dr. R. Madhumitha, gave a talk on AIDS-Latest Advances in Prevention &Treatment, Dr. V. Ramasubramaniam was moderator and Dr. Neorul Amin Shahid gave a talk on Rehabilitation-New Principles to increase Independants, Dr. A. J. Rajendran was the moderator to commemorate World AIDS Day, Rehabilitation day and Constipation awareness month. It was attended by 440 participants. IMA-AMS National Headquarters Chairman Dr. Nomeeta Shiv Gupta ,Dr. Srirang Abkari , Secretary felicitate after the webinar inauguration done by our IMA TNSB State president Dr. Abul Hasan . 9
2. Dr. Jayaraman, Secretary, IMA-AMS, Tamil Nadu, attended the new office bearers installation ceremony of IMA Poonamally High Road branch in Chennai on 7th January Sunday as a guest of honour and spoke about Academy of Medical Speciality members drive and projects like 75 CME to be conducted in for commemoration of 75th Republic day of our nation and new AMS membership form circulated to members. 10
3. Dr. V. Rajesh Babu, Chairman of IMA AMS released on the occasion of Road Safety week 11-17, January, video clipping of Road safety awareness and Innuir Kappom Thittam of Tamilnadu government project in a nice way and this video circulated all the members of IMA and for the public awareness. 4. IMA-AMS, Tamilnadu released flyer for the Pongal celebration for wishing everyone on 14.01.2024. It was circulated to all the members of IMA throughout the Country. 11
6. On 26.01.2024 to wish everyone happy Republic day flayer was released. 7. The new wing of AMS started at IMA, Chennai, Villivakkam, Ayanavaram Branch with 20 members joining as new members on 28.01.2024. Our secretary Dr. Jayaraman attend the program. 12
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IMA-AMS, Villivakkam-Ayanavaram Branch Started the First CME of the 75th Republic day 75 CME Series, on 28-01-2024 from 1P.M.to 5P.M., with Dr. Sabari Giris Ambat giving a talk on Hand Injury Management, Prof. Dr. Harikrishnan Parthasarathy giving a talk on Transcatheter Aortic Valve Implantation, Dr. Selva Seetharaman giving a talk on Reconstruction in Head And Neck Cancer, this programme was well attended by 100 Ima members. 8. On 29.01.2024 Dr. V. Rajesh Babu, Chairman IMA-AMS conducted Organ donation committee meet, organ donation CME-1 in Zoom platform from 3.30 p.m to 6.30 pm. Dr. N. Gopalakrishnan, Member Secretary TRANSTAN, gave a talk on deceased donor organ transplantation What?, Why? How?. After the talk there was a panel discussion on organ donation with panelist Dr. V. Rajesh Babu, Dr. Mageshwaran, Dr. R. M. Kanagavel and Dr. G. Srinivasan. It was attend by around 420 people. 14
9. On 30.01.2024 to commemorate the 75th Republic day, the Second series of CME was conducted by IMAAMS wing Coimbatore at 7.00 pm on 31.01.2024. Dr. Priya Karthic Prabhu presented on IMA Coimbatore gave welcome address, Introduction of the speaker done by Dr. R. Balamurugan, Dr. V. Lakshmi Shanthi gave a talk on currently recommended vaccines Paediatrics and Adolescents. Dr. A. Jail Ahmed gave a talk on Vaccine in special situations, Dr. Nandhani kumar gave talk on New vaccine . This program was conducted along with Coimbatore chapter of Indian Association of Paediatrics . It was well attended by 80 members. 15
10. On 30.01.2024 at 9.00 pm to celebrate the Covid Martyr’s day as instructed by IMA National Head quarters. Covid Martyr’s day was conducted at IMA Coimbatore. 5 of the Covid warriors, Prof.Dr. M. B. Pranesh, Dr. MhamedSadhagathulla, Dr. Sundharavadanam, Dr. Bhuvaneshwari Rajagopal, Dr. N. Natarajan from IMA Coimbatore family members were invited and they were given assurance to give the health protection of the family members and also in case of any help to contact the local Coimbatore IMA. On THE OCCASION, the family members of the Covid Warriors were felicitated with Shalve and a Citation and then Lightening Candles by all the 140 Doctors and a small procession was conducted at the premises of IMA. 16
11. IMA-AMS CHAPTER, COIMBATORE conducted, Symposium at karpagam faculty of medical sciences and research, Coimbatore. On jan,30,2024, World leprosy day Symposium - Convenor: Dr. Shanmuga sundaram. V. Speakers : 1. Dr. Vimalesh -Introduction and immunology 2. Dr. Aswini - nerve examination 3. Dr. Binchu - clinical types and classification 4. Dr. Aishwarya - reactions and relapse 5. Dr. Jeevabharathi - lab diagnosis in leprosy 6. Dr. Preethi- treatment and disability 7. Mr. Selvaraj , Health Educator, Office of ddhs, leprosy - Field surveillance 17
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IMA AMS TAMILNADU ACTIVITY REPORT OF FEBRUARY 2024 1. On 4th February Sunday Sleep Masterclass CME (75th Republic day, the FOURTH series) & Work Shop by IMA AMS Chennai Villivakkam and Ayanavaram branch & MGM Health Care Chennai in association South East Asian Academy of Sleep Medicine(SEAASM) combinely conducted this event to commemorate World Sleep Day at MGM Health Care, Chennai, from 9 am to 5 pm in hybrid mode both online and off line Around 135 Doctors participated physically and more than 400 Doctors participated in online (zoom, you tube and FB live stream). Quiz events were conducted both preliminary written and final rounds for postgraduates with cash awards. This Sleep Masterclass Course Director Dr.Shivani Swami, Senior Consultant and Director Department of Pulmonary and Sleep Medicine, Narayana Multispeciality Hospitals, Jaipur participated and inauguarated Sleep Lab and conducted multi disciplinary panel discussion on Sleep Related Breathing Disorder. Practical Hands on Workshop were conducted on Polysomnography manual scoring, hooking up with leads, Positive Airway Therapy (PAP) manual titration, Devices and interfaces . 19
3. 8th February, IMA AMS TNSB monthly webinar, World Cancer DayCME (75th Republic day, the FIFTH series) was conducted in Zoom platform. The programme was inagurated by Dr. Abul Hasan, President, IMA, TNSB, Felicitation were given by IMA-AMS National Headquarters Chairman Dr. Nomeeta Shiv Gupta, Dr. Srirang Abkari, Secretary, Dr. N. Syed Ibrahim, gave a talk on ABC of Haematopoietic Stem Cell transplantation, Moderated by Dr. Jaya Shankar Subramaniam, Dr. D. aritha, gave a talk on Role of RT in Common Malignancy, Moderated by Dr. S. Alex, A. Prasad, Dr. Mohammed Ibrahim, gave a talk on Recent Advances in Surgical Management of Solid Tumors, Moderated by Dr. N. Senthil Kumar. It was attended by 420 participants in ZOOM PLATFORM. 2. February 4th World Cancer Day video clipping released from IMA AMSTNSB. 20
4. February 12th video release to commemorate World Epilepsy Day. 5. February 13th as a part of Anemia awareness program that's IMA AMS Coimbatore done a program with Government Higher School at Madam Patti a near by village. The event is co organized with NSS unit of Avinashilingam Home science college headed by Dr. S. Velvizi&Dr.A.Kandavelmani, It was well received and interacted by around 150 students. Awareness messages were given by AMS chairman Dr. Balamurugan and Secretary Dr. Jaleel Ahmed. It is a Project to reach Anemia Mukt Bharat. 21
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6. February 13th video release on Lung Cancer to commemorate World Cancer Day was released and circulated among IMA members and public. 23
7. February 14th Dr.V.Rajesh Babu, Chairman, IMA-AMS gave a talk on Clinical Management of Acute Ischemic Stroke, in Zoom Platform, it was well attended by practitioners. (75th Republic Day, the sixth series). WORLD CANCER DAY 2024 8. February 14th Dr.Balamurugan, Chairman IMA-AMS, Coimbatore, gave a talk on Future Insulins in CME (75th Republic day, the Sevanth series) at Diabetes Club of Dindigul, it was actively participated by the members. 24
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9. February 16th Dr. V. Rajesh Babu, Chairman, IMA-AMS gave a talk on Awareness on Epilepsy for the employees of Cholamandalam Insurance, to Commomorate the International Epilepsy Day, it was well attended by insurance staff. 26
10. Dr. S. Jayaraman, Secretary, IMA AMS TNSB, participated in IMANanganallur, Alandur, Adambakkam and Madippakkam (NAAM) branch monthly IMA CME meet on 24-02-2024 and sensitise all the members about Academy of Medical Specialities and encourage to start IMA AMS wing of NAAM branch. IMA AMS membership form distributed to all the attendee. 11. Dr. Srirang Abkari National Secretary of IMA AMS HQ visitedCoimbatore on 24.02.24. Chairman IMA AMS TNSB Dr. V. Rajesh Babu Honoured National Secretary. 12. Dr. S. Jayaraman, Secretary, IMA AMS TNSB, participated in IMAChennai Villivakkam and Ayanavaram monthly meeting and more members were enrolled in AMS wing of this branch on 25-02-2024. 27
13. On 26.02.2024,IMA-AMS Coimbatore Chairman gave a talk on Hypertesion CME (75th Republic day, the Eighth series) at 3 P.M. in Zoom Platform, it was well attended by Practitioners. 14. Indian Medical Association, Academy of Medical Specialities, Coimbatore Branch Conducted World Cancer day CME (75th Republic day, the Nighth series) on 28.02.24. at Rathna Grand Regent, Coimbatore. Dr. Balamurugan chaired the meeting, which was started by த ழ◌் த◌ாய் வ◌ாழ்த், the IMA Prayer and Physician prayer. President Priya Karthik Prabu delivered the inaugural speech, followed by the Secretary Dr. Sree Ramalingam report Dr. V. Rajesh Babu, Chairman, IMA-AMS, talked about IMA-AMS, The oncology updates were presented by a dedicated team from Royal Care Super Speciality Hospital by Dr. Sivakumar Kuppusamy gave a talk on Breast Conservation, Dr. Karthik Shanmugam gave a talk on Bone Marrow Transplant, and Dr. Narmada Rathinasamy gave a talk on Immuno Oncology. The meeting had good attendance, with around 75 members from IMA and other specialties, fostering productive floor interactions. 28
The speakers were honored by the President, and the program concluded with a pleasant dinner. Overall, it sounds like a fruitful gathering for the medical community in Coimbatore. 29
15. On 29-02-2024 Dr. S. Jayaraman, Secretary, IMA AMS TNSB, participated as a guest of honour in IMA Chennai Ambattur and Avadi monthly meet and encouraged all specialist to join AMS. 30
Dr. V. Rajesh Babu, Chairman, IMA AMS TNSB Dr. S. Jayaraman, Secretary, IMA AMS TNSB Dr. Aadhaar Senthil Kumar, Joint Secretary, IMA AMS TNSB 31
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Dr. V. Rajesh Babu MBBS, MS, MCh (Neurosurgery), Senior Consultant Neurosurgeon, Ganga Hospital, Coimbatore. svrbmch@gmail.com, +91 9360030094 ISSUES IN BRAIN DEATH AND ORGAN DONATION DR. V. RAJESH BABU, CHAIRMAN, IMA-AMS, TAMILNADU Dr. V. Rajesh Babu, 9360030094, svrbmch@gmail.com, Chairman, IMA-AMS, Tamilnadu., Chairman, Organ Donation Committee, IM, Tamilnadu. The Concept of Organ Donation has Started from our historic period – Lord Ganasha, Kannappar and Karnan. Brain death is a condition, where the brain stem, mid brain, pons and medulla oblongata dysfunction status. In this condition heart will be beating, blood will be running all around the body and urine will be excreating but brain will not be functioning. The most common cause of brain death is injury – head injury , brain injury , spine injury. Once under treatment the intensivitis decide that it is brain death stags, then we follow the instractions given by the TRANSTAN ( Transplant authority of Tamil Nadu) or ROTTO ( Regional organ and tissue transplant organistation ) Or SOTTO ( State organ and tissue transplant organisation ). The following points based on THOA(Transplantation of Human Organ Act) and G.O.-75 dated 03.03.2008 was discussed and the following recommendations were made by the brain death committee on 20.05.2023. 1.Prerequisites to diagnose Brain Stem Death:1. Evidence of irreversible brain injury of known etiology. Irreversible loss of consciousness and cessation of spontaneous breathing.,2. To exclude alcohol intoxication / depressant drugs / Narcotics / Muscle relaxants / primary hypothermia / hypovolemic shock / metabolic or endocrine disorder. 2. a) Time period to evaluate the patient for identification of clinical brain death in a patient.-- - Minimum 6 hours from the time of admission in the hospital, where clinical examination for Brainstem death is done. 2. b) Time period – identification of clinical brain death to 1st apnoea test.---- Minimum 6 hours after identification of Clinical Brainstem death, if patient is already an inpatient of the hospital. In cases of Anoxic brainstem death, minimum 24 hours. 2. c) If patient has already been clinically diagnosed / certified in another hospital---Wait for minimum period of 6 hours after receiving the patient in the new hospital. During this 6 hours verify 34
and validate the relevant records of the previous hospital through TRANSTAN. If already certified in another hospital, repeat apnoea test or ancillary test after brainstem reflex testing and certify brainstem death. If not certified but only identified, then follow the complete protocol from the beginning. 3. Bio chemical parameters and hemodynamic parameters, at the time of each Apnoea test or ancillary test.---- Mean arterial pressure - consistently >60 mm Hg. or Systolic pressure ≥ 90 mmHg Blood Glucose: 60 – 360 mg/dl. Serum Sodium: 120 - 160 mEq/lt Serum Potassium: 2.5 – 5 mEq/lt. pH: 7.3 – 7.45 PaCo2: 30 to 45 mm Hg PaO2: > 75 mm Hg Core body temperature > 35°C or > 95°F. 4. Brain Stem reflexes to be tested and found absent---a. Pupillary size and light reflex b. Doll's eye movement c. Corneal reflex d. Gag reflex e. Cough reflex f. Bilateral Caloric testing g. Pain response to pressure over the supraorbital ridge. 5. Guidelines for Apnoea Testing.---- Apnoea test to be performed only if the patient satisfies the above mentioned criteria. Preoxygenate with 100% oxygen for 10 to 15 min while on ventilator Ventilator settings to be adjusted to allow PaCO2 to rise to 40mmHg or more. ETCO2 can be used as a guidance but should not replace pre & post arterial PaCO2. A baseline arterial blood gas before apnoea is mandatory Disconnect from ventilator & oxygen at a flow rate of 5 lt/ min through a catheter placed in endotracheal tube is given for 8 -10 minutes. Observe for any spontaneous respiration. Before connecting back to ventilator, arterial sample for ABG is taken. Note: Alternatively a CPAP circuit/ Bains circuit for apnoeic oxygenation maybe used. But, patient should not be connected to mechanical ventilator as even cardiac pulsations might trigger supportive breaths from ventilator. Apnoea test when patient is still connected to ventilator is not recommended. 6. Interpretation of Apnoea Test--- Positive test - No respiratory efforts despite A. post apnoea PaCO2 ≥ 60mmHg or B. post apnoea PaCO2 increase by ≥ 20mmHg from baseline value. Note: either one of A or B is sufficient. No need for both criteria to be simultaneously met. Negative test - Presence of respiratory effort. Indeterminate - No respiratory effort but rise in PaCO2 is insufficient and neither of the criteria A or B are met. 6. a. If 1st Apnoea test is positive.--- To repeat after minimum period of 6 hours in adults, 12 hours in paediatric patients (31 days to 18 years of age) and 24 hours in Term baby to 30 days of age. 6. Time of Death----Time of ABG in which the arterial pCO2 reached the target value in 2nd apnoea test. 6. b. If indeterminate, time period to repeat apnoea test---After 3 hours. 6. c. When to abort apnoea test----- Hypotension, < 90 mmHg systolic - Cardiac arrythmias - Hypoxemia, SpO2 < 85%. - When aborted, apnoea test can be repeated after 3 hours, if haemodynamic parameters meet the guidelines. 6. d. If apnoea or ancillary test is negative, time period to repeat the test---Repeat after 24 hours if strong clinical grounds for brainstem death persists. 7. Ancillary tests: a. When done? a. Bilateral Facio - Maxillary injury b. Thoracic Injury c. High cervical cord injury d. Patient requiring high FiO2 / high PEEP which precludes them being taken off ventilator for apnoea testing. e. When CNS examination could not be completed. Note: Diagnosis of brain death is by clinical criteria. Ancillary tests are only a supplementary tool to diagnose brain death. Ancillary tests should never replace clinical diagnosis. If a complete set of clinical tests & 35
apnoea test cannot be performed, then it is recommended to do the performable components of clinical brain death tests & if these are consistent with death by neurological criteria, ancillary tests can be done to confirm brain death. 7. b. Recommended ancillary test: a. CT cerebral Angiography b. DSA of cerebral circulation c. MRI cerebral Angiography Note: CT cerebral Angiography is the ancillary investigation of choice and is recommended. The four-point CTA criteria has been shown to have 100 percent specificity (ie.0 percent false positive rate) and 85 percent sensitivity (ie.15 percent false negative rate). The four vessels looked at in the 4- point scoring system are: 1. Right Cortical branch of MCA - M4 segment 2. Left Cortical branch of MCA - M4 segment. 3. Right ICV 4. Left ICV For each vessel that shows lack of contrast flow, one point is given. If all 4 vessels show no contrast, then it is a score of 4/4 that implies patient is brain dead. Score of 3/4 or less is negative for Brain death. 7. c. Sequence of clinical & ancillary test--Ancillary test is done minimum of 6 hrs after the first set of performable components of clinical brain death. If ancillary test demonstrates angiographic finding supporting the diagnosis of brain death, then a second set of clinically performable tests are to be done immediately after a positive ancillary test & if the clinical findings are consistent with diagnosis of brain death, the patient is declared dead. 7. d. Time of Death---Time when the second set of clinical tests are done immediately after a positive ancillary test. 7. e. If ancillary test is negative, time period to repeat the test---Repeat after 24 hours if strong clinical grounds for brainstem death persists. 8. Certifying Doctors----Team of 4 doctors must certify Brain Death 1. RMP Incharge of the hospital in which brain stem death has occurred (Head of the Institution / RMO/ ARMO / Duty RMO). No clearance required from the Appropriate Authority. 2. Neurologists / Neuro Surgeon (If not available, surgeon or physician and Anaesthetist or Intensivist, empanelled by Appropriate Authority). 3. RMP nominated from the panel of names sent by the hospital and approved by Appropriate Authority (Physician, Surgeon or Intensivists). 4. RMP treating the deceased person. No clearance required from the Appropriate Authority. 9. Brain Death Certification and organ donation - Identifying brain stem dysfunction, maintaining brain dead patients and brain death certification for the sole purpose of retrieving organs for transplantation should never be the reason for arriving at the diagnosis of brain death. Irrespective of whether the patient's family have consented for organ donation or not, it is mandatory to certify brain death in patients who meet the brain death criteria (GCS3/ on ventilator with no spontaneous respiratory effort/ fixed pupils/ neuroradiologic evidence of irreversible brain injury) . 10. Methyl prednisolone, thyroxine are to be administered only after first positive apnoea test. 11.. Brain death certification team should not be a part of retrieval and transplant team in any manner. 12. Counselling donor family should be done by the grief counsellor. Doctors involved with donor maintenance & brain death certification should not be in contact with donor or recipient family. The retrieval / transplant team of doctors should not be in contact with the donor family 36
13. The specialities that need to be empanelled with Appropriate Authority for Brain Death Certification , the following specialities must be empanelled. Neuro physician Neuro Surgeon Anaesthesiologist / Intensivist General Physician General Surgeon Paediatrician Respiratory physician Cardiologist . So,Organ Donation After Brain Death is very important as the number of people in waitng list are very high throughout the country.The above given guidelines are followed now in Brain death certification. To improve the number of Doctors and General Public registered for organ donation we can initiate the following steps: 1. To spread the message about organ donation registery of IMA,Tamilnadu to all the of IMA members ,to register in the ima tamilnadu,website www.ima tamilnadu. Com. We can be creating a similar GOOGLE FORM for general public.We can issue a Digital Organ Donar ID Card for all those who are registering in our web site. 2. To conduct monthly Zoom webinar every month. With twelve different topics. 3.To conduct organ donation AWARENESS meeting in all the Medical colleges, Nursing colleges,all the Engineering colleges, Rotary clubs, Lion's club and like forums in their IMA region. 4.To print a handout about organ donation and issue to all the people through out India. 5.If a person with brain death donates the organ, the local ,the branch IMA Office bearers to meet the relative during the funeral or after in their home and thank them by giving a citation. 6.In the all IMA meetings minimum 5 mins to be allotted to talk about organ donation in each meeting in the form of A. show the power point about the organ donation ,B. If there is any organ transplant specialists in the Branch, request them to talk about their experiences during the month&if not available we can invite from nearby branch to give the talk. C. show the waiting list for Organs NECESSITY ,to obtain list from TRANSTAN and show it in all IMA meetings. D.To Observe one minute silence for the brain death donar (who has donated the organ in the region). 7. To conduct Regional Organ Donation Awareness Workshop to college Students,Paramedical Staffs and Doctors so that all the procedure can be explained in detail. 8.To conduct Regional Donar Hospital Co-ordination meet by inviting Donar ,Recipient and Transplant Hospital Doctors and conduct meetings once in a month with the Organ Donation Committee MEMBERS of IMA ,. 9.To spread message about TRANSTAN (Transplant Authority Of Tamilnadu) request all IMA members to visit atleast one time to that website to know more about the Organ donation. BE AN ORGAN ORBODY DONAR AND GIVE YOUR CONTRIBUTION TO COMMUNITYREGISTER TODAYFORORGANDONATION . 37
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VACCINE UPDATES Dr. B. Lakshmi Shanthi Consultant paediatrician President IAP Coimbatore branch, IMA-AMS , Coimbatore, 9842271577 Virgoshanthi1976@gmail.com The history of vaccines dates back to 200 BC when dried cowpox scabs were used to provide immunity to smallpox,over 1000 years later Edward Jenner developed the smallpox vaccine and he is considered to be the father of vaccinology. Vaccine can be considered as one of the most effective public health strategy against a communicable disease which the World witnessed during the Covid 19 pandemic. Coming to the history of vaccines in India,BCG,DPT,OPV and measles were introduced in the year 1985 and subsequently various other vaccines followed. The National Immunisation Schedule or the Universal Immunisation Program is a very successful program by the GOI targeting infants,children and pregnant women. The following table illustrates the UIP. 48
The latest addition to the above schedule is a booster dose of IPV at 9 months. The IAP has a committee called the ACVIP[Advisory Committee of Experts on Vaccines and Immunisation Practices] which regularly updates and prepares the vaccination schedule. The latest 2023 guidelines can be summarized as follows: There are differences between the UIP and the IAP schedule which should be explained to the parents by a one-one counselling and help them in making a decision. Some common considerations to be kept in mind during vaccination are as follows: 1. Multiple vaccines when given simultaneously should be in the same sitting or the same clinic day. 2. Vaccine to be given immediately-no need to wait for reaching room temperature. 3. Recommended interval between two doses of a vaccine is 4 weeks. 4. Two or more killed and killed with live vaccines can be administered same day/at any interval. 5. Two or more live vaccines can be given on same day or 4 weeks apart. 6. Changing needles between drawing vaccine and injecting is not necessary. . 7. Every child should be observed 15-20 minutes after vaccination. CONTRAINDICTIONS Permanent contradictions are severe anaphylaxis to a previous dose,severe combined immunodeficiency whereas pregnancy and immunosuppression are temporary contradictions. PRECAUTIONS High fever,persistent crying,hyporesponsive hypotonic episodes and seizures to a previous dose of vaccine are permanent precautions while temporary precautions are severe acute illness,receipt of antibody products. 49
ADVERSE EVENTS FOLLOWING VACCINATION 1. Minor adverse events are local and systemic reactions like pain, redness, fever, swelling. 2. Severe adverse events are the minor events with increased severity. 3. Serious adverse events are death, hospitalization, disability, clusters of children reporting with side effects, community concern regarding a particular vaccine, defect in the vaccine,compromised quality of vaccine. AEFI RESPONSIVENESS Any clinic or a practitioner where vaccination is undertaken must have the emergency tray and oxygen to respond to a case of severe anaphylaxis following vaccination. The emergency tray consists of injection adrenaline[check for expiry date regularly], IV set, intracath/scalp vein set, IV fluids for resuscitation, injection hydrocortisone. The dose is 0.01 ml/kg of 1:1000 undiluted adrenaline, injected intramuscular in the anterolateral aspect of the thigh and can be repeated after 5-10 minutes as needed. age dose < 1 year o.o5 ml 1-2 yrs 0.1 ml 2-6 yrs 0.15 ml 6-12 yrs 0.3 ml >12 yrs 0.5 ml Vaccine storage in clinics has to adhere to strict cold chain maintenance preferably in a Ice Lined Refrigerator [ILR] with temperature monitoring system in place. If domestic refrigerators are to be used then certain precautions like not opening the door often, storing vaccines only in the main racks, storing water bottles in the side racks[to maintain cold chain], not storing anything else in the fridge and defrost cycles to be taken care of during which vaccines have to be temporarily shifted. Vaccines have to be shifted in case of a power shutdown also. Most of the vaccines require a temperature of 2-8%, oral polio vaccines require -20%. Dial thermometers can be used to monitor temperature. Vaccines are the most efficacious preventive modality available to safeguard our children against many of the deadly diseases. When properly administered with utmost care and counselling for side effects, its unlikely to pose a serious problem. 50