Friday, January 17, 2014

Internal Medicine at NJH

There is always a wrong notion going around that NJH do not have much of interesting cases, especially such ones which warrant the presence of a physician doing Critical Care work. Dr. Roshine  tries to dispel this notion through this post. 

We also look forward for fresh graduates who would like to learn from her and the medicine work here. 

A glimpse of the medical work at NJH over the past 6 months, challenges and opportunities ahead.

1. Snake bites continue to plague the community. Here’s some statistics on the increasing number of snake bite victims needing our services. Thanks to the group of students led by Dr Shubhanker from CMC, Vellore, who compiled the data and whose work was acknowledged as the best paper in the young researchers category this year in CMC,Vellore. (Title: Clinico-epidemiological profile of snake bite over 6  years period from a rural secondary care centre of Northern India – A retrospective observational study)

Below is a table showing the number of cases over the last 5 years. 

The numbers are increasing with 118 snake bite patients admitted over the first half of 2013.

Our management of snake bite victims is challenging for various reasons. Awareness of the symptoms of systemic envenomation is sorely lacking in the community and the  strong influence of traditional healers in the community delays  initiation of therapy. To put across a horrific thought, over the past 6 months , we have had roughly 17 patients brought dead after a history of  snake bite with the delay being largely preventable.

Another challenge has been management of viper bites and there has been reason to suspect other species of snakes prevalent in our area that are not covered by the standard ASV being used.

In this respect, we are grateful for the opportunity to be part of a multi centric study by the toxicology group, CMC Vellore, in collaboration with other partners which will focus on envenomation syndromes and more importantly snake species identification .Also hoping that the study will shed light on ASV schedules being used in our country considering the huge costs involved in treatment of such patients.

2. We have been particularly alarmed at the number of patients diagnosed with probable TB meningitis, many of whom have had atypical presentations. I had put some details up in my previous blog.

3. Acute febrile illnesses are rampant during the rainy season. Being able to diagnose rickettsial illnesses,malaria and viral hemorrhagic fevers have helped a great deal in reducing unnecessary higher antibiotic usage.

Eschar in a patient with fever . . . 
A great challenge in the management of acute febrile illnesses has been the indiscriminate use of antibiotics and antimalarials by diagnosing these diseases using  malarial antibody kits and typhoid kits in the community. There are very few health centres doing malarial smears and tube agglutination tests. It is a matter of great concern and we are hoping that good evidence based medicine would be recognised and encouraged  by the medical fraternity in this region. More on the malarial kits in a later blog.

4. Finally, chronic diseases are on the rise. Patients over the age of 40 with no routine medical check up presenting with hemorrhagic strokes.

Considering the large number of diabetic and  hypertensive patients  we see on a regular basis in OPD , knowing they represent the tip of the iceberg, we are soon planning to start a chronic diseases clinic focusing on primary and secondary prevention.

The above are just a few of the areas of interest in Internal Medicine in NJH. Of course, we are keen on doing more in these areas as well as venture into new thematic areas.

I'm grateful that the Lord has been using us. We pray for more people to join the team here and be part of greater things.  

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