October 23   2015, Friday
Dr KK AggarwalDr KK Aggarwal
Change in the way heart attacks will be treated now

The guidelines for primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) have been updated to reflect two major findings from recent trials.

• PCI of a non-infarct artery is now acceptable for some STEMI patients with multivessel disease. In previous guidelines, PCI of non-infarct arteries had been considered unsafe.

• Routine thrombectomy prior to primary PCI for stent implantation is now deemed to have no benefit, though the guideline leaves some room for selective and bailout thrombectomy. Previously, thrombectomy had been deemed reasonable in these patients.

(Journal of the American College of Cardiology, Circulation, and Catheterization and Cardiovascular Interventions)
Breaking news
ACS updates screening mammography guidelines

For the first time since 2003, the American Cancer Society (ACS) has updated its breast cancer screening guidelines for women at an average risk of developing the disease. The guidance is published in the October 20 issue of JAMA. Elizabeth T.H. Fontham, MPH, DrPH, professor of epidemiology and founding dean of Louisiana State University Health Sciences Center School of Public Health, New Orleans, guideline author, the biggest change in the guidelines is that we now recommend women start annual screening at age 45 as against the previous age of 40 years. (Medscape)

Major recommendations

• Women with an average risk for breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation).

• Women aged 45 to 54 years should be screened annually (qualified recommendation).

• Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation).

• Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation).

• Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation).

• The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).
Dr Good Dr Bad
Specialty Updates
• Treatment with the late-sodium-current blocker ranolazine does not improve outcomes in patients with chronic angina and incomplete revascularization after undergoing PCI, suggests new research presented at TCT 2015 and simultaneously published in the Lancet.

• New research suggests that introducing peanuts to babies between 4-11 months of age can reduce allergy risk. The findings are published in the Canadian Medical Association Journal.

• The US Food and Drug Administration (FDA) has approved the first replacement therapy for hereditary Factor X deficiency, derived from human plasma.

• Smoking was not associated with prevalent non-alcoholic fatty liver disease, but low levels of certain micronutrients did appear to have an association, reported a large cross-sectional analysis presented at the annual meeting of the American College of Gastroenterology.

• Patients diagnosed with Hashimoto's disease who underwent a complete thyroidectomy saw improvement in symptoms, most notably a reduction in severe fatigue, suggested novel research presented at the International Thyroid Congress.

• A new study suggests that men with depressive symptoms and a low quality of life due to sleep problems are at increased risk of erectile dysfunction. The study is published in The Journal of Sexual Medicine.

• Hearing loss is linked with accelerated cognitive decline in older adults; however, the use of hearing aids may help safeguard seniors' memory and thinking skills, suggested a new study published in the Journal of the American Geriatrics Society.

• Early results from the Maternal Vitamin D Osteoporosis Study (MAVIDOS) suggest that taking vitamin D supplements during pregnancy may stop the decline in bone mass in women from December through February and may increase the bone mass of babies born then. However, a related study found that taking vitamin D supplements did not improve bone health in pregnant women or their infants, and that high-dose vitamin D supplements weakened the femoral bones in the mothers. The findings were presented at the American Society for Bone and Mineral Research (ASBMR) 2015 Annual Meeting.

• Those who exhibited more 'dispositional mindfulness', or awareness of and attention to their current feelings and thoughts, were less likely to be obese and had less abdominal fat than people who did not exhibit as much of that awareness, suggested new research published in the International Journal of Behavioral Medicine.

• Taking a probiotic strain of Bifidobacterium longum reduced physiologic and psychological stress and led to a modest improvement in memory in a small pilot study of healthy men presented during a press briefing at the Society for Neuroscience (SfN) 2015 Annual Meeting.
The Allopathic Ramayana
Navratras to Diwali is the season of revisiting the messages from Ramayana, the largest epic of our country which was once classified as one of the Puranas.

One can understand the story of Ramayana as the story of mind, body and soul and the story of causation and prevention of a disease, where the soul is represented as Rama and the physical body as Sita. Body is made up of five elements with earth being the predominant. Sita was the daughter of earth (prithvi).

Soul and body can only unite in presence of a determined mind holding them together. Determination means “aim” and in Hindi it is called “lakshya”. The mind with a defined aim, therefore, represents “Lakshmana”.

Rama, Lakshmana and Sita, therefore, represent the union of mind, body and soul. The three will stay together as long as one has his/her 10 senses (five motor and five sensory) under control. Senses are Chanchal like horses. Chariot of two horses is called Rath and chariot of the 10 horses is called “Dasharatha”. Therefore, mind, body and soul will be together with the resultant health only if the body is ruled by “Dasharatha” by controlling all the ten senses.

The next part of Ramayana talks about the causation of disease and worries. The causative factors are “kama, lobha and ahankar”. In Ramayana kama is depicted by Kaikeyi, lobha by Mareech and ahankaara by Ravana. Ramayana would not have happened with any one of them not being there. The sum total of the three is responsible for any disease or miseries in life.

When kama (Kaikeyi) predominates, senses (Dasharatha) have to die. When moha (Mareech) dominates, the mind (Lakshman) gets diverted and when Ahankar (Ravana) takes over, it controls the body (Sita) and makes the mind (Lakshman) and soul (Rama) wander.

The next part of Ramayana is how to win over ego or Ravana. The first step is to win over the mind by controlling the prana Vayu component of the body by indulging in Pranayama. In Ramayana context it means winning over Hanumana, the son of Vayu. Once he is controlled, all the thoughts representing as the Vanar Sena (Chanchal natures) get controlled.

The next step is to control the intellect (King Sugriva). He can only be influenced by killing lust (Bali), who is living with Sugriv’s wife. Lust cannot be killed from front and has to be killed from behind and that is what Rama does to Bali. Killing of the lust from behind is depicted as Pratyahara in Yoga and means living a disciplined satvik lifestyle.

The next step is to follow “one point contemplation” or living in the present. In the context of Ramayana, it represents one point determination or “the war over Lanka”. Once that happens firstly the tamas (Kumbkaran), than the rajas (Meghnad) and finally the ahankar (Ravana) dies. Both tamas and ego dies automatically by the consciousness (Rama) but for killing the rajas one has to conquer it with the mind (Lakshmana).

Once this happen the Satwa or Vibhishana takes over and the mind, body and soul are reunited leading to inner happiness again.

Lastly when Rama, Lakshman and Sita go back to their journey of life, back to Ayodhya, Hanuman goes with them as in Ayodhya, Dasharatha is no more.

If you cannot control your 10 senses by yourself you need to continue Pranayama or carry Hanuman with you for life. These are what the spiritual message from Ramayana.
GP Tip: Giving IM injection

To make intramuscular injection pain-free, squeeze tight the area you want to give the injection and then give it. Chances are it will be painless.

(Source: IJCP)
Legal Quote
Jacob Mathew v. State of Punjab SC / 0457 / 2005: (2005) 6 SCC 1 (iii).

“So also, the standard of care, while assessing the practice as adopted, is judged in the light of knowledge available at the time of the incident, and not at the date of trial. Similarly, when the charge of negligence arises out of failure to use some particular equipment, the charge would fail if the equipment was not generally available at that particular time (that is, the time of the incident) at which it is suggested it should have been used.”
Asset protection: Personal residence

Forcing the plaintiff to pursue an ownership interest in an LLC or in a limited partnership is a lot more advantageous for the doctor because interests in LLCs and limited partnerships are not subject to attachment by a plaintiff. This is known as the charging order protection. The charging order protection limits a plaintiff’s remedy to a lien against the distributions from the legal entity, without conferring on the plaintiff any voting or management rights. Because, the doctor will remain in control of the entity and can defer distributions, the plaintiff will have no way of enforcing the judgment against the doctor’s LLC or limited partnership interests or the assets owned by these entities. As a practical matter, LLCs and limited partnerships create a formidable obstacle to the creditor’s collection efforts and usually force the creditor to drop his collection efforts or to settle. These entities should be considered by doctors for all valuable assets with the exception of their personal residence.

(Source: IJCP)
Industry News
Top startups and entrepreneurs to meet RBI governor: A group of India's top startups and entrepreneurs will meet RBI governor Raghuram Rajan to propose steps that will improve the ease of doing business for these companies, sources familiar with the development told ET NOW. The meeting, which is scheduled on Tuesday, comes at a time when an increasing number of Indian startups are shifting base to Singapore to take advantage of the simpler regulatory and tax regime. (The Economic Times- Chandra R Srikanth)

The future of mobile wallet lies beyond payments: Various estimates today suggest that there are just under a billion cellphone connections in India, and every month, there is an addition of around six million new cellphones in usage. Cellphone users are swiftly switching to smartphones with almost 65 per cent of all new Internet users in India experiencing their first surfing activity through their smartphones. The smartphone has also become the preferred medium for money transactions in tandem with its increased usage and the convenience it provides on the go. (Yourstory- Guest Column)

Hyperlocal startups like Grofers, Pepper-Tap, TinyOwl reduce use of petty cash via prepaid cards: The next time you order grocery from an online retailer, the delivery boy may swipe a debit card at the nearest kirana store or petrol station. In order to control leakages and reduce cash handling, grocery and hyperlocal startups in India have started handing out debit cards and virtual wallets to delivery boys. Grocery delivery and hyperlocal startups such as Grofers, Pepper-Tap, TinyOwl, RoadRunnr and Parcelled have started using cards from a Bengaluru-based startup, Happay, which offers prepaid expense management solutions. (The Economic Times- Harsimran Julka and Nirupama V)

Startup FirstHandle to invest Rs 30 crore in next one year on expansion: Pune: FirstHandle, which helps offline merchants target consumers within a predefined radius with hyper-local offers, will invest Rs 30 crore in the next one year on expansion, according to its cofounder Gaurav Sinha. The startup, which launched in the Delhi-NCR region in August, will start operations in Mumbai and Bengaluru in the next couple of weeks, said Sinha, who is also the CEO of FirstHandle. (The Economic Times- Vasumita S Adarsh)
Inspirational Story
How much do you make an hour?

With a timid voice and idolizing eyes, the little boy greeted his father as he returned from work, “Daddy, how much do you make an hour?” Greatly surprised, but giving his boy a glaring look, the father said: “Look, son, not even your mother knows that. Don’t bother me now, I’m tired.” “But Daddy, just tell me please!? How much do you make an hour,” the boy insisted.

The father finally giving up replied: “Twenty dollars per hour.” “Okay, Daddy? Could you loan me ten dollars?” the boy asked. Showing restlessness and positively disturbed, the father yelled: “So that was the reason you asked how much I earn, right?? Go to sleep and don’t bother me anymore!”

It was already dark and the father was meditating on what he had said and was feeling guilty. Maybe he thought, his son wanted to buy something. Finally, trying to ease his mind, the father went to his son’s room.

“Are you asleep son?” asked the father. “No, Daddy. Why?” replied the boy partially asleep. “Here’s the money you asked for earlier,” the father said. “Thanks, Daddy!” rejoiced the son, while putting his hand under his pillow and removing some money. “Now I have enough! Now I have twenty dollars!” the boy said to his father, who was gazing at his son, confused at what his son just said. “Daddy could you sell me one hour of your time?”
National Consultation on Private Health Sector Engagement for a TB-Free India
MTNL Perfect Health Mela 2015.

Pls click here for details
IMA Digital TV
When should you have your first cholesterol screening?

A. At age 10.
B. At age 20.
C. At age 35.
D. At age 40.
E. It depends on your risk factors.

Yesterday’s Mind Teaser: All of the following features can be observed after the injury to axillary nerve except:

1.Loss of rounded contour of shoulder.
2.Loss of sensation along lateral side of upper arm.
3.Loss of overhead abduction.
4. Atrophy of deltoid muscle.

Answer for Yesterday’s Mind Teaser: 3.Loss of overhead abduction.

Answers received from: dr poonam Chablani, Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan

Answer for 21st October Mind Teaser: 4. Genitofemoral

Correct Answers received from: Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Poonam Chablani, Dr K V Sarma, Dr K Raju, Dr Avtar Krishan.
Defensive Medicine

Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
New Delhi

The rate of cesarean section deliveries is growing all over the country. Obstetricians are often accused of using cesarean section to increase their income. On the other hand, issues such as increasing maternal age, precious babies, mothers’ insistence, safety and ease, parents’ schedule preferences, and preferences for doctor’s and hospital’s office hour delivery all result in increasing operative deliveries. However all doctors believe that ‘natural is the way to go’ in pregnancy. Yet operative deliveries are undertaken to avoid the smallest risk to mother or child. What do you think?

a. Is caesarean section a part of defensive medicine?

b. Do you agree to cesarean section deliveries in general?

c. Can such sections lead to complications for the baby such as prematurity and therefore, should they be always avoided?

d. If no to cesarean section, then what is the alternative?

e. Should there be definite essential requirements for cesarean section?

Adapted and shortened from: UNESCO, 2011. Casebook on Human Dignity and Human Rights, Bioethics Core Curriculum Casebook Series, No. 1, UNESCO: Paris, 144 pp.

Do write in with views and your solutions!
Breaking news
Disaster preparedness should focus on children's needs

A policy statement issued by the American Academy of Pediatrics Disaster Preparedness Advisory Council and the Committee on Pediatric Emergency Medicine recommends that pediatricians should collaborate with federal, state, tribal, local, and regional institutions to ensure that children are cared for physically and emotionally during a disaster.

The policy statement emphasizes that the unique physical, mental, behavioral, developmental, communication, therapeutic, and social needs of all children should be taken into consideration for disaster planning. The effect of disasters on children may be especially significant because debris, smoke, or other environmental hazards may affect them more quickly. As subject matter experts, agents of public health surveillance, healthcare providers, and representatives of practices or institutions, pediatricians can advise on the potential for toxic exposures to have profound negative effects on children. (Medscape)
IMA Satyagraha, suggested slogans
• Writing prescription drugs by a non-MBBS is injurious to health of the community.
• Writing prescription drugs by unqualified people can be dangerous.
• Allow doctors to treat patients irrespective of patients’ income.(If compensation is not capped, we can't do this)
• When there is capping of Rs 2 lakh for a sterilization death, why not for other procedures?
• When there is a compensation of Rs 30,000/- for a sterilization failure, why not for other procedures?
• Allow us to treat poor and rich equally.
• Non pelvic ultrasound providers should be out of PCPNDT Act.
• Unless caught doing sex determination, no criminal offence shall be registered.
• If any prospective parent asks for sex determination, they should be booked under a non bailable offense.
• More patients will die if doctors are not provided protection during duty hours.
• Death does not mean negligence.
• Money spent does not mean you will get a cure.
• Including single clinic and small establishments under Clinical Establishment Act will make treatment costly.
• How can we treat patients using outdated standard treatment guidelines made by government?
• How can government decide the charges of a clinical establishment?
National Consultation on Private Health Sector Engagement for a TB- Free India

The Central TB Division, MoHFW, Indian Medical Association (IMA) and The International Union Against Tuberculosis and Lung Disease (The Union) jointly organized a “Private Health Sector Dialogue towards a TB Free India” on 29th September 2015 at The Park, New Delhi. The event helped in initiating a dialogue with various National Medical Associations and effectively engaging them in supporting the Revised National TB Control Programme.

Around 1 million of the total estimated TB cases in India remain unaccounted for each year. Many of these are likely being managed in the private health sector, which is the first point of contact for a majority of people seeking care for TB. The Private Health Sector Dialogue was organized to call for Professional Medical & Allied Associations to join the TB-Free India campaign and help reach the “missing” TB cases. IMA is supporting the Call to Action for a TB Free India and partnering with MoHFW, Government of India and The Union to accelerate progress towards the collective goal of ending TB in India.

Representatives from more than 30 Professional Medical Associations such as TB Association of India (TBAI), Federation of Obstetricians & Gynaecologists of India (FOGSI), Association of Surgeons of India (ASI), Indian Academy of Paediatrics (IAP), Association of Physicians of India (API), Indian Society of Oncology, Indian Chest Society, National College of Chest Physicians (NCCP), Indian Fertility Society, Trained Nurses Association of India, Ayurveda Medical Association of India, Homeopathy Medical Association of India, SEARPharm Forum, Nursing Research Society of India; and Indian Association of Medical Microbiologists (IAMM) met to discuss the collaborative role of private health sector in achieving the goal of a TB-Free India.
IMA Digital TV
Annual influenza vaccination is the best defense against influenza. For the 2015-2016 influenza season, the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) continue to recommend routine annual influenza vaccination for all persons aged 6 months or older who do not have contraindications. (Medscape)
Fluid therapy with a buffered crystalloid solution does not reduce the risk for acute kidney injury (AKI) or kidney failure relative to saline among intensive care unit (ICU) patients who need intravenous fluids, according to a new study in JAMA. These findings contradict previously reported observational data that suggested buffered crystalloids may decrease the risk for AKI and death compared with saline in critically ill patients. (Medscape)
Is it a statin-induced muscle pain?

• When there are such symptoms as aches, fatigue, and pain that are symmetrical, affect the large muscles, and occur within 2 weeks after the start of treatment and disappear within 2 weeks after withdrawing it, the likelihood that the patient is experiencing a statin-related adverse effect is very high.

• In contrast, if the pain is localized and appears more than 1 month after the start of treatment and does not disappear when it is withdrawn, the likelihood that it is due to the statin is very low.
Severe, untreated isolated vitamin D deficiency can lead to muscle pain and decreased muscle strength, and a few cases of rhabdomyolysis have even been described. Treating a vitamin D-deficient patient with a statin can decrease his or her muscle pain. When patients received vitamin D supplementation and the deficiency was corrected, 80% of them are then able to take a statin.
Mindful people likelier to have less abdominal fat

A new study of around 400 people has found an association between mindfulness and abdominal obesity. Those who exhibited more ‘dispositional mindfulness’ or awareness of and attention to their current feelings and thoughts, were less likely to be obese and had less abdominal fat than people who did not exhibit as much of that awareness. Dispositional mindfulness is not the same as mindfulness meditation, in which people make a conscious, focused practice of attending to their current state and sensations. Instead, it’s more of an inherent personality trait, though it can also be taught. The study by Eric Loucks of Brown University School of Public Health and colleagues is published in the International Journal of Behavioral Medicine. (Financial Express – ANI)
Taiwan becomes the world's fastest aging nation
A report by the National Development Council (NDC) states that Taiwan has become the world's fastest aging country this decade, overtaking Japan, the US, Britain and other developed nations. With a total population of 23.4 million, there are 2.86 people aged 65 and above. And this group is expected to account for more than 14% of the population in 2018 and 20% in 2025, making Taiwan an aged and a super-aged society. An increase from 7% to 14% in the proportion of retirees took 85 years in Sweden and 73 years in the US. But in Taiwan, it will take only 25 years, which underlines the nation's quick aging rate. (The Pioneer – IANS – EFE)
IMA Satyagraha
IMA SatyaGrah
Obesity reduces life expectancy

Obesity in adulthood is associated with a striking reduction in life expectancy for both men and women. Among 3457 subjects in the Framingham Study, done in the United States, those who were obese (Body Mass Index or BMI ≥30 kg/m2 at age 40 years lived 6 to 7 years less than those who were not (BMI ≤24.9 kg/m2). Those who were overweight (BMI 25 to 29.9 km/m2) at age 40 years lived about 3 years less, and those who were both obese and smoked lived 13 to 14 years less than normal–weight nonsmokers. The steady rise in life expectancy during the past two centuries may come to an end because of the increasing prevalence of obesity. Being overweight during adolescence also increase the risk of premature death as an adult. The analysis of Nurses’ Health Study has shown the risk of premature death increases with higher BMIs at age 18 years. For a BMI at age 18 of 18.5 to 21.9, 22 to 24.9, 25 to 29.9, and ≥30 kg/m2, the hazard ratio for premature death were 0.98, 1.18, 1.66, and 2.79, respectively.

A prospective study from the United States, at National Cancer Institute, National Institutes of Health, Bethesda, valuated the relationship between BMI and risk of death over a maximum follow–up period of 10 years among over 500,000 men and women aged 50 to 71 years. Among the subset of individuals 50 years of age (when prevalence of chronic disease is low) who had never smoked, an increased risk of death was associated with being either overweight (20 to 50 percent increase in those between 26.5 to 29.9 kg/m2) or obese (two– to over threefold increase in those ≥30 kg/m2).

Overweight and obesity, when analyzed together, is associated with increased mortality from diabetes and kidney disease. Obesity, when analyzed alone, is associated with increased cardiac mortality and cancers considered to be obesity–related (colon, breast, esophageal, uterine, ovarian, kidney, and pancreatic cancer), but not with mortality from other cancers or non–cardiac mortality.

There are some recent studies which showed that obese people live longer. Overweight was shown to be associated with reduced mortality from non cancer, non–cardiovascular causes, but not with cancer or cardiovascular mortality. In them being underweight was associated with increased mortality from non cancer and non–cardiac causes, but not cancer and cardiac CVD causes. Obesity and increased central fat are associated with increased morbidity in addition to mortality. Overweight and obese individuals have a higher relative risk of hypertension, hypercholesterolemia, and diabetes mellitus compared with normal weight individuals. The risk of hypertension and diabetes increases with increasing BMI.

In the Nurses’ Health and the Health Professionals studies, the risk of developing a chronic disease (gallstones, hypertension, heart disease, colon cancer and stroke (in men only)) increased with increasing BMI, even in those in the upper half of the healthy weight range (BMI 22.0 to 24.9 kg/m2). Obesity is measured by using a measurement called BMI, which is calculated by dividing a person’s weight in kilograms by the square of their height in meters.

A BMI of 18.5 to 23 is considered normal (Asians). One below 18.5 is considered underweight and 25 or above is considered obese.
A teenage boy had just passed his driving test and inquired of his father as to when they could discuss his use of the car.

His father said he'd make a deal with his son: 'You bring your grades up from a C to a B average, study your Bible a little, and get your hair cut. Then we'll talk about the car.'

The boy thought about that for a moment, decided he'd settle for the offer, and they agreed on it.

After about six weeks his father said, 'Son, you've brought your grades up and I've observed that you have been studying your Bible, but I'm disappointed you haven't had your hair cut. The boy said, 'You know, Dad, I've been thinking about that, and I've noticed in my studies of the Bible that Samson had long hair, John the Baptist had long hair, Moses had long hair...and there's even strong evidence that Jesus had long hair.'

You're going to love the Dad's reply.

“Did you also notice they all walked everywhere they went?”
Press Release
Winning the Swine Flu Battle – H1N1 vaccine and its importance

Swine flu cases continue to be recorded from different parts of the country. Given this situation, basic prevention measures become essential.

Swine Flu or H1N1 influenza is a viral respiratory infection, which strikes like a ‘common-cold' infection but is more severe in symptoms and the outcomes. The influenza virus mutates extremely fast and is highly infectious. The typical symptoms of Swine flu are a cough, sore throat, fever, headache chills and fatigue.

Speaking about this issue, Padma Shri Awardee Dr. A Marthanda Pillai – National President Indian  Medical Association and Padma Shri Awardee Dr. K K Aggarwal, IMA Honorary Secretary General and President Heart Care Foundation of India in a joint statement said," Prevention of Swine Flu mainly involves taking simple precautionary steps while coughing and maintaining respiratory and hand hygiene. Respiratory hygiene involves maintaining a distance of at least 3 feet from a person who is coughing and sneezing. Proper cough etiquette demands that the infected person ensures that he or she covers their mouth and nose with a tissue while coughing or sneezing and then disposes of the tissue immediately to stop the disease from spreading to others. In a case where a tissue may not be available, it is best to cough and sneeze into one's upper sleeves and not in their hands or a handkerchief. Sneezing and coughing into one's hands/ using a handkerchief are reasons why the disease spreads at such a rapid pace. In addition to this, vaccination is recommended specially in high risk individuals.”

The Centers for Disease Control and Prevention (CDC) has recently released its recommendations that all persons aged six months or older should receive H1N1 influenza vaccine. A priority list of population groups for vaccine administration should be followed, if the vaccine supply is limited.

This includes pregnant women, individuals from 6 months through 24 years of age, household contacts and caregivers of children younger than six months of age, individuals from 25 through 64 years of age with health conditions associated with increased risk of influenza complications and healthcare and emergency medical services personnel

Drug therapy: Recommendations
Antiviral therapy should be promptly given to

Children, adolescents, or adults with suspected or confirmed influenza infection and any of the following features
Illness requiring hospitalization
Progressive, severe, or complicated illness, regardless of previous health status
Suspected or confirmed influenza infection who were at high risk for complications including:
• Children < 5 years of age, particularly those <2 years of age
• Adults ≥ 65 years of age
• Pregnant women and women up to two weeks postpartum (including those who have had pregnancy loss)
• Individuals with certain medical conditions

Antiviral therapy be started as soon as possible in patients who are severely immunosuppressed such as those receiving treatment for malignancies, hematopoietic or solid organ transplant recipients and present with an acute respiratory illness

Patients with morbid obesity (BMI > 40) and possibly those with obesity (BMI 30 to 39) with suspected or confirmed pandemic H1N1 influenza A virus infection should be carefully evaluated for the presence of conditions that confer an increased risk of influenza complications. If any such conditions were present, treatment is recommended.
Digital IMA