ADOLESCON 2011

ADOLESCON 2011, the 11th National Conference of the Adolescent Health Chapter of the Indian Academy of Paediatrics will be held at Calicut, Kerala on 17th and 18th September, 2011. The registration form can be downloaded from  the IAP Kerala Website. The ADOLESCON 2011 brochure is available for download here.

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Coconut palm leaves


Coconut palm leaves

Nice beautiful green coconut palm leaves from a village in Kerala, India.

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Sweet, fat and health

Longevity of person is determined by genetics, environment and technology related factors. Life expectancy have improved very much over the past few decades, but only to produce more problems of the elderly due to increased longevity. Exercise levels are coming down due to availability of better transport and remote control devices. This leads to more of metabolic syndrome and related problems.
Glucose does not need insulin for absorption, but needs it for metabolism. There are a few alternate mechanisms for glucose metabolism as well. In the skeletal muscle, glucose metabolism can occur independant of insulin. GLUT4 is the glucose transporter in the skeletal muscle, situated in the Golgi apparatus. Though it is possible to delay the onset of diabetes with exercise, it may not be possible to fully treat diabetes with exercise alone. Drug therapy has to be initiated in appropriate stages of diabetes.
Genetic predisposition, overeating, obesity, stress and sedentary habits increase the chance for development of metabolic syndrome and insulin resistance. Exercise increases the non-insulin dependant transport of glucose into the skeletal muscles.
Chronic hyperglycemia leads to non-enzymatic glycosylation of proteins like hemoglobin. Glycosylation products can bind to collagen to produce advanced glycosylation end products (AGE). Advanced glycation end products are important in the pathogenesis of diabetic complications like neuropathy and retinopathy. Intracellular hyperglycemia impair ion pumps within the cells.
Carbonate beverages contain fructose which is 75% sweeter than sucrose. Fructose reduces insulin, leptin and ghrelin. This in turn reduces appetite and affects nutrition. Fructose used in beverages is different from the natural variety and is being used because less amount is required for sweetening. Fructose is absorbed by GLUT5. Over consumption of fructose leads to non absorption and causes overgrowth of intestinal bacteria, bloating due to gas production and diarrhoea due to water retention.

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Immunisation in adolescents

Immunisation started with variolisation in the early era of immunisation. Immunisation is administration of whole or part of a microorganism which causes development of immunity against the disease. The success of an immunisation program is the prevention of all vaccine preventable diseases. The boosting of immunity is needed in adolescents as the immunity aquired from childhood immunisation is waning. In addition adolescents need immunisation for new diseases which occur in adolescents and adults. Meningococcal vaccine, influenza vaccine, pneumococcal vaccine, hepatitis A and B vaccines and human papilloma virus vaccine may be considered in appropriate risk groups. Booster doses for tetanus vaccine is needed. Rubella, MMR and typhoid vaccines may be taken if not taken earlier. Vaccine preventable diseases like diphtheria and pertussis continue to occur even now and need to be our concern. Tdap vaccine can be given between the ages of 19-64 years of age. Tdac contains less of diptheria and pertussis components. There is a concern about the aseptic meningitis related to mumps vaccination, but this does not seem to be very significant. Similarly some concerns have occurred after untoward events following human papilloma virus vaccination which is under investigation. Varicella vaccine can be used as a post exposure prophylaxis within 72 hours of exposure. But the chance of pregnancy should be excluded in a female before giving the vaccine. Rabies vaccination is another vaccine which is mostly used only for post exposure prophylaxis. Influenza vaccine is recommended in high risk individuals with asthma and other respiratory disorders. Pneumococcal vaccine is useful in conditions like nephrotic syndrome and asplenia. Any serious adverse effect due to vaccination should be properly documented and reported for further investigation. Vaccination is the most important aspect of preventive care of an adolescent.

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Adolescent vaccination

Boosters for vaccines taken in infancy are given during adolescence. Certain vaccines which might have been missed earlier can also be given to adolescents. Adolescents at school are also a captive population for mass immunization programs. These campaigns also give an opportunity for health check ups.

Tdap vaccine

Tdap vaccine includes standard dose tetanus vaccine, reduced dose diphtheria vaccine and acellular pertusis vaccine. Standard DTP vaccine is not useful for children above 7 years of age.

Hepatitis B vaccination
 
WHO has recommended it for universal immunization.
 
Human papilloma virus vaccine [HPV]
 
16 and 18 are the important types of viruses involved in human cervical cancer. Vaccination of females before onset of sexual activity and before the age of 26 years.  
 
Varicella vaccination
 
If not exposed  earlier or wthin 72 hours of exposure [90 percent efficacy].
 
Japanese B encephalopalitis vaccination
 
Given in endemic areas

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