Paracetamol: toe the line on proper dosage

Serena Josephine M.

CHENNAI, APRIL 02, 2019 00:00 IST

Excessive use is detrimental to children’s health, say doctors

When children have fever, the majority of parents invariably turn to a commonly used medication — paracetamol. While paediatricians consider paracetamol as a safe drug when given in the prescribed dose, any excess in dosage could be detrimental to the child’s health, even to the extent of causing damage to the liver, they add.

Recently, doctors at a private hospital received a child with serious damage to the liver. The child had fever and the parent administered paracetamol continuously for three days without checking the temperature. Three days later, the child was in a critical condition due to paracetamol toxicity, but went on to recover with treatment.

“Paracetamol is a safe drug when given in the correct dose. Any excess in dosage could cause acute liver cell failure. In such circumstances, children present with drowsiness, vomiting and extreme weakness. But paracetamol overdose may not always be symptomatic. Sometimes, symptoms may emerge two or three days later. So, it is important to make an early diagnosis to save children from acute hepatic failure,” said S. Balasubramanian, medical director of Kanchi Kamakoti CHILDS Trust Hospital.

He drew attention to U.K.’s NICE guidelines that say there is no need to treat fever unless it causes discomfort. “Most children may feel uncomfortable when the temperature is 101 or 102 degree Fahrenheit. Then, we need to relieve the discomfort,” he added.

Drops and syrups

P. Ramkumar, senior consultant paediatrician, Institute of Child Health and Government Hospital for Children, said there is basically confusion between paracetamol drops and syrup. “I frequently remind parents that there is a huge difference between the two. A dosage of paracetamol drops is five times more powerful than say, the same dosage of the syrup, but many are unaware of this,” he said.

Abdominal pain, irritability, generalised weakness, loss of appetite, jaundice, diarrhoea, nausea, vomiting, convulsions and coma are the symptoms of a paracetamol overdose. “Most of the bottles have the dose printed on them and parents should follow the instructions. It should be given once in six hours in the recommended dosage — not more than four times in 24 hours,” Dr. Ramkumar said.

T. Sivaraman, consultant, paediatric intensivist, pointed out that he does receive children with inadvertent overdose of paracetamol such as when it is given eight times instead of the prescribed four times.

A delay in seeking medical help will lead to liver failure requiring a transplant, he said, adding: “Children come to us with a history, dullness and vomiting. Parents might assume these are caused by the fever. We take their previous history into account and check for signs of toxicity. If we suspect paracetamol toxicity, the treatment is started immediately.”

Rs 85 crore Madras University deficit budget sparks concern, student fees may go up

TNN | Mar 31, 2019, 05.39 AM IST

CHENNAI: University of Madras on Saturday presented a budget with a deficit of ₹84.92 crore for 2019-20, sparking concern about the finances of the 162-year-old institution and the possible impact it may have on student fees that have remained unchanged for nearly 15 years.

The university is in a situation where costs are rising, but it has not been able to increase the fees. A resolution passed by the syndicate and senate to increase the fees was delayed by the governor’s office which wanted to know the social impact of the move.

Last year’s budget had a deficit of ₹61.02 crore on a total budget of nearly ₹250 crore, according to reports.At a meeting, the senate resolved that the university would have to use its resources properly and look to increase the revenue to make good the deficit. Professor S Karunanidhi asked how the deficit was going to be made up and sought for an action plan.

Professor Manivasakan said the funds to pay salaries would only last two or three months, adding that the university could be hurtling towards a situation similar to that faced by Annamalai University.

Senators asked vice-chancellor P Duraisamy, a distinguished economist, to take action to stem the fall and present a white paper on the finances.

One of the main reasons for the current situation, vicechancellor P Duraisamy said, was due to the implementation of the Seventh Pay Commission recommendations that had increased the salary bill.

‘Salaries of those hired after 1996 not covered by grants’

Duraisamy said, “The state government has been requested to support the pension and retirement benefits under the old pension scheme”. Sources said ₹30 crore to ₹40 crore had been sought from the government.

The objections raised by the local fund audit, a process in which use of funds sanctioned by state and central government agencies are questioned, were also tabled at the senate meeting. Of the 73 audit objections raised, many have existed since 2004, but Duraisamy said the number of objections had dropped during his twoyear term.

Many of them dealt with improper appointments in the teaching and non-teaching wings. “We are paying salaries to non-teaching staff to the tune of ₹56 crore, but we are only eligible for ₹36 crore. In some cases, the stance of the university and auditors is different,” he said. The recruitment of assistant registrar/deputy registrar was not allowed as the university did not follow a government order to recruit 50% from the open market, he said.

Another major issue, Duraisamy said, was that the government had approved posts filled as per vacancy list prior to January 1996, but salaries for those recruited after that have not been covered by government grants.

Professor Jothi Sivagnanam demanded that the audit report include info about the total objections pending and the action taken, while professor Ramu Manivannan said the objections were due to financial abuses and urged Duraisamy to take action against past offenders.

Objections had been raised against the running of various centres, professor Manivasakan said and suggested adopting minimum qualification requirements to curb irregularities in appointments.

Expressing confidence that the crisis could be resolved, professor M Srinivasan requested the university to fill all teaching staff vacancies as even Supreme Court has given the nod.

Professor S Karunanidhi said an alumnus of the university had donated ₹80 crore for construction of a hostel many years ago and requested that the hostel be named after the person. “This would encourage more alumni to donate,” he said.

Qatar visa centre at Saligramam

TNN | Mar 31, 2019, 09.25 AM IST

CHENNAI: Qatar will open its visa centre in the city at Saligramam to facilitate hassle-free recruitment process and ensure speedy completion of procedures to obtain visas and residence permits for the State of Qatar. This is part of the seven such centres which will be opened across the country.

Work visa applicants will be able to sign on work contracts digitally, enroll their biometrics and undergo mandatory medical test.

The visa centre will be located at Shyamala Towers, east wing, 136 Arcot Road, Saligramam.

Already launched in New Delhi and Mumbai, the visa centers in Kochi, Hyderabad, Lucknow and Kolkata will be opened soon.

Fewer PG medical applicants this year

TNN | Mar 31, 2019, 09.56 AM IST

CHENNAI: The rank list for admission to postgraduate medical courses released by the state selection committee on Saturday had several surprises - fewer students had applied compared to 2018 in spite of more seats. Admission is also likely to get tougher as the number of students with high scores are more.

There were 10,297 candidates compared to 10,576 in 2018. While Dr C R Arunkumar with 1007.5/1200 and Dr V Tamilarasu with 1001.25/1200 got four digit scores, more than 22 had scores above 900, 240 above 800 and more than 1000 had more than 700. The rank list was published on www.tnhealth.org and www.tnmedicalselection.org and counselling will begin on Monday.

Incentive marks - up to 30% of NEET score were given to in-service candidates based on geographical area of work as per recommendation of the Justice A Selvam committee. Those in hilly areas will get up to 10% for each year, those in "difficult plain areas" 9%, those in remote areas 8%, and government doctors in rural areas 5%.

All three toppers are from in-service candidate list, 9 among the top 20 and 27 in top 100. "Toppers will have a big advantage. Many would have been allotted seats in round 1 of all India counselling.

And they have time till April 3 to join. They can come to state counselling to see if they have a chance of getting better course or college," said selection committee secretary Dr G Selvarajan.

However, those joining colleges through all India counselling can't participate in state counselling.

On March 11, the state uploaded prospectus for counselling. The state attempted to take the process online, but the selection committee has decided counselling will be off line. Courses will begin by May 1 and admissions closed by May 31.

This year there will be 899 PG medical seats and two diploma seats in the state bouquet apart from 177 seats in self-financing colleges and institutions.

In the dental category, there are 42 seats in government colleges and 105 in self-financing colleges. Last year, there were 981 PG and diploma state quota seats across 15 government colleges, including 117 vacant all India quota seats returned by the DGHS.

Low fare offers make travel to the US cheaper this summer

TNN | Apr 1, 2019, 06.59 AM IST

CHENNAI: A summer low fare sale introduced by Etihad Airways and Emirates and ticketing portals has brought down the air fare from Chennai to destinations in the US for travel in April and May.

Etihad’s offer of return fare starting at Rs 64,000 to the US is aimed at encouraging passengers who have not planned their trips to plan a holiday. But the offer has led to a general dip in airfare across airlines on the route.

The summer months are peak travel season as families travel to the US to meet relatives. There is a Rs 10,000 to Rs 12,000 decrease in the fare when compared to previous summer months because of the offer. As the airlines in the Middle East which fly via hubs in Dubai, Abu Dhabi and Doha are offering cheaper tickets, the cost of air travel to the US has come down compared to the airlines which fly via Europe or the UK. People need not spend more than a lakh to travel to the US this summer.

The starting return fare for is at Rs 67,000 to New York and Chicago, while it is at Rs 80,000 to Los Angeles and Rs 68,000 to Washington for travel in mid-April. These fares should have been higher by Rs 10,000 usually.

“Etihad, Emirates and Qatar Airways are most preferred by travellers from Chennai. Etihad and Emirates have an offer running which has led to a dip in fare. But because of high demand some of the best fare are not available on weekends,” said Basheer Ahmed of Metro Travels. He said foreign airlines have started to introduce offers on routes from India to the US via the Middle East because the advance booking period window has reduced from six months to two months.

“People these days book tickets two to three months in advance on the route while there used to be long advance booking two years ago. The offers are being introduced because people did not book seats for travel in April and May well in advance this year, a trend different from last year. The fare cut will now cater to people who prefer to book tickets now for travel end of April or May.”

Flying by European airlines are not only expensive but the choice of hub is limited. After Dubai grew as a hub for transit to different destinations, European carriers have begun facing tough competition to attract passengers who travel to the US. Besides, the Middle Eastern countries have started to encourage travellers to make a stopover in Dubai or Abu Dhabi before proceeding to destinations in the US by offering easy transit visa.

Anna University faculty struggle to set exam papers

TNN | Apr 1, 2019, 07.04 AM IST

CHENNAI: Teaching faculty at Anna University have been advised to seek assistance from temporary teaching staff as many found it difficult to set question papers for the forthcoming semester exams.

Earlier this year, the university’s syndicate, the top-most decision making body, decided not to involve teaching fellows in exam-related work citing security reasons.

The university has more than 250 fellows recruited on contractual basis to handle engineering and humanities at undergraduate and postgraduate levels. Amid protests by teaching fellows demanding regularization of services and re-designation of them as assistant professors (on contract), the university not only rejected their plea but also removed them from exam-related duties in order to prevent question paper leaks.

As many as 37 lower-level temporary staff were sacked in connection with leaks reported in 2017 and 2018, according to official data. By eliminating them from the exam process, the university heads has landed in a Catch-22 situation.

Many regular faculty, who were assigned the duty of setting up question papers for the end-semester exams scheduled in April/May 2019, are finding the process difficult, said a source from the university. “Some of the regular faculty members couldn’t set question papers for certain courses as they didn’t handle them. Besides, they were asked to prepare a large number of question papers within a short period of time,” said the source. 

According to an internal communication (copy accessed by TOI) to staff members, the university admitted that heads of various departments are likely to face issues in identifying alternatives for TFs to set question papers. So, the university has advised the heads of departments (HoDs) to obtain model question papers from teaching fellows who handled the course, along with assessment question papers and last year question papers.

“A faculty identified by the HoD will be given all these papers as a base to suitably set the question paper,” the internal communication added.

3-bank merger: BoB will be net job creator

Mayur.Shetty@timesgroup.com

Mumbai:02.04.2019

The complete integration of Dena Bank and Vijaya Bank with Bank of Baroda (BoB) is expected to take nearly 18 months. But customers will reap the benefits much earlier. BoB will be providing cash deposit and withdrawal facility in all branches by May. In an interview with TOI, BoB MD & CEO P S Jayakumar speaks of what customers, employees and investors can expect. Excerpts:

What is the timeline for the integration?

The ATM networks have already been merged and customers will not face any charges. The merger of the three treasuries is effective today (April 1). The core banking integration will take 12 to 18 months. This was the time it took us to migrate from Finacle 7 to Finacle 10 (versions of the core banking software) — 12 months for preparation and six months for stabilisation of the platform. But customer experience in terms of consistency in various branches will be achieved much earlier. The first set of interoperable functions will be rolled out in the first week of May. These will include cash deposits, cash withdrawals, fund transfer and obtained statement of account. We have enabled this by connecting the data centres.

When will you rationalise branches? Do you feel there will be a need for a voluntary retirement scheme (VRS)?

Before we migrate branches, we must meet the technology preconditions for interoperability. We are unlikely to reduce the number of branches but may relocate them to markets where we are not present. For instance, in Horniman Circle (in Mumbai), we have two branches next to each other. We may relocate one of them to Navy Nagar or Malabar Hill. But in the next six months, I do not see this happening. We need more people. There will be re-skilling as we need more people on the sales side. We will be net job creators. As they say, you can’t shrink to glory.

Will you review the current partnership for selling third-party products?

For life insurance, our own group company (IndiaFirst Life) will be the primary provider. As far as wealth management is concerned, it is an open architecture.

Will the employee costs change because of the merger? How will you manage cultural challenges?

The government’s amalgamation statement makes it clear that the better of the three will be adopted. The compensation structure is almost identical, but there are areas like loan policy and insurance benefits that had to be rationalised. Other than that, the wage structures are almost identical. Culturally, there are a lot of similarities. So long as we can ensure that promotions and responsibilities are based on merit and not dependent on the predecessor bank, the cultural integration will happen faster.

What business would you look to grow in the merged bank?

We will pursue sources of growth that do not necessarily call for capital such as fee income lines — forex business, government business and remittances. The idea is to serve the target market, not just by merely giving them a loan. In retail, it will continue to be mortgages, education, personal loans and auto loans. We have invested a lot in analytics and the delivery platform for cross-selling. This will help us identify customers and sell more efficiently without formfilling or one more round of KYC.