International Seminar On 'glomerular Diseases' Being Organized At Muljibhai Patel Urological Hospital, Nadiad, On 19-20 August 2011 Kidney Diseases Have Attained Epidemic Proportion All Over The World. End Stage Renal (kidney) Disease (esrd) Affects As Much As 1.8% Of Our Population And About 17% Are At A Risk Of Developing Kidney Diseases. Treatment Of Esrd Is Beyond The Means Of Common Man Even In Advanced Rich Countries. Glomerular Disease Contributes To 25% Of Esrd Patients. These Are Treatable Diseases And Can Be Prevented In Several Situations. Prof. John Feehally, President, International Society Of Nephrology, Will Be The Main Speaker In This Two Day Seminar. Several Reputed Teachers In Nephrology From All Across India Will Also Be Deliberating As A Faculty. The Seminar Will Be Attended By 150 Nephrology Professionals Consisting Of Nephrologists And Postgraduate Students In Nephrology. This Seminar Is Expected To Give A Boost In Understanding Of Glomerular Disease, It's Treatment And Cutting Edge Research In This Field In Our Country. Joseph@mpuh.org

Patients Must Be Told To Undertake Lifelong Art. Start Treatment For Symptomatic Patients Regardless Of Cd4 Cell Count. Start Drugs For Asymptomatic Individuals With Cd4 Cell Counts <500/l. Do Risk Reduction Counseling At Each Patient–clinician Interaction. Regimen: Consider Resistance–testing Results And Predicted Virologic Efficacy, Toxicity And Tolerability, Pill Burden, Dosing Frequency, Drug–drug Interactions, Comorbidities, Patient And Practitioner Preference, And Cost And Affordability. Combine Two Nucleoside Reverse Transcriptase Inhibitors And A Potent Third Agent From Another Class. Prefer A Fixed–dose Formulations And Once–daily Regimen. Suppress Hiv To Less Than 50 Copies/ml (polymerase Chain Reaction) Or 75 Copies/μl (branched Dna) By 24 Weeks. To Detect Failure: Repeat Testing Of Hiv–1 Rna 2 To 8 Weeks After Initiation, Every Four To Eight Weeks Until Suppressed, And Then Every 3 To 4 Months For At Least The First Year. Monitor Cd4 Cell Counts At Least Every 3 To 4 Months After Starting Therapy, Especially In Patients With Counts <200/μl, To Assess Whether Prophylaxis Is Needed For Opportunistic Infections. Do More Frequent Monitoring In Patients Who Have Changed Therapy Because Of Virologic Failure. Even If One Or More Regimens Have Failed, The Therapeutic Goal Should Still Be Undetectable Plasma Hiv–1 Rna Levels. Achieve This Goal With New Drugs And Regimens. If An Elevation In Viral Load Occurs After Complete Suppression Is Achieved, Consider Poor Adherence, Drug–drug Interactions, Concurrent Infections And Recent Vaccinations As Possible Causes Before Changing Regimens. Repeat Testing For An Isolated Detectable Viral Load To Exclude Errors Or Self–resolving Low–level Viremia. When Changing Regimens After First– Or Multiple–regimen Failure, Consider The Stage Of Hiv, Nadir And Current Cd4 Cell Count, Comorbidities, Treatment History, Current And Previous Drug Resistance Tests, And Drug Interactions. Include At Least Two Drugs, And Preferably Three Fully Active Drugs Or Drugs From New Classes. Single–agent Switches To Decrease Toxicity, Avoid Drug Interactions, Or Improve Convenience And Adherence Are Possible, Provided The Potency Of The Regimen Is Maintained And Drug Interactions Are Managed. Boosted Protease Inhibitor Monotherapy Is Not Recommended, Except When Other Drugs Raise Issues Of Toxicity Or Tolerability. Delaying Such Switches May Affect Adherence And Risk Development Of Resistance

Most People Think Of Pain As Resulting From Physical Injury Or Disease,but Psychological Factors Play A Huge Role In Pain Perception. Pain Is Intimately Tied To Brain Functions That Govern Behaviour And Decision Making, Including Expectation, Attention And Learning. Pain Makes One Feel Tired; It Is Mentally Draining, Making One More Irritable, Emotional And Unable To Remain Positive. It Is Hardly Surprising That As A Result, Things Can Rapidly Spiral Out Of Control. After All, If A Person Goes From Being Energetic, Fun-loving And Happy, To Being Edgy, Withdrawn And Lethargic Because Of The Pain, It Is Inevitable That Very Quickly Family & Social Relationships Begin To Change. An Employer Or Colleague Who Sees A Promising Employee Beginning To Look Tired, Stressed And Tearful, May Quickly Change Their Opinion About That Person’s Abilities To Cope. A Definition Of Pain Pain Is Not Easy To Define. In 1979, The International Association For The Study Of Pain(iasp) Published Its First Working Definition Of Pain: “an Unpleasant Sensory And Emotional Experience Associated With Actual Or Potential Tissue Damage, Or Described In Terms Of Such Damage.” This Definition Emphasizes Not Just The Sensory Nature Of Pain And Its Relation To Tissue Injury, But Also Its Unpleasant Emotional Component And The Fact That It Can Be Felt Just The Same Without An Obvious Cause. The Definition’s Significance Is Exemplified By Pain Lasting Beyond The Point Of Tissue Repair (spinal Cord Injuries) Or Appear Without Tissue Damage (migraines) Or Be Felt By Stimuli That Do Not Normally Evoke Pain, Like Lightly Touching The Skin (post Herpetic Neuralgia). So There Is Much More To Pain Than A Simple Sensory Process. Psychogenic Pain Psychogenic Pain, Also Called Psychalgia Or Somatoform Pain Is Pain Caused, Increased, Or Prolonged By Mental, Emotional, Or Behavioral Factors. Headache, Back Pain, And Stomach Pain Are Sometimes Diagnosed As Psychogenic. Sufferers Are Often Stigmatized, Because Both Medical Professionals And The General Public Tend To Think That Pain From A Psychological Source Is Not “real”. However, Specialists Consider That It Is No Less Actual Or Hurtful Than Pain From Any Other Source. “the Term ‘psychogenic’ Assumes That Medical Diagnosis Is So Perfect That All Organic Causes Of Pain Can Be Detected; Regrettably, We Are Far From Such Infallibility… All Too Often, The Diagnosis Of Neurosis As The Cause Of Pain Hides Our Ignorance Of Many Aspects Of Pain Medicine.” Ronald Melzack, 1996. Why Visit A Psychologist For Pain? One Might Wonder “why Consult A Psychologist If I Have Pain? Are You Telling That The Pain Is All In My Brain?” In One Word, No! Pain Is Seldom, If Ever Exclusively Psychologically Caused. However, The Mind And The Body Are Tied Together In Physiological & Philosophical Terms, And The Mind Can Either Be Of Incredible Help In Healing Or Can Be An Overwhelming Obstacle. Consulting A Psychologist Certainly Does Not State That The Pain Is All In The Person’s Brain, As Unfortunately Some Clients Have Been Advised By Physicians Unable To Establish The Physical Basis Of The Pain. How Can Psychology Help? Psychology May Reverse Some Of The Impact Of The Pain Giving People A Greater Sense Of Control, Reducing Anxiety, Whilst Improving Memory, Concentration And Self-esteem. The Aim Is To Help People Work Out How To Live Their Life As Normally And In The Most Satisfying Way Possible, Despite The Pain. The Psychologist Will Not Tell How To Live One’s Life- After All You Are The Best Expert On How To Be Yourself. Our Role Is To Help One Explore And Discover What Things In Life Are Important And Meaningful, And What Factors Past And Present Stand In The Way Of Regaining Control Of His Or Her Life. Psychologists Assess And Treat Individuals Coping With Chronic Pain. Assessment Often Involves Examination Of Coping Skills And Looking For The Presence Of Depression, Post-traumaticstress And Other Disorders Which Can Occur In Chronic Pain And Traumatic Injuries. Psychologists Employ Treatment Strategies Such As Muscle Relaxation And Cognitive-behavioural Approach To Help Manage Pain And Improve Functioning. Chronic Pain Causes Disruption Of Self-esteem, Occupational & Family Roles. Stress Reactions And Pain Cause The Mind & Body To Become Aroused And Ready For Action. Increased Emotional And Physical Tension Accompany This State Which May Become Chronic, Resulting In Further Increased Pain, Reduction Of Function And Increased Risk Of Anxiety & Depression. Chronic Pain Sufferers May Find It Difficult To Focus On Things Other Than Their Pain, And Lose Access To The Satisfying Things They Previously Enjoyed. Others May Find It Difficult To Reduce Their Expectations And May Overdo Activities Resulting In Further Injuries Or A Cycle Of Overwork And Disability. Relaxation Therapy Along With Cognitive Behaviour Therapy Is Our First Line Of Treatment, Along With Medical Interventions. It Is Customized To One’s Individual Needs, And May Include: Relaxation Training Cognitive Restructuring Stress Management Sleep Hygiene Activity Pacing Coping Strategies & Assertiveness Training The Psychological Interventions Which We Provide At Axon Pain Management Are Highly Effective In Reducing Pain, Disability And Distress, With A Positive Impact On Your Quality Of Life. About The Author: Dr Johnsey Thomas Is A Registered Practitioner Of Clinical Health Psychology In Hyderabad – India, Associated With Axon Pain Management. He Deals With A Wide Range Of Problem Areas, With A Passion For Working With People Suffering From Pain. He Mentions Chronic Pain As One Of The Most Demanding Problem People Come Across With, Which Can Devastate Lives In Terms Of Work, Activities And Relationships