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Category : All ; Cycle : December 2013
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Dec31
HIV /AIDS TREATMENT DEVELOPENT & RESEARCH FOR VACCINE ND MEDICINES IN YEAR 2013-HAPPY NEW YER 2014
HIV /AIDS DEVELOPMENT IN YEAR 2103 :ZERO GOAL & TREATMENT TO ALL: NO DISCRIMINATION,NO SHAME NO STIGMA : TAKE TREATMENT AND CURE IT
HAPPY NEW YEAR 2104 TO ALL MY FRIENDS,HIV/AIDS FRIENDS/MEMBERS OF LGBT
PROF.DRRAM ,HIV/AIDS,SEX DISEASES,SEX WEAKNESS & ABORTION SPECIALIST
profdrram@gmail.com,07838059592, DELHI –NCR,marriage & sex counseling
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FEW SUCCESSFUL STORIES OF HIV TREATMENT OF YEAR 2013 IS AS FOLLOWS:----
HIV research and development achieved several discoveries in 2013 - from drug therapy to unconventional and risky methods to eliminate the virus. Some of them found new things about HIV and plans to put them into trial. Here are some of notable anti-HIV results for this year to know what we can expect for 2014.
Saving Infected Cells
Two new discoveries are revealed by researchers at Dresden Technical University in Germany and Gladstone Institutes in California to save infected cells from HIV viral load. German scientists found out that there is a way to restore infected cells back to normal by cutting HIV viral load using an enzyme on the DNA of host cells. Scientists in California figured out that HIV host cells are killed by the immune system by Pyroptosis and stopping the process will prevent the body to eliminate infected cells in order to stop further spread of viral loads.
Vaccine Research
Scientists from Spain and United Kingdom are expected to begin clinical trials against HIV in the coming years. Spanish Hospital researchers announced an upcoming plan in 2014 regarding a new drug to treat the disease instead of preventing it. Experts and clinicians from five leading universities in United Kingdom aim a functional cure for HIV by starting clinical trials. It will be a combined therapy of antiretroviral drugs and two additional components to wipe viral loads completely.
Genetic and Transplant
Bone marrow transplant has been used as an unconventional method to cure or treat HIV/AIDS. Timothy Brown is the only survivor with no reoccurrence of HIV viral load after a successful transplant to treat his blood cancer. The genetic mutation called CCR5 delta 32 from his donor provided resistance against the virus which prevented HIV from killing off T cells in Brown's blood.
Scientists are looking into a solution to engineer drugs or methods to replicate such genetic mutation to allow HIV/AIDS patients to resist the viral effects. CCR5 delta32 genetic flaw will prevent HIV to attach on T cells and allows the immune system to cleanse out the entire body.
HIV just got a new strain that can put someone into AIDS stage in just five years. Since there is no cure or vaccine against the usual strains, it is going to be more dangerous if HIV mutates again and developed another dangerous strain. Hopefully, all clinical trials receive positive results and reach commercial markets next year.


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Dec31
Choking Child
Just after I had gone to bed after a heavy day of plenty of surgeries, I got a call from emergency room. A four year old baby has been rushed into the emergency with sudden inability to swallow & throat pain. In minutes I was there. Parents were in great anxiety & the child was crying continuously. Mother said that she had seen her playing with a two rupee coin and suddenly her condition became an emergency.

So we rushed her to X-ray department and found that the coin was stuck up in her upper part of food pipe. It was too big to go inside and too big to vomit out. It was completely stuck. It was blocking the food pipe and hence she could not even swallow her own saliva. I immediately called the anesthetist and rushed her to the endoscopy department. Although the child has dinner just few hours ago, I had to take her up and relive her from this life threatening situation.

Under general anesthesia, I entered the food pipe. Saw the coin impacted. Under anesthesia the coin had moved downwards. There was not much space in this small child's food pipe for me to manipulate it to come out. I gently pushed it into the stomach taking care that I do not damage her delicate food pipe. Once the coin was in stomach, there was ample of space for me to manipulate the coin & put it into a special wire basket that I introduced it thro my endoscope.

Under vision, I gently pulled put the coin thro the food pipe. The basket had gripped the coin so well that there was no chance that while removing the coin would fall into the windpipe or oral cavity. The parents were greatly relieved. Next morning the child was as playful as before and was discharged.

Parents should be careful about the objects that their children play with. I have removed buttons, parts of toys, coins, button cells and even pins. These are potentially dangerous and can cause sudden accidental catastrophe in the family.


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Dec29
Mississippi baby cured of HIV!: A BREAK THROUGH RESEARCH OF YEAR 2013 :
Mississippi baby cured of HIV!: A BREAK THROUGH RESEARCH OF YEAR 2013 :

PROF.DRRAM ,HIV/AIDS,SEX DISEASES,SEX WEAKNESS & ABORTION SPECIALIST
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In what could be termed the biggest medical breakthrough in the last century, a baby born with the AIDS virus has been cured of the diseases after following an aggressive regime of drugs. This is the second documented case of a person being completely cured of the virus after an adult known as the Berlin Patient was cured as a result of bone-marrow transplant.This startling piece of information was discovered when the baby’s mother stopped treatment and doctors lost track of the baby who was given a bout of heavy drugs (current procedure suggests only a modest daily dose of antiretroviral treatment) about 30 hours after she was born at a rural Mississippi hospital, doctors said at a medical meeting in Atlanta.

The baby was born to an HIV positive mother who didn’t know she had the virus so hadn’t taken any antiretroviral treatments before giving birth. The infant was immediately put on anti-HIV medication regime which lasted for 18 months after which the mother disappeared. When the child returned for care five months later, it was found that she had an ‘undetectable viral load’ – the baby was no longer considered HIV-positive.Researchers and experts have cautioned against taking this as a standard case and it has no bearing on most people who contract the virus in adulthood. However, further studies could spur widespread use of such an aggressive regimen in babies born with HIV, most of them in low and middle income countries.

Current WHO guidelines suggest treating infants with a modest daily dose of antiretroviral treatment for four to six weeks, in part because extensive studies haven’t been carried out on the subject yet. There’s however some evidence to suggest that the doctor’s approach of aggressive antiretroviral treatment within 30 hours of the infant’s birth may have led to this cure. Experts hypothesize that the heavy dose prevented the formation of the viral reservoirs that harbour the virus. These viral reservoirs are the key hurdle to treatment because even though AIDS drugs prevent the virus from replicating, it continues to lurk in the reservoirs and usually surge back when the treatment is stopped. The baby was constantly tested for the virus and has now been virus-free for one year.


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Dec29
HIV /AIDS CONTROL ; BY GENE THERAPY HUMAN MX2 GENE KILLS IT -RESEARCH OF YEAR
HIV /AIDS CONTROL: BY HUMAN MX2 GENE-GREAT RESEARCH OF YEAR 2013

PROF.DRRAM ,HIV/AIDS,SEX DISEASES,SEX WEAKNESS & ABORTION SPECIALIST
profdrram@gmail.com,07838059592, DELHI –NCR,marriage & sex counseling
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Human body has got so many genes out of which one gene known as MX@ Gene hs been isolated and it is found that in nimal experiment this gene inhibit HIV Virus bypenetrating its envelop and proteins associated with it .

so there is role of Human MX2 gene effective in inhibiting HIV

A study published in the journal Nature identified the role of human MX2 gene in inhibiting HIV, thereby preventing the spread of the virus after entering the body. Researchers suggest that MX2 gene could be used as the new target for developing efficient, less toxic treatments involving the body’s own natural defense mechanism against the virus.


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Dec28
MEDICAL MISTAKES CANNOT BE EXCUSED -SO BE CAUTIOUS THEY NEVER OCCUR IN AN DOCTORS LIFE TREATING PATIENTS:-
SOME MEDICAL MISTAKES CANNOT BE EXCUSED -SO BE CAUTIOUS THEY NEVER OCCUR IN AN DOCTORS LIFE TREATING PATIENTS:------

DR.D.R.NAKIPURIA,drnakipuria@gmail.com,09434143550,09832025033

1- Joan Morris (a pseudonym) is a 67-year-old woman admitted to a teaching hospital for cerebral angiography. The day after that procedure, she mistakenly underwent an invasive cardiac electrophysiology study. After angiography, the patient was transferred to another floor rather than returning to her original bed. Discharge was planned for the following day. The next morning, however, the patient was taken for a open heart procedure. The patient had been on the operating table for an hour. Doctors had made an incision in her groin, punctured an artery, threaded in a tube and snaked it up into her heart (a procedure with risks of bleeding, infection, heart attack and stroke). That was when the phone rang and a doctor from another department asked “what are you doing with my patient?” There was nothing wrong with her heart. The cardiologist working on the woman checked her chart, and saw that he was making an awful mistake. The study was aborted, and she was returned to her room in stable condition.

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2- In what was, perhaps, the most publicized case of a surgical mistake in its time, a Tampa (Florida) surgeon mistakenly removed the wrong leg of his patient, 52-year-old Willie King, during an amputation procedure in February 1995.

It was later revealed that a chain of errors before the surgery culminated in the wrong leg being prepped for the procedure. While the surgeon's team realized in the middle of the procedure that they were operating on the wrong leg, it was already too late, and the leg was removed. As a result of the error, the surgeon's medical license was suspended for six months and he was fined $10,000. University Community Hospital in Tampa, the medical center where the surgery took place, paid $900,000 to King and the surgeon involved in the case paid an additional $250,000 to King.

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3- In St. Louis Park, Minnesota, a patient was submitted at Park Nicollet Methodist Hospital to have one of his kidneys removed because it had a tumor believed to be cancerous. Instead, doctors removed the healthy one.


"The discovery that this was the wrong kidney was made the next day when the pathologist examined the material and found no evidence of any malignancy," said Samuel Carlson, M.D. and Park Nicollet Chief Medical Officer. The potentially cancerous kidney remained intact and functioning. For privacy and family's request, no details about the patient were released.

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4- A West Virginia man's family claims inadequate anesthetic during surgery allowed him to feel every slice of the surgeon's scalpel - a trauma they believe led him to take his own life two weeks later. Sherman Sizemore was admitted to Raleigh General Hospital in Beckley, W.Va., Jan. 19, 2006 for exploratory surgery to determine the cause of his abdominal pain. But during the operation, he reportedly experienced a phenomenon known as anesthetic awareness -- a state in which a surgical patient is able to feel pain, pressure or discomfort during an operation, but is unable to move or communicate with doctors.

According to the complaint, anesthesiologists administered the drugs to numb the patient, but they failed to give him the general anesthetic that would render him unconscious until 16 minutes after surgeons first cut into his abdomen. Family members say the 73-year-old Baptist minister was driven to kill himself by the traumatic experience of being awake during surgery but unable to move or cry out in pain.

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5- When Nancy Andrews, of Commack, N.Y., became pregnant after an in vitro fertilization procedure at a New York fertility clinic, she and her husband expected a new addition to their family. What they did not expect was a child whose skin was significantly darker than that of either parent. Subsequent DNA tests suggested that doctors at New York Medical Services for Reproductive Medicine accidentally used another man's sperm to inseminate Nancy Andrews' eggs.

The couple has since raised Baby Jessica, who was born Oct. 19, 2004, as their own, according to wire reports. But the couple still filed a malpractice suit against the owner of the clinic, as well as the embryologist who allegedly mixed up the samples.


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Dec28
DOCTORS WEAR WHITE COAT -WHY ONLY WHITE COAT NOT OTHER COLOR DRESS ?
The American Medical Association voted on a resolution that would recommend hospitals ban doctors' iconic white lab coats, citing evidence that the garment contributes to the spread of infection. Indeed, a number of studies have shown that the coats harbor potentially harmful bacteria.

If white coats are so bad, why do doctors still wear them?

Because a white lab coat says "I am a scientific healer." The knee-length coat in medicine crossed over from the laboratory sciences at the turn of the 20[SUP]th[/SUP] century. Before that time, medicine was generally seen as the haphazard province of quacks and frauds, and physicians wore street clothes even in the operating room. As the field developed into a respected branch of applied science in the early 1900s, doctors adopted the costume of the laboratory as a way of bolstering their scientific credibility.

In pre-white-coat times, physicians used primitive tools and techniques and had little formal training. (Medical school could be finished in a year.) Early doctors competed for legitimacy (and patients) with other healing arts like homeopathy and medical eclecticism. But the development of antiseptics and anesthesia, among other things, demonstrated the exceptional power of science to improve health.

Doctors strove to become more scientific, in practice and in dress. The lab coat served both purposes by providing a (supposedly) sterile work environment and soothing patients with its air of scientific authority. The traditional lab coat was beige, but doctors adopted white because the color symbolizes life and purity. (In earlier times, doctors were more likely to wear black, in keeping with the high mortality rates seen at hospitals. The nuns who served as nurses often wore black habits.) By 1915, physicians working in hospitals had for the most part switched from street clothes to white coats and pants.

With their scientific bona fides firmly in place, doctors today are divided on the white-coat question. Supporters say the coat instills docs with a humbling sense of responsibility and puts patients at ease, while detractors see it as an alienating symbol of medical hubris. More than 100 medical schools host "white coat ceremonies" where first-year med students are outfitted with shortened versions of the white coat, and the coats are ubiquitous at large teaching hospitals where they help differentiate between doctors and students.

However, doctors in smaller hospitals and private practice are more likely to wear regular clothes. A recent study suggests that only 1 in 8 doctors actually sport a white coat at work. Perhaps the most ardent supporters of the garment are patients: In one study, 56 percent of those surveyed believed doctors should wear coats, compared with only 24 percent of doctors. (Elderly people tend to be most supportive of the white coat.) Another study found that patients were much more likely to trust a doctor if they were wearing a white coat than if they were in scrubs.

If hospitals followed the AMA resolution and banned the white coat, what would doctors wear? The Scottish National Health Service outlawed white coats and instituted a uniform of color-coded scrubs for all medical personnel. The Mayo Clinic doesn't allow white coats; their doctors wear business attire.


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Dec28
BEST MEDICAL APPS FOR MEDICAL STUDENTS AND DOCTORS ON ANDROID PHONES-LEARN FROM THIS AND USE IT
The Best 15 Free Android Medical apps for Doctors and Medical Students


1. Medscape

One of the most anticipated apps to hit Android, Health care professionals had been waiting eagerly for this comprehensive medical application. Medscape was just recently released on the Android Market and has already become the number one downloaded medical app for the Android platform.

The amount of free content provided by Medscape is absolutely mind numbing and seems to continuously grow with each update. 7,000+ drug references, 3,500+ disease clinical references, 2,500+ clinical images and procedure videos, robust drug interaction tool checker, CME activities, and more.

Medscape is a great drug reference app — but many don’t realize it’s also a mini-textbook packed with protocols for disease pathologies — great for a quick reference and refreshing you medical knowledge. Its not as detailed as the famous Pocket Medicine Red Book — but it does more than an adequate job of providing clinical pearls from the most common to less common pathologies. On top of this, the application has instructional medical procedure videos and pictures.

2. Epocrates

The free version of Epocrates is considered by many to be an essential drug reference. Useful and easy-to-learn features like the pill identifier, several medical calculators, and drug interaction checker make Epocrates a favorite of clinicians and students alike.

Of note, Epocrates recently announced support for the premium versions of Epocrates on the Android platform.

As with other popular and new Android apps, Epocrates is not available for Android users with older operating systems (version 1.5 or older).

3. Skyscape

This app makes our top ten list for two major reasons: First, until recently Skyscape has been the only high-quality all-in-one type app for Android. Many of the quality android medical apps we have reviewed, such as the Red Book and Netter’s Anatomy have worked within Skyscape’s universal app. Second, it’s available on all Android operating system versions.

By all-in-one, we essentially mean that Skyscape offers health care professionals and students access to a robust selection of medical calculators (Archimedes), periodically updated medical news alerts, select practice guidelines, access to paid textbooks (like Netter”˜s), and solid drug reference (RxDrugs) and disease monographs (Outlines in Clinical Medicine).

Users of older Android operating systems who cannot access Medscape and Epocrates will find that Skyscape, which includes RxDrugs, is a fair replacement.

4. Evernote

Evernote is a great organization tool that can be especially useful for health care professionals and students. There are not many quality PDF organization apps on the Android Marketplace, and Evernote shines above most of the paid apps. Evernote allows you to access and read your PDF documents on the go. Other tools, such as notes and image capture allow you to record atypical disease pathology encountered while practicing for your own reference — possibly even a future presentation.

5. Calculate by QxMD

Calculate by QxMD scores major points (and lands in our top 10) for its aesthetically appealing design and smooth user interface. The collection of medical calculators contained in this android app is wide enough in scope to satisfy most generalists and students.

Each calculator in the app progresses through a number of screens, often posing a question to the user to determine the score or value of interest. In contrast, most other medical calculator apps have a single screen with numerous input fields. Although this atypical method requires more clicks, it also enhances the learning experience without markedly slowing the process.

Those keen on referencing medical literature will be satisfied that the developers have included citations and PubMed links in the “More Information” tab

6. MedPage Today

We find that a well-designed medical news app can be the cure for an email inbox full of unread daily news headlines. MedPage Today is both simple and comprehensive in delivering medical news to your mobile device that is relevant to your particular subspecialty interest. Much of the content is partnered with the University of Pennsylvania School of Medicine — giving a reassuring sense of legitimacy to the news articles provided. Along with reading articles, CME activities are also presented in text, video, and audio form.

After specifying your interests and preferences, medical news stories from the MedPage Today web site are delivered to the “My News” app screen. Each category menu opens to reveal recent medical news stories in text and occasionally audio formats. It’s simple, clean,

7. Harvard School of Public Health

The Harvard School of Public Health News app is surprisingly functional and useful. We say surprisingly because Harvard isn’t the first school to make an application to push their content, but they stand out amongst their peers for the simplicity, overall user interface, and solid functionality delivered by the application.

The app features news articles from the School of Public Health — however, the articles link to the school website, and it would be nice if the articles were native or customized for the app. But the true functionality comes from the delivery of educational audio and video content. Some of the best minds in Public Health are at Harvard and the multimedia content is rich with useful knowledge.

In these pictures you can see one of the recent audio podcasts by Dr. Milton Weinstein on comparative effectiveness research. His podcast is a great overall summary of the history of comparative effectiveness research and also how it applies to current times, mixed with the current political ramifications ”“ great listening material. The app will even send you notifications when new audio and video content is available. As the pictures show, the application is embedded deeply with Twitter, allowing a dynamic and interactive conversation with the content contained in the app.

8. Monthly Prescribing Reference (MPR)

The Monthly Prescribing Reference (MPR) claims to be “The most widely used drug reference by clinicians.” For the many clinicians who use MPR, this app is a great mobile substitute.

Drugs are classified by treatment category, similar to the print version. Prescribing notes and drug monographs outline useful information for clinical practice.

9. Standard Dictations

The tedious work of internship is both challenging and overwhelming. For those of us who are soon-to-be interns an app like Standard Dictations is a welcomed anxiolytic.

This app has basic templates to read while dictating. Everything from admission orders to discharge summaries, along with numerous exams, procedures, and several different types of H&P formats for different health care settings. Of note, many EMRs offer similar templates. So residents who work with a robust EMR may not have as much need for this app.

10. USPSTF ePSS (electronic preventive services selector)

This is a public health tool provided to health care professionals by the US Department of Health and Human Services (HHS) — from the Agency for Healthcare Research and Quality (AHRQ) — the nation’s lead federal agency for research on health care quality, costs, outcomes, and patient safety.

As you can see from the included pictures, the application allows you to input your patient’s age, along with other key demographic information, and gives you the basic screening and public health information pertinent to your patient. Much of the content is based on the recommendations made by the United States Preventative Services Task Force (USPSTF). The app also provides great links to screening calculators and reference tools available on the web.

11. PubMed Mobile

This app is a quick and easy access to PubMed on a mobile device. Those who use PubMed regularly can put this app to good use. As we reviewed before, users can search for and view abstracts on a mobile device. After tagging articles of interest, the user can send article links via email or share articles through social networks. Features added to PubMed Mobile since our review include links to PubMed articles in a browser, and direct links to PubMed Central “PMC Free Articles.”

Health care professionals and students who need to have the latest evidence at their finger-tips (literally) will certainly find opportunities to use this app in a variety of clinical settings.

12. Ob (Pregnancy) Wheel

Some may call an OB Wheel app too specialty specific to make it into a Top 15 list for all health care providers. Nonetheless, many clinicians would find this app useful, such as those working in primary care, the emergency department, and of course, obstetrics. Medical students and residents would find utility with this app when rotating through OB/GYN or the emergency department. Curious mothers and fathers could also put the app to use.

Numerous adjustable preferences and settings, ultrasound exam dating, and dating ordered patient lists make Ob (Pregnancy) Wheel the best among several free and paid OB wheels available on the Android Market.

13. Eponyms

Eponyms are the bane of many students and providers health care existence. Eponyms are medical phrases or pathologies that are named after key people, such as “Beck’s Triad”. There are hundreds, if not thousands, of them, and it’s near impossible to keep them all straight.

This app contains over 1,700 of the most popular Eponyms and is a great resource to both help refresh your knowledge, and to also use as a reference material.

14. Speed Anatomy

If you are looking for a fun, quick-hitting anatomy quiz ”“ or you are interested in learning anatomy in four different languages ”“ then Speed Anatomy is your best bet among free anatomy apps. Unlike Netter’s Anatomy, Speed Anatomy is not an exhaustive atlas of human anatomy, and the drawings are unimpressive compared to Netters. It is, however, a great tool for students who are about to take their next anatomy practical exam. The faster and more accurately you identify structures, the more points you get.

Do not be fooled by the simplicity of the “overview” practice exams (can you identify a vein?); the more specific practice exams (nasal cavity, foot bones, brain, etc.) are difficult enough to challenge any student learning gross anatomy. In sum, this free anatomy quiz is a simple, but challenging supplement to your anatomy textbook.

15. Calorie Counter by FatSecret

This is a great application to use when counseling patients about diet and exercise. The application is extremely powerful, able to look up almost any type of food category ”“ fast foods, grocery store foods, and prepared foods. You can even scan barcodes with your camera and the app can identify the type of food along with allocating the appropriate calories.
DR.D.R.NAKIPURIA ,SENIOR GASTRO INTEST SPECIALIST & HIV/AIDS CONSULTANT
DR.MRS.RANJU NAKIPURIA,SENIOR GYNAECOLOGIST,OBST & INFERTILITY EXPERT
DR.MAYANK NAKIPURIA ,GENERAL PHYSICIAN.

drnakipuria@gmail.com, 09434143550,09832025685, 07838059592,09832025033.,
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Dec28
BEST MEDICAL APPS FOR MEDICAL STUDENTS AND DOCTORS ON ANDROID PHONES
DR.D.R.NAKIPURIA ,SENIOR GASTRO INTEST SPECIALIST & HIV/AIDS CONSULTANT
DR.MRS.RANJU NAKIPURIA,SENIOR GYNAECOLOGIST,OBST & INFERTILITY EXPERT
DR.MAYANK NAKIPURIA ,GENERAL PHYSICIAN.
SHREYA NAKIPURIA MEDICOS –MEDICAL TRAINEE
drnakipuria@gmail.com, 09434143550,09832025685, 07838059592,09832025033.,
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Dec27
ORAL INSULIN PILLS;GREATEST REASEACH OF THIS YEAR
ORAL INSULIN OR INSULIN PILLS :
A revolutionary innovation in diabetes treatment was the recent introduction of insulin pills that promise to replace timely administration of painful insulin injections.As stated in our previous article Insulin pills or oral tablet form of Insulin is possible now,One indian scientist Dr.Sanjyog Jain has tested it in mice by lebelling insulin to a nano particle and that will by pass gastric jiuce having hydrochoric acid and other enzymes which digest Insulin if given orally in tablet form.The second challenge we faced was the fact that insulin, being a high molecular weight protein, is unable to cross the intestinal membrane and be absorbed in the blood stream.
Sanyog Jain, the creator of insulin pill, believes that the pill has the ability to overcome the limitations of current therapies as well as reduce the chances of diabetes complications.It causes no pain of injections and is self monitored so risk of avoiding treatment is less and patients will more adhere to treatment .
Diabetes is never controlled as we take daily and regular medicine we control it better way,so its complication becomes less.Secondly Insulin is only treatment for Type one Diabetes mellitys in childre,Diabetes of Prgnancy,Control of Diabetes during any surgical operation or treat complication of diabetes as retinopathy,nephro and neuropathy etc .
Only problem is that it is combined with nano particle so cost may be high but as new pharma companies will come cost may be low,secondly it as been tried only in mice its complication in Human is yet to be explored.
But it is one of the great innovation of year 2013.

DR.D.R.NAKIPURIA ,SENIOR GASTRO INTEST SPECIALIST & HIV/AIDS CONSULTANT
DR.MRS.RANJU NAKIPURIA,SENIOR GYNAECOLOGIST,OBST & INFERTILITY EXPERT
DR.MAYANK NAKIPURIA ,GENERAL PHYSICIAN.
drnakipuria@gmail.com, 09434143550,09832025685, 07838059592,09832025033.,
FOLLOW ON FACE BOOK:www.facebook.com/drnakipuria
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Dec27
DIABETES:RECENT ADVANCEMENT IN TREATMENT AND DIFFERENT DRUG THERAPY MODULE
DIABETES ; RECENT ADVANCEMENT OF CONTROL & TREATMENT

DR.D.R.NAKIPURIA ,SENIOR GASTRO INTEST SPECIALIST & HIV/AIDS CONSULTANT
DR.MRS.RANJU NAKIPURIA,SENIOR GYNAECOLOGIST,OBST & INFERTILITY EXPERT
DR.MAYANK NAKIPURIA ,GENERAL PHYSICIAN.
drnakipuria@gmail.com, 09434143550,09832025685, 07838059592,09832025033.,
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About 61.3 million people in India suffer from diabetes, and according to estimates,one in every 5 people in India will be diabetic by 2025. Similiary in China The number of Diabetic patients will increase like anything.Diabetes is a metabolic disease which is characterised by high blood sugar levels. It can be caused either due to the lack of insulin (type 1 diabetes) or because the body’s cells fail to respond to the insulin produced (type 2 diabetes). There’s another form of diabetes that afflicts pregnant women called gestational diabetes.
Symptoms:In diabetes,the body is unable to absorb glucose which leads to a host of problems. Here are some of the symptoms that could indicate diabetes:
1.Increase in appetite,Frequent urination,Feeling too thirsty,Loss of weight,Feeling fatigued all day long,Frequent infections,Poor wound healing,High irritability/Depression
,Blurred vision etc.
Our Digestive system breaks down whatever food we eat into glucose.This glucose is absorbed by the blood with the help of a hormone called insulin. Diabetes occurs when the body is not able to produce insulin or is not able to use it effectively. Here are some of the reasons why this happens.
1. Genes:Genes can be responsible for causing both Type 1 and Type 2 diabetes. Having certain combination of genes may increase or decrease the risk of diabetes. If your parents were diabetics, you should be extra careful about your lifestyle.So it runs in family,so if both mother and father diabetic child being diabetic is very high.
2. Autoimmune destruction of beta cells:Sometimes,our own immune system may recognise the beta cells that produce insulin as antigens, and create antibodies to destroy them.Often, diabetes is diagnosed after most of the cells are destroyed and the patient then needs a daily dose of insulin to survive.
3.Lack of physical activity/obesity:Lack of exercise and obesity can be major causes of Type 2 diabetes. An imbalance between calories consumed and calories burned renders our body incapable of absorbing insulin properly. Just 30 minutes of physical activity reduces the chances of you having diabetes by 30 per cent. So, make sure you include activities like walking and cycling in your daily timetable.
4.Age:As a person ages, several parts of his/her body stop functioning at their optimum best. This can lead to diabetes, along with several other ailments.
5. Certain drugs :Certain medicines like nicotinic acid, psychiatric drugs, diuretics, etc. can destroy the beta cells that produce insulin or disrupt insulin absorption.
6.Pancreatic disease or injury:Since the beta cells are present in the pancreas – any injury or diseases like cancer, pancreatitis, etc. can stop beta cells from functioning and ultimately lead to diabetes.
Diagnosis:Diabetes is diagnosed using blood tests, and the three tests used for diagnosing diabetes are:
1.A1C test or glycohaemoglobin test;This test is used for diagnosing Type 2 diabetes. It measures a person’s average blood glucose levels over the past three months.If a person’s A1C level is below 5.7%, it means that he/she is normal. If it is between 5.7 to 6.4%, it indicates prediabetes which may lead to diabetes if appropriate measures are not taken.A person is diagnosed with diabetes if he/she has an A1C level of 5.7% or above.
2.Fasting Plasma Glucose (FPG) test;The Fasting Plasma Glucose test is the most common test used for diagnosing diabetes. It is performed by measuring a person’s blood sugar level, after he/she has fasted for at least 8 hours.If a person has a fasting glucose level of 126 mg/dL or above, he or she has diabetes. It is advised to repeat the test on another day for confirmation.
3. Oral glucose tolerance test (OGTT);In an oral glucose tolerance test, a person has to fast for at least 8 hours. After that, he/she has to drink a glass of water mixed with 75g of glucose.If a person’s 2-hour blood glucose-level is between 140 to 180 mg/dL, the person has prediabetes which could lead to diabetes if appropriate measures are not taken. If the blood glucose-level is above 180 mg/dL, then the person is diagnosed with diabetes as this level kidney excerete sugar in urine and urine show sugar and patient is called diabetic below this level sugar not seen in urine of person.
Treatment:Beast way to treat Diabetic is first to control food avoid Glycemic food or food which produce more sugar as sugaar and its product or food under ground like potato,reddish,carrot,beet,sugar cane,rice,apples,grapes etc even hifh fat is changed in to sugar so high fat content or high starch food or high calorie diet lead to more load of high calorie to our gut and as aresult of less Insulin or This food being les utised so high bloodglucose or Diabetes occurs.So food having less gluscose,freen veteables and leafy food should be taken.
If we do excersie this excessive food is burnt so excercise is also good and is second step to control diabetes,mostly pre Diabetic condition is controlled by food and excercise only.If diabetes can’t be controlled with diet, xercise and weight control,ten we take anti-diabetic medications or insulin.Type I diabetes occur only in children and young s and there is lack of Insulin so treatment is only Insulin which is injected either three times or once or twice with long acting insulin.
Most people who have type 2 diabetes start with an oral medicine. Here are some of them:
Drugs that act on your pancreas ;
Sulfonylureas (DiaBeta, Glucotrol, Amaryl, etc.) lower blood glucose levels by increasing the release of insulin from the pancreas. These drugs decrease blood sugar rapidly but may cause abnormally low and dangerous levels of blood sugar (hypoglycaemia) leading to mental confusion and even coma. Meglitinides (Prandin, Starlix, etc.) also work on the pancreas to increase insulin secretion. Their effects depend on the level of glucose. Victoza (lyraglutide), an injectable medicine, helps the pancreas make more insulin after eating a meal. It improves blood sugar in people with type 2 diabetes when used with a diet and exercise programme.
Drugs that decrease the amount of glucose released from the liver:
Biguanides (Metformin) decrease glucose production by the liver, decrease the absorption of glucose in the intestines and improve the body’s resistance to insulin. It also suppresses hunger, which may be beneficial in diabetics who are overweight.
Drugs that increase the sensitivity (response) of cells to insulin :
Thiazolidinediones (Actos and Avandia) lower blood glucose by increasing the sensitivity of the muscle and fat cells to insulin. These drugs may be taken with metformin and/or a sulfonylurea. They can cause mild liver problems but are reversible with discontinuation of the drug.
Drugs that decrease the absorption of carbohydrates from the intestine:
Alpha glucosidase is an enzyme in the small intestine which breaks down carbohydrates into glucose. Acarbose is the drug that inhibits this enzyme. Carbohydrates are not broken down as efficiently and glucose absorption is delayed, thus preventing high glucose levels after eating in people with diabetes.
Drugs that slow emptying of the stomach:
Exenatide (Byetta) is a substance like gut hormone (GLP-1) that cannot be easily broken down. It slows stomach emptying, slows the release of glucose from the liver and controls hunger. Administered in the form of an injection, Byetta also causes weight reduction, thus making it particularly suitable for patients with type 2 diabetes who are also overweight. DPP-IV inhibitors (Januvia, Onglyza, Tradjenta), inhibit DPP-IV enzyme from breaking down gut hormone (GLP-1). This allows the hormone already in the blood to circulate longer. They also increase insulin secretion when blood sugars are high and signal the liver to stop producing excess sugar.
Insulin Injections – Insulin is the backbone of treatment for patients with Type 1 diabetes. Insulin is also important in Type 2 diabetes when blood glucose levels cannot be controlled by diet, weight loss, exercise and oral medicines. Different types of insulin are:
1. Rapid-acting insulin – starts working in about 15 minutes and lasts for 3 to 5 hours. There are 3 types of rapid-acting insulin: Insulin lispro, Insulin aspart and Insulin glulisine
2. Short-acting insulin (regular insulin) – starts working in 30 to 60 minutes and lasts 5 to 8 hours.
3. Intermediate-acting insulin (insulin NPH) – starts working in 1 to 3 hours and lasts 12 to 16 hours.
4. Long-acting insulin (insulin glargine and insulin detemir) – starts working in about 1 hour and lasts 20 to 26 hours.
5. Premixed insulin- combination of 2 types of insulin (usually a rapid-acting or short-acting insulin and an intermediate-acting insulin).
Various methods for administering insulin are:
Pre-filled Insulin Pens – This is similar to an ink cartridge in a fountain pen. An insulin cartridge is held by a small pen-sized device. The amount of insulin to be injected is dispensed by turning the bottom of the pen until the required number of units is seen in the dose-viewing window. The tip of the pen consists of a needle that is disposed off with each injection.
Insulin pump – This is the most recently available advance in insulin delivery. It is composed of a pump reservoir similar to that of an insulin cartridge, a battery-operated pump and a computer chip that allows the user to control the exact amount of insulin being delivered. The pump is used for continuous insulin delivery. The amount of insulin is programmed and is administered at a constant rate.
Insulin Inhalers – Inhaled form of insulin is not much in use these days. The insulin is packaged in dry packs which are inserted into an inhalation device. This device allows the insulin to enter a chamber that has a mouth piece. Through this mouth piece the user can inhale the insulin.
Newer injectable injections - Symlin (pramlintide) is an injectable medication for use in diabetes patients treated with insulin but unable to achieve adequate sugar control. Amylin is a hormone synthesised by pancreas and helps control glucose after meals. It is absent or deficient in patients with diabetes. Pramlintide, a synthetic form of human amylin, when used with insulin, can improve sugar control. Symlin reduces blood sugar peaks after meal, reduces glucose fluctuations throughout the day and increases the sensation of fullness (leading to weight loss).
Insulin pills: insulin has been synthesises in tablet form by nano particle and will be absorbed in intestine passing Gastic acid and it is succesful in mice.
Permanant : Either transpnting B-cells of langerhans in Pnacreas a or complete pancreatic transplant to control diabetic in patient undergoing idney replacement due to high diabetes.But process is expesive and and dosenot work well with so many immunosuppresants.
Bariatic Surgery/Obesity Surgery:bariatic surgery bypass food from stomach to intestines so less food absorption and weight loss so daibetes is controlled.
Prognosis/complications:
Diabetes, if uncontrolled can lead to deadly complications.
1. Effect on fat and metabolism (Diabetic ketoacidosis): Since the hormone insulin which breaks down glucose is lacking, in uncontrolled cases, the body starts using fat as the fuel source. While you might think it’s not such a bad idea to lose some fat, what this leads to is build up of by-products of fat digestion called ‘ketones’. If you’re not taking your insulin doses regularly, have fever/diarrhoea/vomiting and/or going through a lot of stress or are an alcoholic, you need to be extra careful about developing this condition called ‘ketoacidosis’. If you develop symptoms like deep gasping breathing, acute pain in the abdomen, bad dehydration leading to weakness and fainting, vomiting, it’s time you take it seriously and contact your doctor.
2. Effect on the eyes (Diabetic retinopathy): Retina (the innermost layer of your eye) is affected by ineffective blood glucose control. The small blood vessels in the retina are damaged and weakened. The early symptom of eye problems related to diabetes is blurred vision and double vision. It can also cause a severe, permanent loss of vision. Diabetes increases the risk of developing cataracts and glaucoma.
3. Effect on kidneys (Diabetic nephropathy): If you notice swelling in your feet and legs or around your eyes, your kidneys might get affected because of the uncontrolled blood sugar levels. If you have hypertension (or high BP), your chances of developing this is even higher.
4. Effect on nerves: Some of the nerves, especially around your peripheries like legs might get affected first leading to a loss of sensation. You might not be able to figure out if you’ve had an injury and it may end up getting infected. Diabetic gangrene (infection of the leg, leading to decay of flesh) can occur and the leg may have to be amputated. Uncontrolled diabetes can also affect nerves that control your heartbeat, blood pressure, digestion, blood flow to organs etc leading to diarrhoea, erectile dysfunction, loss of bladder control, vision changes, and dizziness.
5.Effect on heart: If you are a smoker, have high blood pressure, are grossly overweight and/or have a family history of diabetes and are diagnosed with diabetes, you have a greater risk of developing heart disease, strokes.


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