DEFINITION & NOMENCLATURE:----
"Koro" is a Genital Retraction Syndrome where a person thinks that his/her external genitilia (Penis/Testicles or Vulva / nipple of Breast ) will shrink, retract and disappear with or without fear of Death.It occurs more in male than female patients.The earliest Chinese refrence is seen in'Yellow Emperor's classic of Internal Medicine' dated 300 BC,Western reference to the term koro is found in B.F. Matthes' Dictionary of Beginese Language (1874) of South Sulawesi ,Indinesia. The word is also used in Makassarese Language,meaning "to shrink"; the full dialect for it is garring koro. In Malaysian Language,keruk is the probable linguistic link of koro which means "to shrink". The term shuk yang or shook yong or suo yang (Chinese),Jinjina bemar (Assamese,India),Rok-joo(Thai) are coined for this diseas all in regional language, means "the shrinkage of penis".Actual word "KORO"originated from Malaysian word Tortoise (which is another name for "Penis" in slander language)as Tortoise has a habit of retracting their head resembling (like a PENIS)in to body,so people probably used that example to express this disease.
PSYCHOSOCIAL CLASSIFICATION
Koro has been described as"Culture Bound Syndrome"(which means it occurs in person with certain cultures where these cultural beliefs or myths generate and spread this classical form of disease,it is seen endemic with outbreaks or epidemics as in China,South East Asia, Malaysia, Indonesia (migrated people from China with classical )and certain part of Africa,Thailand,Singapore,India (non chinese local peoples as both classical and non cultural form ) and Western countries like Britain,America, France, Canada, Jordan (sporadic non cultural or secondary Koro where only shrinkage without any fear of death associatedwith CNS disorder,drug induced or under another psychiatric diorder) in mental disorder book and has been subgrouped as'Specific Culture-imposed nosophobia'or 'The genital retraction Taxon' or 'Cultural related beliefs as causes of occurrence'.
PREDISPOSING FACTORS & CAUSES
Psychosocial cultural belief which predispose "koro" a punishment of personal guilt of sex with other ladies/prostitutes(than Spouse/Wife),masturbation/Impotence or Sexual inadequacy (many such ancient folk stories are rampant in Chinese culture or theory of loss of yang humor (The Yan & Ying theory)or semen which is condsidered as vital energy,excess loss of this by frequent Ejaculation(depicted in Taosim which strongly inflence chinese medical thought) may lead to death.Witch Craft or evildoers or Fox spirit or ghost stories and folklore novels or KALA JADU (Assam & Bengal) are prevalent in China where it has been described that these spirits cause genitilia to retract in abdomen,making them physically and sexually weak and utimately dead.in South China and in south asian and Africa and even in India where this disease is prevalent,people have strong belief in such stories and play. Mass hysteria that Contaminated pork with swine fever cause epidemic of Koro in singapore in 1967.In Africa,Black magic was behind this and in Nigeria and ghana,there was panic that penis has disappeared by touch of a stranger.
But in isolated 03 cases in America, patients suffering from anxiety and worries about Penis suffered it after smoking Cannabis which may increase worries and anxiety as its side effect.In Britian and other western part it was due to depression resulting from psychological disorder,phobia for AIDS,brain tumor,schizophrenia etc.,but never a social or folk beliefs based on prevalent ancient stories and dramas.Ethnographic psychologist (who study different cultures) consider koro to be closely related to panic attacks caused by either social belief based on prevalent stories or myth or rumors of food poisioning or evil doers or as punishment to evil doing in form of self perceived or believed sexual offence resulting in retraction or shrinkage of genitialia with or without fear of death.Attacks of koro are often set off when men are in situations that would normally cause the male genitals to shrink slightly,such as emotional distress or cold temperatures.as Scrotum and penis more responds for shrinkage on exposure to mental stress and cold temperature they affect more than female.But tensed and psychological disturbed or introverted sexually freezed or tense female may suffer too complaining of retraction of Nipples and of vulva or disappearance of vulva under tight thighes under severe stress and strain.
SIGN & SYMPTOMS: Koro exist in two forms.Classical or True or Primary Koro where patients under a social belif or rumor or myth complains of shrinkage of Penis or testicles or both in Male and of Vulva or Nipples of breast / breast or both in female folowed by retraction of them in abdomen with physical and sexual weakness with or without fear of death.Mostly present as acute attack lasting for hours to maximum duration of 02 days.But some may show symptoms for years as chronic cases or recurrent cases ,some instead of shrinkage of genitilia complain genital shortening,alteration of penis size,loss of muscular strength,genital paraesthesia with no complain of retraction or breast mass in female with altered breast size and hidden or distorted nipples.Feature of sexual dissolution,loss of sexual or physical power,weakness,urinary obstruction,sterility may be seen.Psychologically Pateint suffer from anxiety neurosis may include fear of death,non specific physical danger,impending madness,spirit possession and feeling of being bewithched or under cover of black magic with feeling to sex change to eother female or vice versa or turning Enuch.
But in secondary or unclassical form of Koro as seen in western world only retraction of penis or loss of penile strength is coplained where person has got intense anxiety for penis with a strong psychosocial disease or under any organic brain disease or under influence of drug or intoxication.
While there are no substantiated reports of the condition itself resulting in any physical damage to the individual, many sufferers have unfortunately inflicted harm upon themselves or physical damage in frantic attempts to stretch the penis or Breast to prevent further shrinkage. It is not unusual for those with koro themselves or wthrough their family members and social sympathisers to resort to using devices such as clamps or weights or pegs or by aloop of string for retraction of penis as mechanical traction device.female either herself or ladies around her grab breast,pull nipples out or insert iron pins in nipple so that it cannot go inside.
Chanting of local religious songs and puja or religious celebration to please God/Goddess through local preachers and pandits or programmes for their blessing or correct any unknown mistake conducted in their past celebration or work out by local witch hunters by putting wood fire and smoking to remove bad blessing or evils or black witch from society or beating or killing of socalled wrong or evildoers suspected in society or villages is done.In North bengal people are putting lime water over both ears and nose ,keep Kush grass or pure water of a temple or river to keep these bad evils from them .some also cover their genitilia and breast so much under clothe as nothing happens to these organs.
DIAGNOSIS: it is easily done when epidemics occur as strong social belief or myth or rumor based on past prevalent stories and drama of witch hunt or as a punishment of some sexual wrong doing or intake of contaminated food or prsence of some diseases with typical full blown symptoms of penile/Testicle shrinkage or retraction in abdomen in patient of introversion suffering from anxiety or psychological disorder or under religiuos and social belifs and faith in myths or evil doers with or without sexual and physical weakness and fear of death.Injuries are secondary to measures taken by patients or relatives to prevent injuries.
TREATMENT:---
As the disease involves social beliefs and psychological insult so both Medical and Indigenous treatment should be given otherwise complete eradication may not be possible.As no defect is found in genitilia and breast to nothing is done for this if injuries inflicted by patient or relatives as mechanical manipulation to prevent retraction of genitilia or nipples then local injuries are dealt both surgically and medically.
in Cultural bound cases,lectures should be organised through healers of society by educating them with anatomy and physiology of Genitilia with audio visual or practical demonstration either as alone or to whole society utilising local media,radio /Tv/poster/leaflets and picturing small booklets,Individualy affect person psychosocial analysis is done and therapy for underlying disease is started.Inwestern type sexual conflict is identified and patient treated for any psychological or organic disease diagnosed.
indigenous medicines by local healers may be also advised to win the belief of people,praying to Gods and submitting to socalled social healers and witch hunters may be allowed to control epidemic spread but side to side strong counselling and health education should be provided individually ,by NGO or by Government health agency and social reforming departments.In china people hit gongs or bells to drive out witches .They use chinese a yang or yin augmenting medicine including herbs,animal penises (of tiger,deer,and fur seal )pilose anter(stag of deer) or deer tail.Pepper soup ,ginger soup,Louki or cucumber soup or liquor is also drunk to cure the diesease,in north Bengal people are using lime water application over both ears and nose and kush grass and holy water keeping to keep awya bad evils.
PROGNOSIS:prognosis is seen in patient having an acute attack with short history having uncomplicated sexual life,low freauency of attack with previous functional personality.
Dr.D.R.Nakipuria

09434143550
**Author is a naco trained HIV and sex specialist

Festive seasons are on,it is a common practice in our society to crack crackers and put fire to sound bombs emitting light or fire with sound ,often we forget how much our such activites will cause damage in form of fire and noise to others but we also forget that this noisy sound of high intensity may damge our precious ear for life time.Not only this,the way we live our life everyday we listen to Radio,TV ,Ipods,mobile phones,music system,High speed Rail engines,taking off of Airplanes,Helicopter or noisy vehicles on road or high speedy noisy making machines in factories or Automobile work shops ,announcements and open speeches or mike being displayed before our home or residence by political parties or different religious celebrations or puja or Dusshera or local cultural functions where loud sound comes to us involuntarily and such sound may damage our hearing as smoker in a public places spread damage to near by innocent persons.Hearing loss also occurs when we become old (Presbycusis) or when bony growth takes place at inner ear called Otosclerosis. Protection ,prevention is the best method to get over this donot submit ourself to this noisy sound if possible,donot crack noisy sound crackers,donot listen to radio,mobile phone,TV,Ipod Phones turnig volume very high and close to ears ,in avoidable circumstances either use ear plugs or drums or fingers in ear or cotton packs to prevent hearing loss,simple formula is to avoid listening too noisy or loud sound,tooclosely listening sound and to hear loud sound for some time or continuously.
Sound intensity is measured in the form of a unit called Decibels,sounds too loud or loud sound for aggod time may damage our hearing,sound above 85 decibels may cuase hearing loss even it may be music sound.if a sound of 85 decibels is listened for 8 hrs a day or for about 5 days in a week may damge or hearing,here if sound intensity is increased only upto 03 decibels,i.e.,88 decibels will damage same in half time and a sound of 120-150 decibles or more may damage our hearing in no time.For a sound measurement 10 decibels is considered as one unit ,increase in10 decibels increase sound intensity by double i.e.,this sound is two times loud on listening.Asound below 75 decibels donot damage our hearing evenlistened for much time ,Ipod listend at 60% volume doesnot damage but 100% intensity may damage and it also depends on make,type of sound emitting,how much time and close we are to these instruments .
For example ,Awishper produce 30 decibels,a rainy storm 50 decibels,a Normal conversation 55 decibels , TV 60 decibels,a noisy office 70 decibels,a busy traffic 80 decibels,Hair dryer 90 decibels,an IPOD full volume 110-130 decibels,and same for rock concrete,loud car or home stereo or inside modern cinema house or sitting close to high sound emitting music programmes,Firecrackes and arms upto 140 decibels and same true for a loud engines even at 25 meters.
A sound wave or energy traves from our Ear pinna and Ext auditory Meatus through Bony Ear canal and produce impact on ear drum and make it vibrated and this vibration is carried to inner ear through bones of middle ear MIS and in inner ear Cochlea which contains fluid and a Basilar Membrane on which hair cells are situated are allowed to vibrate and this sound wave is changed into electrical impulse which is carried by Auditory Nerves to Auditory centres in Brain ,all this is situated in a portion clalled Labriynth which also helps us to correct our positon and balacing so damage to internal ear aslo damge our balancing system and in our early childhood Hearing and understanding it also stimulate speeching so if no good hearing speech is also affected and in the last intellegence and learning is also affected.
such hearing loss is some time so slowly that we hardly take precautions in time,so for better undestanding the defect we should be cautions if following symptoms starts as follows:----------------Do I have a problem hearing over the telephone?
Do I have trouble following the conversation when two or more people are talking at the same time?
Do people complain that I turn the TV volume up too high?
Do I have to strain to understand conversation?
Do I have trouble hearing in a noisy background?
Do I find myself asking people to repeat themselves?
Do many people I talk to seem to mumble (or not speak clearly)?
Do I misunderstand what others are saying and respond inappropriately?
Do I have trouble understanding the speech of women and children?
Do people get annoyed because I misunderstand what they say?
so if we found our selves suffering from any thing like this,we should be precautioned and avoid listening close to Mobile Phones,Music System, TV, Ipods,Radio or any cultural or Political or cultural programme or cinema sitting close to loud sound emitting system or use ear plugs at railway or airports or during takeoff and grounding of flights or at factories or at traffic jams or putting fire to crackers or sound emitting crackers or bombs or fire arms.if we prevent it Loud noise hearing loss is completely avoidable.
Dr.D.R.Nakipuria

09434143550

RECENT ADVANCES IN TREATMENT OF HIV/AIDS PATIENTS
-----DR.D.R.NAKIPURIA
AIDS is acquired immunodeficiency syndrome comprises of many symptoms and signs (different complains of patients and many thing evaluated by Doctor on examination)of Patient suffering from HIV,Hunam Immunedeficiency Virus.AS THE NAME SUGGEST OUR DEFENCE SYSTEM or Immune system is paralysed or made less responsive(measured in this infection by determining CD4 Count from Blood examination as a type of Lymphocyte fighting with invasion of HIV in our Body) whenever any infection of Bacteria,Virus,Fungus or parasite invade our body as a result infection can occur in any part of our body and as primary resistance from our Body System is weak,infection spreads more and more resulting in further growth of invading microbes and this HIV virus too(measured by Viral Load as Copies of Virus in Blood and susceptibility to drugs by sensitivity test).Therefore development of Anti Retro Virus (as HIV is Retrovirus) medicines has developed which once started raise immune system CD4 count by checking further growth of HIV virus and prevent infection by other Microbes(Oppurtinistic Infections) but as we know more and more about these medicines and their side effects and different Oppurtinistic Infections,WHO put some best guidelines when to start these medicines in HIV patients as in Year 2006 ART was to be started if CD4 count is below or 200 but in 2010 it is upto 350 But Amercan Journal suggest it upto 500 when patient is symptomatic or in stage I and II as per WHO staging(Patients with less grade of infections)but in stageIII and Stage IV patients or patients with severe form of disease or seriously ill as suffering from TB,Meningitis,Kidney or Cardiomyopathy,Chest or GI tract infections does not require any estimation of CD4 count as this is presumed and fact that their CD4 count is below 350 or 200 and ART or Better called HAART Medicines immediately.In case of TB patients ATT should be started after start of ART generally within 2-8 wks to avoid IRIS or any adverse reaction,those on HAART developing TB ,ART should be started immediately(with efavirenz except children below 03 yrs of age and first trimester pregnancy).In case of Pregnant Patient same module is practised ,in patients suffering with Hepatitis B or C patients,like TB, ART should be started immediately without any staging or delay of 2-8 wks.In case of Childrens too now same strategy is applied but here CD4 count varies according to age groups,we can start ART immediately in stage III and IV in infant or children upto 12 yrs of age but in Infants and children up to 2yrs of age no need of checking CD4 count start ART if patient is sytomatic or is diagnosed as HIV patients,even in infants now ART may be started if we strongly clinically suspect HIV (As Mother strongly positive or both parents positive or breast fed positive mother children etc) but in early age from 2-5 yrs reduction of CD4 count up to 750 or % of CD4 count below 25 but above 05 yrs criteria is 350 for stage I and II . In Developed countries Art is being started CD4 count upto 500 or less above 05 yrs and adult.CD4 count was previously estimated every 06 months but now at every 03 months and if it is not raising considered as immunological failure and Viral load to be done before starting therapy and also at 3-6 months to see copies below 5000/ml it is raising then drug sensitivity test is done and if not possible then IInd Line drug is started,if IInd line drug started then now a days IIIrd line drug is started.In pregnancy either mother exposed to AER earlier or not ART started in first trimester(avoiding Efavirez) with drug regime and is continued life long unlike nevirapine during labor or Zidovudine regime only,Zidovudine and Nevirapine found good in CD4 count between 250-350.
Now HAART medicines has been slightly modified,Two NRTIs and one NNRTIs is still practised to check drug resistance by Virus mutation but instead of dT4(Stavudine 30 or 40 as per wt above or below 60kg causing severe lididolysis or peripheral neuropathy,pancreatitis ) now3TC(Lamivudine)+AZT/ZDV(Zadivudine causing severe anaemia or neutropenia ) or 3TC + TDF(Tedofil,causing nephropathy and calcinosis ) or TDF + FTC (Emcritabine),AZT+ FTC(causing hepatitis) so 3TC+ AZT+NVP(causing hepatitis and stevenson Zhonson syndrome) or 3TC+AZT+EFV (Efavirenz)or 3TC+TDF+NVP(Nevirapine) or EFV is preferred ,even Simple FTC+NVP or FTC+ EFV is preferred.here Abacavir (ABC) or Diadanosine (ddi) is also used as NRTIS but combination like Stavudine+Zaduvidine,3TC+FTC or AZT+TDF or dt4+Abacavir is not used . Incase of Tuberculosis patients,Efavirenz is given not NVP except when patient is child below 03 yrs or Ist trimester pregnant or under Psychotic condition or medicines.If possible and patient can afford Rifabutine may be started in ATT instead of Rifampcin but mostly if patient is not renal compromised or under hepatic pathology simple ATT is good.In Resistant cases(increase in viral load,less cd4 count or drug resistance)IInd line drug of 03 drugs combination is started here one protease inhibitor(Liponavir(LPV) / Squanavir(SQR)/ Indinavir(IDV) /Atazanavir(ATV) /Fosamprenavir(FPV) / Darunavir(DRV) /Etarvine(ETV) with boosted Ritonavir(r)or plain Ritonavir(RTV) is used and along with this in TB patients with Rifampcin dose of protease inhibitor like Lopinavir+ boosted ritonavir(LPV/r) or Squanavir +Boosted Ritonavir or Indinavir + boosted Ritonavir is increased but with Rifabutine no dose adjustment is done.Instead of using NRTIS used in past as for dt4 or 3TC ,AZT + TDF or TDF + FTC or simply replacing 3TC by TDF or FTC or ABC or ddi is done,if any drug produce complication or side effect as mentioned above it is also replaced.In case of Hepatitis B TDF +3TC is used with NNRTIS or Protease Inhibitor.Revebrine and Pregylated Interferon is used with ART in Hepatits C patients.If after IInd line treatment CD4 count is increased third line treatment using one NNRTIS ,one Protease inhibitor as newly added ATV,DRVor FPV with Integrase inhibitor Raltegravir(RAL) is used.
Cotrimoxazole is added to prophylaxis below 350 to prevent malaria,bacterial,PNeumocystis Jivorecii or Campylobacter Diarrhoea and Toxoplasmosis.STD clinic for any sexual inflicted persons like commercial or flying sex worker (counselling and promoting use of condom )and treatment and screening of suspected highly prone patients like IDUs,drug users,(not sharing needle)migratory labours,Truck drivers etc., at target Intervention clinic is backbone to control it and every suspect should be submitted for HIV screening ,Similiarly every TB patient and in ICTC every Blood donor and PTCT pregnant mother is screened for HIV.Proper counselling of these patients with advise and regular follow up of these persons at primary or semi primary or assisting ART centre is must by doing off and on viral load and CD4 count examination. Every oppurtunistic infection should be controlled and here medicines shold be contined for a long time to prevent recurrence and continuation of ART medicine of great importance.Adhrence,compliance and continued taking medicines with proper counselling during IRIS or any other drug reaction is most important of HIV treatment.

09434143550
Author is an HIV specialist Doctor

DOCTORS ARE ON STRIKE AT JODHPUR! WHOLE RAJASTHAN! AT SAFDARGANJ HOSPITAL! NOIDA!GAZIABAD! KOKATA! NORTH BENGAL MEDICAL COLLEGE! ----------SO MANY PATIENTS DIED! NO TREATMENT FOR POORS!PATIENTS ARE RETURNING HOME!MOVING TO PRIVATE CLINICS!GOVERNMENT HAS FAILED!-----THESE SLOGANS ARE COMMON ON ELECTRONIC MEDIA GIVING 24X7 NEWS AND PRINT MEDIA.EVEN AT ANY PLACE,HOME,OFFICE, CLUB,RESTURANTS,PARK,HOTELS,AMUSEMENT CENTRES OR LIBRARY ANY GENRAL PERSONS WILL BE OF VIEWS THAT MEDICAL IS A NOBLE PROFESSIONS,A PROFESSION TO SERVE THE HUMAN BEING ACCEPTING ALL SUFFERINGS TO THYSELF,SO DOCTORS AND ITS FAMILY MEMBERS LIKE NURSES,HOSPITAL STAFFS,PARAMEDICS, MEDICAL STUDENTS, TEACHERS, RESEARCH SCHOLARS,LAB ASSISTANTS, DIAGNOSTIC CENTRES ,HOSPITAL, PRIVATE CLINICS MEDICAL REPRESENTATIVES AND DRUG MANUFACTURERS AND RETAIL SELLERS SHOULD NEVER CALL FOR STRIKE CLOSING THEIR WORK COMPLETELY, ABSTAINING FROM EXAMINING,PRESCRIBING AND TREATING PATIENTS AT WHATEVER REASON AND WHATEVER COST OF PERSONAL OR COMMUNITY SUFFERINGS AS THEY ARE WORSHIPED LIKE GOD AND GENERAL PEOPLE SEE AN IMAGE OF GOD IN DOCTOR'S BODY.
SECONDLY FOR MAKING A GOVERNMENT DOCTOR,GOVERNMENT PAYS A HUGH MONEY COLLECTING FROM TAX PAYER'S POCKET SO DOCTORS HAVE NO RIGHT TO CEASE WORKS -MANY CHANNELS AND WRITERS ARE ADVISING GOVERNMENT TO BRING LAWS LIKE ASMA TO BAN DOCTOR'S STRIKE AND CEASEWORK AND PUNISH DOCTORS OPENLY FOR VIOLATION OF THEIR DUTY FOR PERSONAL OR COMMUNITY GAIN.
SUCH POPULISTIC AND GENERAL VIEWS ARE OFTEN SOUNDED BY LEADERS OF POLITICAL PARTIES AND SOCIAL WEFARE GROUPS WITHOUT GOING INTO DETAIL OF SUFFERINGS WHICH THE WHOLE MEDICAL WORLD UNDERGOES BEFORE SUBMITTING THEMSELVES TO THIS LAST PAINFUL WEAPON OF SUBMITTING THEMSELVES FOR STRIKE!OR CEASE WORK! EVEN DURING SUCH STRIKE MOSTLY DOCTORS KEEP OPENS EMERGENCY SERVICE BUT NUMBER OF PATIENTS IN GOVERNMENT AND SEMI GOVERNMENT CENTRES ARE SO MUCH THAT IT CANNOT TAKE LOAD OF PATIENTS SMOOTHLY ,SECONDLY MEDIA PEOPLE BECOMES SO ACTIVE THAT THEY START REPORTING NEWS OF DEATH AND SUFFERINGS SO MUCH FOCUSING THE STRIKE THAT IT APPEARS AS IF IT IS ALL BECAUSE OF STRIKE WHERE AS FACTS REMAIN THE SAME THAT SUCH KIND OF SUFFERINGS AND DEATH ARE COMMON IN THESE HOSPITALS BECAUSE OF LATE ARRIVALS OF SERIOUSLY ILL PATIENTS,INABILITY TO PROVIDE ADEQUATE MEDICINES,INVESTIGATIONS, TREATMENT FACILITIES TO THESE PATIENTS FREE BY GOVERNMENT WHO SPEND LESS THAN 3% OF GDP ON HEALTH WHEREAS 30% IS PAID FOR ARMY AND DEFENSE,AT MOST OF GOVERNMENT CENTRES ADEQUATE MEDICAL STAFFS,NURSES, PARAMEDICAL ASSITANTS AND HELPERS ARE LACKING,EVERYTHING IS LEFT ON TREATING DOCTORS AS THEY WILL MANGE EVERYTHING AND THEY ARE AT FAULT FOR EVERY MISTAKES OR LACK OF TREATMENT OR IF ANY COMPLICATION OR DEATH RESULT FROM TREATMENT .NOW A DAYS PEOPLE FROM EVERY CORNERS BLAME DOCTORS FOR SUCH PROBLEMS OF NOT GETTING GOOD TREATMENT OR DEVELOPING COMPLICATION OR DEATH AND FOR PROTESTING INSTEAD OF LAUNCHING PROTEST OR COMPLAINS THROUGH HOSPITAL OR POLICE OR ADMINISTRATION,TAKES LAW IN THEIR HAND AND TO MAKE ISSUE HIGHLIGHTED IN MEDIA AND EVEN POLITICAL PARTIES AND MANY CLUBS,NGO.S, SOCIAL WORKERS AND EVEN SOME MISCREANTS JOIN THESE PROTESTORS OPENLY AND ATTACK DOCTORS,NURSES,MEDICAL STUDENT, PARMEDICAL STAFFS AND MEDICINE SELLERS PHYSICALLY INFRONT OF EVERY BODY(MEDIA-WHO INSTEAD OF CONTROLLING SUCH JEHADI PROTESTORS REMAIN ENGAGED IN TAKING PHOTOGRAPHS AND TAKING BITES TO SELL THEIR NEWS TO EARN MONEY BY PUTTING MORE MASALA AND TARDKA AND PRESENTING THEMSELVES AS FIRST CHANNEL TO DICOVER IT AND TO GAIN MORE AND MORE TRP,POLICE; IS OFTEN CALLED FOR CONTROLLING LAW AND ORDER BUT MANY PLACES THEY DONOT REACH IN TIME BECAUSE MOSTLY CRIME IS COMMITTED BEFORE THEIR REACHING AT SPOT AND EVEN REACHING IN TIME,THEY MOSTLY REMAIN SILENT BECAUSE OF POLITICAL PRESSURE OR ATLEAST CONTOL DEMONSTATORS AND PROTESTORS WHO USE BAD UNPARLIAMENTARY LANGUAGES AND SLOGANS TO MALIGN "DOCTORS" AS SPEAKING IS OUR BASIC RIGHT,MOSTLY MOB BECOME FURIOUS BEFORE MEDICAL ADMINSTRATORS AND DOCTORS AND START DAMAGING HOSPITAL PROPERTY BY BRAKING RECEPTIONS,DIGNOSTIC CENTRES,OT, OPD LAUNGE,INDOOR INSTRUMENTS ,BEDS AND FUNITURES,AT SOME PLACES THEY PUT THESE ON FIRE BEFORE LAW PROTECTING FORCE IN NAME OF SHOWING AGONY ,GRIEVNCES AND SHOCK FOR DEATH OR MISS MANGEMENT OF THEIR NEAR ONES AS IF DOCTORS HAS CREATED THE ACCIDENT OR DISEASE TO THAT PERSON AND DOCTOR IS THE ONLY SOLE RESPONSIBLE FOR SUCH ACCIDENT.EVEN IN MOB GENERAL PEOPLE ALSO BECOMES PART OF THESE DEMOSTRATIONS THNKING THAT DOCTORS ARE CORRUPT,THEY EARN HUGH MONEY BY CHEATING GENERAL PEOPLE,MOVE IN GOOD CARS AND LIVE IN GOOD HOUSES BY TAKING COMMISSION FROM DRUG COMPANIES,DIAGNOSTIC CENTRES ILLEGAL PRACTICE FROM GOVERNMENT HOSPITAL TO PRIVATE HOSPITALS AND AS GNERAL PEOPLE ARE NOT GETTING GOOD SERVICE FOR THEIR HEALTH PROBLEMS AS GOVERNMENT CLAIMS AS IT IS FREE AND FAIR BUT PRACTICALLY DUE TO LESS INVESTMENT IT IS ALSMOST ABSENT ,SO DOCTORS BECOME EYESORE OF COMMON PEOPLE TOO AND POLITICIAN AND ADMINSTRATOR ALSO REMAIN SILENT AS THEY KNOW PUBLIC WANTS DEFAME AND DISREPUTE OF DOCTORS SO IF THEY SUPPORT DOCTORS IN SSUCH CRISIS PEOPLE AND MEDIA WILL DESTROY THEIR VOTE BANK AND IMAGE,SO DOCTORS ARE LEFT FOR BEATING AND PHYSICAL HURT IN OPEN DAY LIGHT.
EVEN GOD WILL BE BEATEN ON BASIS OF SOME FILTHY CHARGES WHERE HE IS NOT DIRECTLY INVOLVED OR WHERE DEATH OR COMPLICATION IS A PART AND PARCEL OF THE TREATMENT PROCEDURES WHERE LIFE AND DEATH ARE EXISTING SHARING SHOULDER OF EACH OTHER
,GOD WILL TOO REACT WHAT TO TALK OF THESE HUMAN BEINGS ,HOW ONE CAN ASPECT A FEARLESS GOOD TREATMENT BY DOCTORS WHEN WHOLE SOCIETY IS STANDING AGINST HIM FOR NOT PROVIDING GURANTED GOOD TREATMENT AND RECOVERY,DOCTORS ARE MOSTLY SHACKEN BY CONSUMER PROTECTION ACT,RTI ACT,VIGILANT AND INTROSPECTING MEDIA WHO IS ALWAYS IN HOSPITAL TO CLICK ANY STORY ON DOCTORS PATIENT TUSSEL OR ANY MISHAPPENING IN HOSPITAL TO EARN TRP AND IF SUCH SHOCKED AND TREMOROUS DOCTORS ARE BEATEN OPENLY,THEIR REPUTATION IS CHALLENGED SO OPENLY IN SOCIETY,THRE IS NO OPTION LEFT BUT TO ASK FOR PROTECTION AND FORM GOOD LAWS AND BRINGING STRICT ACTIONS AGAINST MISCREANTS SO THAT SUCH ACCIDENTS DONOT HAPPEN IN FUTURE BUT AS THIS IS A NORM IN OUR PRESENT SOCIO POLITICAL SYSTEM THAT UNLESS YOU PRESENT YOUR SELF IN A VERY SERIUOS UNPARLIAMENTARY MANNER NO BODY LISTENS TO YOU,EVEN PARLIAMENTS AND ASSEMBLY SHOWS US SOMANY ROUDY AND BREAKING MIKES,CHAIRS AND WINDOWS IN THESE HOUSES BY ELECTED MLSAS AND MPS AS GOVERNMENT DONOT LISTEN TO THEIR SIMPLE PROTEST.
EVRY DEATH IS PAINFUL ,NO DOCTORS WANT THAT SOMETHING WRONG OR COMPLICATION OR DEATH OCCURS TO HIS/HER PATIENTS (EVEN EVRY GENERAL PERSON ACCEPTS IT) BUT DURING SUCH ACT SUCH THINGS ARE FORGOTTEN AND AN ONE THEME AGENDA OF BRUTALLY ATTACKING DOCTOR'S AND THEIR FAMILY MEBERS OF MEDICAL WORLD PHYSICALLY AND DAMAGING HOSPITAL PROPERTY IS TAKEN,INSTEAD OF RECOMMENDING FOR PUNISHMENT OF THESE PEOPLE,POLITICAL LEADERS START SCORING THEIR GAIN AGANIST RULING PARTY FOR SUCH ACT,STRATS ENCOURAGING THEM MORE AND MORE AND RECOMMENDS FOR THEIR IMMEDIATE RELEASE EVEN CUGHT BY POLICE ,MEDIA SHOWS THEM AS GREAT PCIFIER,NGO'S ANS SOCIAL WORKERS, CLUB ALL COMES FOR THE RESCUE OF THESE TROUBLE SHOOTERS JUSTIFYING THEIR PROTEST AS NATURAL BECAUSE A HUMAN LIFE HAS BEEN LOST AND DECLARES "DOCTORS"AS CRIMINALS WHO HAS COMMITTED THE CRIME MAKING HIM RESPONSIBLE FOR EVERY SUCH MISDOING FORGETTING ALLOCATION OF MONEY,FACILITIES, INFRASTRUCTURES STAFF,WILL POWER,WORK CULTURE ETC., IN THESE HOSPITALS.
SO MANY TYPE OF CRIMES ARE COMMITTED IN OUR SOCIETY BUT IN MOST OF THEM MASS DOESNOT PARTICIPATE,INVESTIGATION AUTHORIITE S LIKE POLICE,CID,CBI AND STF WORKS AND EVEN PUBLIC OR MISCREANTS TRY TO SABOTAGE SUCH INVESTIGATIONS ,THEY ARE BOOKED AND TAKEN TO TASK BUT IN CASE OF MEDICAL INVOLVEMENT, "DOCTORS" HAVE BEEN MADE SOFT TARGET AS IF ANY BODY CAN HIT THEM PHYSICALLY AND DAMAGE THE HOSPITAL PROPERTY,NO EXELEMPARY PUNISHMENT IS IMPOSED (GOVERNMENT OF ANDHRA HAS BROUGHT A LAW TO ARREST AND RECOVER MONEY FROM MISCREANTS AND PROTESTOR DAMAGING HOSPITAL PROPERTY ) BUT SUCH LAW SHOULD BE PASSED BY OUR PARLIAMENT AND SUCH AN EXAMPLE SHOULD BE CITED BY ARRESTING AND RECOVERING FROM SUCH PROTESTORS THAT IN FUTURE NO BODY SHOULD TAKE LAW IN HAND,MEDIA SHOULD STOP SHOWING AND REPORTING SUCH INCIDENTS AS THEY ENCOURAGE MORE PEOPLE TO TAKE LAW IN THEIR HAND.BUT FACTS REMAIN THIS,MEDIA IS FREE! POLICE CANNOT ACT! POLITICIANS ARE WELL WISHERS OF PEOPLE,NGOS AND SOCIAL WORKERS ARE SERVING SOCIETY! POLICE CANOT BE CONTROLLED AND DISCIPLINED !ADMINISTRATION AND LAW MAKERS NEVER SOLVE PROBLEM BY SIMPLE WRITING, DEMANDS, DEMONSTRATIONS,PROTESTS UNTIL AN EXTREME STEP IS TAKEN IN THE FORM OF STRIKE OR CAESE WORK IS TAKEN ,THEN THEY RESPOND BY GIVING MERE CONSOLATIONS ,ARRANGING POLICE PICKETING AND SECURITY PROTECTION FOR FEW DAYS,AS THE TIME PASSES EVERYTHING AGAIN COMES TO SAME PREVIOUS STAGE, A NEW INCIDENT TOOK PLACE AND EVERY THING IS REPEATED IN THE SAME WAY.
THEREFORE,IT IS NEED OF TIME THAT OUR POLITICIANS ,ADMINISTRATORS,MEDIA AND PEOPLE SHOULD SIT TOGHTHER AND THINK'WHY DOCTORS ARE BOUND FOR STRIKING" ,SOLVE THEIR PROBLEM IN TIME,LISTEN TO THEIR REPRESENTATIONS AND JUSTIFIED DEMANDS (WHEN EVERY PARLIAMENTARIANS AND BUREAUCRATS ARE ENJOYING SO MUCH HIKED PAY AND FACILITIES,WHY DOCTORS WHO TREAT THE PATIENTS ARE PAID SO BADLY,WHY THEIR BASIC AMENTIES,FACILITIES ARE NOT IMPROVED, WHY MORE CAPITA IS NOT EXPENDITURES ON HEALTH,WHY FACILITIES OF BED,DIAGNOSTIC CENTRES,MEDICINES AND ADEQUATE STAFFS ARE NOT INCREASE IN HOSPITALS,WHY A PUBLIC RELATION OFFICERS IS NOT APPOINTED IN HOSPITALS WHO ACCEPTS ALL GRIEVANCES AND REPORT TO MEDIA AS WH IS AT FAULT FOR MISMANGEMENT OF PATIENTS AT HOSPITAL,WHY A DOCTOR IS MADE RESONSIBLE FOR ANY MISHAPPENING IN HOSPITAL?)CREATE SO MUCH AWARENESS IN PUBLIC THAT THEY UNDERSTAND ALL SUCH MIS HAPPENINGS AND NEVER RESORT FOR SUCH ACT OF TAKING LAW IN HAND.
THESE ARE BASIC QUESTIONS WHICH A GOD WILL ALSO LIKE TO BE RESOLVED BECAUSE MOST OF TIME HE IS NOT AT FAULT AND NO BODY ERRONEOUSLY BLAME HIM,SYSTEM IS POLLUTED AND AS HE IS DIRECTLY AT TOP IN HOSPITAL ,SO HE CANNOT BE BLAMED BECAUSE INDIRECT BOSSES ARE IN POLITICS AND ADMINISTRATIONS. EVERY GENRAL PEOPLE HAVE RIGHT TO COMPLAIN TO ADMINISTRATION,POLICE,JUDICIAL COURT,STRICT ACTION SHOULD BE TAKEN IF DOCTOR IS FOUND AT FAULT BY INVESTIGATIONS OF COMPETENT AUTHORITY ,OUR COURT SHOULD BE MADE RESPONSIVE FOR EARLY TRIAL AND JUDGEMENT ,ALL ADMINSTRATIONS AND POLITICIANS SHOULD SHARE THEIR DISCREPANCIES AND FAULTS(INSTEADING OF PASSING WHOLE BUCK TO "DOCTOR")AND RESORT TO DOCTOR'S PERSONAL OR COMMUNITY PROBLEMS AS SOON AS POSSIBLE SOTHAT SUCH A HARSH AND UNJUSTIFIED WEAPON OF PROTEST "STRIKE OR CAESE WORK " IS EVER TAKEN BY DOCTORS .EVEN DOCTORS SHOULD TAKE STERN MEASURES TO IMPROVE PATIENT DOCTORS RELATIONSHIP BY DOING SOME GOOD SOCIAL WORKS AS MANY DOCTORS ARE DOING INVOLVE MEDIA AND GENERAL PEOPLE IN POLITICIANS IN THESE PROGRAMMES SO THAT NOBLE WORK OF DOCTORS GET MAXIMUM EXPOSURE IN SOCIETY SO THAT GENERAL PEOPLE COMES IN SUPPORT OF DOCTORS AND HAVE TO BE REMAIN UNITED SO THAT GOVERNMENT AND ADMINISTRATIONS LISTEN TO DOCTORS ,NOW A DAYS SELF DEFENCE IS BEST DEFENCE RESPECTING LAWS OF OUR COUNTRY.SO MERE CRTICISM WILL NOT YIELD ANY RESULT,DOCTORS ARE MOST IMPORTANT MEMBERS OF SOCIETY WHO SPEND SO MANY VALUABLE TIME ABOUT 15 YRS MINIMUM TO BE A GOOD DOCTOR WHO HAS TO READ THROUGHT OUT LIFE AND UP TO DATE TO REMAN AS GOOD DOCTOR WITH VERY LOW PAYMENT INCOMPARISON TO MBA,IIT,BUREAUCRATS AND CEO OF MODERN COMPANIES AND A PROPER RESPECT AND RECOGNITION IS ESSENTIALS TO THEM AND OUR SOCIETY AND ADMINISTRATION SHOULD BRING ALL CHANGES IMMEDIATELY SOTHAT SUCH HOOGALINISM,VADILISM AND GOONDISM IS STOPPED IN OUR HEALTH ENVIORNMENT.
DR.D.R.NAKIPURIA
SILIGURI

CACANCER-DEATH / DISABILTY / DRUG DEPENDANCE ----ARE THEY ASSOCIATED ?HOW TO FIGHT IT?

Cancer ,word it self fetches us to a very frieghtening and fearful meaning,if ,unfortunately somone in our family or society is being suspected or suffering from it and the word "CANCER" comes beore us in any way ,we start presuming very badly and gets completely shocked and nervous assuming that person concerned is very very seroius and his /her days are almost in counting scale and we became wholly sympathetic for that person forgetting every his/her adversary towards us and try to help the person as far as possibly by money,service or any other means if possible.But in real Biological sense "CANCER" is not that kind of Lion or Tiger that once you face it there is no hope of life and certainly it is not curable and we should be completely depressed and hopeless becauuse many "CANCERS" are now completely curable and life becomes as normal as it was without it ,only thing is that it should be detected as early as possible and treatment should be started as soon as possible.It is commonly believed that once Cancer means we,shall be never cured from this ,we have to take medicine regularly throughout the life,and we donot know when recurrence may occur and again mor discomfort or Death may come to us any time,person has to be in screening throughout the life moving to Hospital or doctor almost off and on throughout the life.Yes,for some persons these lines are true but in many cases these are simple myths ,Cancer once cured,never recurs or recur in so less percentage that one has nothing to worry,even follow up of symptoms noticing is important,that is with every disese once one suffers from cold or cough or diarrhoea one goes to Doctor,same way here one has to go to Doctor,no test or investigations are required and life becmes as normal as it was originally without Cancer,so nothing to worry,be happy,never get depressed or shcoked by this word,cancer, never loose heart face it at first meeting boldly and fight so well that finish it nipped into bud.As the modern science is growing and more and more reaseaches are done and treatment bieng enforced to treat Cancer by means of better chemotherapeutics or medicines with very less sideeffects,Monoclonal Antibodies,different caccines,interferons and Stem cell with development of Gene therapy ,better rays inform of Positron euipped with Ct scan and MRI or Tomography machine,Cyber knief,Brain Suits,or IMRT or Brachytherapy, Stereotactic Radiotherapy beside cobalt ,gamma and X-rt with linear acceletor and modern Surgical removl of cancer using ultrasound,ct scan,Laproscope and modern robotic Surgery with the facility of FNAC, TRUCUT BIOPSY,FROZEN BIOPSY and better detectection and control of micro metastases has made much advancement leading to almost curbing and controlling Cancer denovo.

In Medical Biology Cancer is defined "Uncontrolled Growth of Cells." that is if our finger which is shaped like a finger is constituted by Bone,Many MUscles,Tendon,Nerve and Blood and Lymphatic vessels covered by skin with hairs,sweat glnd and many type of receptors of pain,temperature,touch etc, type of tissues and each of these tissues are made up of many cells,like a brick which forms our house.if one or few cells starts dividing rapidly and excess cells are not destroyed ,first the shape of Finger will be destroyed and then whole finger will be deformed and gradually such growth will spread to hand and will deform and dysfunction it too.Normally in our body there is a check and balance of every Growth,excess and unrequired growth is destroyed or designed sothat a proper shape and function of every organ is established.But once this check and balance is destroyed such growth is called "CANCER" or "TUMOR" which may be localised to the organ where it was orginated or spread to adjoining organs or may spred by Lymph or Blood vessels to differnet distanorgan as cancer of leg spreading to Brain,Liver,Lung etc. and vice versa.if locally organised Tumor these are called "BENIGN CANCER OR GOOD TUMORS' as once excised they are mostly completely curable with use of Surgery or radiotherapy BUT THOSE TUMORS WHICH SPREAD FROM ORIGINATIONG ORGAN TO OTHER ORGANS ARE CALLED "metastatic tumors or bad tumors or growth" as they are once removed from a local place by radio or Surery may recur immediately or after months or years from distant place ,so they are taken care of by using Chemotherapy or Cancer Drugs which also kills normal cell too,so are some time very toxic killing Blood,Hairs,skin and many growing cells bringing so many side effects,some time so much that we have to stop these medicines as patient cannot bear them physically and economically resulting into icreased morbidity and mortality.Newer added Medicines like Interferons,Monoclonal Antibodies,Genetherapy,Stem cells and modern cancer drugs are very very costly being out of reach from many Patients of Developing countries.

Human body is made up of 60 trillion cells and different type of Tissues which after combinig form differnt organs and Organs form the Body .Till date if these Organs are working synchronically or working in order from each organ to another organ ,Life exists as their chronological or systemic or disciplined working toghther is hampered or this cycle is stopped by any meber organ of cycle ,all organs stars failig one after another and we say Death occured,we donot know which is starting point and which is end point,some say Brain,Some Say Heart but in real sense it is their working togher with each other mattrers,no one is superior,no one is inferior. Most of the cells except the cells in the brain re-live by the process of division and replacement. It can be simply understood that after a given time the old cell is replaced by new cell, exact replica of its predecessor. The renewal of the cells after a given time is a natural process but uncontrolled growth of cells is not natural.Even some cells grow abnormally ,to start with these are killed by Body Immunity as checking mechanism but if growth is excessive or Immunity is not reacting ,these became permanent and called Cancer.This is the reason that cancer is not recognised as an abnormal activity by the immune system of the body and therefore, cancer detection is very difficult unless it affects the performance of an organ or organs,symptoms or signs are attributed to the organ concerned if Eye means loss of vission,if Larynx means loss of voice etc.,but Cancer in itself does not have any symptoms. The first question which comes to anyone's mind is –If it is not a natural process then why does a cell start uncontrolled growth? The exact answer for this question is not yet known to humanity. The answer to this question lies in identifying the part of the cell, which is responsible for initiating the process of self replication and excessive reproduction. Presumably, it may be some section in the DNA, cell membrane or may be anything else either being stimulated by some external things like sunlight in cancer of skin Melanoma or heat,or application of some chemicals used locally or ingested inside but many times cause is not exactly known,some cancer runs in family and strong genetic basis is present for every Cancer either coming as sporidally mutation of gene in an Individual or by hereditary in family.Here lies the success of stem therapy or gene Modulation or therapy to treat cancer.

Surgery is the basic of treating most cancers of Abdominal organs,Hand,leg or extremities,lung,brain,breast and chest wall ,skin etc but surgery completely cannot remove the whole tumor as tumor might have spread to important organ completely as to Liver or pancreas ,we cannot completely remove these organs so after a good chunk removal we use radiotherapy to remove these cells or we can use radiotherapy initially to control thest tumors and then can resect them once their size is less or can use with surgery or after it to rmove any remaining tumor unvisiblt that time or because of important organ not removed in first chance.Some time for mouth ,tongue,cervix,breast cancer we use Raditherapy to burn these tumor in first instance and donot use surgery at all but may use surgey if tumor remains after 8-10 wks of radiotherapy or if tumor recurs at this site .Similiarly for cancer of Blood and connective tissue crmotherapy or Medicines are only needed no sugery or Raditherapy is needed,some time to make tumor resectable we use cheotherapy first but mostly we use it after surgery or radiotherapy to remove tumor completely from originationg sit and then removing any micro spread which occured to ant distant organ either dtectable or undeteable in first phase or recurrence phase.

Overall the subject is very vast and many reasearches are going on making Human life more safe and precious ,the days will come soon when Man will win over this demon completely and even today our victory should not be ubderestimated because we can completely overcome Cancer if it is detected and treated in early stage by present modern gadgets of Surgery,Chemotherapy and radiotherapy,many Ayush and otherwise natural healers and therapist claim many medicnes to cure them completely by showing or claiming their personal cases and experiences,in this regard this is advisable that please expose first your claim internationally by publishing papers in good modern Journals of modern Medicines or of your subject or therapy,simple assertions and personal claim may not be hold good for many other patients as aberrations are known in medical science so,please refer the patient to good medicl college or centre when you see any cancer patient,donot keep patient in your clutch only,allow them to get detected the Disease or cancer completely and then get started the therapy ,with this therapy you may add your medicines too if you are very confident or qualified otherwise for earning money if some false promises or trials are done on some patients of villages or slum or from poor uneducated class of our country by so many self claimed healers or doctors using any therapy is a heinous crime on the earth and please restrain from this and help the society to curb this fatal disease completely and in first instance.

Dr.d.r.Nakipuria

Ambika chikitshalya

29 agrasen road

siliguri-734005