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Nov23
MANAGEMENT OF ACTIVE PULMONARY TUBERCULOSIS IN GENERAL PRACTICE
MANAEMENT OF ACTIVE PULMONARY TUBERCULOSIS IN GENERAL PRACTICE
DR.S.ABBAS ALI
MD DNB MNAMS
Fellowship in clinical cardiology
PGDHSC (Ultrasonography)
PGDHSc (Echocardiogram)
FCGP., MCCP (cardiology)
230/12 Chandralok colony
NH-2 Goverdhan chauraha
Mathura – 281004
Uttar Pradesh

Pulmonary tuberculosis is a sub acute respiratory infection with acid fast bacilli Mycobacterium tuberculosis. The most frequent symptoms are cough, fever, night sweats and malaise. Cough in pulmonary tuberculosis is initially non-productive, but often progress to sputum production and in some cases Haemoptysis. The sputum is generally yellow and is neither malodorous nor thick. Extremely advanced cases may also present with bloody sputum. Rarely, the bleeding is massive leading to shock, asphyxia and death.
Tuberculosis (TB) is one of the top 10 causes of death worldwide. In 2016, 10.4 million people fell ill with TB, and 1.7 million died from the disease (including 0.4 million among people with HIV). Over 95% of TB deaths occur in low- and middle-income countries. Seven countries account for 64% of the total, with India leading the count, followed by Indonesia, China, Philippines, Pakistan, Nigeria, and South Africa. In 2016, an estimated 1 million children became ill with TB and 250 000 children died of TB (including children with HIV associated TB).

The management of active pulmonary tuberculosis starts with proper classification, such as drug susceptible tuberculosis, Drug resistant tuberculosis and HIV-PTB by advising following investigations
• Sputum smear (AFB) examination: • atlest two samples of sputum should be examined. Early morning sputum specimens tend to have a higher yield than specimens collected at either times and overnight sputum collection have provided even greater sensitivity. Presence of AFB confirms the diagnosis that the patient is suffering from active pulmonary tuberculosis. This investigation does not confirm that this active PTB is whether DSPTB or DRPTB or HIV-PTB
• X-ray chest PA view: this is not a confirmatory investigation unless confirmed by sputum microscopy. X-ray chest will be helpful in knowing the extent of damage of lung.
• CB NAAT or Gene xpert of sputum AFB: this is latest weapon which delivers very fast results within 2 hours. This rule out drug susceptibility PTB from Drug resistance PTB. It also rules out Rifampicin Resistance.
• Card test for HIV: It is essential to rule out HIV-PTB. Many TB patients were being treated without knowledge of the presence or absence of concurrent HIV infection. Detection of HIV antibodies among TB patients is crucial to the holistic management.
• The other tests Interferon gamma release essay (TB Gold, TB spot), ADA, PCR Blood and Mantoux test were not helpful in diagnosis of Active Pulmonary Tuberculosis and should not be prescribed.
Classification
DST TB: it is assumed 85% of pulmonary TB cases were drug susceptible and curable. They include new cases, Retreatment and default cases.
DIAGNOSIS: Diagnosis of Drug susceptible tuberculosis requires clinical history plus three investigations such as
• LED microscopy AFB Sputum smear examination
• X-ray chest PA view
• CB NAAT or Gene xpert sputum of AFB: this test is strongly recommended is retreatment and default cases
Management and treatment:
Two months RHEZ and four months RHE if your area is high risk
Rule and treat other comorbidities such diabetes, COPD, anaemia, immunodeficiency etc.
Monitor the therapy using AFB sputum smear examination and X-ray chest every 2 months
Case cured: previous sputum positive TB becomes sputum negative on two occasions of 2 months gap.
Drug Resistant TB: An estimated prevalence of 3% in new cases and 12-15% in retreatment cases. Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. WHO estimates that there were 600 000 new cases with resistance to rifampicin – the most effective first-line drug, of which 490 000 had MDR-TB. Drug resistance tuberculosis is divided in to two categories; primary resistance, which is the presence of drug resistance in someone who has never had treatment from tuberculosis and secondary resistance, which is the presence of resistance in a patient who has previously been treated for tuberculosis. Primary resistance results from acquiring an infection that is already drug resistance, while secondary resistance is the result of inappropriate therapy which may be either due to patient attitude towards treatment or empirical prescription of drugs by physicians without following fixed guidelines of WHO or serial DST reports. MDRPTB is defined as resistance to at least rifampicin and isoniazid. The treatment of MDRPTB is extremely difficult, since the drugs used are less effective, more costly and poorly tolerated due to drug related side effects. Failure to control drug resistance tuberculosis has led to outbreak of PRE XDRPTB, XDRPTB and XXDRPTB.
PRE XDR-PTB: defined as resistance to Rifampicin, isoniazid plus resistance to fluoroquinolones or second line injectable (3 drugs).
XDR-PTB: defined as resistance to rifampicin, isoniazid plus resistance fluoroquinolones and at least one second line injectables (capreomycin, amikacin, or kanamycin) (four drugs)
XXDR-PTB: resistance to more than four drugs.
DIAGNOSIS: initial diagnosis of drug resistance PTB requires clinical history (such as previous prescriptions) and 3 investigations such as
• LED microscopy AFB sputum smear examination
• X-ray chest PA view
• CB NAAT (Cartridge Based Nucleic acid amplification test) or Gene Xpert: this is initial test in treatment failures.
For Management we require one more test such
• Serial Liquid cultures: liquid culture gives fast results with in three weeks in comparison of solid cultures. The management and treatment of MDRPTB is complex and if family physician has expertise in managing MDRPTB cases, then manage the cases according to serial DST reports. Management of XDRPTB cases were definitely beyond the reach of family physicians and should be referred to specialized Government sectors where such services available.
HIV-PTB: Tuberculosis is a major opportunistic infection of HIV patients’ worldwide and is a leading killer of HIV-positive people: in 2016, 40% of HIV deaths were due to TB. The management again starts with identification and proper classification of TB such as Drug sensitive and Drug resistance, as drug resistance TB has been responsible for high rates of mortality in HIV infected individuals.
DIAGNSOSIS: investigations required for drug susceptible HIV-PTB
• Sputum for AFB
• X-ray chest PA view
• Gene Xpert of sputum
• Rapid card test for HIV : Out of three cards at least two cards of different companies and confirmed by ELISA
For drug resistance HIV-PTB
• Liquid cultures for AFB sputum
Investigations for Management and follow-up:
• CD4 cell count:
• Viral load
• Haemogram
• Liver profile
• Identification and management of Comorbities eg. Diabetes, malnutrition
The investigations and treatment of HIV-TB is expensive and this services were available to patients at free of cost nearest Government ART centre. Beside ATT it requires lifelong ART (antiretroviral therapy) which should be initiated within 2 weeks of starting ATT.


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May22
DEAF & BLIND CAN NOW WATCH TELEVISION REAL TIME
DEAF & BLIND CAN NOW WATCH TELEVISION REAL TIME

PROF .DRRAM,HIV /AIDS,HEPATITIS ,SEX DISEASES & WEAKNESS expert,New Delhi,India, profdrram@gmail.com,+917838059592,+919832025033,ON WHATSAPP

For the first time, researchers have developed a new technology that types Braille or subtitles of television channels in real time and helps deaf-blind people "watch" television without intermediaries.The people, who have tried it, highlighted the advantage of being able to access information they previously could not, in real time and without intermediaries, and they have also praised its ability to transmit to Braille lines and the ability to adjust the reading and viewing speed.

Researchers from Universidad Carlos III de Madrid explained Pervasive SUB, it compiles all the subtitles of television channels and sends them to a central server which forwards them to smartphones or tablets.From there, they are sent to the Braille line of the deaf-blind person thanks to the GoAll app, which integrates the software, is compatible with different Braille lines and makes it possible to control the speed of the subtitles that are captured directly from the TV broadcast in perfect synchronization.
The lead researcher García Crespo said that at Telefonica their endeavor is to become a more accessible company and that way contribute to equal opportunities for all.The research team is now providing this service free of charge to anyone who needs it. Interested parties need only to download the GoAll app, available on ¡OS and Android.
Deaf-blind persons suffer a combined deterioration of sight and hearing, which impedes their access to information, communication and mobility in a way that seriously affects everyday abilities necessary for a minimally independent lif


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May21
ANTIBODY IDENTIFIED TO KILL CANCER CELLS-prof dr ram hiv/aids,hepatitis expert
ANTIBODY IDENTIFIED TO KILL CANCER CELLS-prof dr ram hiv/aids,hepatitis expert

PROF .DRRAM,HIV /AIDS,HEPATITIS ,SEX DISEASES & WEAKNESS expert,New Delhi,India, profdrram@gmail.com,+917838059592,+919832025033,ON WHATSAPP


Researchers have found that an antibody -- originally developed for studying the autoimmune condition multiple sclerosis -- can promote the immune system`s ability to fight cancer and decreases tumour growth.In a study published in the journal Science Immunology, the researchers reported that the antibody decreased tumour growth in models of melanoma (skin cancer), glioblastoma (brain cancer) and colorectal carcinoma, making it an attractive candidate for cancer immunotherapy.
The antibody can precisely target regulatory T cells which in turn unleash the immune system to kill cancer cells. T cells (Tregs) which help maintain the immune system`s tolerance of "self," can, inadvertently, promote cancer`s growth by preventing the body`s immune system from detecting and attacking cancer cells.
The researchers, led by neurologist Howard Weiner from Brigham and Women`s Hospital in Boston, Massachusetts, found that they could precisely target Tregs using an antibody.The team developed these so-called anti-LAP antibodies initially to investigate the development of multiple sclerosis, but realised their work had implications for the study of cancer.
In the current study, the team used preclinical models to investigate how well anti-LAP antibodies could work in blocking the essential mechanisms of Tregs and restoring the immune system`s ability to fight cancer. They found that anti-LAP acts on multiple cell populations to promote the immune system`s ability to fight cancer, including increasing the activity of certain types of T cells and enhancing immune memory.
"In addition to studying its therapeutic effect, we wanted to characterise the mechanism by which the anti-LAP antibody can activate the immune system," said lead author Galina Gabriely, a scientist in the Weiner laboratory. "We found that it affects multiple arms of the immune system," Gabriely said.


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Mar05
REGULAR INTAKE OF MEDICINE "ADHERANCE" IMPROVED HIV PATIENTS-THE LANCET STUDY
REGULAR INTAKE OF MEDICINE "ADHERANCE" IMPROVED HIV PATIENTS-THE LANCET STUDY


PROF .DRRAM,HIV /AIDS,HEPATITIS ,SEX DISEASES & WEAKNESS expert,New Delhi,India, profdrram@gmail.com,+917838059592,+919832025033,ON WHATSAPP

A new dtudy has been published in The Lancet - Infectious Diseases, the breakthrough deals with how patients take their medication and adhere to regimes, as too many face irregular regimes or discontinue medication.A new program or better patient assistance was designed by University of Aberdeen and Academic Medical Centre (Amsterdam) teams. University of Aberdeen Professor, Marjin de Bruin, stated ‘this is the first adherence intervention in HIV care that demonstrates clinical and cost effectiveness. The intervention can be applied in routine clinical care, and the effects have been reproduced in consecutive trials. Although HIV medications are very effective, they can have quite a few side effects and people with HIV don’t usually experience any symptoms of the disease, so for these and other reasons it is unsurprising that adherence among some patients is suboptimal. We designed a programme in such a way that it would fit in with routine care and only adds about 10 minutes to the consultation. Our intervention has proved to be very successful at improving drug-adherence and in turn reducing treatment failure. Importantly, these effects were most profound amongst patient groups from which we know struggle most with this treatment. As well as important for patients’ own health, having a very low viral load means that people are extremely unlikely to transmit the virus to other people. So not only is this a significant improvement to individual patients’ health, it is also important for public health because it may help to curb the pandemic by interrupting the transmission of the virus. That the intervention also saved money rather than required extra resources was unexpected, and strongly suggested that introducing this programme in routine HIV care is beneficial for patients and safety. It is very important to note that the medication non-adherence is very common with long and short-term treatments for many conditions, often contributing to poor patient outcomes and increased health care expenditure. We will therefore seek to adapt and test the benefits of this intervention in a range of other chronic condition.’


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Oct09
CHIKUNGUNIYA PATHO PHYSIOLOGY & MANAGEMENT
CHIKUNGUNIYA -PATHO PHYSIOLOGY MANAGEMENT
Chikungunya is a mosquito-borne viral disease first described during an outbreak in southern Tanzania in 1952. It is an RNA virus that belongs to the alphavirus genus of the family Togaviridae. In 2006, total 13,90,322 clinically suspected cases of Chikungunya were reported from 16 States/UTs in India.This Chikungunya fever guideline is published by the Directorate of National Vector Borne Disease Control, Govt of India in the year 2016. This guideline synopsis is dedicated to the Clinical management of Chikungunya. The information also covers the origin of the disorder, its epidemiology, diagnostic evaluations of the tests and management of the disease. Clinical Management of Chikungunya guidelines are summarized as follows: Since 1960, the outbreaks of the Chikungunya disease in South Eastern Asia were reported from India, Sri Lanka, Myanmar, Thailand, Indonesia, Philippines and Malaysia. Chikungunya outbreaks typically result in large number of cases but deaths are rarely encountered. Transmission and Trends: Chikungunya fever epidemics display cyclical and seasonal trends. There is an inter-epidemic period of 4-8 years (sometimes as long as 20 years). Outbreaks are most likely to occur in post-monsoon period when the vector density is very high and accentuates the transmission. Human beings serve as the Chikungunya virus reservoir during epidemic period. Types of Laboratory Tests available For Detection of Chikungunya Virus: Virus Isolation (Exposing cell lines samples from blood). Serological Diagnosis (ELISA IgM Specific). RT-PCR. Differential Diagnosis: Dengue Fever Malaria Leptospirosis Enteric Fever Rheumatic Fever Reactive arthritis Serum sickness illness Rickettsial disease Clinical Features: Acute phase: Less than 3 weeks Sub-acute phase: > 3 weeks to 3 months Chronic phase: > 3 months Symptoms: Fever Arthralgia/Arthritis Backache Headache Skin rash/Itching Symptoms which are seen in Children (Rarely in Adults) Photophobia Retro-orbital pain Vomiting Diarrhea Meningeal syndrome Acute encephalopathy Long course symptoms: Arthralgia Myalgia Arthritis Persistent Joint stiffness Restricted joint movement Painful joint movement Enthesopathy Tendinnitis Skin pigmentation Skin rash Impact of chikungunya on Pregnancy: A pregnant woman can get affected with the chikungunya virus at any stage of pregnancy. The time of huge risk of Chikungunya virus transmission from a mother to a fetus appears to be during birth. Chikungunya is more deadly in children as compared to adults because children cannot express exact symptoms and it may take time to diagnose the disease. Chikungunya in Elderly: The elderly are affected in more serious manner than the younger population. The body resistance is low in case of elderly and this causes the debilitating effects on their bodies. Chikungunya in elderly people could cause cerebral problems like dementia and paralysis and kidney disorders. Chikungunya Co-infection with Dengue: This is not very unusual as both Dengue and Chikungunya are arboviral diseases, transmitted by the same Aedes mosquitoes. The other observed symptoms in the patients who are suffering from infections of chikungunya and dengue are other non-specific constitutional symptoms such as anorexia, vomiting, headache, and muscle or joint pains and subjected the samples to Chikungunya serology as well. Guidelines for Management of the Chikungunya Disease: Management during Acute and sub-acute phase of the illness Management during Chronic phase or Sequelae. There is no antiviral drugs against Chikungunya Most of the signs and symptoms are self-limiting. Treatment for Chikungunya is purely symptomatic-supportive care and rest and nutrition Analgesics, antipyretics and fluid supplementation are important aspects in managing this infection. Supportive or Palliative Medical Care With Anti-inflammatories Supportive care with rest is indicated during the acute joint symptoms. Movement and mild exercise tend to improve stiffness and morning arthralgia, but heavy exercise may exacerbate rheumatic symptoms. There Is No Vaccine Currently Available. Disabling peripheral Arthritis/ Artropathy refractory to NSAID: Short term corticosteroid may be used. Long term anti-inflammatory therapy Physiotherapy Chloroquine phosphate Management of Chikungunya with High risk group: Proper management of Co-morbid condition and co-infection. Through the recent epidemics, Chikungunya has demonstrated its ability to spread and infect large proportions of the population. There is a very good chance that Chikungunya will continue to spread unless measures are taken to improve the recognition of the disease, to control the vectors responsible for the transmission Show Less


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Sep14
CAN AYUSH / AYURVEDA DOCTOR PRACTICE SURGERY / MEDICINE USING ALLOPATHIC DRUGS ?
A battle is being fault every second day as AYUSH OR AYURVEDA/HOMEOPATHIC/UNANI SIDDA/ ACUPUNCTURIST/ ACCUPRESSOR/REKI /RMP /COMMUNITY PRACTITIONERS/ALTERNATIVE MEDICINES HEALERS can be treated as ALLOPATHIC DOCTORS OR MODERN MEDICINE DOCTORS and inspite of being training only in their systmem OF THERAPY ,CAN THEY USE MODERN MEDICINES /DRUGS TO CURE DISEASES in Practice ?Can be appointed at same level in Govt.Hospitals by Government /Pvt Hospitals & Nursing homes using modern surgical procedures or medicines for treatment or Can be converted in to Modern Medicines Doctors? Regarding this SUPREME COURT UNDERLINES THAT NO ALLOPATHIC DOCTOR CAN WRITE AYUSH MEDICINES SAME WAY NO AYUSH DOCTORS CAN WRITE MODERN MEDICINES AND CAN NOT PRACTICE AS MODERN MEDICINES DOCTORS as Modern medicine is very Life saving but fatal too as any mistake can cause serious damage or kill the patient so cant be practised by simple knowing few pharma medicines and as its study is difficult and need a course of six years for undergraduate, 10 yrs for PG and 12-15 yrs for being superspecialist with hard to crack entrance examinations at every label sothat DOCTORS PRODUCED HAVE GOOD KNOWLEDGE TO BE RECOGNISED NATIONALLY AND INTERNATIONALLY.HENCE A STRICT MCI MADE TO LOOK AFTER ITS ETHICS,CURICULLUM AND TRAINING BUT AS MBBS DOCTORS HAVE NAME AND FAME WITH MONEY SO MANY PVT MEDICAL COLLEGES CAME AND UNDER TAINTED MCI WITH DR KETAN DESAI OR FOLLOWERS AS GOVERNORS SOLD EVERY ETHICS RECOGNISED MANY PVT MEDICAL COLLEGES WITH FAKE PATIENTS,GHOST FACULTY TEACHERS AND POOR LABS/OTS AND EQUIPMENTS TAKING CRORES AS BRIBE AND A MARKET OF BLACK MONEY OF THOUSAND CRORES IS EXISTING SO THERE IS SHORTAGE OF DOCTORS MORE FOR SPECIALIST AND SUPERSPECIALISTS. To counter this SHORTAGE ,our policiticians have recommended that ALL AYUSH DOCTORS SHOULD BE TRAINED A LITTLE AND CONVERT THEM TO MODERN MEDICINES DOCTORS AS THERE IS CORRUPTION AND KICKBACKS IN OUR POLITICS SAME WAY THEY THINK DOCTORS CAN BE MADE but who will get treated by these no educated QUACKS as Politicians and rich affordable always move to specialists and super specailist for their problems only poor and backward will be allowed to die in their hand ,secondly no country in world will recognise them,no one from foreign country will come to India for treatment whose modern medicines,at present time,is at par or excellant than UK/USA/Germany/France /Australia's Treatment Modalities. But our politicians for winning votes want otherwise,they have posted Ayush doctors with same payment scale in all government hospitals ,started a new ministry disregarding the fact that MOST OF THEM TREAT PATIENTS IN THEIR CHAMBERS IN CITY/TOWN/ MOHALLAS/ VILLAGES AND EVEN IN METROS BY MODERN MEDICINES ONLY PUTTING TOUGH COMPETITIONS TO TRAINED MODERN MEDICINES DOCTORS.GOVERNMENT NEVER TAKES ACTION AGAINST SUCH "QUACKS" AS STATED BY SUPREME COURT. IT IS CLEAR THAT TO BE MODERN DOCTORS MANY USE EASY AYURVEDA / HOMEOPATHIC / UNANI SYSTEM TO BE A DOCTOR WHERE FEES ARE CHARGED ONLY AND MANY STUDENTS ARE PASSED WITHOUT PROPER TRAINING BY PAYING BRIBES TO THESE AYUSH COLLEGES AND AFTER PASSING THEY ONLY USE MODERN MEDICINES AND WORK AS JUNIOR DOCTORS IN MANY SMALL AND BIG HOSPITALS/ NURSING HOMES OF MANY CITIES/TOWN ALMOST ALL OVER INDIA WHICH HAS BEEN TERMED ILLEGAL BY SUPREME COURT.IN INDIA ANY BODY CAN PRESCRIBE MEDICINES,WITHOUT TRAINING MANY "BABAS"/SADHU PRACTICE MEDICINES AND ARE HIGHLY RECOGNISED IN THE SOCIETY AND OUR LAW ENFORCEMENT AGENCY NEVER TAKES ANY ACTION,IN COURT JUSTICE IS SO MUCH DELAYED THAT NO ACTION HAPPENS IN 10-20 YRS SO TO BE A DOCTOR IS A FASHION IN INDIA IF ONE CAN'T READ MEDICINES THEN TAKE A TRAINING IN REKI, SABLOK, ACCUPUNCTURE,MAGNET THERAPY,ACCUPRESSURE, PHYSIOTHERAPY, OPTOMETRY,LAB ASSISTANT OR AS RMP NURSE AND PUT "DOCTOR "INITIAL BEFORE NAME AND "DOCTOR SIGN" ON YOUR CHAMBER/HOUSE/ MARKET/VEHICLE AND PRACTICE ,NO BODY WILL CHECK YOU AND IF CAUGHT, PAY MONEY TO HEALTH OFFICIALS/ POLICE/POLITICIANS OR COURT AND GET FREE SO TO PRACTICE MEDICINE IN INDIA IS VERY EASY AND IS A GOOD PROFESSION TO EARN .EVEN SENIOR DOCTORS WHO GET REFERRAL FROM SUCH "QUACK" DOCTORS,TRY TO PROTECT THEM FROM INSIDE BUT OUTSIDE THEY ARE AGAINST THEM IN THEIR ASSOCIATIONS LIKE "IMA". A NEW BATTLE FOUGHT IN KERALA HIGH COURT WHERE SURGERY AND OTHER PROCEDURES AS DELIVERY OF CHILD BY USING MODERN MEDICINES CAN BE TAUGHT TO THEM OR NOT AND LATER CAN THEY PRACTICE IT USING MODERN MEDICINES.During the hearing, allopathic practitioners argued, that such training and observations hardly benefitted people while being in clear violation of the spirit of the MCI Guidelines. Ayurvedic practitioners on the other hand argued such training and observations were a part of their curriculum and was being imparted to students for the last 20 years.Dr Rejith Anand, general secretary of Ayurveda Medical Association of India said that knowledge could not be monopolised by anyone, which emphasised the right of Ayurveda students to train in modern medicine and the future of Ayurveda students and even existence of Ayurveda colleges hangs in balance, unless the government takes a concrete decision.If the training is not imparted as per syllabus, the Central Council of Indigenous Medicine (CCIM) and even the state council is unlikely to give registration to students and affiliation to colleges.” The argument was met with a strong rebuttal from the allopathy doctors, who stated that no ‘observership’ of any kind could be allowed in modern medicine hospitals, and if such a thing happens, allopathic practitioners would oppose it. Dr A V Jayakrishnan, IMA State president highlighted that this went clearly against MCI guidelines which state that modern medicine students can only be trained in modern medicine institutions. Speaking to IE, he also questioned Ayurveda doctors’ claim of observing the procedure for an exposure in basic aspects of modern medicine, saying,‘’Our system is different from theirs. Then what is it they want to observe? Surgery, labour and autopsy are not exhibitions. Moreover, what use it will be for an Ayurveda doctor who does not practise modern medicine?’’ PLEASE WRITE YOUR VIEWS WHETHER MODERN MEDICINES DOCTORS SHOULD ALLOW THIS"QUACKERY" ? THE PRESENT TOUGH COMPETITIONS OF MODERN MEDICINES DOCTORS IN PRACTICE TO FACE SO CALLED "QUACKS / OR OTHER PATHY DOCTORS USING MODERN MEDICINES FOR TREATMENT" BE ALLOWED BY OUR POLITICIANS LAW ENFORCEMENT AND DELIVERING SYSTEM? OR CHANGING THEM LEGALLY INTO MODERN MEDICINES DOCTORS BRINGING NEW LAW IS JUSTIFIED OR NOT?


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Sep06
NITI AYOG & NMC PROMPTING CORPORATES TO OPEN MEDICAL COLLEGES MAY RUIN OUR MEDICAL EDUCATION
There is,no,need of any new medical colleges in this country by any agency profit making or non profit making . There are enough medical colleges churning out substandard , poorly trained medical graduates .Already most private medical colleges are owed by rich or politicians. So no need to start any more. The need of the hour is quality and not quantity. Most private medical colleges are having on roll staff and not regular staff. All their Data is highly inflated. The quality of knowledge which doctors aged 65 yrs have is not there in new graduates. So have a mercy on poor citizens and do not start any more Private college. Need is to,bring the existing medical colleges to the standard that a medical colleges needs to,have . Further more all other central and state run medical facilities needs to,be strengthened and made accountable . Referral and evacuation system from primary to,tertiary medical,facility should be developed . The tragedy here is even the primary centre is so poor in provinding services that one can simply shudder thinking if your own kith and kin was to seek medical service there . Our present medical colleges are ill equipped , they lack in facilities that a normal standard medical college must have . Faculty members are practice oriented and non committed lot . Reason they are paid starvation wages . Very high quality training , assured placement I. Government run health facility with adequate salary ,ban on practice and development of state wide interlinked clinical service network is the need . Medical record keeping at all centres from primary health centre to the apex tertiary care unit in the chain of evacuation needs to,be developed . Health of an individual who reports at a primary centre should become total responsibility of the state including transfer of the patient to a higher centre , computerised nationally linked web WAN ( wide area network ) should,be developed and be functional to all health care providers working at any place in the country , involved in the care and treatment of a patient . Private sector must also have responsibility to maintain electronic records of patients and the same be connected to state,system for retrieval of the information of the patient . Internship should,be closely monitored and supervised with maintenance of interns logs and they be examined for their work place based competencies before being given an internship completion certificate . I have seen interns being totally unaware and unfamiliar with any good clinical oriented work and working as independent doctor a most are busy to have training for PG and most rely diagnostic blood tests and radiological tools as x-ray,usg,mrict scan for diagnosis only. DR ASHOK PANGARIYA IA NOTHING BUT IMF USA man HERE CHOOSEN BY PM MODI WITHOUT SEEING HIS CREDENTIALS,HE OPPOSED INDIA BEFORE IMF AND USA MANY TIMES AS STATED BY SUBRAMANIYAM SWAMY ,HE IS HERE TO EARN CRORES,A NEXT CHELLA OF DR KETAN DESAI,HE HAS FORMED NATIONAL MEDICAL COMMISSION WHERE 60% SEATS WILL BE ALOTTED BY PVT MEDICAL COLLEGES ON THE FEE STRUCTURE DECIDED BY THEM,A MBBS SEAT WILL BE SOLD FOR 2 TO 5 CRORES AND PG SEAT FOR 10-15 CRORES AND MCH,DM FOR 20 TO 30 CRORES,ONLY MIDDLE CLASS PEOPLE OR LOWER CLASS PEOPLE SEND THEIR SIBLINGS FOR STUDYING MEDICAL SO NO ONE WILL BE ABLE TO READ HERE ONLY BIG BUSNESSMEN,NRIS,INDUSTRALISTS OR FOREIGNERS ,POLITICIANS,BUREAUCRATS,JUDGES EARNING IN CRORES CAN AFFORD IT,SO NOW THEIR CHILDREN WILL BE DOCTORS AND THEN THEY WILL MULTISPECIALITY HOSPITALS AND MEDICAL COLLEGES AS ADVISED BY NITI AYOG WHER POOR WILL STARVE OR WILL DIE WITHOUT TREATMENT ,so what Pangariya and other colleagues and Members of NMC ,politically selected, incompetant bureaucrats or policy makers or their stooges or 1 to 2 doctors will EARN IN CRORES AS JUSTICE KABIR AND DR KETAN DESAI EARNED .By replacing Planning Commission to Niti Ayog nothing happened but all persons replace by new faces with poor credentials who enjoy big salaries,foreign trips with free air fare and meetings in 5 storey buildings.Same way by changing MCi nothing new will come as present day many elected members have got no say,mostly president secretary and few top office bearers are followers of Dr Ketan desai so doing all illegal works,send their selected few Assessors to different pvt medical colleges in name of computer selection and recognise such colleges where most of their indoor and outdoor patients list is fake,even fake nearby villagers are admitted on day of inspections with more than 60 percent ghost faculty teachers who are present on the day of assessment only with very few icu,ot,lab and diagnostic facilities and meagre teaching facilities,class rooms,libraries,play ground etc BUT as crores paid and share provided to top office bearers so WHERE EVERY BODY IS BLIND,DEAF AND DUMB , THESE ARE EVIDENT ON MANY TV STING OPERATIONS,BY SUPREME COURT BY PARLIAMENTARY COMMITTEE which recognise MCI as A MOST CORRUPT BODY RESPOSIBLE FOR A BUSINESS OF THOUSAND CRORES OF MEDICAL EDUCATION.Taking steps from this and SC intervention to introduce NEET ,Niti Ayog thought new idea of forming a NMC where Big houses has been allowed to open new colleges with discreation to keep their own fee in 6o percent seats where for any deficiency in medical college be it infrastructure of fake patients or ghost teachers or lack of medical educaton for up to 03 yrs by paying simple penality MEDICAL COLLEGES WILL BE ALLOWED TO RUN ,where few its members will decide every thing and even court will not be able to interfere in their decision.Beside this they will bring a MBBS and PG exit exam so that more people help foreign countries to establish fake medical colleges there as foreign students till date are allowed only for such exit examinations as MBBS or PG students will have to pass four semisttars and part clearance examinations and pg entrance test but IAS ,IPS,Pangariya like economic graduated passed a single post gradute exam or one PSC competition test with viva where every chance of selection by manipulation or favourism present but now these LESS EDUCATED AND IMCOMPETANT RULERS ,most of could not competer mbbs or enginnering PMT,PET TO BE DOCTORS OR ENGINEERS at their time AS PVT COLLEGES WERE NOT PRESENT THAT TIME WILL NOW GOVERN US,THE MOST TALENTED AND HARD WORKERS DOCTORS. Need of hour is that we replace MCI with good office bearers elected on good credentials rather than politically as selected from most state council and by centre and if they really work honestly and recognize PVT Medical Colleges on merit of good no of facilities where good no of patients are really treated,good faculties in enough number always present to impart good education rather all these on papers by DIGITAL ON LINE LIVE MONITORING NOT ON THE DAY OF INSPECTION BUT ROUND THE CLOCK ,VISIBLE TO ALL as offenders should be punished by a prompt judiciary rather than a RECOGNITION on payment.Fee should be decided by elected Government or MCI considering facilities of medical Colleges by grading and no need of many EXIT EXAM FOR ALREADY HEAVY BURDENED PASSOUT MBBS GRADUATE AS HE HAS TO TAKE EXAM FOR PG ENTRANCE TOO. Industralists or businessmen or politicians may be encouraged to open new medical colleges for imparting good knowledge by mind set of donations not for earning and multiplying their wealth as SUPREME COURT SAYS MEDICAL FIELD IS FOR EDUCATION AND SERVICE NOT FOR MINTING & PRINTING MONEY AS PREVALENT NOW A DAYS AND OUR NITI AYOG IS ALSO PROMOTING THE SAME. Would you like to share this with your colleagues? Email Be the first one to share this post


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Sep03
WHY ART CALLED HAART WHAT IS COUNITY VIRAL LOAD
WHY ART CALLED HAART WHAT IS COUNITY VIRAL LOAD
PROF.DRRAM ,HIV/AIDS,SEX Diseases, Hepatitis .& Deaddiction
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ART is the acronym commonly used today to describe HIV antiretroviral therapy. Previous to this, clinicians and scientist would use the term cART (combination antiretroviral therapy), and previous to that the popular term HAART was used to describe "highly active antiretroviral therapy."
Whatever the acronym used, the term implies the use of three or more antiretroviral drugs, either taken individually or in fixed dose combinations. The aim of therapy is to ensure the suppression of HIV to so-called "undetectable" levels—meaning that the virus is not fully eradicated, but is simply beneath detection levels of current testing assays.
As opposed to single-drug or dual-drug therapy, the combination of three or more active drugs is known to effectively suppress the variety of resistant HIV that can exist within a viral population. Essentially, if one drug is unable to suppress a certain viral mutation, the others will likely be able to do so.
High levels of adherence are needed in order to maintain therapeutic drug levels in the blood. If these levels fall beneath the therapeutic threshold, resistant strains are provided an opportunity to thrive. The larger these resistant populations, the less effective the drugs will be in suppressing HIV replication—eventually leading to viral rebound and treatment failure.
Classes of ART
There are currently five classes of antiretroviral drug, each of which inhibit a specific stage in the HIV life cycle:
Entry or Fusion inhibitors (which include CCR5 receptor antagonists)
Nucleoside and nucleotide reverse transcriptase inhibitors (NRTI/NtRTI)
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Integrase inhibitors
Protease inhibitors
Other classes of antiretrovirals are being investigated, while newer-generation drugs aim to improve tolerability, reduce adverse effects and simplify dosing for those on therapy.
To this end, an increasing number of fixed dose combination (FDC) drugs are now available, combining two or more drug into a single pill or tablet. Some, including Atripla ((tenofovir + emtricitabine + efavirenz), Triumeq (abacavir + lamivudine + dolutegravir) and Stribild (tenofovir + emtricitabine + elvitegravir + cobicistat) offer all-on-one formulations for simplified, daily dosing.
Future of ART
With advances in HIV drug developments, ART is now being employed as a means to reverse infection rates in high prevalence HIV populations.The strategy, known as Treatment as Prevention (TasP), has been shown to reduce the risk of transmitting HIV by suppressing viral activity to undetectable levels. In doing so, the risk of transmission is reduced by as much as 96%.By ensuring widespread drug distribution, ART can lower the so-called "community viral load" (the median viral load within a community) to levels where the likelihood of transmission is significantly, even profoundly, reduced


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Sep03
What are the relevant MCI Regulations for Issuance of Medical Certificates
1.3.3 A Registered medical practitioner shall maintain a Register of Medical Certificates giving full details of certificates issued. When issuing a medical certificate he/she shall always enter the identification marks of the patient and keep a copy of the certificate. He/She shall not omit to record the signature and/or thumb mark, address and at least one identification mark of the patient on the medical certificates or report. The medical certificate shall be prepared as in Appendix 2.
1.4.1 Every physician shall display the registration number accorded to him by the State Medical Council/Medical Council of India in his clinic and in all his prescriptions, certificates, money receipts given to his patients.
1.4.2 Physicians shall display as suffix to their names only recognized medical degrees or such certificates/diplomas and memberships/honors, which confer professional knowledge or recognizes any exemplary qualification/achievements.
7.3 If he/she does not display the registration number accorded to him/her by the State Medical Council or the Medical Council of India in his clinic, prescriptions and certificates, etc. issued by him or violates the provisions of regulation 1.4.2.
7.7 Signing Professional Certificates, Reports and Other Documents: Registered medical practitioners are in certain cases bound by law to give, or may from time to time be called upon or requested to give certificates, notification, reports and other documents of similar character signed by them in their professional capacity for subsequent use in the courts or for administrative purposes etc. Such documents, among others, include the ones given at Appendix–4. Any registered practitioner who is shown to have signed or given under his name and authority any such certificate, notification, report or document of a similar character which is untrue, misleading or improper, is liable to have his name deleted from the Register.
Source: MCI Code of Ethics Regulations, 2002.


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Sep03
INDIAN MOS HEALTH ANUPRIYA PATEL SAYS "ILLEGAL SURROGACY IS A 2 BILLION DOLLAR INDUSTRY "
INDIAN MOS HEALTH ANUPRIYA PATEL SAYS "ILLEGAL SURROGACY IS A 2 BILLION DOLLAR INDUSTRY "



The government said commercial surrogacy has become a USD 2 billion illegal industry and a means to exploit vulnerable women even as it vowed not to let women in India become “baby factories”.

Minister of State for Health Anupriya Patel said commercial surrogacy has also become a means of exploiting children also, when they get abandoned. “We want to communicate that surrogacy should be the last option and we in no way are going to promote the idea of commercial surrogacy,” Patel told NDTV.


The minister also spoke on Surrogacy (Regulation) Bill 2016, which was recently approved by the Union Cabinet, and has drawn criticism from several quarters. She said the government is “conscious and sensitive” and various issues which has not been touched so far may be addressed in the course of discussions in the parliament. The bill is yet to be tabled in Parliament and there will be many more rounds of deliberation, Patel said.

“It’s a long process. I believe that the outcomes are going to be in the larger interest of the nation,” she said. She said 80 per cent of the total child births taking place through surrogacy in India are for foreign nationals. “Women in India are not baby factories. If you consider the total number of births of children which are taking place through surrogate mothers, 80 per cent of such births have been for foreign nationals. “Why are they doing this? Are Indian women only made for this purpose? They are trying to escape the tough laws of surrogacy in their own homeland and therefore they are coming to India because poor, vulnerable tribal women are easily available. They give them petty money,” she said. The bill proposes a complete ban on commercial surrogacy and allows only legally-wedded Indian couples to opt for it. It also seeks to bar unmarried couples, single parents, live-in partners and homosexuals from opting for surrogacy.

I THINK WHAT SHE SAYS IS ALMOST CORRECT ILLEGAL SURROGACY TREAT OUR POOR MOTHERS BADLY AND ONLY AS COMMIDITY TO BE PURCHASED BY MONEY


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