tag:blogger.com,1999:blog-17667794566326413382024-03-15T01:35:52.887-07:00survival of fittestWe aim to keep you all updated about recent guidelines, management updates and general health tips.
Our focus is on issues related to Primary Health Care, Public health, Rural and Remote health challenges and solutions.Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.comBlogger73125tag:blogger.com,1999:blog-1766779456632641338.post-36086186837417274722020-02-27T00:17:00.001-08:002020-02-27T00:17:05.971-08:00Hypertension : How to keep Your Blood pressure in control । उच्च रक्तचाप...Hypertension : How to keep Your Blood pressure in control ।<br /><br />
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https://www.youtube.com/watch?v=UBauSo3jK_8&t=21s<br /><br />
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<span style="background-color: #f9f9f9; caret-color: rgb(13, 13, 13); color: #0d0d0d; font-family: Roboto, Arial, sans-serif; font-size: 14px; white-space: pre-wrap;">Hypertension is getting very common and we must understand why it's getting common, how can we prevent it and what are the precautions and advice to keep blood pressure within normal limits.<br />
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Dr. Pratyush Kumar<br />
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Clinic - Makhaniya Kuan, Near Maszid<br />
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Mobile - 08130668400<br />
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website - www.drpratyush.com<br />
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Health advice and information from one of the best physician in Patna.</span><br /><br />
<span style="background-color: #f9f9f9; caret-color: rgb(13, 13, 13); color: #0d0d0d; font-family: Roboto, Arial, sans-serif; font-size: 14px; white-space: pre-wrap;"><br /></span>Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com31tag:blogger.com,1999:blog-1766779456632641338.post-89715034460398198522018-12-28T11:04:00.002-08:002018-12-28T11:04:46.086-08:00Avian Influenza : Prevention and food hygiene practices<div dir="ltr" style="text-align: left;" trbidi="on">
Do not panic!!<br />
<a href="https://m.timesofindia.com/city/patna/hospitals-put-on-alert-docs-advise-people-to-avoid-eggs/articleshow/67278474.cms" target="_blank">Recently there have been news</a> of H5N1 Avian influenIn virus cases at Patna zoo which has put the state on alert.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJpCJgOotnwwA3EVCsbZKWE0TJJTgI5clIIrl_Ppn2Rmfx62Wqsgl5eDEz7V9FlfzNIdo99Tfc3y2dXRgVsMPPo2O5CaiqaIexsQGy-XhmASE6A3pK3CEqlli0RM3_BMTaaauzvUB6k-q4/s1600/images+%252816%2529.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="541" data-original-width="514" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJpCJgOotnwwA3EVCsbZKWE0TJJTgI5clIIrl_Ppn2Rmfx62Wqsgl5eDEz7V9FlfzNIdo99Tfc3y2dXRgVsMPPo2O5CaiqaIexsQGy-XhmASE6A3pK3CEqlli0RM3_BMTaaauzvUB6k-q4/s640/images+%252816%2529.jpeg" width="608" /></a></div>
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📣 Prevention tips📣<br />
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🐔Regular hand washing with proper drying of the hands<br />
🐓Good respiratory hygiene – covering mouth and nose when coughing or sneezing, using tissues and disposing of them correctly<br />
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🦅Early self-isolation of those feeling unwell, feverish and having other symptoms of influenza<br />
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🦃Avoiding close contact with sick people<br />
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🐦Avoiding touching one’s eyes, nose or mouth<br />
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📢 Recommended good hygienic practices to reduce exposure to the virus in areas with outbreaks in poultry📢<br />
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🐦No birds from flocks with disease should enter the food chain.<br />
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🐥Do not eat raw poultry parts, including raw blood, or raw eggs in or from areas with outbreaks in poultry.<br />
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🐤Separate raw meat from cooked or ready-to-eat foods to avoid contamination. Do not use the same chopping board or the same knife. Do not handle both raw and cooked foods without washing your hands in between and do not place cooked meat back on the same plate or surface it was on prior to cooking. Do not use raw or soft-boiled eggs in food preparations that will not be heat treated or cooked.<br />
Keep clean and wash your hands. After handling frozen or thawed raw poultry or eggs, wash your hands thoroughly with soap. Wash and disinfect all surfaces and utensils that have been in contact with the raw meat.<br />
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🐣Cook thoroughly: Thorough cooking of poultry meat will inactivate the virus. Either ensure that the poultry meat reaches 70°C at the centre of the product (“piping” hot) or that the meat is not pink in any part. Egg yolks should not be runny or liquid.<br />
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#PrimaryHealthCare<br />
#AvianInfluenza</div>
Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com13tag:blogger.com,1999:blog-1766779456632641338.post-65616946942684477582018-11-09T05:51:00.000-08:002018-11-09T05:51:08.312-08:00Model polyclinic visit at Astana, Kazakhstan <div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Arial; font-size: 11pt; white-space: pre-wrap;">Global conference on primary healthcare was held in its beautiful capital Astana, Kazakhstan. Astana declaration on primary health care was released. </span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Health center visits was organised and We got an opportunity to visit model polyclinic at Astana during conference. </span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><img height="284" src="https://lh3.googleusercontent.com/Eo2bMQvtV15zEAEfxohT2VcB9EI2IkW0IFI60bFM5VtpuocXwFVa0Ka4271jV-O-OM5G1If01YJeSvtAUxbfG-7UqB-ogJqhqpa3UkTw0o8U3u1M9hG7UBu0XfPPHZ-_SP2O-856" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="602" /></span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">This polyclinic is situated at the heart of it's very beautiful and well planned capital Astana. It was built in 2015 and was informed of it being on lines of Alma Alta declaration following principle of primary health care.</span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><img height="284" src="https://lh6.googleusercontent.com/WnRJXWcoqKQE7gNvN2WJLPRzNngpTeljPuT_Bpy7szUQRE0po71EdaIZxruI85mrUfs4Z89uTRYbIMJ0KyIjaaHVURAS8iNhn5L9v-VLQjwOnNN0BVoTNqWtUJO_Q7gTAKwglr1p" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="602" /></span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">This polyclinic has over 130 doctors including gynaecologist, family physician, gastroenterologist, ophthalmologist, surgeon, dermatologist etc who works in 2 shifts daily as per schedule. Daily outpatient census is around 1000 patients.</span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><img height="284" src="https://lh3.googleusercontent.com/QHph5TG00kH5aK0SvwRDkh5j9A8ozjyvdgijh_EyfxmIGmrTV91WLgSyPGRhGmGaeelZZD7WmgOC6IdLR8UKEndGTwwjiwf2WFt2iyI4c_Fv9gQ2Z0bIyGuhRJgX7jNERH7m88oc" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="602" /></span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">This center has tele consultation facility taken care by nurses. On entry to the polyclinic each patient gets registered with their national unique Id and receive a password to access their reports online anywhere. This is a pilot work being done and there is plan to expand it Nationwide.</span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><img height="284" src="https://lh3.googleusercontent.com/WaBiU2XfwOT_WhtiFcjTwNDN_kHVJRPG53SP4yh3FUc7vg47nD9VNr5HFrTOCFDs0FQhxWtdBoj-yWoEMu5vvsxlzINay47q2n064cjbZlFY6LO38xOkmmkm2V_Yx_pQjCXhTczc" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="602" /></span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Then triage is done and patient goes directly to the consulting doctor. All specialty are well equipped with state of art diagnostics.</span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><img height="284" src="https://lh6.googleusercontent.com/Ln9NCx3199mpAQ52P4u2y0ZGiijDMAtI1mluLNh69C463eV4Rmali4qPBtZq126o7lc70dDWgoFunoKgwbGi_NJWYh9j6WagPWKWB3j22FF3iBQmkovN9T_HjXrj5C3VAsbRHHis" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="602" /></span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><img height="284" src="https://lh5.googleusercontent.com/_lYGMuM6a302grRLcFOfAk2I3xYKfr0QW22Lb5TtBsYFrUGFv1w-zrk5cY_AjnZ8IiGSZ5FxwEpR8A32rockI6cDPyNrn2tGybAMkU0QK15agcbAmuJ-ILTeGCsIoysvdhSZJy8f" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="602" /></span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Impressive to note was their disable friendly design of hospital including ramp made for visually impaired and relaxation room to get de-stress.</span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><img height="284" src="https://lh6.googleusercontent.com/9oxm_qmnwJdy0Shr5JStkgGalwVyuzcayuzmLUJh7_8fX6wuWyOHs8AHXqSZz4rJShsJYDO6wT1HJcKwbVcJWsIHexIMN_Z29yblk3zYjEpj2phpw396n5V5_-ymrMUx22txkb3C" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="602" /></span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">They also have upper GI and colonoscopy facility and daily around 3 endoscopy done and a minor OT and recovery room which is only for daycare surgery.</span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><img height="1275" src="https://lh3.googleusercontent.com/-VozmoXylD4i-vtiqMHU0a7q6Ig-Mgx0qj1F12q7pQMXbIiiC13CG_W0KGjAEfCit9B7-AqRb8QD_HLnW8l16Rtszrs5h1ATBdrbUXgjYebu21JmFZT2-ZV6OnaXADkFvpJ98OGb" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="602" /></span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Prenatal and Antenatal care is provided at this polyclinic but for delivery they are sent to designated hospital. Similarly for cataract surgery there is designated hospital where patients are reftrred after screening from this hospital.</span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">For outreach they have ambulance, medical train and helicopters. There are special ambulance specially designed for emergency delivery and hemodialysis.</span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><img height="284" src="https://lh4.googleusercontent.com/GO1ho0ALVzvq3HVgZxHM945KB61e6xyqvCpAiV7D_q3pK2V9jYhHSayb2EBaTs0yQfhJfEr7O6hEZu6L8b8S06-JkbvIvnBXorFpclv9Z-bFVjWBohKz7Pe-VnYUl275xb9_dCvs" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="602" /></span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><img height="1275" src="https://lh6.googleusercontent.com/y--XPG0k_1xE2S50edJzSUcsNYSmPz37nTBWx0lytznTVKVnLGEAv57h9YmZVixCI9BxQoAGpKsCRunG6GkGuD7cq4RChM1IU-PC8g4ABsFtKyG4KypJFTE1U-17cqZQKiZCSWnp" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="602" /></span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> For outreach in periphery the bigger mobile units which have diagnostics facility as well as consultation chambers for physician, ophthalmologist, gynaecologist and dentists are used.</span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><img height="284" src="https://lh3.googleusercontent.com/lQJpwQ0KQ8LgXsOSP_Vx977Mw8ploOvMAo_NaAsDtjkXvWo58FQhVawBb6mjp1bGklZLjAOfHib4bCkqFN-t3EDzRPCsIV-etqwTG_HJZci3f0fPs6259ZdAbfqwVgXvdDe2mm6W" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="602" /></span></div>
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<span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">These model hospitals looked impressive well equipped and good model for providing highest quality primary health care services.</span></div>
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-41472213559973749742017-08-06T12:52:00.000-07:002017-09-04T09:50:54.813-07:00Dengue fever: All facts which you should know <div dir="ltr" style="text-align: left;" trbidi="on">
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"Dengue Fever : Don't Panic, Know How to Deal With It" by Pratyush kumar mishra - <a href="https://www.practo.com/healthfeed/dengue-fever-don-t-panic-know-how-to-deal-with-it-29261/post">https://www.practo.com/healthfeed/dengue-fever-don-t-panic-know-how-to-deal-with-it-29261/post</a></div>
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com1tag:blogger.com,1999:blog-1766779456632641338.post-56435030411105643792017-07-30T12:21:00.002-07:002017-07-30T12:22:56.619-07:00Lychee deaths due to pesticides or hypoglycin A and MCPG toxicity bcoz of lychee consumption???<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgr8y_Yb6RkkqcPHZtdpAiBlPZCTJEinnMp4guaJsClG2cz4ONJgjGSRYTwEZ3TUF-m8xYkNxjq-Ewzk9_RdGdoWeBZJ-xNjGn-2CK4C9KmaxIyNL3cmii1Y7sf8E9HUHn783vvzUjSRG2O/s1600/Screenshot_20170731-004936.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1080" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgr8y_Yb6RkkqcPHZtdpAiBlPZCTJEinnMp4guaJsClG2cz4ONJgjGSRYTwEZ3TUF-m8xYkNxjq-Ewzk9_RdGdoWeBZJ-xNjGn-2CK4C9KmaxIyNL3cmii1Y7sf8E9HUHn783vvzUjSRG2O/s1600/Screenshot_20170731-004936.png" /></a></div>
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<br />
This news article was there in all leading newspapers recently. All of them carry the same mistake of misrepresenting facts.<br />
As these are two different studies published in Lancet and AJTMH.<br />
Both research papers can be accessed online.<br />
The mistakes are :<br />
1. Lancet study was done in Muzaffarpur while AZTMH study in Bangladesh.<br />
2. Lancet study sample size was 104 whereas in AJTMH is just 14.<br />
3. Lancet study also included pesticide sample in their study methodology.<br />
4. In AJTMH, no acute samples were taken.<br />
So Both research studies are significant papers but may not be unviersally applicable.<br />
So we should not jump to any conclusion very quickly.<br />
Lancet study - <a href="http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30035-9/fulltext">http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30035-9/fulltext</a><br />
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AJTMH study- <a href="http://www.ajtmh.org/content/journals/10.4269/ajtmh.16-0856">http://www.ajtmh.org/content/journals/10.4269/ajtmh.16-0856</a></div>
Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-74110135443754381042017-07-05T19:10:00.003-07:002017-07-05T19:10:55.594-07:00Snake Bite management guidelines<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsdMwkxTSBucaP8YGdx4fYkezQ6jeW0bkZQW1vESp4x7HfuwxhBO8PQtUbRu4bQ63lJLzO4EXhrCmSPdjs7lEL5NQcHUJb-KBJcnauBr460rlD3UxUaELRbqprpdAbdMBa9XMy-zSSJkQC/s1600/IMG_20170625_211212461_HDR.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsdMwkxTSBucaP8YGdx4fYkezQ6jeW0bkZQW1vESp4x7HfuwxhBO8PQtUbRu4bQ63lJLzO4EXhrCmSPdjs7lEL5NQcHUJb-KBJcnauBr460rlD3UxUaELRbqprpdAbdMBa9XMy-zSSJkQC/s1600/IMG_20170625_211212461_HDR.jpg" /></a></div>
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-9284724161297012422017-05-06T23:42:00.002-07:002017-05-06T23:42:51.997-07:00HIV - Management update<div dir="ltr" style="text-align: left;" trbidi="on">
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NACO follows WHO recommendation to start ART irrespective of cd4 count, clinical stage,age or population ..</div>
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<span style="font-weight: normal;">link to WHO guidelines : <a href="http://www.who.int/hiv/pub/arv/arv-2016/en/" target="_blank">Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection</a></span></h3>
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com1tag:blogger.com,1999:blog-1766779456632641338.post-63400876361743692302017-01-07T23:26:00.000-08:002017-01-07T23:43:01.855-08:00HbA1c : interpretation and common errors<div dir="ltr" style="text-align: left;" trbidi="on">
<div dir="ltr" id="docs-internal-guid-5e9d86c8-7d01-6e3d-cae0-a2b7232c7239" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
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<span style="font-family: "arial"; vertical-align: baseline;">HbA1c measures glycation of hemoglobin and considered equivalent to mean blood glucose over period of 8 to 12 weeks.</span></div>
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<span style="font-family: "arial"; vertical-align: baseline;">It depends on :</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Red cell turnover</span></div>
</li>
<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">HbA1c in reticulocytes</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Rate of glycation which depends on age of RBCs</span></div>
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</ol>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; vertical-align: baseline;">Any factor which cause reduced life span of RBCs may give erroneously low hba1c and vice versa .</span></div>
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<span style="font-family: "arial"; vertical-align: baseline;">Conditions causing high HbA1c</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Iron deficiency anemia</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Pernicious anemia</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Drugs - statins,Aspirin in high doses</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Hyperbilirubinemia</span></div>
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<span style="vertical-align: baseline;">Renal failure</span></div>
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<span style="vertical-align: baseline;">Few Hemoglobinopathies</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Splenectomy</span></div>
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<span style="font-family: "arial"; vertical-align: baseline;">Conditions causing low HbA1c</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Hemolytic anemia</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Renal failure</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Hemoglobinopathies</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Splenomegaly</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Drugs - hydroxyurea, Administration of iron and b12, Vitamin c & e ~ antioxidants, TMP-SMX, antiretroviral</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Alcoholism</span></div>
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<span style="vertical-align: baseline;">Chronic liver disease</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Hypertriglyceridemia</span></div>
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<span style="font-family: "arial"; vertical-align: baseline;">Alternatives for glycated hemoglobin HbA1c are</span></div>
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<span style="font-family: "arial"; vertical-align: baseline;">glycated albumin, fructosamine, or serum albumin-adjusted fructosamine.</span></div>
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<span style="font-family: "arial"; vertical-align: baseline;">Studies done on HbA1c</span></div>
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<span style="vertical-align: baseline;">NHANES Study </span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">DETECT 2 </span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">ADAG STUDY</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">DCCT </span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">UKPDS</span></div>
</li>
</ol>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; vertical-align: baseline;">The A1C test should be performed using a method that is certified by the NGSP (www.ngsp.org) </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; vertical-align: baseline;">Criteria for Diabetes</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; vertical-align: baseline;">A1C ≥6.5%(48mmol/mol).The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.*</span></div>
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<span style="font-family: "arial"; vertical-align: baseline;">Criteria for Pre Diabetes (ADA 2017)</span></div>
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<span style="font-family: "arial"; vertical-align: baseline;">A1C= 5.7 - 6.4% (39 - 47 mmol/mol)</span><br />
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<span style="font-family: "arial"; vertical-align: baseline;">Reference</span></div>
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<span style="vertical-align: baseline;">American Diabetes Association Standards of Medical Care in Diabetes 2017</span></div>
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<li dir="ltr" style="font-family: Arial; list-style-type: decimal; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="vertical-align: baseline;">Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus Abbreviated Report of a WHO Consultation - 2011</span></div>
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com1tag:blogger.com,1999:blog-1766779456632641338.post-13990134642530611672017-01-04T06:22:00.000-08:002017-01-04T07:18:17.175-08:00A2 milk, desi cows and Jallikattu - Need to unlearn what's wrong been taught over years.<div dir="ltr" style="text-align: left;" trbidi="on">
<div dir="ltr" id="docs-internal-guid-5e9d86c8-69d8-8769-e2a6-b0cd144470a2" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Times, Times New Roman, serif;">Recent debate on the ban of Jallikattu which will decimate India’s indigenous cattle breed (<a href="https://thewire.in/19157/banning-jallikattu-will-decimate-indias-indigenous-cattle-breeds/">https://thewire.in/19157/banning-jallikattu-will-decimate-indias-indigenous-cattle-breeds/</a>) brought my attention over another ongoing debate in West on a1 vs a2 milk which I feel everyone should know.</span></div>
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<span style="font-family: Times, Times New Roman, serif; vertical-align: baseline;">Milk contains lots of water, carbohydrates, proteins and fat. Debate is on its protein part which are caseins and whey proteins. Among caseins it's a1 and a2 variant which has brought so much of debate.</span></div>
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<span style="font-family: Times, Times New Roman, serif; vertical-align: baseline;">A2 is by default in our desi cows and a1 is supposed to be mutant type prevalent in European cows.</span></div>
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<span style="font-family: Times, Times New Roman, serif; vertical-align: baseline;">A1 and a2 proteins differs by an amino acid, In a1 at 69th position histidine is there whereas in a2 proline is there.</span></div>
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<span style="font-family: Times, Times New Roman, serif; vertical-align: baseline;">This difference leads to a major change when these proteins are digested in our body. A1 protein because of histidine which form a weaker bond with BCM7, on digestion it gets released which gets absorbed in our body. BCM7 has been found to be associated with type 1 diabetes mellitus, autism, ischaemic heart disease and schizophrenia.</span></div>
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<span style="font-family: Times, Times New Roman, serif; vertical-align: baseline;">BCM7 is a bioactive peptide beta caseomorphine 7 which leads to harmful effects on immune and nervous system. (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475924/">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475924/</a>)</span></div>
<span style="font-family: Times, Times New Roman, serif;"><br /></span>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Times, Times New Roman, serif; vertical-align: baseline;">By default most of our desi cows used to give a2 milk and imported cattles give a1 milk. But now with imported and crossbreed jersey and Holstein Friesian cattles from abroad to increase milk production, We lost our own desi breed in race of quality over quantity of milk.</span></div>
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<span style="font-family: Times, Times New Roman, serif; vertical-align: baseline;">Those imported cows give a1 milk.</span></div>
<span style="font-family: Times, Times New Roman, serif;"><br /></span>
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<span style="font-family: Times, Times New Roman, serif; vertical-align: baseline;">Now since it's been crossbred with our desi cows it's difficult to identify cows giving a2 milk. Although there are genetic tests available in few countries to correctly identify but it's not available everywhere.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Times, Times New Roman, serif; vertical-align: baseline;">It's easy to identify our desi cows producing a2 milk by the hump on back and flaps of akin beneath it's neck which are absent in exotic cows.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6ysQT3a-9RjTIne8PwUlRtq9nLHaHihxYbjt1QqNxaJ57cCyIS0BdRSLfWIycRCPDXj67HFCQxUntMTc8YCBtROAgO6ovZvHA-7csx44kWskDAUxEaBuZEB-jaEMzr3NUWMKcZ98ZmveA/s1600/images.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Times, Times New Roman, serif;"><img border="0" height="378" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6ysQT3a-9RjTIne8PwUlRtq9nLHaHihxYbjt1QqNxaJ57cCyIS0BdRSLfWIycRCPDXj67HFCQxUntMTc8YCBtROAgO6ovZvHA-7csx44kWskDAUxEaBuZEB-jaEMzr3NUWMKcZ98ZmveA/s640/images.jpg" width="640" /></span></a></div>
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<span style="font-family: Times, Times New Roman, serif; vertical-align: baseline;">Although it needs more research to substantiate the claims made so far and prove harmful effects of BCM 7, but at present it's better to switch over to our own desi cows for milk.</span></div>
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com15tag:blogger.com,1999:blog-1766779456632641338.post-21323437262666348862016-12-16T17:24:00.000-08:002016-12-16T17:27:32.675-08:00ADA - Standard of care in Diabetes - 2017<div dir="ltr" style="text-align: left;" trbidi="on">
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{Recent changes in ADA guidelines 2017}<br />
1. Emphasis on role of psychosocial care in Diabetes management.<br />
2.Staging of Type 1 diabetes mellitus<br />
Grade 1 - Presymptomatic with Normoglycemia<br />
Grade 2 - Presymptomatic with dysglycemia<br />
Grade 3 - Symptomatic with new onset hyperglycemia<br />
3. New validated screening tool has been added. Its a 7 questions set based on age, sex, weight, family history, gestational dm and h/o hypertension. Score more than 5 signifies increased risk of diabetes.<br />
4. Delivery baby more than 9lb is no longer an independent risk for diabetes.<br />
5. Recommendation to test GDM patient postpartum for persistent diabetes has been changed from 6-12 weeks to 4-12 weeks.<br />
6.In view of emerging evidence on sleep duration and quality on glycemic control, assessment of sleep duration and pattern has been included in comprehensive medical evaluation.<br />
7. Diabetes comorbidities list has been updated with inclusion of autoimmune diseases, HIV, anxiety disorders, depression, disorderedeatingbehavior, andseriousmental illness.<br />
8. In nutrition apart from carbohydrates counting protein and fat counting has been added.<br />
9. Need to interrupt prolonged sitting of more than 30 minutes with physical activity.<br />
10. Long term networking leads to B12 deficiency, requires monitoring and supplementation.<br />
11.Bariatic surgery now referred to as metabolic surgery reinforcing it's role in T2DM management.<br />
BMI cut off has been updated.<br />
12. Pharmacological approach to glycemic control updated:<br />
Empaglifozin and liraglutide recommended reduces CVS mortality in established cardiovascular disease.<br />
Non inferiority of basal plus glp1 agonist versus basal plus 2 rapid acting versus 2 premixed insulin<br />
13. Any of 4 antihypertensives (ACE inhibitors, angiotensin receptor blockers, thiazide-like diuretics, or dihydropyridine calcium channel blockers) may be used in patients without albuminuria.<br />
14. Beneficial effect of specialised therapeutic footwear for patients with high risk of foot problems.<br />
15. there are concern regarding concentration of metformin on the fetal side of the placenta and glyburide levels in cord blood. Insulin remains treatment of choice.<br />
16. In pregnancy target HbA1c is 6-6.5% but optimal is less than 6%.<br />
Targets for T1DM,T2DM,GDM<br />
Fasting - less than or equal to 95 mg/dL<br />
1hr PP - less than or equal to 140mg/dl<br />
2hr PP - less than or equal to 120mg/dl<br />
17. In hospital setting, sole use of sliding scale should be discouraged. Basal insulin or Basal plus bolus should be given, Target 140-180mg/dl.<br />
18.Classification of hypoglycemia<br />
Level 3 - Severe hypoglycemia - severe cognitive impairment requiring external assistance for recovery<br />
Level 2 - clinically significant hypoglycemia is now defined as glucose ,<=54 mg/dL (3.0 mmol/L)<br />
Level 1- glucose alert value is defined as less than or equal <=70mg/dL(3.9mmol/L)<br />
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com1tag:blogger.com,1999:blog-1766779456632641338.post-70547328835104515502016-11-13T11:26:00.000-08:002016-11-13T11:26:30.051-08:00Recommendations of DHR-ICMR Guidelines for diagnosis & management of Rickettsial diseases in India<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
1. Scrub typhus can occur in areas where scrub vegetation
consisting of low lying trees and bushes is encountered, and also in habitats
as diverse as banks of rivers, rice fields, poorly maintained kitchen gardens8
, grassy lawns which can all be inhabited by chiggers</div>
<div class="MsoNormal">
2. Presenting manifestations Acute fever is the most common
presenting symptom often associated with breathlessness, cough, nausea,
vomiting, myalgia and headache</div>
<div class="MsoNormal">
3. the presence of eschar is highly variable ranging from
7-97 per cent. Eschars are painless, punched out ulcers upto 1 cm in width,
with a black necrotic centre (resembling the mark of a cigarette burn), which
is surrounded by an erythematous margin. Eschar is a pathognomonic sign of
scrub typhus.</div>
<div class="MsoNormal">
4. untreated cases have case fatality rates as high as 30-45
per cent with multiple organ dysfunction, if not promptly diagnosed and
appropriately treated</div>
<div class="MsoNormal">
5. Presence of rash is common in spotted fever and is
extremely rare in scrub typhus. Rash usually becomes apparent after 3-5 days of
onset of symptoms. Initially rash is in the form of pink, blanching, discrete
maculae which subsequently becomes maculopapular, petechial or haemorrhagic</div>
<div class="MsoNormal">
6. The complications of scrub typhus usually develop after
the first week of illness. Jaundice, renal failure, pneumonitis, acute
respiratory distress syndrome (ARDS), septic shock, myocarditis and
meningoencephalitis are various complications known with this disease</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="color: blue;">Guidelines for management</span></b></div>
<div class="MsoNormal">
1. Definition of suspected/clinical case: Acute
undifferentiated febrile illness of five days or more with or without eschar
should be suspected as a case of rickettsial infection (if eschar is present,
fever of less than five days duration should be considered as scrub typhus)</div>
<div class="MsoNormal">
2. Definition of probable case: A suspected clinical case
showing titres of 1:80 or above in OX2, OX19 and OXK antigens by Weil-Felix
test and an optical density (OD) > 0.5 for IgM by ELISA is considered
positive for members of typhus and spotted fever groups of Rickettsiae.</div>
<div class="MsoNormal">
3. Definition of confirmed case: A confirmed case is the one
in which (a) Rickettsial DNA is detected in eschar samples or whole blood by
PCR, or (b) Rising antibody titres on acute and convalescent serum samples
detected by indirect immune fluorescecnce assay (IFA).</div>
<div class="MsoNormal">
<b><span style="color: blue;">Laboratory criteria</span></b></div>
<div class="MsoNormal">
1. Weil-Felix: This test should be carried out only after
5-7 days of onset of fever. Titre of 1:80 is to be considered possible
infection.</div>
<div class="MsoNormal">
2. IgM and IgG ELISA: a significant IgM antibody titre is
observed at the end of 1st week, whereas IgG antibodies appear at the end of
2nd week. The cut-off value is optical density of 0.5</div>
<div class="MsoNormal">
3. Polymerase chain reaction (PCR)</div>
<div class="MsoNormal">
4. Immunufluoroscence assay (IFA):</div>
<div class="MsoNormal">
5. Indirect immunoperoxidase assay (IPA)</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
1. Haematology (i) Total leucocytes count (TLC) during early
course of the disease may be normal but later in the course of the disease,
leucocytosis is seen, i.e. WBC count > 11,000/µl. (ii) Thrombocytopenia
(i.e. < 1,00,000/µl) is seen in majority of patients. </div>
<div class="MsoNormal">
2. Biochemistry: Raised transaminase levels are also
observed. </div>
<div class="MsoNormal">
3. Imaging: Chest X-ray shows infilterates, mostly
bilateral.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="color: blue;">Treatment</span></b></div>
<div class="MsoNormal">
<i>Without waiting for
laboratory confirmation of the rickettsial infection, antibiotic therapy should
be instituted when rickettsial disease is suspected.<o:p></o:p></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
In adults: (a) Doxycycline 200 mg/day in two divided doses
for individuals above 45 kg for a duration of seven days. Or (b) Azithromycin
500 mg in a single dose for five days.</div>
<div class="MsoNormal">
In children: (a) Doxycycline in the dose of 4.5 mg/ kg body
weight/day in two divided doses for children below 45 kg. Or (b) Azithromycin
in the dose of 10 mg/kg body weight for five days.</div>
<div class="MsoNormal">
In pregnant women: Azithromycin 500 mg in a single dose for
five days. Azithromycin is the drug of choice in pregnant women, as doxycycline
is contraindicated.</div>
<div class="MsoNormal">
At secondary and tertiary care level</div>
<div class="MsoNormal">
Intravenous doxycycline (wherever available) 100 mg twice
daily in 100 ml normal saline to be administered as infusion over half an hour
initially followed by oral therapy to complete 7-15 days of therapy. </div>
<div class="MsoNormal">
Or (b) Intravenous azithromycin in the dose of 500 mg
intravenous (iv) in 250 ml normal saline over one hour once daily for 1-2 days
followed by oral therapy to complete five days of therapy25. </div>
<br />
<div class="MsoNormal">
Or (c) Intravenous chloramphenicol 50-100 mg/kg/day 6-hourly
doses to be administered as infusion over one hour initially followed by oral
therapy to complete 7-15 days of therapy</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Download guidelines :- <a href="http://icmr.nic.in/ijmr/2015/april/0406.pdf">http://icmr.nic.in/ijmr/2015/april/0406.pdf</a></div>
<div class="MsoNormal">
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</div>
Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-68716683577526795042016-11-10T11:24:00.000-08:002016-11-10T11:24:56.183-08:00 Rendezvous with Family health centres of Rio de Janeiro<div dir="ltr" style="text-align: left;" trbidi="on">
Public health system developed over past few years in state of Rio de Janeiro, Brazil is definitely one of the better models of primary health care available anywhere. It was indeed a great opportunity to visit family health clinic in urban area and also in slums which is being known as favelas in Rio.<br />
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The first thing which you will notice is their commitment towards providing a hygienic environment, well cleaned clinic without much noise and chaos even in the health centre locate in favelas which is the most congested and densely populated area of Rio de Janeiro.<br />
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These health clinics have HIS which stores all the data of patient electronically. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHSBlYuGWGaRzUjJ2NKYNWDvn6TLQtYW2l2J3NqDJuhXXgr1Ln9vonOcrL6V7JOk1WRzte_QkkhAcc0mv6syDItGM_H_fH9Ji84pDm9NJJLfSHqw9Z5xdUKgoM6blJWNVIzML7rGU88KyQ/s1600/IMG_20161106_103606089.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHSBlYuGWGaRzUjJ2NKYNWDvn6TLQtYW2l2J3NqDJuhXXgr1Ln9vonOcrL6V7JOk1WRzte_QkkhAcc0mv6syDItGM_H_fH9Ji84pDm9NJJLfSHqw9Z5xdUKgoM6blJWNVIzML7rGU88KyQ/s1600/IMG_20161106_103606089.jpg" /></a><br />
These clinics are equipped with X ray machine, USG and laboratory which collects all the samples and sends it to a central laboratory.<br />
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At the entry you will find a health worker with “may I help” sign. Their duty is to guide everyone towards appropriate place of their need.<br />
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As some people only come to collect report, others for investigations, dressing, vaccination or for taking drugs. For these purposes they don't need consultation with doctors and are being managed efficiently at entrance itself. It reduces time and crowd in the clinic.<br />
Next you will find a big map which is google map snapshot of the catchment area of that clinic. This is equally divided based on total number of families in 7-12 groups. Each group is being taken care by team which consists of 1 doctor mostly family physician, 1 nurse, 1 technical nurse, and 5 community health workers. Out of 5 community workers 3 goes out to community and remaining 2 works in clinic daily and they rotate among themselves. Each community Worker has been assigned families out of their area for which they are responsible. Doctor has to spent 40 hrs per week in the clinic and out of this 4 hrs in the community. During the visit, doctor has to see those patients who couldn't come to hospital for various reasons.<br />
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Public health care is completely free. All the investigations, drugs, consultation are free. Every 2-3months dental kit with tooth brush and paste are provided free of cost.<br />
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For every 2 team 1 dentist is there to look after oral hygiene.<br />
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Consultation with specialists from ENT, Ophthalmology, Paediatrics etc are also provided only on reference of their family physicians. These specialist visit these hospital on a weekly schedule.<br />
Each patient has got their health book where all the consultation made are written. They have also got a health app in their mobile to schedule their consultation etc. Whenever they visit the clinic they have to go to their respective team registration area from where they will be given necessary directions.<br />
Each team has got their own team office and consultation area. In the team office you will find data of individuals assigned to each community worker. On an average each team has to look after 2000 individuals. On a big chart You will find picture of Doctor, nurses and technical nurses and below there are 6 groups with picture of respective community worker. In each group there is space for 296 families. By the side of each Family there are 6 Colour coded boxes which is To be filled by community worker. Important data which is to be entered according to colour code in the boxes are age less than 1 year, age 1-5 year, tuberculosis, pregnancy, HTN/DM, HA.<br />
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These all details are also available electronically through their HIS. Same goes for vaccination they track all the children in their area electronically and monitor them for vaccination.<br />
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This not only eliminates any form of error but makes healthcare more accessible to the population. Community participation is also there as they are receiving good quality service at affordable price. Affordable because they have to only pay taxes to the govt and in turn get free healthcare.<br />
There are so many things we can learn from their health system, First is the politival commitment of health secretary of Rio towards building a strong public health system which is entirely based on principles of primary health care that are affordable, available, accessible and appropriate. Hygiene and cleanliness can never be achieved only by good administration but also requires community participation and commitment towards keeping it clean.<br />
I would also like to mention few things which are different there like abortion which is illegal, although they promote contraception and condoms are available for free from their health centres. Have a look at this graffiti (anyway in Rio u will find lots and lots of graffiti all around). "<span style="background-color: white; color: #222222; font-family: Roboto-Regular, HelveticaNeue, Arial, sans-serif; font-size: 14px;">FAÇA SEXO SEGURO USE CAMISINHA" which means make safe sex use condoms.</span><br />
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There are many cases reported of early pregnancy in age group of 11-15 years. Only in cases of anencephaly or intrauterine death abortion is recommended.<br />
So would like to thank the health secretary and his team for explaining us everything.<br />
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-49887173748207847572016-10-19T23:40:00.000-07:002016-10-19T23:50:26.219-07:00Family medicine as your career choice.. why and why not!<div dir="ltr" style="text-align: left;" trbidi="on">
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Let me clear conflict of interest first. I am Dr. Pratyush and have done my DNB family medicine from Sir Ganga Ram Hospital, New Delhi. I took family medicine at my DNB CET rank 1725, where during councelling i had options of other clinical specialities like medicine, peds etc at periphery centres. Since i have thought of doing my own “start up” ..to setup my own clinic near to our village, Family medicine was the best option for me.<br />
Every one of us (postgraduate aspirant) may not have decided their plan post their pg courses. Some decide based on their rank, some are clear about their choice and they wait till they get their dream branch. But most of them finally end up doing postgraduate courses and with time everything settles. Life moves on.<br />
Family medicine is not a new branch, in fact its into existence for past so many years. Family medicine is that speciality which finds its place most of govt health reforms plan. But beyond that there is still need of more political committment.<br />
Family medicine is a broad speciality which is designed for specific purpose and that is primary care. Need for primary health care is huge in country like India with over a billion population. Family medicine deals with all age groups and all body systems, its a concept of generalism. There is huge potential for this specialty in terms of job, affordable and quality health care. Only thing we need is more structures health care with defined role of family physicians.<br />
Training in family medicine covers various specialty like internal medicine – 9 months, obs – 3 months, peds 3 months, surgery 3 months, ICU and emergency medicine – 3 month, ent,ophthal, psychiatry, dermatology postings. It also include posting in primary health care. Duration of these postings is not uniform across all institutes. But over all, major posting is medicine then peds, surgery and obs gynae.<br />
Rest all other rules are similar, you have to submit a thesis for which your guide and co - guides can be from any speciality belased on your thesis topic. At the end you have to give exam which consists of 4 papers. Paper 4 is mcq based only from community medicine. Rest all subjects are asked in other 3 papers. Theory exam is not that tough as it seems because you are expected only the basics.<br />
In practical exam you get 2 cases of medicine, 2 cases of peds and 1 case of surgery or obs/gynae. There will be a separate medicine viva, peds viva and community medicine viva.<br />
Frequently asked questions.<br />
1.<span class="Apple-tab-span" style="white-space: pre;"> </span>I want to do only medicine posting/surgery posting during my tenure as i am intrested only in surgery/medicine.<br />
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No, its not possible.<br />
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2.<span class="Apple-tab-span" style="white-space: pre;"> </span>Can i extend my posting in few specialities of my choice?<br />
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Look, generally u have to follow the set pattern which your institute have made it for its DNB trainees and is also based on NBE guidelines.<br />
<br />
3.<span class="Apple-tab-span" style="white-space: pre;"> </span>Can i do superspeciality/subspeciality courses in neurology, cardiology, gastroenterology?<br />
<br />
No, if you are interested, u should only take general medicine not family medicine.<br />
<br />
4.<span class="Apple-tab-span" style="white-space: pre;"> </span>Any other courses available after family medicine?<br />
<br />
Yes, u can do geriatrics, palliative care and various other skill based courses.<br />
<br />
5.<span class="Apple-tab-span" style="white-space: pre;"> </span>Are family residents being treated equally in departments being posted?<br />
<br />
Mostly yes, you will be treated at par with other residents of department and will be given opportunities in various academic programs of that department. But it also depends on your sincerity and dedication.<br />
<br />
6.<span class="Apple-tab-span" style="white-space: pre;"> </span>Is it similar to community medicine?<br />
<br />
No, Both are different and their curriculum is different. Family medicine is a clinical speciality where you are going to practice as family physician.<br />
<br />
7.<span class="Apple-tab-span" style="white-space: pre;"> </span>Is it a approved/recognised course?<br />
<br />
There should be no confusion regarding it. Its approved by MCI and after completing your training you can update it in your MCI and state medical council registration. <br />
<br />
8.<span class="Apple-tab-span" style="white-space: pre;"> </span>Is their any postgraduation MD family medicine courses?<br />
<br />
Yes, it has been started. New AIIMS which have been set up have also got Department of community and family medicine.<br />
<br />
9.<span class="Apple-tab-span" style="white-space: pre;"> </span>What about research opportunities ?<br />
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There are lots of research opportunities in this field. We have many journals like journal of family medicine and primary care, rural and remote health etc. If you are interested in research, family medicine and primary care will never disappoint you.<br />
<br />
10.<span class="Apple-tab-span" style="white-space: pre;"> </span>What about family medicine conferences?<br />
<br />
There are many conferences which takes place at national and international level. WONCA which stands for world organisation of family doctors conducts various confernces on various themes in association with regional groups. Details you can check it on website wonca.net .<br />
In India we have Academy of family physicians of India which supports and promotes family medicine. AFPI has got a journal jfmpc.com . AFPI has got various state chapter which conducts regular CMEs and orientation programs. AFPI conducts national level family medicine and primary care conference. Next conference is at Kochi from 26 jan 2017. There are various bursaries and awards to support you for your travel in many international conferences.<br />
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com18tag:blogger.com,1999:blog-1766779456632641338.post-65544793492367570762016-10-14T11:39:00.003-07:002016-10-14T12:01:39.419-07:00Topic for thesis protocol – Search for research<div dir="ltr" style="text-align: left;" trbidi="on">
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Every resident joining any postgraduate course must have faced it. This is probably the first hurdle you will find after joining any postgraduate course.Mostly in hospital its all on you to find a thesis topic and prepare protocol.<br />
Through this post i wanted to simplify the things and clear common errors and give you some basic ideas how to find a best topic for your thesis.<br />
1. Finding a suitable topic for your thesis protocol<br />
A. Choose a topic based on your interest eg, Diabetes, Hypertension, Infectious Disease, Critical care,depression etc.<br />
B. There should not be any scarcity of cases in your hospital as your thesis is a time bound study.<br />
C. Your thesis methodology should not have very costly investigations which is not standard of care for the disease. As you will find it difficult to get it approved from ethics committee.<br />
D. Your thesis topic should be new and unique. Unique in the sense that there is something new which have not been done before. In reality its very difficult to find a really unique topic, then you can search for topic which have been done else where, which has got different population characteristics but not in your region.<br />
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2 Thesis topics ideas.<br />
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You can search on <a href="http://pubmed.com/">pubmed.com</a> or google scholar or <a href="http://www.cochranelibrary.com/">www.cochranelibrary.com</a> to read various published research papers . You can look for thesis topic through these search engines.<br />
<br />
Diabetes<br />
1. Assessment of neuropathy through various scale (eg mnsi) and correlation with glyceamic control<br />
2. Assessment of retinopathy and its correlation<br />
3 Assessment of nephropathy<br />
4. Assessment of microvascular complications and correlation with glyceamic control<br />
5 Assessment of depression among t2dm using various depression scale<br />
6. Assessment of well being among t2dm using who 5 point well being score and correlation with glyceamic control<br />
7. Assessment of sexual health among t2dm and its correlation with duration and glyceamic control<br />
8. Assessment of drug compliance among patients of t2dm<br />
9. Knowledge attitude and practice about dietary modifications in t2dm<br />
10. Correlation of vit d<br />
11.correlation of serum magnesium<br />
12. Correlation of serum zinc, chromium<br />
And prevalence of microvascular complications<br />
13. Correlation of above glyceamic control<br />
14. Study on Metformin and B12 level<br />
15. Study on peripheral macrovascular disease and glyceamic control using Doppler<br />
16. Prevalence of osa among diabetic using scales for OSA and its correlation with glyceamic control<br />
Similar studies can be done using various scale for depression, anxiety, drug compliance and well being.<br />
<br />
Infectious disease<br />
1. Drug compliance study, psychiatric scales on tuberculosis.<br />
2. Knowledge attitude and practice study among health care providers and general public about<br />
A. Tuberculosis<br />
B. Hiv<br />
C. Dengue<br />
D. Chikungunya<br />
E. Hepatitis b<br />
3. Drug resistance pattern and radiological pattern in tb<br />
4. Clinico laboratory profile of<br />
A. Scrub typhus<br />
B. Leptospirosis<br />
C. Tiberculosis<br />
D. Dengue<br />
E. Chikungunya<br />
F. H1N1<br />
5.Radiological pattern and its correlation with severity and outcome among pulmonary kochs<br />
6. Study using various psychiatric scales in tubercuslos to look for depression anxiety etc<br />
7. study on Discrimnation and stigma among people living with hiv aids<br />
8. Clinical profile, cd4 count and other lab parameters in hiv<br />
9. Osteoporosis in hiv compared to general population using BMD.<br />
10. Study on prevalence of tb and hiv<br />
11. Drug resistance pattern, treatment outcome, in tb/hiv<br />
12. Study on newer modalities like line probe assay cb naat gen probe and comparison with conventional tests like sputum for AFB and chest xray<br />
<br />
Critical care<br />
1. KAP study on palliative care<br />
2. Study on hospital acquired infection, drug resistance pattern among icu patients.<br />
3.Prevalence of Icu psychosis<br />
4. Prevalence of critical care neuropathy and its correlation with severity and duration<br />
5. Prevalence of dyselectrolytemia and its correlation with infection and mortality<br />
6. Study using sofa score, apache score and other scores and its correlation with lab parameters and duration of hospital stay<br />
Methodology.<br />
You need to calculate sample size which is usually based on previous studies. Try to keep a achievable sample size.<br />
Observational studies are easier to do.<br />
<br />
References.<br />
Its the most important thing. Keep all the references in Vancouver style. You can use this website <a href="http://citethisforme.com/">citethisforme.com</a><br />
<br />
This is most common cause of rejection of your thesis protocol.<br />
You must define everything including various scale and values used, its reference range etc in protocol. Inclusion and exclusion criteria should be clearly defined.<br />
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Thesis protocol<br />
Please follow guidelines as per national board examination strictly. Dont change the heading by yourself. Keep it as given in the guideline In the same order otherwise its going to be rejected.<br />
<a href="https://draft.blogger.com/goog_792795450"><br /></a>
<a href="http://www.natboard.edu.in/pdoof/thesis/NBE%20Guideline%20for%20thesis%20protocol-2013%20_NEW_.pdf">http://www.natboard.edu.in/pdoof/thesis/NBE%20Guideline%20for%20thesis%20protocol-2013%20_NEW_.pdf</a><br />
<br />
Common mistakes<br />
1.<span class="Apple-tab-span" style="white-space: pre;"> </span>References not in correct order as cited in protocol and numbered in reference column.<br />
2.<span class="Apple-tab-span" style="white-space: pre;"> </span>Reference dont match with the topic.<br />
3.<span class="Apple-tab-span" style="white-space: pre;"> </span>Citing old references<br />
4.<span class="Apple-tab-span" style="white-space: pre;"> </span>Avoid writing “incidence” in observation studies as its a prevalence study<br />
5.<span class="Apple-tab-span" style="white-space: pre;"> </span>Headings should be according to NBE guidelines and in the same order.<br />
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P.S. If your research topic is good it will be easier to get your work published later. So choose it wisely.<br />
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-90343914114206317402016-10-01T22:29:00.003-07:002016-10-01T22:39:06.696-07:00Key to health by Mahatma Gandhi<div dir="ltr" style="text-align: left;" trbidi="on">
We celebrate today birth anniversary of Mahatma Gandhi who spread the message of truth,peace, self restraint and non violence; Lal bahadur shastri who epitomized simplicity and honesty.<br />
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Mahatma Gandhi wrote a book "KEY TO HEALTH" during his confinement in Aga khan palace in pune during 1942-1944.<br />
Lets read this book today on his birth anniversary and understand the philosophy of health.<br />
He made beautiful remarks on ill effects of alcohol, tobacco, opium and other intoxicants. He also defined health in this book and wrote about several determinants of health like air, water, food, condiments and 'brahmcharya' (self restraint).<br />
He considered human body as a miniature universe within and stresses on understanding of our inner human machinery.<br />
In the 2nd part of this book he dealt with natural therapeutics using earth, water, akash, air and sunlight. Most of these like sitz bath, phototherapy, breathing exercises are still being practiced.<br />
He also made it a point to the readers our limitation which despite so much of progress and research is still not enough to understand our human body and brain.<br />
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So lets pray for peace, good health and love for everyone.<br />
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PDF file link - http://www.gandhiashramsevagram.org/pdf-books/key-to-health.pdf<br />
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-36796603699178829792016-09-30T07:20:00.004-07:002016-10-06T11:10:47.515-07:00Recent changes in Tuberculosis guidelines 2016<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: "times" , "times new roman" , serif;">Based on RNTCP guidelines 2016.</span><br />
<span style="font-family: "times" , "times new roman" , serif;"><br /></span>
<span style="font-family: "times" , "times new roman" , serif;">1.<span class="Apple-tab-span" style="white-space: pre;"> </span>3 new goals – cure, prevent resistance and break chain of transmission.</span><br />
<span style="font-family: "times" , "times new roman" , serif;">2.<span class="Apple-tab-span" style="white-space: pre;"> </span>Introduction of daily regime</span><br />
<span style="font-family: "times" , "times new roman" , serif;">3.<span class="Apple-tab-span" style="white-space: pre;"> </span>Definition and treatment of mono and polyresistance apart from MDR and XDR Tuberculosis</span><br />
<span style="font-family: "times" , "times new roman" , serif;">4.<span class="Apple-tab-span" style="white-space: pre;"> </span>Treatment in CAT 1 – 2(HRZE) + 4 (HRE) : Continue ethambutol in continuation phase too </span><br />
<span style="font-family: "times" , "times new roman" , serif;">5.<span class="Apple-tab-span" style="white-space: pre;"> </span>Treatment in CAT 2 – 2(HRZES) + 1(HRZE) + 5 (HRE)</span><br />
<span style="font-family: "times" , "times new roman" , serif;">6.<span class="Apple-tab-span" style="white-space: pre;"> </span>Introduction of Bedaquiline as a new drug. ATP synthase inhibitor specifically targets myc. Tb. Indicated in age more than 18 years. Contraindicatef in pregnancy and those taking hormonal OCP. It may be given in patients with stable arrythmia.</span><br />
<span style="font-family: "times" , "times new roman" , serif;">7.<span class="Apple-tab-span" style="white-space: pre;"> </span>Definition of presumptive tuberculosis. Duration > 2 weeks etc</span><br />
<span style="font-family: "times" , "times new roman" , serif;">8.<span class="Apple-tab-span" style="white-space: pre;"> </span>New algorithm to diagnose Tuberculosis – pulmonary, extrapulmonary, drug resistant.</span><br />
<span style="font-family: "times" , "times new roman" , serif;">9.<span class="Apple-tab-span" style="white-space: pre;"> </span>Introduction of Newer molecular methods like CBNAAT and line probe assay in diagnostic algorithm apart from smear microscopy and chest Xray.</span><br />
<span style="font-family: "times" , "times new roman" , serif;">10.<span class="Apple-tab-span" style="white-space: pre;"> </span>Diagnosis of tuberculosis based on X-ray will be called as Clinically diagnosed tuberculosis</span><br />
<span style="font-family: "times" , "times new roman" , serif;">11.<span class="Apple-tab-span" style="white-space: pre;"> </span>Sputum should be around 2ml and preferably be mucopurulent.</span><br />
<span style="font-family: "times" , "times new roman" , serif;">12.<span class="Apple-tab-span" style="white-space: pre;"> </span>Follow up – New and previously treated Drug sensitive pulmonary tuberculosis – No need to extend Intensive phase, sputum microscopy at end of IP and end of treatment, weight monthly, chest x-ray if required.</span><br />
<span style="font-family: "times" , "times new roman" , serif;">13.<span class="Apple-tab-span" style="white-space: pre;"> </span>Follow up – MDR tuberculosis – sputum smear monthly 3,4,5,6,7 months in intensive phase and at 3 months interval in continuation phase 9,12,15..., extend ip phase by maximum 3 months total of 9 months.</span><br />
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com9tag:blogger.com,1999:blog-1766779456632641338.post-34661203084999869532016-07-17T23:44:00.000-07:002016-07-17T23:44:16.488-07:00WHO - HIV treatment guidelines - 2016<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><a href="http://apps.who.int/iris/bitstream/10665/208825/1/9789241549684_eng.pdf" target="_blank">Download WHO - HIV guidelines</a>- 2016</b></div>
Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-17919589482252352312016-07-16T02:37:00.003-07:002016-07-17T23:45:05.520-07:00RNTCP latest treatment guidelines - 2016<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0tEbLfqxMeLz6wlIv8yyp5t9njcppVrL3KLCIM39dEPe2VlxE399lCg1tdH79FqK3ySaqVM5hPHZGeqz-Vpk8hgJYM7sloTYgqFQ9F8EcQwpVgUvDdfTobDXEksJJO7hMpRDicapNTmCh/s1600/Capture.PNG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0tEbLfqxMeLz6wlIv8yyp5t9njcppVrL3KLCIM39dEPe2VlxE399lCg1tdH79FqK3ySaqVM5hPHZGeqz-Vpk8hgJYM7sloTYgqFQ9F8EcQwpVgUvDdfTobDXEksJJO7hMpRDicapNTmCh/s1600/Capture.PNG" /></a></div>
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<b>Treatment guidelines can be downloaded from the links given below.</b><br />
<a href="http://tbcindia.nic.in/showfile.php?lid=3219" target="_blank"><b>Chapter 1</b></a><br />
<a href="http://tbcindia.nic.in/showfile.php?lid=3220" target="_blank"><b>Chapter 2</b></a></div>
Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-53193888356852847842016-02-01T10:40:00.003-08:002016-02-01T10:41:52.556-08:00Zika Virus - Recent updates 2016<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<span style="font-family: "arabic typesetting"; font-size: 20pt; line-height: 115%;"><span style="color: orange;">Zika virus is a RNA virus belonging to filovirus family and
transmitted by Aedes mosquitoes.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "arabic typesetting"; font-size: 20pt; line-height: 115%;"><span style="color: orange;">Its maternal-fetal transmission and anecdotal reports of sexual
transmission have been reported.<o:p></o:p></span></span></div>
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<span style="font-family: "arabic typesetting"; font-size: 20pt; line-height: 115%;"><span style="color: orange;">Aedes mosquitoes usually bite during the daytime and breed in
standing water so prevention is similar to dengue fever.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "arabic typesetting"; font-size: 20pt; line-height: 115%;"><span style="color: orange;">It’s a predominant mild or asymptomatic dengue like disease
without any hemorrhagic tendencies. Symptoms occur in just 20-25% of patients
with low case fatality rates. . It causes acute onset low grade fever with
multiple small joint pain, muscle ache, eye pain, prostration and maculopapular
rash and usually present 2 to 12 days after mosquito bite.<o:p></o:p></span></span></div>
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<span style="font-family: "arabic typesetting"; font-size: 20pt; line-height: 115%;"><span style="color: orange;">Recent reports suggests its association with fetal microcephaly
and intra cranial calcification which requires antenatal serial Ultrasonography
and biochemical evaluation in suspected cases<o:p></o:p></span></span></div>
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<span style="font-family: "arabic typesetting"; font-size: 20pt; line-height: 115%;"><span style="color: orange;">Treatment is bed rest and supportive care. <o:p></o:p></span></span></div>
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<span style="font-family: "arabic typesetting"; font-size: 20pt; line-height: 115%;"><span style="color: orange;">Similar to dengue aspirin should be avoided and hematocrit and
pulse pressure needs to be monitored.</span></span></div>
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<span style="font-family: "arabic typesetting"; font-size: 20pt; line-height: 115%;"><span style="color: orange;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKjr4QKXvjz03f1e2KAdyqw4O8nffuuzB-Pkm3hjVPVslzDNEXu32215t2o-z2bcpQpKuzkLrSjYXagGi1y-ptUqtfRE90nzX7pxyinZZVmMhrcltanzNNsm6tMUEZ-wJH0HL_I4ci1Hpi/s1600/Untitled.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="489" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKjr4QKXvjz03f1e2KAdyqw4O8nffuuzB-Pkm3hjVPVslzDNEXu32215t2o-z2bcpQpKuzkLrSjYXagGi1y-ptUqtfRE90nzX7pxyinZZVmMhrcltanzNNsm6tMUEZ-wJH0HL_I4ci1Hpi/s640/Untitled.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><b>Diagnostic Algorithm for Zika virus detection</b></span><br />
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<span style="font-size: large;"><b><span style="color: orange; font-size: 26.6667px; line-height: 30.6667px; text-align: left;">Reference :- PAHO & WHO guidelines</span></b></span></div>
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</tbody></table>
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-30916966244626940502016-02-01T10:34:00.001-08:002016-02-01T10:34:34.752-08:00Dengue fever - What you must know<div dir="ltr" style="text-align: left;" trbidi="on">
<br /><br /><span style="color: orange; font-size: large;">It’s a viral infection caused by flavivirus and transmitted by aedes mosquito.<br /><br />Aedes mosquito usually bites during day time and breeds in stagnant water. Since dengue virus has four antigens so there is risk of getting dengue again for maximum 4 times.<br /><br />Usually it’s a self limiting illness but it may progress to Dengue hemorrhagic fever and Dengue shock syndrome.<br /><br />Thrombocytopenia is usually seen on 3-4 day of fever and decreasing trend till 6th day and again increases from 7th day.<br /><br />If there is pain abdomen, breathlessness, bleeding, hypotension or low blood pressure, hospitalization is recommended.<br /><br />Rule of 20 for Doctors - Rise in hematocrit (pcv) more than 20% and fall by 20% after fluid replenishment, 20 petechiae in tourniquet test, pulse pressure less than 20mm of hg<br /><br />Treatment remains supportive... paracetamol for fever and plenty of fluids. For inpatients if platelet is less than 10000 platelet transfusion is done. Avoid drugs which may cause thrombocytopenia...<br /></span> <br /><br /> </div>
Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-83476883709502787662016-02-01T10:27:00.004-08:002016-02-01T10:27:47.016-08:00Diabetes management during Ramadan<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Andalus, serif; line-height: 14.5pt;"><span style="color: orange; font-size: large;"><o:p></o:p></span></span><br />
<br />
<span style="color: orange; font-size: large;">Ramadan, a holy month of Islam varies between 29 and 30 days. Muslims who fast abstain from eating drinking smoking and use of oral medications. <br />Patients of diabetes mellitus who fast are at greater risk of complications which are hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), Diabetic ketoacidosis, dehydration and thrombosis.<br />Medical recommendation most often for the patients is to not undertake fasting. But if they insist on fasting they must make such decision in consultation with their doctors understanding risks associated with it.<br />Management is individual centric.<br />General considerations <br />1. There should be frequent monitoring of blood glucose level.<br />2. Nutrition should be adequate enough to maintain a constant body mass. Avoid taking heavy sunset meals rich in carbohydrate and fats. Take plenty of fluids during non fasting hours and food containing complex carbohydrates at the predawn meal is advised.<br />3. Normal level of exercise. Avoid excessive exercise as it may cause hypoglycemia.<br />4. Breaking the fast. If blood sugar is less than 60mg/dl anytime or less than 70mg/dl within few hours of fast, or if blood sugar is in excess of 300mg/dl.<br /><br /><br /><br />Management of Type 2 Diabetes mellitus<br /><br /><br />1. Patients controlled with lifestyle modification alone may distribute calories over 2 to 3 smaller meals to avoid hyperglycemia.<br />2. Patients on oral drugs- insulin sensitizers like metformin are preferred. <br />Those treated with metformin can safely fast. Dose needs to be modified - 2/3 of total dose should be given with sunset meal and 1/3 before predawn meal.<br />Pioglitazones are not independently associated with hypoglycemia but they can’t be substituted for any other OHA as it takes 2-4 weeks to exert its effects.<br />Sulfonylureas like glimepride, glyburide, glipizide are not recommended in view of hypoglycemia risk.<br />Glinides may be taken twice daily as it is short acting.<br />DPP 4 inhibitors (gliptins) are best tolerated drugs and can be taken. Alpha glucosidase inhibitors like acarbose miglitol and voglibose can be taken.<br /><br /><br /><br />Patients treated with insulins :<br /><br /><br />One long or intermediate acting insulin injection along with short acting insulin before meal can be used. Use of 50:50 premixed insulin in evening and 30:70 insulin at early morning was also found useful.<br />Insulin pump is better option.<br /><br /><br /><br />References :- ADA guidelines</span></div>
Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-63993341731330430502016-02-01T10:12:00.000-08:002016-02-01T10:16:45.484-08:00Snake bite - what should not be done<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="color: #141823; font-family: "andalus" , "serif"; font-size: large;">What should not be done?<o:p></o:p></span></div>
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<span style="color: #141823; font-family: andalus, serif; font-size: large; line-height: 14.5pt;">1.
Do not apply a tourniquet. (Don’t tie arm or leg with rope or clothes as it’s unnecessary
and makes the condition worse for the patient.)</span></div>
<span style="color: #141823; font-family: "andalus" , "serif"; font-size: large;"><div style="text-align: justify;">
<span style="font-family: andalus, serif; line-height: 14.5pt;">2. Do not wash the bite site with soap or any other
solution to remove the venom. </span></div>
<span class="textexposedshow"><div style="text-align: justify;">
<span style="font-family: andalus, serif; line-height: 14.5pt;">3. Do not make cuts or incisions on or near the
bitten area.</span></div>
</span>
<span class="textexposedshow"><div style="text-align: justify;">
<span style="font-family: andalus, serif; line-height: 14.5pt;">4. Do not use electrical shock.</span></div>
</span>
<span class="textexposedshow"><div style="text-align: justify;">
<span style="font-family: andalus, serif; line-height: 14.5pt;">5. Do not freeze or apply extreme cold to the area
of bite. </span></div>
</span>
<span class="textexposedshow"><div style="text-align: justify;">
<span style="font-family: andalus, serif; line-height: 14.5pt;">6. Do not apply any kind of potentially harmful
herbal or folk remedy.</span></div>
</span>
<span class="textexposedshow"><div style="text-align: justify;">
<span style="font-family: andalus, serif; line-height: 14.5pt;">7. Do not attempt to suck out venom with your
mouth.</span></div>
</span>
<span class="textexposedshow"><div style="text-align: justify;">
<span style="font-family: andalus, serif; line-height: 14.5pt;">8. Do not give the victim drink, alcohol.</span></div>
</span>
<span class="textexposedshow"><div style="text-align: justify;">
<span style="font-family: andalus, serif; line-height: 14.5pt;">9. Do not attempt to capture, handle or kill the
snake and </span></div>
</span>
<span class="textexposedshow"><div style="text-align: justify;">
<span style="font-family: andalus, serif; line-height: 14.5pt;">9. Patients should not be taken to quacks.</span></div>
</span><o:p></o:p></span></div>
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-40319238063402482632012-09-06T05:23:00.002-07:002012-09-06T05:24:10.344-07:00IQ Classifications<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4r_52l8nuxEIeLbUl7MEbqPkCZtFJOJwjdTy0w4T5jDZAlC_0jh6W3NkvrXh0J5OdJ3t375ae3etvdzHFvL0IVg1p7yvO7hicOFq10_JVHQc4JegiwCMiKiqq3jnSRvKQMiiQkL542na3/s1600/Capture.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="492" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4r_52l8nuxEIeLbUl7MEbqPkCZtFJOJwjdTy0w4T5jDZAlC_0jh6W3NkvrXh0J5OdJ3t375ae3etvdzHFvL0IVg1p7yvO7hicOFq10_JVHQc4JegiwCMiKiqq3jnSRvKQMiiQkL542na3/s640/Capture.JPG" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLAJejkTP63lIk_WHdi8hlJcB1NGzP8X976KSr7j7Cot9giAPD85vKBH1iuNfvhtq_OBEEd3MWODqTljw8afh-_RjvPGYyUudj9NIQt7RQ6gZNLfSwrcrAmvGTkxsj4QF4nQgcBm6ox5Gf/s1600/Capturew.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLAJejkTP63lIk_WHdi8hlJcB1NGzP8X976KSr7j7Cot9giAPD85vKBH1iuNfvhtq_OBEEd3MWODqTljw8afh-_RjvPGYyUudj9NIQt7RQ6gZNLfSwrcrAmvGTkxsj4QF4nQgcBm6ox5Gf/s640/Capturew.JPG" width="566" /></a></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-color: white;">IQ score ranges (from DSM-IV): </span></span></b><br />
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<li class="toclevel-1"><b><span style="color: red; font-family: Arial, Helvetica, sans-serif;">Mild mental retardation: IQ 50–55 to 70; children require mild support; formally called "Educable Mentally Retarded".</span></b></li>
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b>
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<li class="toclevel-1"><b><span style="color: orange; font-family: Arial, Helvetica, sans-serif;">Moderate retardation: IQ 35–40 to 50–55; children require moderate supervision and assistance; formally called "Trainable Mentally Retarded".</span></b></li>
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b>
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<li class="toclevel-1"><b><span style="color: yellow; font-family: Arial, Helvetica, sans-serif;">Severe mental retardation: IQ 20–25 to 35–40; can be taught basic life skills and simple tasks with supervision.</span></b></li>
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b>
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<li class="toclevel-1"><b><span style="color: cyan; font-family: Arial, Helvetica, sans-serif;">Profound mental retardation: IQ below 20–25; usually caused by a neurological condition; require constant care.</span></b></li>
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-56332407914517672342012-09-03T06:13:00.001-07:002012-09-03T06:13:09.497-07:00National Health Committees <div dir="ltr" style="text-align: left;" trbidi="on">
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<div style="background-color: white; font-family: Verdana; font-size: 12px; line-height: 17px; padding: 0px; text-align: justify;">
Various committees of experts have been appointed by the government from time to time to render advice about different health problems. The reports of these committees have formed an important basis of health planning in India. The goal of National Health Planning in India is to attain Health for all by the year 2000.</div>
<div class="pageSubHeading2" style="background-color: white; color: #363869; font-family: Verdana; font-size: 10pt; font-weight: bold; line-height: 17px; padding: 10px 0px;">
1. BHORE COMMITTEE. 1946.</div>
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View >> <a href="http://www.nihfw.org/NDC/DocumentationServices/Reports/bhore%20Committee%20Report%20VOL-1%20.pdf" style="background-color: transparent; background-image: url(http://www.nihfw.org/assets/images/icon_pdf.gif); background-position: 100% 50%; background-repeat: no-repeat no-repeat; color: #27358c; margin: 0px; padding: 5px 20px 5px 0px; text-decoration: none;">Vol-1</a> <a href="http://www.nihfw.org/NDC/DocumentationServices/Reports/Bhore%20Committee%20Report%20-%20Vol%20II.pdf" style="background-color: transparent; background-image: url(http://www.nihfw.org/assets/images/icon_pdf.gif); background-position: 100% 50%; background-repeat: no-repeat no-repeat; color: #27358c; margin: 0px; padding: 5px 20px 5px 0px; text-decoration: none;">Vol-2</a> <a href="http://www.nihfw.org/NDC/DocumentationServices/Reports/Bhore%20Committee%20Report-%203.pdf" style="background-color: transparent; background-image: url(http://www.nihfw.org/assets/images/icon_pdf.gif); background-position: 100% 50%; background-repeat: no-repeat no-repeat; color: #27358c; margin: 0px; padding: 5px 20px 5px 0px; text-decoration: none;">Vol-3</a></div>
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This committee, known as the Health Survey & Development Committee, was appointed in 1943 with Sir Joseph Bhore as its Chairman. It laid emphasis on integration</div>
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of curative and preventive medicine at all levels. It made comprehensive recommendations for remodeling of health services in India. The report, submitted in 1946, had</div>
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some important recommendations like :-</div>
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<div style="background-color: white; font-family: Verdana; font-size: 12px; line-height: 17px; padding: 0px; text-align: justify;">
1.Integration of preventive and curative services of all administrative levels.</div>
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<br /></div>
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2. Development of Primary Health Centres in 2 stages :</div>
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<div style="background-color: white; font-family: Verdana; font-size: 12px; line-height: 17px; padding: 0px; text-align: justify;">
a. Short-term measure – one primary health centre as suggested for a population of 40,000. Each PHC was to be manned by 2 doctors, one nurse, four public health</div>
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nurses, four midwives, four trained dais, two sanitary inspectors, two health assistants, one pharmacist and fifteen other class IV employees. Secondary health centre</div>
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was also envisaged to provide support to PHC, and to coordinate and supervise their functioning.</div>
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<br /></div>
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b. A long-term programme (also called the 3 million plan) of setting up primary health units with 75 – bedded hospitals for each 10,000 to 20,000 population and</div>
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secondary units with 650 – bedded hospital, again regionalised around district hospitals with 2500 beds.</div>
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<br /></div>
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3. Major changes in medical education which includes 3 - month training in preventive and social medicine to prepare “social physicians”.</div>
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2. MUDALIAR COMMITTEE. 1962.</div>
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<a href="http://www.nihfw.org/NDC/DocumentationServices/Reports/Mudalier%20%20Vol.pdf" style="background-color: transparent; background-image: url(http://www.nihfw.org/assets/images/icon_pdf.gif); background-position: 100% 50%; background-repeat: no-repeat no-repeat; color: #27358c; margin: 0px; padding: 5px 20px 5px 0px; text-decoration: none;">View report</a></div>
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This committee known as the “Health Survey and Planning Committee”, headed by Dr. A.L. Mudaliar, was appointed to assess the performance in health sector since</div>
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the submission of Bhore Committee report. This committee found the conditions in PHCs to be unsatisfactory and suggested that the PHC, already established</div>
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should be strengthened before new ones are opened.</div>
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<br /></div>
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Strengthening of sub divisional and district hospitals was also advised. It was emphasised that a PHC should not be made to cater to more than 40,000 population and</div>
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that the curative, preventive and promotive services should be all provided at the PHC. The Mudaliar Committee also recommended that an All India Health service should</div>
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be created to replace the erstwhile Indian Medical service.</div>
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3. CHADHA COMMITTEE, 1963.</div>
<div style="background-color: white; font-family: Verdana; font-size: 12px; line-height: 17px; padding: 0px; text-align: justify;">
<a href="http://www.nihfw.org/NDC/DocumentationServices/Reports/chada%20committe%20report%204.pdf" style="background-color: transparent; background-image: url(http://www.nihfw.org/assets/images/icon_pdf.gif); background-position: 100% 50%; background-repeat: no-repeat no-repeat; color: #27358c; margin: 0px; padding: 5px 20px 5px 0px; text-decoration: none;">View report</a></div>
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This committee was appointed under chairmanship of Dr. M.S. Chadha, the then Director General of Health Services, to advise about the necessary arrangements for</div>
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the maintenance phase of National Malaria Eradication Programme. The committee suggested that the vigilance activity in the NMEP should be carried out by basic</div>
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health workers (one per 10,000 population), who would function as multipurpose workers and would perform, in addition to malaria work, the duties of family planning</div>
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and vital statistics data collection under supervision of family planning health assistants.</div>
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4. MUKHERJEE COMMITTEE. 1965.</div>
<div style="background-color: white; font-family: Verdana; font-size: 12px; line-height: 17px; padding: 0px; text-align: justify;">
<a href="http://www.nihfw.org/NDC/DocumentationServices/Reports/Mukerjee%20Committee%20Report.pdf" style="background-color: transparent; background-image: url(http://www.nihfw.org/assets/images/icon_pdf.gif); background-position: 100% 50%; background-repeat: no-repeat no-repeat; color: #27358c; margin: 0px; padding: 5px 20px 5px 0px; text-decoration: none;">View Report</a></div>
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The recommendations of the Chadha Committee, when implemented, were found to be impracticable because the basic health workers, with their multiple functions</div>
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could do justice neither to malaria work nor to family planning work. The Mukherjee committee headed by the then Secretary of Health Shri Mukherjee, was appointed</div>
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to review the performance in the area of family planning. The committee recommended separate staff for the family planning programme. The family planning</div>
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assistants were to undertake family planning duties only. The basic health workers were to be utilised for purposes other than family planning. The committee</div>
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also recommended to delink the malaria activities from family planning so that the latter would received undivided attention of its staff.</div>
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5. MUKHERJEE COMMITTEE. 1966.</div>
<div style="background-color: white; font-family: Verdana; font-size: 12px; line-height: 17px; padding: 0px; text-align: justify;">
<a href="http://www.nihfw.org/NDC/DocumentationServices/Reports/Mukerji%20Committee%20Report%20%20-%20Part%20II.pdf" style="background-color: transparent; background-image: url(http://www.nihfw.org/assets/images/icon_pdf.gif); background-position: 100% 50%; background-repeat: no-repeat no-repeat; color: #27358c; margin: 0px; padding: 5px 20px 5px 0px; text-decoration: none;">View Report</a></div>
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Multiple activities of the mass programmes like family planning, small pox, leprosy, trachoma, NMEP (maintenance phase), etc. were making it difficult for the states</div>
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to undertake these effectively because of shortage of funds. A committee of state health secretaries, headed by the Union Health Secretary, Shri Mukherjee, was set</div>
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up to look into this problem. The committee worked out the details of the Basic Health Service which should be provided at the Block level, and some</div>
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consequential strengthening required at higher levels of administration.</div>
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6. JUNGALWALLA COMMITTEE, 1967.</div>
<div style="background-color: white; font-family: Verdana; font-size: 12px; line-height: 17px; padding: 0px; text-align: justify;">
<a href="http://www.nihfw.org/NDC/DocumentationServices/Reports/Jungalwal%20Committee%20Report.pdf" style="background-color: transparent; background-image: url(http://www.nihfw.org/assets/images/icon_pdf.gif); background-position: 100% 50%; background-repeat: no-repeat no-repeat; color: #27358c; margin: 0px; padding: 5px 20px 5px 0px; text-decoration: none;">View Report</a></div>
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This committee, known as the “Committee on Integration of Health Services” was set up in 1964 under the chairmanship of Dr. N Jungalwalla, the then Director of</div>
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National Institute of Health Administration and Education (currently NIHFW). It was asked to look into various problems related to integration of health services,</div>
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abolition of private practice by doctors in government services, and the service conditions of Doctors. The committee defined “integrated health services” as :-</div>
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<br /></div>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top" width="33">a.</td><td align="left" style="margin: 0px; padding: 0px;" valign="top" width="520"><div align="justify" style="margin: 0px; padding: 0px;">
A service with a unified approach for all problems instead of a segmented approach for different problems.</div>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top"> </td><td align="left" style="margin: 0px; padding: 0px;" valign="top"><div align="justify" style="margin: 0px; padding: 0px;">
</div>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top">b.</td><td align="left" style="margin: 0px; padding: 0px;" valign="top"><div align="justify" style="margin: 0px; padding: 0px;">
Medical care and public health programmes should be put under charge of a single administrator at all levels of hierarchy.</div>
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Following steps were recommended for the integration at all levels of health organisation in the country</div>
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<br /></div>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top" width="15">1</td><td style="margin: 0px; padding: 0px;" width="95%">Unified Cadre</td></tr>
<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top"> </td><td style="margin: 0px; padding: 0px;"> </td></tr>
<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top" width="15">2</td><td style="margin: 0px; padding: 0px;">Common Seniority</td></tr>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top" width="15">3</td><td style="margin: 0px; padding: 0px;">Recognition of extra qualifications</td></tr>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top" width="15">4</td><td style="margin: 0px; padding: 0px;">Equal pay for equal work</td></tr>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top" width="15">5</td><td style="margin: 0px; padding: 0px;">Special pay for special work</td></tr>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top" width="15">6</td><td style="margin: 0px; padding: 0px;">Abolition of private practice by government doctors</td></tr>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top" width="15">7</td><td style="margin: 0px; padding: 0px;">Improvement in their service conditions</td></tr>
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7. KARTAR SINGH COMMITTEE. 1973.</div>
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<a href="http://www.nihfw.org/NDC/DocumentationServices/Reports/Kartar%20Singh%20Committee%20Report.pdf" style="background-color: transparent; background-image: url(http://www.nihfw.org/assets/images/icon_pdf.gif); background-position: 100% 50%; background-repeat: no-repeat no-repeat; color: #27358c; margin: 0px; padding: 5px 20px 5px 0px; text-decoration: none;">View Report</a></div>
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This committee, headed by the Additional Secretary of Health and titled the "Committee on multipurpose workers under Health and Family Planning" was constituted to</div>
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form a framework for integration of health and medical services at peripheral and supervisory levels. Its main recommendations were :-</div>
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<br /></div>
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a. Various categories of peripheral workers should be amalgamated into a single cadre of multipurpose workers (male and female). The erstwhile auxiliary nurse</div>
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midwives were to be converted into MPW(F) and the basic health workers, malaria surveillance workers etc. were to be converted to MPW(M). The work of 3-4 male</div>
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and female MPWs was to be supervised by one health supervisor (male or female respectively). The existing lady health visitors were to be converted into female health supervisor.</div>
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<br /></div>
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b One Primary Health Centre should cover a population of 50,000. It should be divided into 16 subcentres (one for 3000 to 3500 population) each to be staffed by a</div>
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male and a female health worker.</div>
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8. SHRIVASTAV COMMITTEE. 1975.</div>
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<a href="http://www.nihfw.org/NDC/DocumentationServices/Reports/Srivastava%20Committee%20Report.pdf" style="background-color: transparent; background-image: url(http://www.nihfw.org/assets/images/icon_pdf.gif); background-position: 100% 50%; background-repeat: no-repeat no-repeat; color: #27358c; margin: 0px; padding: 5px 20px 5px 0px; text-decoration: none;">View Report</a></div>
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This committee was set up in 1974 as "Group on Medical Education and Support Manpower" to determine steps needed to (i) reorient medical education in accordance</div>
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with national needs & priorities and (ii) develop a curriculum for health assistants who were to function as a link between medical officers and MPWs. It recommended immediate action for :</div>
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<br /></div>
<div style="padding: 0px;">
1. Creation of bonds of paraprofessional and semiprofessional health workers from within the community itself.</div>
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<br /></div>
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2. Establishment of 3 cadres of health workers namely – multipurpose health workers and health assistants between the community level workers and doctors at PHC.</div>
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<br /></div>
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3. Development of a “Refferal Services Complex”</div>
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4. Establishment of a Medical and Health Education Commission for planning and implementing the reforms needed in health and medical education on the lines of</div>
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University Grants Commission.</div>
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<br /></div>
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Acceptance of the recommendations of the Shrivastava Committee in 1977 led to the launching of the Rural Health Service.</div>
<div class="pageSubHeading2" style="color: #363869; font-size: 10pt; font-weight: bold; padding: 10px 0px; text-align: left;">
9. BAJAJ COMMITTEE, 1986.</div>
<div style="padding: 0px;">
<a href="http://www.nihfw.org/NDC/DocumentationServices/Reports/Bajaj%20Committee%20report.pdf" style="background-color: transparent; background-image: url(http://www.nihfw.org/assets/images/icon_pdf.gif); background-position: 100% 50%; background-repeat: no-repeat no-repeat; color: #27358c; margin: 0px; padding: 5px 20px 5px 0px; text-decoration: none;">View Report</a></div>
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An "Expert Committee for Health Manpower Planning, Production and Management" was constituted in 1985 under Dr. J.S. Bajaj, the then professor at AIIMS. Major recommendations are :-</div>
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<br /></div>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top" width="2%">1.</td><td style="margin: 0px; padding: 0px;" width="98%">Formulation of National Medical & Health Education Policy.</td></tr>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top">2.</td><td style="margin: 0px; padding: 0px;">Formulation of National Health Manpower Policy.</td></tr>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top">3.</td><td style="margin: 0px; padding: 0px;">Establishment of an Educational Commission for Health Sciences (ECHS) on the lines of UGC.</td></tr>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top">4.</td><td style="margin: 0px; padding: 0px;">Establishment of Health Science Universities in various states and union territories.</td></tr>
<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top"> </td><td style="margin: 0px; padding: 0px;"> </td></tr>
<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top">5.</td><td style="margin: 0px; padding: 0px;">Establishment of health manpower cells at centre and in the states.</td></tr>
<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top"> </td><td style="margin: 0px; padding: 0px;"> </td></tr>
<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top">6.</td><td style="margin: 0px; padding: 0px;"><div style="padding: 0px;">
Vocationalisation of education at 10+2 levels as regards health related fields with appropriate incentives, so that good quality paramedical personnel may be</div>
<div style="padding: 0px;">
available in adequate numbers.</div>
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<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top"> </td><td style="margin: 0px; padding: 0px;"> </td></tr>
<tr style="margin: 0px; padding: 0px;"><td align="left" style="margin: 0px; padding: 0px;" valign="top">7.</td><td style="margin: 0px; padding: 0px;">Carrying out a realistic health manpower survey.</td></tr>
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</div>
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0tag:blogger.com,1999:blog-1766779456632641338.post-83750667357003988982012-09-02T14:38:00.001-07:002012-11-07T04:30:17.445-08:00Nobel Prize in Physiology or Medicine 2011 and 2012<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td class="tr-caption" style="text-align: center;">Nobel Prize in Physiology or Medicine <span style="background-color: #f1c232;">2012</span></td></tr>
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Pratyush kumarhttp://www.blogger.com/profile/15481932901013591479noreply@blogger.com0