It is a common belief that MDRO’s (multi-drug resistance organisms) are found and generated in hospitals, but in recent times this may not be entirely correct. Resistance bacteria are present in community and present in our home environment. This trend is dangerous as millions of people are losing battle to antimicrobial resistance (AMR) and MDROs every year. AMR alone is killing more people than cancer and road traffic accidents combined besides economic loss. To combat AMR, it is important to find causes of generation of MDROs and how they enter human body and community environment. Therefore, it is important to realize the contribution by all the following four important factors: humans, animals, food and environment.
Prevention of MDROs and AMR in India is a challenge. India has been referred to as ‘the AMR capital of the world’. While on one hand, emergence of newer multi-drug resistant (MDR) organisms pose newer diagnostic and therapeutic challenges, on the other hand India is still striving to combat old enemies such as tuberculosis, malaria and cholera pathogens, which are becoming more and more drug resistant. Factors such as poverty, illiteracy, overcrowding and malnutrition further compound the situation. Lack of awareness about infectious diseases in the general masses and inaccessibility to healthcare often preclude them from seeking medical advice.
Easy availability of over- the- counter (OTC) drugs, leads to self-prescription of antimicrobial agents or administered without any professional knowledge regarding the dose and duration of treatment.
Pharmaceutical industry has caused tremendous rise in the amount of chemical waste. With the lack of strict supervisory and legal actions, this waste reaches the water bodies and serves as a continuous source of AMR in the environment.
Another important challenge could be the use of antimicrobial agents as pesticides and insecticides in the agriculture industry. Farmers use antimicrobial agents to protect their hard-earned field and animals from pests and rodents. They are unaware about future consequences and impact on environment.
AMR in milk and food animals has been another big challenge. Gram-negative bacilli with extended-spectrum β-lactamases (ESBL) have been isolated from milk samples and poultry. Enterobacteriaceae isolated from fish and Salmonella species from broiler were isolated.
AMR in environment; Antimicrobial-resistant bacteria have been reported from different water sources of India. The major sources are the pharmaceutical waste waters and hospital effluents that are released into the nearby water bodies without adequate treatment.
In large rivers of India, multiple inlets with varying concentration of drug-resistant bacteria have been found. ESBL producers among Gram-negative bacteria isolated and E. coli isolates found from north as well as south Indian rivers.
To combat AMR, there are many steps possible at communityand Government level. Antibiotic stewardship plans for healthcare settings, promoting further research on the drivers of AMR, judicious use of antibiotics, strict vigilance of over the counter(OTC) antibiotics, control of hospital effluent plants, monitoring waste water discharges from pharmaceutical companies, regulation of use of antimicrobial in food and milk animals, improving agricultural practices and educating masses at community level about AMR.
Saif-Ali- Khan transported in auto- Primitive Ambulance retrieval system
An index case can be made, and important conclusions can be drawn of the analysis regarding Mr Saif Ali Khan case- A celebrity icon– resident of big city Mumbai- got near fatal trauma. Important point to ponder is that How he was transported to hospital? A servant went and arranged for an auto-rickshaw. He was lucky enough as he did not required oxygen or his vitals were stable. If a person like Mr Saif could not arrange or did not opt for life saving Ambulance, what can a common person expect- to be transported especially in smaller cities or remote areas. Night emergencies like heart attack, stroke, pneumonias or even severe trauma permit few minutes and need interventions at the earliest. Such situations are life-threatening and unforgiving. Not all problems of the health care can be neglected by just passing the buck to doctors. Health care delivery requires much more efficient systems, that common man can trust in time of need. Even if the retrieval system exists in Mumbai, why family of Mr saif could not depend upon that?
Whatever the situation, calling an Ambulance was not considered as first responder in this case. Ambulances are not merely transport vehicles. They are equipped with oxygen, ventilators or lifesaving drugs and more importantly with a doctor or paramedic who can actually save life in those critical moments.
As systems in our country come out of slumber only after a celebrity or VIP is involved, it is an opportunity to look at the retrieval aspect and improve upon availability of the timely safe transport of critically unwell patients. A lot of improvement can be made by making Mr Saif’s as an index case.
#Kolkata-R-G-Kar-murder case has not only exposed the cruel injustice doctors work with, but also the inability of system to provide them justice. It also exposes the law-and-order issues and poor capability of enforcing agencies to provide justice to common man.
In real terms, it is not a problem for only doctors, but such poor law and order is a problem of masses and affects all common people.
Doctors working with routine injustice whole those years looks trivial as compared to cruelty inflicted on lady doctor during this incident. But strangely, still the doctors of R G Kar hospital are facing a kind of oppression and moral blackmail. They have become more insecure and unsure about whether they will get fair justice. To continue the protest for their genuine demands is getting difficult. Even when justice is still far and distant as it can be, they may face punitive action of worst kind. There is only a faint hope of real justice left although ‘token justice’ of temporary nature may be a possibility at the best.
Overall, a complex scenario for doctors. There is increasing discontentment amongst doctors because of complex and punishing system. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally, there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.
They are regulated in a way- no one else is. Judiciary, police, government agencies and every one else are not accountable for most of their blunders, but doctors are. But still- in such cases, everyone is looking at Supreme court and Government agencies, about whether they can deliver justice in such high-profile cases, when very powerful people are involved. Will supreme sacrifice of a young lady doctor be enough to shake up the system? Was it enough for the courts and powerful agencies to show and utilize their power in best manner? Was the animal behaviour of the accused has made courts and powerful enforcement agencies to get up and go beyond the “CULTURE OF TOKEN JUSTICE” and not merely catching scapegoats?
Common masses are curious about performance of Supreme court and Government agencies and expect to deliver real justice.
#Kolkata-R-G-Kar-murder case has exposed the hardship of doctors in present era. Working with routine injustice whole those years looks trivial as compared to this incident. But strangely, still the doctors of R G Kar hospital are facing a kind of moral blackmail. To continue the protest for their genuine demands is getting difficult. Even when justice is still far and distant as it can be, they may face punitive action of worst kind. There is only a faint hope of real justice left although ‘token justice’ of temporary nature may be a possibility at the best.
Doctors are the only community who face worst kind of moral blackmail from governments and courts to end protest, even in case of blatant and cruel injustice as in R G Kar hospital.
Overall, a complex scenario for doctors. There is increasing discontentment amongst doctors because of complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients. They are also supposed to maintain meticulous documentation and also supposed to work under norms of medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally, there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.
In the present circumstances, when doctors have become doubtful about the advice for choosing medical career, some are naïve enough to spend millions on securing an expensive medical college seat. Problems faced by doctors are not only innumerable but are also so exceedingly complex that they are difficult to be analysed. Doctors feel so disgusted about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession.
More of a law and order issue, the physical assault on doctors reflects that they are serving an uncivilized society. Such news is viewed by medical community anxiously and is definitely a poor advertisement for younger generation to take medicine as profession. The medical students need to think, why they wish to enter medical profession in such an unsupportive environment?
Mpox (monkeypox) is a viral illness caused by the monkeypox virus, a species of the genus Orthopoxvirus. Two different clades exist: clade I and clade II
Common symptoms of mpox are a skin rash or mucosal lesions which can last 2–4 weeks accompanied by fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes.
Mpox can be transmitted to humans through physical contact with someone who is infectious, with contaminated materials, or with infected animals.
Laboratory confirmation of mpox is done by testing skin lesion material by PCR.
Mpox is treated with supportive care. Vaccines and therapeutics developed for smallpox and approved for use in some countries can be used for mpox in some circumstances.
In 2022–2023 a global outbreak of mpox was caused by a strain known as clade IIb.
Mpox can be prevented by avoiding physical contact with someone who has mpox. Vaccination can help prevent infection for people at risk.
Overview
Mpox (monkeypox) is an infectious disease caused by the monkeypox virus. It can cause a painful rash, enlarged lymph nodes and fever. Most people fully recover, but some get very sick.
Anyone can get mpox. It spreads from contact with infected:
persons, through touch, kissing, or sex
animals, when hunting, skinning, or cooking them
materials, such as contaminated sheets, clothes or needles
pregnant persons, who may pass the virus on to their unborn baby.
If you have mpox:
Tell anyone you have been close to recently
Stay at home until all scabs fall off and a new layer of skin forms
Cover lesions and wear a well-fitting mask when around other people
Avoid physical contact.
The disease mpox (formerly monkeypox) is caused by the monkeypox virus (commonly abbreviated as MPXV), an enveloped double-stranded DNA virus of the Orthopoxvirus genus in the Poxviridae family, which includes variola, cowpox, vaccinia and other viruses. The two genetic clades of the virus are clades I and II.
The monkeypox virus was discovered in Denmark (1958) in monkeys kept for research and the first reported human case of mpox was a nine-month-old boy in the Democratic Republic of the Congo (DRC, 1970). Mpox can spread from person to person or occasionally from animals to people. Following eradication of smallpox in 1980 and the end of smallpox vaccination worldwide, mpox steadily emerged in central, east and west Africa. A global outbreak occurred in 2022–2023. The natural reservoir of the virus is unknown – various small mammals such as squirrels and monkeys are susceptible.
Transmission
Person-to-person transmission of mpox can occur through direct contact with infectious skin or other lesions such as in the mouth or on genitals; this includes contact which is
face-to-face (talking or breathing)
skin-to-skin (touching or vaginal/anal sex)
mouth-to-mouth (kissing)
mouth-to-skin contact (oral sex or kissing the skin)
respiratory droplets or short-range aerosols from prolonged close contact
The virus then enters the body through broken skin, mucosal surfaces (e g oral, pharyngeal, ocular, genital, anorectal), or via the respiratory tract. Mpox can spread to other members of the household and to sex partners. People with multiple sexual partners are at higher risk.
Animal to human transmission of mpox occurs from infected animals to humans from bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses, or eating animals. The extent of viral circulation in animal populations is not entirely known and further studies are underway.
People can contract mpox from contaminated objects such as clothing or linens, through sharps injuries in health care, or in community setting such as tattoo parlours.
Signs and symptoms
Mpox causes signs and symptoms which usually begin within a week but can start 1–21 days after exposure. Symptoms typically last 2–4 weeks but may last longer in someone with a weakened immune system.
Common symptoms of mpox are:
rash
fever
sore throat
headache
muscle aches
back pain
low energy
swollen lymph nodes.
For some people, the first symptom of mpox is a rash, while others may have different symptoms first.
The rash begins as a flat sore which develops into a blister filled with liquid and may be itchy or painful. As the rash heals, the lesions dry up, crust over and fall off.
Some people may have one or a few skin lesions and others have hundreds or more. These can appear anywhere on the body such as the:
palms of hands and soles of feet
face, mouth and throat
groin and genital areas
anus.
Some people also have painful swelling of their rectum or pain and difficulty when peeing.
People with mpox are infectious and can pass the disease on to others until all sores have healed and a new layer of skin has formed.
Children, pregnant people and people with weak immune systems are at risk for complications from mpox.
Typically for mpox, fever, muscle aches and sore throat appear first. The mpox rash begins on the face and spreads over the body, extending to the palms of the hands and soles of the feet and evolves over 2-4 weeks in stages – macules, papules, vesicles, pustules. Lesions dip in the centre before crusting over. Scabs then fall off. Lymphadenopathy (swollen lymph nodes) is a classic feature of mpox. Some people can be infected without developing any symptoms.
In the context of the global outbreak of mpox which began in 2022 (caused mostly by Clade IIb virus), the illness begins differently in some people. In just over a half of cases, a rash may appear before or at the same time as other symptoms and does not always progress over the body. The first lesion can be in the groin, anus, or in or around the mouth.
People with mpox can become very sick. For example, the skin can become infected with bacteria leading to abscesses or serious skin damage. Other complications include pneumonia, corneal infection with loss of vision; pain or difficulty swallowing, vomiting and diarrhoea causing severe dehydration or malnutrition; sepsis (infection of the blood with a widespread inflammatory response in the body), inflammation of the brain (encephalitis), heart (myocarditis), rectum (proctitis), genital organs (balanitis) or urinary passages (urethritis), or death. Persons with immune suppression due to medication or medical conditions are at higher risk of serious illness and death due to mpox. People living with HIV that is not well-controlled or treated more often develop severe disease.
Diagnosis
Identifying mpox can be difficult as other infections and conditions can look similar. It is important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmissible infections, and medication-associated allergies. Someone with mpox may also have another sexually transmissible infection such as herpes. Alternatively, a child with suspected mpox may also have chickenpox. For these reasons, testing is key for people to get treatment as early as possible and prevent further spread.
Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for mpox. The best diagnostic specimens are taken directly from the rash – skin, fluid or crusts – collected by vigorous swabbing. In the absence of skin lesions, testing can be done on oropharyngeal, anal or rectal swabs. Testing blood is not recommended. Antibody detection methods may not be useful as they do not distinguish between different orthopoxviruses.
More information on laboratory confirmation of mpox can be found here.
Treatment and vaccination
The goal of treating mpox is to take care of the rash, manage pain and prevent complications. Early and supportive care is important to help manage symptoms and avoid further problems.
Getting an mpox vaccine can help prevent infection. The vaccine should be given within 4 days of contact with someone who has mpox (or within up to 14 days if there are no symptoms).
It is recommended for people at high risk to get vaccinated to prevent infection with mpox, especially during an outbreak. This includes:
health workers at risk of exposure
men who have sex with men
people with multiple sex partners
sex workers.
Persons who have mpox should be cared for away from other people.
Several antivirals, such as tecovirimat, originally developed to treat smallpox have been used to treat mpox and further studies are underway. Further information is available on mpox vaccination and case management.
Self-care and prevention
Most people with mpox will recover within 2–4 weeks. Things to do to help the symptoms and prevent infecting others:
Do
stay home and in your own room if possible
wash hands often with soap and water or hand sanitizer, especially before or after touching sores
wear a mask and cover lesions when around other people until your rash heals
keep skin dry and uncovered (unless in a room with someone else)
avoid touching items in shared spaces and disinfect shared spaces frequently
use saltwater rinses for sores in the mouth
take sitz baths or warm baths with baking soda or Epsom salts for body sores
take over-the-counter medications for pain like paracetamol (acetaminophen) or ibuprofen.
Do not
pop blisters or scratch sores, which can slow healing, spread the rash to other parts of the body, and cause sores to become infected; or
shave areas with sores until scabs have healed and you have new skin underneath (this can spread the rash to other parts of the body).
To prevent spread of mpox to others, persons with mpox should isolate at home, or in hospital if needed, for the duration of the infectious period (from onset of symptoms until lesions have healed and scabs fall off). Covering lesions and wearing a medical mask when in the presence of others may help prevent spread. Using condoms during sex will help reduce the risk getting mpox but will not prevent spread from skin-to-skin or mouth-to-skin contact.
Outbreaks
After 1970, mpox occurred sporadically in Central and East Africa (clade I) and West Africa (clade II). In 2003 an outbreak in the United States of America was linked to imported wild animals (clade II). Since 2005, thousands of suspected cases are reported in the DRC every year. In 2017, mpox re-emerged in Nigeria and continues to spread between people across the country and in travellers to other destinations. Data on cases reported up to 2021 are available here.
In May 2022, an outbreak of mpox appeared suddenly and rapidly spread across Europe, the Americas and then all six WHO regions, with 110 countries reporting about 87 thousand cases and 112 deaths. The global outbreak has affected primarily (but not only) gay, bisexual, and other men who have sex with men and has spread person-to-person through sexual networks. More information on the global outbreak is available here with detailed outbreak data here;
In 2022, outbreaks of mpox due to Clade I MPXV occurred in refugee camps in the Republic of the Sudan. A zoonotic origin has not been found.
Death is the inevitable conclusion of life, a universal destiny that all living creatures share. Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. But the evaluation and compensation of ‘Death’ in this new era of consumerism has become a story of paradox. Compare the situation when someone is admitted in hospital for a serious ailment to a healthy person who is travelling happily in train. It doesn’t require an Einstein’s brain to compare, who is more at risk for death. Although death in both situation is sad but the differential compensation formulas applied by courts and justice systems require a re-look in both the situations.
Accidents can happen everywhere. It can be on roads, trains or in the air and more possible in the hospital, when doctors are trying to save a critically sick patients. Chances are more in hospital as situation is akin to as doctors are trying to fly a defective aeroplane.
Medical accidents are usually interpreted as medical negligence. Ironically, for genuine mistakes or even a natural poor outcome, an impression is created as if the doctors have killed a healthy person and is assumed as a doctor’s fault. Not uncommonly doctors become punching bags as a revenge in case of a hospitalized death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event. But all these issues are variable and depend upon understanding level and wisdom of people. What is surprising is the non-uniformity of courts and justice systems in evaluating and compensation of death. For hospital death alleged due to medical negligence – compensation formula is applied that is not used for other hundreds of healthy deaths.
An unfortunate incident of train accident causing hundreds of untimely deaths happened yesterday. In fact the burden of negligence here (like a train accident- hundreds of deaths) in healthy deaths is massive and these deaths are unpardonable.
It will be interesting to see how courts apply the formula for compensation in hundreds of healthy deaths due to negligence as is applied in cases of medical negligence when someone has poor outcome.
That brings forth a fundamental question. Why compensation to death is not uniform? Why medical profession is handed over a harsher punishment and pays a higher compensation (while trying to treat) for a death which is more natural and consequence to some disease? Why for compensation in hundreds of healthy deaths that was completely unnatural – same formula is not applied?
Such differential evaluation and compensation of death is not only illogical and unreasonable but a grave injustice to medical profession. Point to ponder- if trying to save someone’s life raises a risk of heavy compensations, why should doctors do it?
Has the time come to say ‘no to medical profession’? At least paying millions and becoming a doctor is not worth it.
Movements like #NO-TO-RTH are result of long standing humiliation of medical profession.
Social media and celebrities have rewired the people’s mind against medical profession. It has created a terrifying picture about the harm that doctors do to patients. The turmoil against medical profession in the society is linked to social media that exploits the deep wired craving of patients to know more about the “realities”. This hot emotion, generating a sense of threat to them in hospitals, is exactly what they are designed to provoke. Especial comments- facts or not- produces entirely different reactions. The analytical comments about the possible harm awaken negative thinking, tribal instinct, and hardens opinion one way or other.
Media, celebrities and others are getting away with making disparaging remarks and doctors have no mechanism to retaliate. The hurtful blabber continues at will. By theatrically deriding hard work of doctors, they grabbed eyeballs to be at the centre stage of health care and prove their relevance to the system.
Among millions of patients being treated every day, there are bound to be few handfuls of adverse events, poor outcomes. Media, lawyers and other opportunistic elements sniff those few incidents and discuss it with distorted version that rewards are instantaneous.
Talking about death, negligence in medical care on media is a frightening topic and not without consequences. Ethical lines are crossed frequently. Negative emotions are generated like hate, anger and hurt and usually instigating against the medical profession. By use of few provocative words, the media can be set on metaphorical fire; the populism statistics hit the roof. The negative projection played in a peculiar way rules the internet and television. The media journalist hits an instantaneous stardom.
In the mad game for popularity, cross ethical lines and create rifts. They embellish it with more provocative words and share it with their name hoping to drive more engagement.
With no strong retaliation from doctors’ associations, shrugging and ignoring by individual doctors has made medical profession not only a scapegoat but a medium to gain cheap popularity for everyone who can publically bash the medical community. Doctors’ associations have failed to fight to save dignity and pride of their members.
In such unfavourable and hostile circumstances, medical students paying crores to get medical college seat is like getting into a trouble zone and getting entrapped into a system of exploitation and may be a self-bought disaster. Someone paying for being a doctor in millions and crores is an absurd thought and highly ill advised. For the candidates who are not financially strong, it may be difficult to even recover the money spent, what to say about the time and youth wasted in getting a degree which may or may not be that worth.
The painful aspect is that after a medical student is awarded a degree, he becomes part of the community that is labelled as ‘thief’ or ‘butcher’ or ‘worst’ on various platform openly by media and prominent people. Sadly no action is taken for their public humiliation and passed as a routine issue. Courts and human right commission also remain silent on grave injustice to this educated and hard working community.
Has the time come to say ‘no to medical profession’? At least paying millions and becoming a doctor is not worth it.
In the present era, Doctors are ebbed from all sides, need to earn back the dignity of profession and resist oppression. The phenomenon of oppression in the name of medical- regulation is a global issue. The oppressive schemes in the misleading names like #RTH Rajasthan (RIGHT TO HEALTH) are prevalent everywhere globally in some form or another.
Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.
Doctors in Rajasthan India have shown first of its kind revolt, that is just waiting to happen globally at some stage.
It is not easy to practice as doctor these days. Media full of doctors bashing, credibility crisis and regulators perpetually hounding doctors, who are forced to work under imposed medico-legal sword. There is no day that passes when system does not perpetuate negativity against medical profession.
By certain laws and Acts like RTH, an effort is on to place medicine under State control. Acquiring kind of skill , the years of passionate, merciless excruciating medical learning is placed at the disposal of administrators, who themselves have already failed to develop a good health care system in real sense.
Doctors have become soft targets for populist attention mongering and transforming social nuisance into messiah of the deprived by administrators -by sprouting the fraudulent generalities.
All the calculations that usually precede the enslavement of medicine, everything gets discussed by administrators and industry – except the well-being of the doctors and nurses.
Doctors have often wondered at the smugness with which administrators assert their right to enslave them, to control their work, to force their will, to violate their conscience, to stifle their mind. Irony is that while administrators do this, still they depend on the same doctors for saving lives -whose life they have throttled, who resent the treatment meted out to the health care workers. Like the failed medical system, administrators have failed to realize that all the negativity perpetuated against doctors, who are working with the burden of mistrust under medico-legal sword is going to make them less safe.
Administrators, who have never treated a patient in their lifetimes, not only try to control treatment of thousands of patients, but project themselves messiah by demonizing doctors. Lowly educated celebrities and administrators have found a new easy way to project themselves on higher pedestrian by publicly insulting highly educated but vulnerable doctors. The biggest tragedy to the medical profession in the present era is the new fad of administrators to discourage and demonize the medical profession for their popularity gains. Being so distant from the ground reality, their role should not have been more than facilitators, but they have become medical administrators. To control the health system, administrators have a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses.
Slow or acute revolt is long due. Doctors have only two ways- either to persist, fight or perish. Silently quitting their beloved profession is going on for some time all over the world. Even in developed countries, there has been a fading enthusiasm to be a doctor. But doctors of Rajasthan have shown the way. The way to persist and resist the indignity handed over to medical profession. The have shown that the struggle was not that difficult that it looked to be. They have chosen the correct path of struggle for Independence (Professional). That makes them global leaders without any doubt.
Up to the end of World War II, less than 10% of the general anaesthetics administered were with intravenous barbiturates. The remaining 90% of anaesthetics given in the USA were with diethyl ether. In the United Kingdom and elsewhere, chloroform was also popular. Diethyl ether administration was a relatively safe and simple procedure, often delegated to nurses or junior doctors with little or no specific training in anaesthesia. During the Japanese attack on the US bases at Pearl Harbor, with reduced stocks of diethyl ether available, intravenous Sodium Pentothal(®), a most ‘sophisticated and complex’ drug, was used with devastating effects in many of those hypovolaemic, anaemic and septic patients. The hazards of spinal anaesthesia too were realised very quickly. These effects were compounded by the dearth of trained anaesthetists. The anaesthesia tragedies at Pearl Harbor, and the discovery in the next few years of many other superior drugs that caused medical and other health professionals to realise that anaesthesia needed to be a specialist medical discipline in its own right. Specialist recognition, aided by the foundation of the National Health Service in the UK, the establishment of Faculties of Anaesthesia and appropriate training in pharmacology, physiology and other sciences soon followed. Modern anaesthesiology, as we understand it today, was born and a century or more of ether anaesthesia finally ceased.
The World War II medical tragedies, especially those at Pearl Harbor, were a wake-up call for surgeons and the medical profession generally throughout the world. There was a realisation that it was no longer appropriate for any junior doctors or nurses to administer ‘sophisticated’ anaesthetic drugs for many types of surgeries and to critically ill patients. This had been known for many years in thoracic surgery and neurosurgery, but in the years after the war it was clear that appropriately trained anaesthetists were required, who had the knowledge and skills to use advanced drugs such as thiopentone and the new techniques and equipment which had rapidly developed in the 1940s.
The significance of the results of attempts of nurse and doctor anaesthetists to use thiopentone anaesthesia in military casualties who were hypovolaemic was very clear. Cardiovascular collapse and respiratory arrest with a lack of oxygen supplies, resuscitative skills and knowledge of thiopentone’s pharmacology and dosage, along with the insufficient numbers of skilled anaesthetists, clearly resulted in many tragedies. Some spinal anaesthetics also contributed to the perioperative mortality. So it was not too long during that fateful day in 1941 before surgeons and others reverted to using ‘drip ether’ as the principal anaesthetic technique and restricted the use of the available local anaesthetics, procaine and tetracaine, to infiltration only—mainly in burns patients. Exactly how many anaesthetic deaths resulted from intravenous thiopentone and hexobarbital will probably never be known as there were no defined classifications of such deaths as we have today.
In summary, the greatest significance of the anaesthetic events at Pearl Harbor, and more broadly throughout World War II, was that the surgeons, the medical profession generally and health authorities recognised the need for appropriately trained and skilled specialist practitioners of anaesthesia. Modern anaesthesia, or anaesthesiology as I believe we should refer to it, was born soon after Pearl Harbor and World War II, and the ‘ether century’ began to expire, although ether continued to be used into the 1970s for many simpler surgeries in less developed centres.
Psychedelics (serotonergic hallucinogens) are powerful psychoactive substances that alter perception and mood and affect numerous cognitive processes. They are generally considered physiologically safe and do not lead to dependence or addiction.
Their origin predates written history, and they were employed by early cultures in many sociocultural and ritual contexts. After the virtually contemporaneous discovery of (5R,8R)-(+)-lysergic acid-N,N-diethylamide (LSD)-25 and the identification of serotonin in the brain, early research focused intensively on the possibility that LSD and other psychedelics had a serotonergic basis for their action.
Psychedelics are a subclass of hallucinogenic drugs whose primary effect is to trigger non-ordinary mental states (known as psychedelic experiences or psychedelic “trips”) and/or an apparent expansion of consciousness.Sometimes, they are called classic hallucinogens, serotonergic hallucinogens, or serotonergic psychedelics. True psychedelics cause specific psychological, visual, and auditory changes, and oftentimes a substantially altered state of consciousness. The “classical” psychedelics, the psychedelics with the largest scientific and cultural influence, are
Mescaline,
LSD,
Psilocybin,
DMT.
LSD in particular has long been considered the paradigmatic psychedelic compound, to which all other psychedelics are often or usually compared.
Many psychedelic drugs are illegal worldwide under the UN conventions, with occasional exceptions for religious use or research contexts. Despite these controls, recreational use of psychedelics is common.
Legal barriers have made the scientific study of psychedelics more difficult. Research has been conducted, however, and studies show that psychedelics are physiologically safe and rarely lead to addiction. Studies conducted using psilocybin in a psychotherapeutic setting reveal that psychedelic drugs may assist with treating depression, alcohol addiction, and nicotine addiction. Although further research is needed.
List of psychedelic drugs
LSD (Lysergic acid diethylamide)
Psilocin (4-HO-DMT)
Mescaline (3,4,5-trimethoxyphenethylamine)
DMT (N,N-dimethyltryptamine)
2C-B (2,5-dimethoxy-4-bromophenethylamine)
Uses
Traditional
A number of frequently mentioned or traditional psychedelics such as Ayauasca (which contains DMT), San Pedro, Peyote, and Peruvian torch (which all contain mescaline), Psilocybin mushrooms (which contain psilocin/psilocybin all have a long and extensive history of spiritual, shamanic and traditional usage by indigenous peoples in various world regions, particularly in Latin America, but also Gabon, Africa in the case of iboga. Different countries and/or regions have come to be associated with traditional or spiritual use of particular psychedelics, such as the ancient and entheogenic use of psilocybe mushrooms by the native Mazatec people of Oaxaca, Mexico or the use of the Ayauasca brew in the Amazon basin, particularly in Peru for spiritual and physical healing as well as for religious festivals.
Although people of western culture have tended to use psychedelics for either psychotherapeutic or recreational reasons, most indigenous cultures, particularly in South America have seemingly tended to use psychedelics for more supernatural reasons such as divination.
Psychedelic therapy
Psychedelic therapy (or psychedelic-assisted therapy) is the proposed use of psychedelic drugs to treat mental disorders. As of 2021, psychedelic drugs are controlled substances in most countries and psychedelic therapy is not legally available outside clinical trials, with some exceptions.
The procedure for psychedelic therapy differs from that of therapies using conventional psychiatric medications. While conventional medications are usually taken without supervision at least once daily, in contemporary psychedelic therapy the drug is administered in a single session (or sometimes up to three sessions) in a therapeutic context.
As of 2022, the body of high-quality evidence on psychedelic therapy remains relatively small and more, larger studies are needed to reliably show the effectiveness and safety of psychedelic therapy’s various forms and applications.
Evolution of Medical profession-Extinction of good doctors 