Diabetes Mellitus-causes-symptoms-prevention


Mayo clinic

Diabetes mellitus –Diagnosis and treatment

Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it’s an important source of energy for the cells that make up your muscles and tissues. It’s also your brain’s main source of fuel.

The underlying cause of diabetes varies by type. But, no matter what type of diabetes you have, it can lead to excess sugar in your blood. Too much sugar in your blood can lead to serious health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes and gestational diabetes. Prediabetes occurs when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes. And prediabetes is often the precursor of diabetes unless appropriate measures are taken to prevent progression. Gestational diabetes occurs during pregnancy but may resolve after the baby is delivered.

Symptoms

Diabetes symptoms vary depending on how much your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may sometimes not experience symptoms. In type 1 diabetes, symptoms tend to come on quickly and be more severe.

Some of the signs and symptoms of type 1 diabetes and type 2 diabetes are:

  • Increased thirst
  • Frequent urination
  • Extreme hunger
  • Unexplained weight loss
  • Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there’s not enough available insulin)
  • Fatigue
  • Irritability
  • Blurred vision
  • Slow-healing sores
  • Frequent infections, such as gums or skin infections and vaginal infections

Type 1 diabetes can develop at any age, though it often appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it’s more common in people older than 40.

When to see a doctor

  • If you suspect you or your child may have diabetes. If you notice any possible diabetes symptoms, contact your doctor. The earlier the condition is diagnosed, the sooner treatment can begin.
  • If you’ve already been diagnosed with diabetes. After you receive your diagnosis, you’ll need close medical follow-up until your blood sugar levels stabilize.

Causes

To understand diabetes, first you must understand how glucose is normally processed in the body.

How insulin works

Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).

  • The pancreas secretes insulin into the bloodstream.
  • The insulin circulates, enabling sugar to enter your cells.
  • Insulin lowers the amount of sugar in your bloodstream.
  • As your blood sugar level drops, so does the secretion of insulin from your pancreas.

The role of glucose

Glucose — a sugar — is a source of energy for the cells that make up muscles and other tissues.

  • Glucose comes from two major sources: food and your liver.
  • Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
  • Your liver stores and makes glucose.
  • When your glucose levels are low, such as when you haven’t eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.

Causes of type 1 diabetes

The exact cause of type 1 diabetes is unknown. What is known is that your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.

Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what those factors are is still unclear. Weight is not believed to be a factor in type 1 diabetes.

Causes of prediabetes and type 2 diabetes

In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it’s needed for energy, sugar builds up in your bloodstream.

Exactly why this happens is uncertain, although it’s believed that genetic and environmental factors play a role in the development of type 2 diabetes too. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.

Causes of gestational diabetes

During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin.

Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can’t keep up. When this happens, too little glucose gets into your cells and too much stays in your blood, resulting in gestational diabetes.

Risk factors

Risk factors for diabetes depend on the type of diabetes.

Risk factors for type 1 diabetes

Although the exact cause of type 1 diabetes is unknown, factors that may signal an increased risk include:

  • Family history. Your risk increases if a parent or sibling has type 1 diabetes.
  • Environmental factors. Circumstances such as exposure to a viral illness likely play some role in type 1 diabetes.
  • The presence of damaging immune system cells (autoantibodies). Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes autoantibodies. If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But not everyone who has these autoantibodies develops diabetes.
  • Geography. Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes.

Risk factors for prediabetes and type 2 diabetes

Researchers don’t fully understand why some people develop prediabetes and type 2 diabetes and others don’t. It’s clear that certain factors increase the risk, however, including:

  • Weight. The more fatty tissue you have, the more resistant your cells become to insulin.
  • Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
  • Family history. Your risk increases if a parent or sibling has type 2 diabetes.
  • Race or ethnicity. Although it’s unclear why, certain people — including Black, Hispanic, American Indian and Asian American people — are at higher risk.
  • Age. Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing among children, adolescents and younger adults.
  • Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you’re also at risk of type 2 diabetes.
  • Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
  • High blood pressure. Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.
  • Abnormal cholesterol and triglyceride levels. If you have low levels of high-density lipoprotein (HDL), or “good,” cholesterol, your risk of type 2 diabetes is higher. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know what your cholesterol and triglyceride levels are.

Risk factors for gestational diabetes

Pregnant women can develop gestational diabetes. Some women are at greater risk than are others. Risk factors for gestational diabetes include:

  • Age. Women older than age 25 are at increased risk.
  • Family or personal history. Your risk increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You’re also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.
  • Weight. Being overweight before pregnancy increases your risk.
  • Race or ethnicity. For reasons that aren’t clear, women who are Black, Hispanic, American Indian or Asian American are more likely to develop gestational diabetes.

Complications

Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:

  • Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you’re more likely to have heart disease or stroke.
  • Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.

Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.

  • Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
  • Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
  • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
  • Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
  • Hearing impairment. Hearing problems are more common in people with diabetes.
  • Alzheimer’s disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer’s disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.
  • Depression. Depression symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management.

Complications of gestational diabetes

Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.

Complications in your baby can occur as a result of gestational diabetes, including:

  • Excess growth. Extra glucose can cross the placenta, which triggers your baby’s pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to require a C-section birth.
  • Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby’s blood sugar level to normal.
  • Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
  • Death. Untreated gestational diabetes can result in a baby’s death either before or shortly after birth.

Complications in the mother also can occur as a result of gestational diabetes, including:

  • Preeclampsia. This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.
  • Subsequent gestational diabetes. Once you’ve had gestational diabetes in one pregnancy, you’re more likely to have it again with the next pregnancy. You’re also more likely to develop diabetes — typically type 2 diabetes — as you get older.

Complications of prediabetes

Prediabetes may develop into type 2 diabetes.

Prevention

Type 1 diabetes can’t be prevented. However, the same healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can also help prevent them:

  • Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.
  • Get more physical activity. Aim for about 30 minutes of moderate aerobic activity on most days of the week, or at least 150 minutes of moderate aerobic activity a week.
  • Lose excess pounds. If you’re overweight, losing even 7% of your body weight — for example, 14 pounds (6.4 kilograms) if you weigh 200 pounds (90.7 kilograms) — can reduce the risk of diabetes.

Don’t try to lose weight during pregnancy, however. Talk to your doctor about how much weight is healthy for you to gain during pregnancy.

To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

Sometimes medication is an option as well. Oral diabetes drugs such as metformin (Glumetza, Fortamet, others) may reduce the risk of type 2 diabetes — but healthy lifestyle choices remain essential. Have your blood sugar checked at least once a year to check that you haven’t developed type 2 diabetes.

history and discovery of Diabetes mellitus-ancient medicine

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NEET-PG-Counselling: A larger public emergency issue due to Pandemic


        NEET PG Post-Graduation after MBBS is an entrance qualification exam, one of toughest and important exam not only for medical students but for medical colleges and hospitals. As this exam will decide and form the back bone of the health care system in the whole country. Ultimately this exam will be the check gate to supply specialist doctors to medical colleges, hospitals and private health institutions in all the states.  Post graduate trainees form the bulk load of doctors performing the duties.  Needless to say these doctors form the back bone of the total health system across the country. For last two years, these junior doctors were at the forefront of the fighting the pandemic. 

       Since NEET PG was to be conducted in Jan 2021, but due to pandemic got postponed to Sept 2021 and result were declared few months back.

      NEET PG counselling is not only issue for doctors but an actually a larger public health issue and kind of emergency due to pandemic, which will decide the availability of doctors to public.

         Actually it is in patient’s interest to have early counselling.

         It is a sad situation, when the world is preparing to tackle the wave of pandemic due to Omicron Variant, other countries are ramping up their health care infrastructure and manpower, and Indian doctors are being dragged on roads by police instead of employing them in hospitals.

       Its importance assumes an emergency situation in face of looming pandemic. If the administrators had perceived it as merely a trivial doctors’ issue and remained complacent, it had been a grave mistake.

     What was the emergency to change and frame new rules when a pandemic of such a large proportion was going on?

    A delay in academic counselling means a wasted year for the NEET PG aspirants. It also means that 50000 doctors are missing from the medical system and  the health care force because of bureaucratic delays, at a time when health care staff is overworked and in desperate need of more hands.

      Point to ponder here is that is it the doctors who desperately need help? More precisely and in reality it is the patients and public who need doctors desperately. An early counselling is in public interest actually, the point administrators have failed to understand.

       But sadly, it is up to the wisdom of administrators that decides “what is emergency and what is not” rather than medical wisdom, a case of misplaced priorities.

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Want to be a Doctor: Expect No Justice


           

        Medical students or aspiring doctors should be carefully watching the behaviour and cruelty by which doctors are governed, regulated and treated by administrators. Mere few words of respect and false lip service during Covid-pandemic  should not mask the real face of administrators, indifference of courts and harshness of Government towards medical profession. Choosing medical careers can land anyone into the situations, which are unimaginable in a civilized world.

At a time when Political groups, terrorists, drug addicts, celebrities commit crimes and get a priority hearing by courts and speedy relief (whether deserve or not worthy), doctors pleadings even for their rightful issues and routine problems are paid deaf and indifferent ears. It is disheartening to see that they receive apathetic attitude and dealt with stick or false assurances even for the issues which should have been solved automatically in routine even by average application of governance.

             It is discouraging for the whole medical fraternity to see that even the rightful is not being given what to expect the gratitude and respect.

          The barbaric response of Police towards peacefully demanding doctors has unmasked the real indifferent attitude of Government and administrators as well as apathy of courts towards medical profession. The cruel behaviour has also unveiled the approach of  tokenism such as ‘mere lip service’  showing respect to corona warriors.

      The strong political and legal will is absent to solve Doctors’ problems.

      It also shows the scant  concern of the Government to provide a real good health care system despite showing a verbal concern for medical services. It also explains why successive Governments irrespective of political moorings  have terribly failed to provide healthcare to its people.  Why patients fail to get a bed, oxygen, doctors or nurse is consequence to the misplaced priorities of administrators.

    Who would be the worst sufferer of the apathetic attitude of the Government? Doctors will suffer initially till they continue to choose medical profession. Once they also become apathetic like administrators, it would be the patients.

Delhi: AIIMS, FAIMA doctors join protest after police crackdown

A day after resident doctors protesting delays in NEET-PG counselling alleged that they were assaulted by the police, doctors from the All India Institute of Medical Sciences (AIIMS) as well as those associated with the Federation of All India Medical Association (FAIMA) have decided to join the stir.

Doctors from AIIMS, one of the only big tertiary-care government medical college hospitals that had stayed away from the protest, in a letter to the Union health minister, said that they would withdraw from all non-emergency work on Tuesday if no concrete steps are taken.

“It’s high time for the government to release a report of what has been done till date, and what are the government’s plans moving forward for expediting NEET-PG counselling. If no adequate response from the government is received within 24 hours, AIIMS RDA shall proceed with a token strike on 29/12/21 including shutdown of all non-emergency services,” the letter read.

This would hamper patient care in the city further. With emergency departments of big hospitals like Safdarjung and Lok Nayak affected by the strike, patients were being referred to the AIIMS for treatment.

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In addition, FAIMA called for its resident doctors’ association to withdraw from all work, including emergency services, after Monday’s incident. The protest began with withdrawal from outpatient department (OPD) services in November end by two national organisations – the Federation of Resident Doctors’ Association (FORDA) and FAIMA.

The protest slowly intensified with doctors boycotting even emergency work, following which on the insistence of the government the strike was paused for one week.

The strike resumed on December 17 as FORDA members withdrew from all services.

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Highly Contagious – Low Virulence?  Omicron-Covid-Variant


    If the initial data is correct, the Omicron-Variant of Covid is proving to  be of Highly Contagious –  Low Virulence.

     The Omicron variant is less likely to lead to less severe disease in people who have taken vaccines or had Covid-19 in the past, two studies from the UK have said.

Taken together with findings from South Africa – all three studies were released on Wednesday – there is now sound scientific basis to conclude the variant is less virulent than others, especially Delta, which caused a devastating outbreak in India last summer and sparked new waves in other countries.

The findings are the first encouraging scientific evidence linked to the variant of concern (VOC) discovered last month when it started tearing through parts of South Africa at a rate not seen with any other Sars-Cov-2 variant. Scientists soon discovered it was also the most resistant configuration of the coronavirus, leading to higher odds of repeat and vaccine breakthrough infections.

If the Omicron variant was to be as virulent, or more, than Delta, the implications would have been dire, although its high transmissibility and resistance still pose a threat.

“Our analysis shows evidence of a moderate reduction in the risk of hospitalisation associated with the Omicron variant compared with the Delta variant. However, this appears to be offset by the reduced efficacy of vaccines against infection with the Omicron variant. Given the high transmissibility of the Omicron virus, there remains the potential for health services to face increasing demand if Omicron cases continue to grow at the rate that has been seen in recent weeks,” said professor Neil Ferguson of Imperial College London, which released the analysis of Omicron and Delta cases in England.

Two UK studies, similar severity findings

The Imperial College study included all RT-PCR-confirmed Covid-19 cases recorded between December 1-14 in England. It found that Omicron cases have, on average, a 15-20% reduced risk of needing to visit a hospital (the lowest level of severity) and an approximately 40-45% reduced risk of a hospitalisation resulting in a stay of one or more nights.

It also found that a past infection offered approximately a 50-70% reduction in hospitalisation risk compared. All of these comparisons were made against risks of hospitalisation seen with the Delta variant.

The researchers estimate that in unvaccinated people being infected for the first time, the risk of hospitalisation may be lowered by 0-30%, suggesting the severity in completely immune-naive people may not be very different from those who had a Delta infection for the first time, without any vaccine.

The other UK study was from Scotland. Although based on a small number of hospitalisations, the study made similar findings: those with Omicron infections were 68% less likely to need hospitalisation compared to people infected with the Delta variant.

Both reports, as well as the South African study, are yet to be peer-reviewed.

The Imperial College researchers also said in their study that Omicron infections in people with vaccination may be even less likely to require ICU admission or lead to death when compared to Delta variant, “given that remaining immune protection against more severe outcomes of infection are expected to be much higher than those against milder endpoints”.

Need for vaccines, boosters

The detailed findings corroborate lab studies that show people with booster doses have a more adequate immune response to counter the Omicron variant. In their real-world analysis, the Scotland report found a 57% reduction in the risk of symptomatic infection in people who were infected with the VOC compared to those who just had two doses at least 25 weeks prior.

The detailed Imperial College findings made similar findings. For instance, people with two doses of the AstraZeneca vaccine (used in India as the Covishield vaccine), had a higher risk ratio of 0.37 than those with three doses of the same vaccine (0.21). These risk ratios mean two doses reduced the risk of hospitalisation by 63% while three doses cut it by 79%.

Crucially, the report added, people who took the AstraZeneca vaccine had a lower risk in needing to visit a hospital if infected by the Omicron variant when compared to the equivalent risk in the case of a Delta variant infection. In the case of Pfizer-BioNTech or Moderna vaccines, the likelihood of requiring a hospital visit – defined as the lowest level of severity – were similar between Omicron and Delta infections.

The report also stressed on the need to vaccinate the unvaccinated, especially those who did not have a past infection. “The proportion of unvaccinated individuals infected is likely to be substantially higher. In that context, our finding that a previous infection reduces the risk of any hospitalisation by approximately 50% and the risk of a hospital stay of 1+ days by 61% (before adjustments for under ascertainment of reinfections) is significant,” the report said.

  Most cases In India Asymptomatic

With reports of new cases surfacing, the overall number of Omicron cases in India has now reached 33. According to experts, the spread of the new variant is less concerning than that of Delta as the symptoms are mild. While this is partly because of the nature of this new variant, another reason might be the high rate of seropositivity of Indians, experts have said.

“India has the advantage of a very high rate of ‘seropositivity’ of 70, 80 per cent, and in big cities more than 90 per cent people already have antibodies,” Rakesh Mishra, former Director of CSIR-Centre for Cellular and Molecular Biology (CCMB) here, told PTI. Even if people get infected by Omicron, it will be very mild and mostly asymptomatic, Mishra said.

India’s Omicron tally rises to 33: Tracing Covid-19’s new variant in various states

A fresh wave of the pandemic may come even without Omicron, Mishra said referring to the fresh waves in Europe. Ruling out the possibility of a surge in hospitalisation, he said wearing the mask, maintaining social distancing and getting vaccinated remain the three major weapons against future waves.

All Omicron cases in India are mild and there has been no report of Omicron death in India and in any country of the world. The common symptoms are weakness, sore throat etc. Many Omicron patients of India have already recovered and tested negative for Covid.

Capital Delhi reported a new Omicron case on Saturday as a Zimbabwe-returnee tested positive. Reports said the patient only complained of weakness.

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Medical Education: Doctors- Victims of Grave Injustice Expected to Impart Justice to all


        Non-uniformity of medical education is treating  medical students  as  slaves and  killing enthusiasm of young doctors.

    Medical profession is an extremely strenuous and highly specialised field that requires individuals to dedicate their lives in the service of others. As part of medical professionals’ education and training, they are necessitated to undertake training across various settings. In this context, a stipend is paid as a matter of right and not charity. It is therefore essential that parity and equity be maintained across all medical institutions, whether run by private bodies or by the government.    In absence of proper Governance and rules, the young doctors are thrown at the mercy of cruel businessman for proper pay and working conditions.

Ensure uniform stipend to Interns: Binoy Viswam, Rajya Sabha MP

Great disparity in stipend at Govt. Private Colleges

     Medical education is one field where  one can notice the  extreme  variations of the unimaginable magnitude that are beyond comfort.  

      Falling standards  of medical education is the most important  side effect  which  should be an  important issue, but sadly it is the last  priority  on the list of administrators. Each and every medical college can be different and student passing out of many colleges receive below average medical education.

     Another important  variation is in the stipend and remuneration of  young  trainee doctors receive. It varies from college to college, city to city, state to state as well as North to  South and East to West. Besides being a cause for heartburn. it is a cause for  extreme  dissatisfaction among medical students.

      Needless to say the arbitrariness exercised  by various authorities to pay  them at their will is a reflection of grave injustice imposed by administrators.

    Another arbitrariness reflecting injustice is variation in fee of medical colleges. The steep fee charged by private medical colleges and restrictive bonds of Government  medical colleges in name of expensive medical seats need a sincere and honest introspection by authorities. The basis for calculations of the cost of medical education should be transparent and shown in public domain.

     Needless to say that medical students have been sufferers  of poor and arbitrariness of inept  administrative policies. Just because they decided to be doctors, they have to endure poor,  unjust  and arbitrary policies.

     Ironically as a child decides to be a  doctor, he is exploited in name of such policies of  unreasonable  high fee, poor education and low pay. That too while working in  extremely inhuman   conditions,  long and hard working hours. Strangely these medical students  suffer grave injustice  inflicted by the society  since  start of their medical education, but when they become doctors, everyone  expects sympathy, empathy and honesty.

    In absence of proper Governance and rules, the young doctors are thrown at the mercy of cruel businessman.

      Still the sufferers of grave  injustice themselves  are expected to impart justice to everyone  along with  burden  of mistrust.

Ensure uniform stipend to Interns: Great disparity in stipend at Govt. Private Colleges

Binoy Viswam, Rajya Sabha MP, has urged Union Health Minister Mansukh Mandaviya to ensure equity in payment of internship to medical students in private and government medical colleges across the country.In a letter to the Minister, Mr. Viswam said that the National Medical Commission’s Draft Regulations on Compulsory Rotating Internship, 2021, issued on April 21 and gazetted on November 18, had said that all interns shall be paid stipend “as fixed by the appropriate fee fixation authority as applicable to the institution/university/State.”

Ambiguity

“The phrasing of this provision allowed for great ambiguity and arbitrariness. It may also result in management of private colleges denying stipend to the interns as they have complete discretion without any safeguarding mechanism. The ramifications of the same are already being seen in colleges across the country as great variance exists in stipend amounts being paid in government colleges as opposed to private colleges,” he pointed out.

A right, not charity

Mr. Viswam said that medical profession was an extremely strenuous and highly specialised field that required individuals to dedicate their lives in the service of others. “As part of medical professionals’ education and training, they are necessitated to undertake internships across various settings. In this context, a stipend is paid as a matter of right and not charity. It is therefore essential that parity and equity be maintained across all medical institutions, whether run by private bodies or by the government,” he said.

The MP requested the Minister to consult with all stakeholders, including State governments, medical college managements, medical professionals, and students to formulate a policy that ensures equity among medical students. A uniform stipend to all interns would ensure that, he added.

The erstwhile Medical Council of India had come up with a public notice on January 25, 2019, on Graduate Medical Education Regulations, 1997. The Board of Governors that superseded the MCI was considering a provision that said “All the candidates pursuing compulsory rotating internship at the institution from which MBBS course was completed, shall be paid stipend on par with the stipend being paid to the interns of the State government medical institution/Central government medical institution in the State/Union Territory where the institution is located.” However, it was not gazetted until the Board was dissolved.

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History & Evolution of Vaccination


Before the first vaccinations, in the sense of using cowpox to inoculate people against smallpox, people have been inoculated in China and elsewhere, before being copied in the west, by using smallpox, called Variolation.

Variolation was the method of inoculation first used to immunize individuals against smallpox (Variola) with material taken from a patient or a recently variolated individual, in the hope that a mild, but protective, infection would result.

   The procedure was most commonly carried out by inserting/rubbing powdered smallpox scabs or fluid from pustules into superficial scratches made in the skin. 

    The earliest hints of the practice of variolation for smallpox in China come during the 10th century. The Chinese also practiced the oldest documented use of variolation, which comes from Wan Quan’s (1499–1582) Douzhen Xinfa  of 1549. They implemented a method of “nasal insufflation” administered by blowing powdered smallpox material, usually scabs, up the nostrils.

   Various insufflation techniques have been recorded throughout the sixteenth and seventeenth centuries within China. Two reports on the Chinese practice of inoculation were received by the Royal Society in London in 1700; one by Martin Lister who received a report by an employee of the East India Company stationed in China and another by Clopton Havers. In France, Voltaire reports that the Chinese have practiced variolation “these hundred years”.

     In 1796, Edward Jenner, a doctor in Berkeley in Gloucestershire, England, tested a common theory that a person who had contracted cowpox would be immune from smallpox. To test the theory, he took cowpox vesicles from a milkmaid named Sarah Nelmes with which he infected an eight-year-old boy named James Phipps, and two months later he inoculated the boy with smallpox, and smallpox did not develop.

   In 1798, Jenner published An Inquiry into the Causes and Effects of the Variolae Vacciniae which created widespread interest. He distinguished ‘true’ and ‘spurious’ cowpox (which did not give the desired effect) and developed an “arm-to-arm” method of propagating the vaccine from the vaccinated individual’s pustule. Early attempts at confirmation were confounded by contamination with smallpox, but despite controversy within the medical profession and religious opposition to the use of animal material, by 1801 his report was translated into six languages and over 100,000 people were vaccinated. The term vaccination was coined in 1800 by the surgeon Richard Dunning in his text Some observations on vaccination.

   In 1802, the Scottish physician Helenus Scott vaccinated dozens of children in  Mumbai (previous Bombay) against smallpox using Jenner’s cowpox vaccine. In the same year Scott penned a letter to the editor in the Bombay Courier, declaring that “We have it now in our power to communicate the benefits of this important discovery to every part of India, perhaps to China and the whole eastern world”.  Subsequently, vaccination became firmly established in British India. A vaccination campaign was started in the new British colony of Ceylon in 1803.

    By 1807 the British had vaccinated more than a million Indians and Sri Lankans against smallpox. Also in 1803 the Spanish Balmis Expedition launched the first transcontinental effort to vaccinate people against smallpox. Following a smallpox epidemic in 1816 the Kingdom of Nepal ordered smallpox vaccine and requested the English veterinarian William Moorcroft to help in launching a vaccination campaign. In the same year a law was passed in Sweden to require the vaccination of children against smallpox by the age of two. Prussia briefly introduced compulsory vaccination in 1810 and again in the 1920s, but decided against a compulsory vaccination law in 1829.

    A law on compulsory smallpox vaccination was introduced in the Province of Hanover in the 1820s. In 1826, in Kragujevac,  future prince Mihailo of Serbia was the first person to be vaccinated against smallpox in the principality of Serbia. 

    Following a smallpox epidemic in 1837 that caused 40,000 deaths, the British government initiated a concentrated vaccination policy, starting with the Vaccination Act of 1840, which provided for universal vaccination and prohibited Variolation.

    The Vaccination Act 1853 introduced compulsory smallpox vaccination in England and Wales.

    The law followed a severe outbreak of smallpox in 1851 and 1852. It provided that the poor law authorities would continue to dispense vaccination to all free of charge, but that records were to be kept on vaccinated children by the network of births registrars. It was accepted at the time, that voluntary vaccination had not reduced smallpox mortality, but the Vaccination Act 1853 was so badly implemented that it had little impact on the number of children vaccinated in England and Wales.

In the United States of America compulsory vaccination laws were upheld in the 1905 landmark case Jacobson v. Massachusetts by the Supreme Court of the United States. The Supreme Court ruled that laws could require vaccination to protect the public from dangerous communicable diseases. However, in practice the United States had the lowest rate of vaccination among industrialized nations in the early 20th century.

    Compulsory vaccination laws began to be enforced in the United States after World War II. In 1959 the World Health Organization (WHO) called for the eradication of smallpox worldwide, as smallpox was still endemic in 33 countries.

     In the 1960s six to eight children died each year in the United States from vaccination-related complications. According to the WHO there were in 1966 about 100 million cases of smallpox worldwide, causing an estimated two million deaths.

     In the 1970s there was such a small risk of contracting smallpox that the United States Public Health Service recommended for routine smallpox vaccination to be ended.

   By 1974 the WHO smallpox vaccination program had confined smallpox to parts of Pakistan, India, Bangladesh, Ethiopia and Somalia.

     In 1977 the WHO recorded the last case of smallpox infection acquired outside a laboratory in Somalia. In 1980 the WHO officially declared the world free of smallpox.

   In 1974 the WHO adopted the goal of universal vaccination by 1990 to protect children against six preventable infectious diseases: measles, poliomyelitis, diphtheria, whooping cough, tetanus, and tuberculosis.

    In the 1980s only 20 to 40% of children in developing countries were vaccinated against these six diseases. In wealthy nations the number of measles cases had dropped dramatically after the introduction of the measles vaccine in 1963. WHO figures demonstrate that in many countries a decline in measles vaccination leads to a resurgence in measles cases. Measles are so contagious that public health experts believe a vaccination rate of 100% is needed to control the disease.  Despite decades of mass vaccination polio remains a threat in India, Nigeria, Somalia, Niger, Afghanistan, Bangladesh and Indonesia.

   By 2006 global health experts concluded that the eradication of polio was only possible if the supply of drinking water and sanitation facilities were improved in slums. The deployment of a combined DPT vaccine against diphtheria, pertussis (whooping cough), and tetanus in the 1950s was considered a major advancement for public health. But in the course of vaccination campaigns that spanned decades, DPT vaccines became associated with high incidences of side effects. Despite improved DPT vaccines coming onto the market in the 1990s, DPT vaccines became the focus of anti-vaccination campaigns in wealthy nations. As immunization rates decreased, outbreaks of pertussis increased in many countries.

      In 2000, the Global Alliance for Vaccines and Immunization was established to strengthen routine vaccinations and introduce new and under-used vaccines in countries with a per capita GDP of under US$1000.

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 COVID-19 Vaccination  during Pregnancy; CDC data


Safety and Effectiveness of COVID-19 Vaccination during Pregnancy-

CDC released the first U.S. data on the safety of receiving an mRNA COVID-19 vaccine during pregnancy.

Evidence about the safety and effectiveness of COVID-19 vaccination during pregnancy, although limited, has been growing. These data suggest that the benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy.

  • No safety concerns were found in animal studies: Studies in animals receiving a ModernaPfizer-BioNTech, or Johnson & Johnson (J&J)/Janssen COVID-19 vaccine before or during pregnancy found no safety concerns in pregnant animals or their babies.
  • No adverse pregnancy-related outcomes occurred in previous clinical trials that used the same vaccine platform as the J&J/Janssen COVID-19 vaccine: Vaccines that use the same viral vector have been given to pregnant people in all trimesters of pregnancy, including in a large-scale Ebola vaccination trial. No adverse pregnancy-related outcomes, including adverse outcomes affecting the baby, were associated with vaccination in these trials. Learn more about how viral vector vaccines work.

  • COVID-19 vaccines do not cause infection, including in pregnant people or their babies: None of the COVID-19 vaccines contain the live virus that causes COVID-19 so a COVID-19 vaccine cannot make anyone sick with COVID-19, including pregnant people or their babies.
  • Early data on the safety of receiving an mRNA COVID-19 vaccine (Moderna or Pfizer-BioNTech) during pregnancy are reassuring:
    • CDC released the first U.S. data on the safety of receiving an mRNA COVID-19 vaccine during pregnancy. The report analyzed data from three safety monitoring systems in place to gather information about COVID-19 vaccination during pregnancy. These early data did not find any safety concerns for pregnant people who were vaccinated or their babies.1
    • Another report looked at pregnant people enrolled in the v-safe pregnancy registry who were vaccinated before 20 weeks of pregnancy. Scientists did not find an increased risk for miscarriage among people who received an mRNA COVID-19 vaccine during pregnancy.2
    • Many pregnancies reported in these safety monitoring systems are ongoing. CDC will continue to follow people vaccinated during all trimesters of pregnancy to better understand effects on pregnancy and babies.
  • Early data suggest receiving an mRNA COVID-19 vaccine during pregnancy reduces the risk for infection: A recent study from Israel compared pregnant people who received an mRNA COVID-19 vaccine with those who did not. Scientists found that vaccination lowered the risk of infection from the virus that causes COVID-19.3
  • Vaccination of pregnant people builds antibodies that might protect their baby: When pregnant people receive an mRNA COVID-19 vaccine during pregnancy, their bodies build antibodies against COVID-19, similar to non-pregnant people. Antibodies made after a pregnant person received an mRNA COVID-19 vaccine were found in umbilical cord blood. This means COVID-19 vaccination during pregnancy might help protect babies against COVID-19. More data are needed to determine how these antibodies, similar to those produced with other vaccines, may provide protection to the baby.4

Additional clinical trials that study the safety of COVID-19 vaccines and how well they work in pregnant people are underway or planned. Vaccine manufacturers are also collecting and reviewing data from people in the completed clinical trials who received a vaccine and became pregnant.

Vaccine Side Effects

Side effects can occur after receiving any of the available COVID-19 vaccines, especially after the second dose for vaccines that require two doses. Pregnant people have not reported different side effects from non-pregnant people after vaccination with mRNA COVID-19 vaccines (Moderna and Pfizer-BioNTech vaccines). If you experience fever following vaccination you should take acetaminophen (Tylenol®) because fever—for any reason—has been associated with adverse pregnancy outcomes. Learn more at What to Expect after Getting a COVID-19 Vaccine.

Although rare, some people have had allergic reactions after receiving a COVID-19 vaccine. Talk with your healthcare provider if you have a history of allergic reaction to any other vaccine or injectable therapy (intramuscular, intravenous, or subcutaneous).

Key considerations you can discuss with your healthcare provider include:

  • The unknown risks of developing a severe allergic reaction
  • The benefits of vaccination

If you have an allergic reaction after receiving a COVID-19 vaccine during pregnancy, you can receive treatment for it.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

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     Covid paradox: salary cut for doctors other paid at home

Medical Education- a business: Supreme Court


The medical profession and education have become a business and now the regulation of medical education has also gone that way which is the nation’s tragedy, an anguished Supreme Court said on Tuesday, giving one chance to the Centre to put its “house in order” and take a call on reversing the changes made to the NEET Super Speciality Examination 2021 syllabus.

The apex court was not satisfied with the justification given by the Centre, National Board of Examination (NBE) and National Medical Commission (NMC) on making the last minute changes after the notification for examination was issued in July.

“This is how botched up our education system has become,” it said.

A bench of Justices D Y Chandrachud, Vikram Nath and B V Nagarathna in an over two hour hearing gave time to the Centre, NBE and NMC to come up with a solution by Wednesday morning and said it will continue hearing the matter to avoid any prejudice to the young doctors.

“This matter is part heard and you can still put your house in order, we will give you time until tomorrow. We will not adjourn the part heard matter now as this will only cause prejudice to the students but we hope better sense prevails. If there is a sense of obduracy, then we are armed with law and they are long enough to reach out to the obduracy. We are giving you one opportunity to reform,” the bench said.

The top court was hearing a batch of pleas of 41 Post Graduate doctors and others who have challenged the last minute changes made to the syllabus after the notification for examination was issued on July 23 for the test to be held on November 13 and 14.

Additional Solicitor General (ASG) Aishwarya Bhati, appearing for the Centre, said the court should not get the impression that the last minute change in syllabus was done to fill vacant seats in private colleges and they will try to persuade the court to dispel this notion.

“We are getting a strong impression that the medical profession has become a business, medical education has become a business and the regulation of medical education has also become a business. That’s the tragedy of the nation,” the bench said.

The authorities should show some concern for the students, as these are the students who do not start preparation for these course two or three months in advance but right from the time they join a Postgraduate course, they aspire for a super speciality, which requires years of commitment, it said.

The government has to balance out the investment made by the private sector in these medical colleges but it should equally think in the interest of the medical profession and the interest of students, the top court said.

“The interest of students must weigh far higher because they are the people who are going to be a torch bearer of providing medical care and it seems perhaps we have forgotten them in the whole process,” it said.

The top court said that prior to 2018, 100 per cent questions came from the feeder courses; from 2018 to 2020 there was major modification under which 60 per cent marks were from super specialisation and 40 per cent from the feeder super specialisation courses.

“Now what is sought to be done is one hundred per cent questions will be from primary feeder speciality which is general medicines. It is completely overlooking the facts that you are fundamentally changing the examination pattern and you are doing it for an examination announced to be held in November, 2021,” it said.

The bench added that NBE and NMC are not doing any favour in asking the court to push back the examination by another two months.

It told Bhati, “It does not matter as these doctors will join the Super Speciality courses two months later, so long the seats are filled up it does not matter. This shows us the length to which your clients are willing to go to ensure that seats are filled up. Nothing should go vacant”.

Bhati said that seats going vacant is not the only consideration that has weighed on experts but it is the comparative opportunity and comparative ease which will be in larger public interest of the students that has weighed with the experts.

The bench said, “So what really happened is this for all specialisation of super speciality, starting from critical care medicines, cardiology, clinical haematology and other courses the specialisation is only going to be and the examination will be on general medicines.”

“The idea is that general medicine has the largest pool, the largest group in PG, so tap and fill up the vacant seats. That seems to be the logic behind this, nothing more and nothing less”.

The top court said, “You may have a rationale; we are not saying you may not have a rationale. The question is that all changes, which you have brought has caused serious prejudice to the students. Problem is that you didn’t plan for the future. You did not have a vision and all that you do is that just because you have a certain degree of authority you will exercise it in whatever time you want”.

Don’t treat young doctors as football in power game, says Supreme Court on changes in syllabus

The bench asked Bhati and senior advocate Maninder Singh, appearing for NBE, what was the great hurry to do it for this year as heavens would not have fallen except for the fact that some 500 seats would have remained vacant in some private medical colleges.

On September 27, the top court said, “Don’t treat young doctors as football in the game of power,” and warned the Centre that it may pass strictures if it is not satisfied with justification for last minute changes to the syllabus.

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Overuse of Antibiotics: Wrong analysis # Rebuttal Times of India


     The Times of India today   carries an editorial by Mr Sandeep Bansal on over prescription of antibiotics. Although there are few points which may be correct, but the article fails to highlight the basic reasons for the problem, which it was supposed to address.

    The reason for failure to find the correct reasons can be the distant analysis. Someone working in London and trying to analyse the grass root problem of India may not be a perfect idea. People need to work at ground level to identify the real issues. Otherwise the analysis remains half-baked and gives a glimpse  of the bias, which celebrities use commonly for gaining popularity by finding faults of doctors.

 

     The overall picture has to be understood to identify real reasons and hence the proper solution to the problem. The correct steps taken would settle the issue; otherwise the analytical article would   just remain a piece of paper and an matter of discussions for Arm chair preachers.

over prescription of antibiotics

   The author failed to highlight the factors like easy availability of antibiotics. People can directly approach pharmacist and get whatever antibiotic they want.  Pharmacist can sell whatever brand, doses and kind of antibiotic. The uncountable quacks, doctors of alternate medicines use all kind of antibiotics with impunity. Tons of antibiotics are consumed without any proper medical advice. Self-medication by people themselves, as it is easily available can’t be ignored as an important cause.  

       The reasons written by the author in TOI, actually constitute a minuscule fraction (5-10%), as far as use of antibiotics is concerned. By writing imperfect article, without knowing actual problems by a distant analysis, such article provides real misguidance rather than actual solutions to the problems.

         Someone to do justice to such complex and important issues, one has to work at the place and be aware about real issues and ground problems. Otherwise it just remains a method to gain cheap popularity.

   Sadly, in present era, people who do not treat patients,  are away from  truth, but they can influence the treatment of thousands of patients  just by doing an ‘On Table’ analysis.

        Wrong analysis, hence incorrect conclusions can lead to wrong decisions.

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     Covid paradox: salary cut for doctors other paid at home

Expensive Medical College Seat; A Bad Choice


In the present circumstances, when doctors themselves are doubtful about the advice for choosing medical career, some are naive 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. Following are the reasons, why spending a fortune on the medical college seat may be a bad idea, at least for the students from moderate family backgrounds.

1. Medical courses are comparatively lengthy and expensive courses and difficult training with slave like duties. “enslavement of doctors”.

2. Uncertain future for aspiring doctors at time of training:  Nowadays, doing just MBBS is not enough and it is important to specialise. Because of lesser seats in post-graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice.  They have to just flow with system ultimately.

3.Hostile environment for doctors to begin: Suddenly young and bright children complete  training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

4. Difficult start of career: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and half treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.

5. The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.

 6. Blamed for all malaise: The society gets biased because of the   media reports and some celebrity talking glib against medical profession. The blame for  inept medical system, administrative failure and complexity of medical industry is conveniently loaded on doctors. These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.

7. Personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.

8. Risk to doctor himself: Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include   tuberculosis and other bacterial and viral illnesses. Radiologists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.

9. Unrealistic expectations of society:  Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative every day is enough to spoil the mood for the day.

10. Retrospective analysis of doctor’s every action continues all the life. It could be by  patients and relatives  every day  in the form of  “ Why this was not done before?” Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving, or it could be by courts and so many regulatory bodies. If unfortunately there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.

 The decision taken in emergency will be questioned  and  in retrospect they may not turn out to be the best one. But later with retrospective analysis along with wisdom of hindsight with luxury of time, may be labelled as wrong if a fault-finding approach is used. This along with general sentiment and sympathy with sufferer makes medical profession a sitting duck for lawsuit and punishments. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation would be full and almost permanent.

11. Physical assault, routine instances of verbal abuse and threat are common for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. Recently, even female doctors have not been spared by mobs. Silence of prominent  people, celebrities and society icons on this issue is a pointer towards increasing uncivilized mind-set of society.

12. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.

13. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: I have seen zero fee and fixed commission ads on television by lawyers in health systems in certain developed countries. They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such   relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations.  This encouragement and instigations of lawsuit against doctors is a major disadvantage for medical profession.

14. Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this 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.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

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