Cervical cancer: myths and facts


Of all the cancers affecting  women, cervical cancer has emerged as one of most common cause of cancer.

Women between 15 and 44 years of age are particularly at risk.

Cervical cancer is mostly caused by the Human Papilloma Virus or HPV. It is a condition that affects lining of the cervix, or the lower part of the uterus. This cancer develops gradually and becomes full-blown over time.

HPV infection can spread through sexual or skin-to-skin contact. Though this infection usually goes away on its own over time in most women, in others, it can persist and cause precancerous changes in the cells of the cervix.

Some symptoms of this cancer include abnormal vaginal bleeding, vaginal bleeding after menopause or sex, bleeding or spotting between periods, longer or heavier menstrual periods than usual, other abnormal vaginal discharge, and pain during sexual intercourse

As with any other disease, there are certain myths associated with cervical cancer as well.

Myth 1: Women without a family history of cervical cancer do not need to get screened.

Those without a family history of this condition may also be at risk. This is because the HPV infection can spread through sexual contact. It is, thus, important to get take preventive measures and get Pap tests done.

Myth 2: Pap tests should be done every year

There is no need to get a Pap test every year if this test and the one for HPV are normal. The recommended schedule is once in three years in women between 21 and 29; and once every five years in women between 30 and 64. Those above the age of 64 should follow their doctor’s advice.

Myth 3: It is not possible to prevent cervical cancer

Cervical cancer is one of the most preventable cancers. A Pap test can help determine any kind of changes in the cells of the cervix. Once any such change is detected, it is possible to start treatment early and prevent the cancer from developing. Pap test is imperative for anyone who has been sexually active or in women who have HPV and are smokers.

Myth 4: Women with no symptoms need not get tested

HPV infections do not show any symptoms in most cases. While there are different types of HPV, some high-risk types are associated with cervical cancer and can go undetected until the development of abnormal cells. This makes it important for women to get tested on a regular basis.

Myth 5: Women who have had a hysterectomy do not need to get tested

It is imperative to undergo a screening for cervical cancer irrespective of whether a woman has had a hysterectomy. Only those who have undergone a total hysterectomy (a process where both cervix and uterus are removed) need not get screened.

Myth 6: Pap test is similar to a pelvic exam

Pelvic exam is a physical examination of the pelvis, vagina, and pelvic floor (the area encompassed by the hip bones), whereas, in a Pap test, cells from the cervix are gently scraped away and examined for abnormal growth.

Myth 7: Condoms can prevent HPV

Condoms can help prevent certain sexually transmitted infections (STI). However, this may not be true for HPV as the virus can inhabit areas that condoms do not cover.

Myth 8: Cervical cancer treatment can cause infertility

Advances in medicine and surgery have ensured that cervical cancer treatment does not affect fertility in a woman. These surgical treatments can help a woman conceive by removing only the cervix and not the uterus.

Timely screening and detection are two very important aspects of combating cervical cancer, as it is a completely treatable condition. Apart from this, women should make some basic lifestyle changes to avoid contracting an infection. These include avoiding sexual contact with multiple partners; getting screened on a timely basis; quitting smoking; consuming a healthy diet rich in fruits, vegetables, and whole grains; and maintaining a healthy weight. All these can go a long way in preventing cervical cancer.

source;

https://www.deccanchronicle.com/lifestyle/health-and-wellbeing/010218/8-myths-and-facts-about-cervical-cancer.html

 

Reversal of medical advancement, reversion of the enemy : ANTIBIOTIC RESISTANCE


Substances with antibiotic properties had been used for various purposes since ancient times.

Before the early 20th century, treatments for infections were based primarily on medicinal folklore. Mixtures with antimicrobial properties that were used in treatments of infections were described over 2000 years ago. Many ancient cultures, including the ancient Egyptians and ancient Greeks, used specially selected mold and plant materials and extracts to treat infections.

For their successful development of penicillin, which Fleming had accidentally discovered but could not develop himself, as a therapeutic drug, Chain and Florey shared the 1945 Nobel Prize in Medicine with Fleming.

Germ theory and discovery of antibiotics has contributed a lot to development of modern medicine. Treatment of advanced multi system diseases, complex surgeries, advanced procedures have become easier to handle because of  advent of antibiotics.  

Over the last several decades, antibacterial drug use has become widespread with their misuse being an ever‑ increasing phenomenon. Consequently, antibacterial drugs have become less effective or even ineffective, resulting in a global health security emergency. These infections will be associated with a high consumption of healthcare resources manifested by a prolonged hospital stay and high mortality. The World Health Organization  has identified antimicrobial resistance as one of the most important problems for human health with significant adverse impacts on clinical outcomes and higher costs due to consumption of healthcare resources.

Antibiotic resistance is a serious problem in all parts of the world including Asia–Pacific, Latin America, Middle East, Europe and North America regions. A particular concern is the misuse or overuse of antibiotics, which has led to the development of resistant or super-resistant bacterial strains.

Reasons for widespread antibiotic resistance:

  1. High burden of infectious diseases
  2. Poor control of infectious diseases and lack of prevention.
  3. Easy availability of antibioics.
  4. Liberal prescription and crosspathy. Common and unrestricted use  by alternative medical system doctors, non doctors and quacks.
  5. Over the counter sale of antibiotics by pharmacists.
  6. Self administration of antibiotics by patients.
  7. Shorter courses and irregular intake of antibiotics by patients.
  8. Inappropriate doses of antibiotics, specially if given by non trained person.
  9. Pressure by patients for early recovery, resulting in over prescription.
  10. Presence of large number of generics of molecules and their quality not ensured.
  11. Poor environmental sanitation, widespread  water contamination, animal waste.
  12. Lack of proper regulation and control of quality of antibiotics
  13. Unregulated  use of antibiotics in animal industry, agriculture, and aquaculture.

 

It is not uncommon to see patients not responding well to treatment. Such scenario increase difficulty for doctors, besides they may be blamed for not doing enough. Reasons may be any of the  above.  Bacteria have been the occupants around us in environment  and also in our body, have acquired deadly weapons  quickly.  Discovery of antibiotics have not lasted even 100 years. Over enthusiasm and euphoria  created by  mass production and use of antibiotics may prove lethal for human race. Antibiotic resistance has potential to undo all the advancement and is a threat of return to pre- antibiotic era .

 

 

Misdiagnosis of health care, wrong and misdirected treatment of real problem


       Yesterday, there was a painful news in paper about the death of a child due to rabies.  It is really painful  loss of life due to a preventable disease. Every one sympathizes with child and parents. But equally strange was the suggestion  that action will be taken  against the  doctor.  Newspaper also  fails to raise a point that,  why at all a preventable disease should happen?  Similar trend we always see in media, when some death occurs due to diseases like dengue and malaria, it is a doctor, who treated the patient or trying to fight with the advanced complications is punished or made a scapegoat and projected as a villain in the story by media.

  No one including administration,  government, courts or media raises a point, that why at all the diseases which  are  completely preventable,  should happen and  keep on happening.  In my previous article, I mentioned the misplaced priorities of media about the same.  At least public, who is suffering should understand that dog bite and mosquito bite is preventable. Therefore more emphasis should be on preventing these bites. That should be made a priority. If  that bite is not prevented and no action is taken to prevent that, these diseases will keep on happening in  a large proportions.  Beds  and doctors are limited in number and will be unable to treat it, specially in advanced stage. So we need really good people to make a proper diagnosis  of our health care. Every time such cases happen and these are preventable disasters, doctors are sacrificed as scapegoats.  Some one sensible need to do a root cause analysis of preventable deaths.  Media people will  have to  find the correct remedy  and demand for it. Otherwise it is not going to help and treat sufferings of common people.

NMC bill, Medical crosspathy and antibiotic resistance : recipe for potential global catastrophe


   Genesis of a system, where every body will suffer and no one is beneficiary.  There has been lot of debates going on  about the Government willingness to allow crosspathy. There has been indications in newspapers about possibility of government  allowing Ayurvedic,  homeopathic and Unani medicine graduates and others  to practice modern allopathic medicines.  Most importantly which medications will be allowed to be practiced? Will  thousands of alternate medicine graduate will dispense all antibiotics,  anticancer , anti diabetic , cardiac medications. It is hard to think about hundreds of potentially dangerous medicines being given without structured training and  proper exams in this system of crosspathy. No one is bothered about the fact that every allopathic medicine is a potential hazardous chemical, if not used properly.

              It will be done through some bridge course. The structure and effectiveness of the said course is yet to be knowm. Whether it will be of 3 days or 3 months?  Who will be able to do it ? whether some level of efficiency  will be expected or every body will be allowed to just dispense allopathic medicine. What ever some one may argue, bridge courses can not be substitute to proper training for these complex diseases and drugs. Following may be side effects of dilution  of medical education and crosspathy:

  1. Alternative or ayurvedic medicine systems themselves: detrimental to these systems themselves because of many reasons. If  the  ayurvedic doctors   start allopathic practice, how we expect ayurvedic stream to florish and respected. It will be diluted to no end. After few years no one will be left will ayurvedic practice.  In my opinion it is a death sentence to ayurvedic system.

       Secondly,  the decision is not respectful to ayurvedic stream itself. Stream of                Ayurveda will suffer.

  1.  Public and patients: crosspathy clearly means a diluted and suboptimal medical services. Government may create few area of need and implement the scheme in selected areas, and selected simple drugs.
  2. Allopathy will be clearly a sufferer. If every body can practice allopathic medicine, why one should go for rigorous training. It will discourage the people who have opted and got admission to allopathic courses. They are paying and slogging hard for their training.
  3.  Dangerous to human race and potential global catastrophe:  All  allopathic medicines are hazardous chemicals in inexperienced hands. But  incorrect and massive use of antibiotics will  cause antibiotic resistance, which has global ramifications. From this angle, it is a retrograde step. When  all over the world,  need is being  felt that there has to be better control of antibiotic prescription.  We are entering an era, where antibiotics are getting useless and more so because of rampant misuse of antibiotics.  Rather than exercising a better control, it can be a catastrophic to human race world over by causing antibiotic resistance.
  4. have our public and people given consent for such diluted medical  excellence and services? It is  public  ultimately who  accepts  a decision for suboptimal medical service. Government may create few area of need and implement the scheme in selected areas, and selected simple drugs. But that also has not been planned.

 

25 factors -Medical treatment costs becoming expensive: are doctors responsible?


Although doctors are blamed for expensive medical treatment, but the real cause  is the aberrant evolution of medicine and medical education to almost an industrial model. There has been tremendous rise in health care  expenses in last few decades and it is usually borne by the government, taxpayer, insurance or patient himself. Discontent is all the more if patients  are unable to bear these expenses and if the results are not as per  expectations ( realistic or unrealistic).

Following features have led to increasing dependence on investors in medical field which then has to run along the lines of an industry to ensure its financial viability-

1.Newer technology and  rapid advances in newer innovations in medical fields  for improvement in diagnostic and newer treatment modalities. If a hospital or doctor does not upgrade, it will be regarded as  having obsolete technology.  Most of these medical technologies  are extremely expensive and owned and marketed  by big multinational companies who  sell them.

Since cost involved is very high, there can be various types of deals involved between  middlemen  involved in selling and buying these equipments and technologies. Doctors  are the  end users of these technologies, but  not part of business process. They are actually the consumers and users  for  these technologies.

2.Expensive real estate:  A self made doctor at the start  or even during his life time, does not have the kind of finances  to build  a hospital which needs a large parcel of land with commercial location. Therefore there  is a need for big investment or investor to pitch in and invest funds.  And if they invest, obviously they would look for some returns.

3.Equipping the Hospital: Building of hospital with the  infrastructure  and equipping it well needs lot of money and investment which only an investor can provide. Same is true for maintenance of equipment, bills,  insurances, AMC  etc.

4.Staffing of Hospital: A hospital needs lot of skilled human resources, health care being a highly labour intensive industry.  Doctors , nurses,  technicians, para medical, administrative and clerical staff is required.  Employment of non medical  in hospital industry too has been increasing because of various regulatory requirements and complex processes other than just treating patients.

5.High regulatory requirements:  globally the requirements of regulatory authorities have been sky rocketing and it requires  a lot of manpower to maintain such data. Getting accreditation etc are  processes which requires manpower, time, and a legal team. All these legal  requirements are expensive.

6.Consumer protection act:  This single important factor can increase the cost of  healthcare for the patient. As doctors are increasingly scared of being dragged to court, they are always on backfoot and are forced  to do defensive practice. Investigations are required for documentation. Patient and courts will ask for proof and goes by documentation.  Medical problems are very complex and  sometimes it is difficult to judge  the future course of disease or decisions for surgery, or how patient will behave before or after surgery. A doctor, thus, will always try to play safe legally  in present scenarios. Because everything he does will be scrutinized later, with retrospective wisdom,  by courts. And   since doctors manage  so many patients everyday, they never know which one will harass and deceive them  later.  Mistrust has increased to such an  extent that patient relatives do not understand even if things are told in good faith and in patient’s interest.  Summarily doctors have to safeguard themselves from treatment as well as legal and  documentation hassles.

7.Expensive legal services:  Every case that goes to court involves lawyers and their expensive fees. Most of the time even though the doctors may be right, he has to defend himself with the help of  lawyers.  Law industry has been  benefitted enormously because of consumer protection act at the cost of doctors. Increasing mistrust and unhappiness in patient’s mind definitely does not  help patients and doctors. Strangely  doctor’s fee are quite low but lawyers charges them astronomical amounts, which are beyond any logic.

8.Increased expectation of patients : People want exceptional care, best in the world with best technology,  that also at a price less than  even a meal in restaurant, and then they want a quick relief!!  This is an expectation almost impossible to fulfil. Even government hospitals, which are funded by taxayer’s money find it difficult to provide free treatment with quality.

9.Large claims given by courts:  in a country where people  fight with their parents, brothers and  sisters for money and property, it will be naive to think that idea of making money from doctor  does not exist. With court compensations going into crores, doctors  can sense many times that some patient relatives  try to use the opportunity. They have nothing at stake so they try to make some noise on social media and harass the doctor in court or on social platforms. Even for patients, who had poor prognosis at the very onset of treatment, relatives can create problems. Doctors have no protection from these nuisanse. All these factors further enhance insecurity in doctor’s mind.

  1. Expensive and time consuming Medical education, on sale: Although an open secret , as reported routinely in news, medical seats are big business. Each private medical college seat sells for huge money. Such doctors, who have purchased seats have already  behaved as investors. Once these  doctors are in practice, they will try to  recover the investment. This can obviously push up the health care costs not to mention vitiation of the medical fraternity.

11.Requirement for maintaining huge data and audits:  to maintain standards, to have accreditions, for medicolegal issues , large data storage, audits and surveillance is required. These systems also need  new systems and manpower.

12.Employment of large numbers of  non-medical personnel:  earlier management work was handled by doctors. All senior doctors were given small and differnet  departments of  administrative work at very little  or no extra cost. But now for all these works separate administrators  are appointed. Now a days ratio of doctors to nondoctors is higher as compared to previous years. Increased regulatory and  and insurance system needs more non- medical staff.

But  productivity of hospital still remains by  doctor-patient interaction.  This change in arrangement in Hospitals has caused  increase in costs and hence pushed the health care  expenses. Advantages and disadvangages of these changes  in arrangement will be known  with time in future.

13.Non regulation of  businesses  associated with large health care industry: for example pharma industry,  suppliers , biomedical, equipments, consumables. Such individuals,  although play important part in medicine, cost, sale and purchase, but are largely  unregulated. Unlike doctors, who are regulated by multiple governing bodies. But doctors are  often perceived  as culprits for these costs escalation.

 

14.Increasing extinction of Single doctor and  small setups: for them it will be difficult to keep pace with newer technology and buying expansive equipments. It will be difficult  for them to manage requirements of new medical system, legal problems . At the most they will continue to provide cheap medical services,  but for only common and simple ailments. It will be difficult to manage serious patients and sick and complex patients in view of high public expectations . These set ups are under severe security threat and pressure because of non – acceptance of even genuinine complications of treatment.  As legal requirements increase,  these systems will become unviable and option of common public for cheaper, friendly services may become extinct. So it will decrease  the  easy and  sometimes last option of  doctors to settle with a small set up. Chances of them to work for investors  and insurance companies will increase, and they will be cheap labour for industry.

15.Medical and health Insurance becoming indispensible:  Insurance companies are every where.  They sell policies to patients , as well as doctors.  In fact, they are  positioned between doctor and patients. They make money from both sides. Obviously more expensive the treatment, more dependence on insurance. Therefore a cycle has been set up.  Increase in  insurance cost  will push health care  more expensive and a vicious cycle is set up. One should not be surprised, if in future treatment to a large extent will be dictated by insurance companies.

 

16.Conversion to a industry:

Because of above reasons Medical and health care has become an industry and needs investors. So as it is business proposition. Funded by investors and run on commercial principles, the  doctors are being slowly reduced to  skilled labour, alienated from the core.

  1. Aging, multiple diseases : as life expectancy is increasing, it is leading to multiple diseases and more complex diseases  and new expensive treatments.  In this changed scenario and  all people  want to prolong life as much as possible. Cost of prolonging life with multiple problems is quite high. It consumes more medication and resouces and hence consequently pushes up the cost of medical treatment.

18.Evolution of complex infections:

    Advent of antibiotics   and germ theory was thought to be game changer in medical history. But because bacteria proved to be smarter than humans and acquired resistant. New and expensive antibiotics have been gradually being rendered useless. Need for more antibiotics is causing treatment to be costlier.

 

19.Evolution  of  advanced treatment:  Invention  of Expensive and new diagnostic techniques along with highly technical treatments by industry is not without added cost.  Although it may be useful in certain patients, but how much it will help overall in masses, for general treatment, as it increases the  cost of overall treatment.

20.Increasing  need for heightened security:  It is not uncommon to have mobs causing physical harms to medical workers  and  damaging hospital properties. These incidents have caused increased need for security for the premises and adding to the cost.

 21.Complex interplay of various industries eg pharma industry and consumable industry:  large  number of consumables pharmaceuticals, sutures,  surgical instruments, IT industry, drugs, implants, medical supplies are required.  These industries supply their items on a price commanded by them and there is complex interplay  of various industries.

  1. Non uniform and variable care and cost:  each city has multiple hospitals. Care and cost varies in  every set up. Even all government set ups are  not uniform in facilities and cost. Private setups  vary in cost and care, to the extent of  maximum possible variations. All this non-uniformity has created confusion in the mind of patients and variation in financial issues.
  2. Poor public health care facilities: due to less expenditure on health care, government health care facilities have been under developed.  Less  investment by government has given way to private health care to flourish.

24: Conversion to a industry model  and entry of Investor: all the above investments are very expensive. Doctors usually do not have that much money to invest. Therefore   Investors and financers  have become indispensible part of health.   once investor invests money, it will be driven on business principles.

 

  1. Future course: I do not see in future that this arrangement is going to change , rather it will be strengthened more and more and quality care will become more costly. Doctors will  be totally  alienated  from financial  and business aspect, because industry will  not be sustainable without an investor.

 

As we look at reasons above, Doctors are no where in the financial picture and  to be blamed for increase in overall health cost.  But since only doctors are visible part of industry, who treat and interact with patients, often they are blamed for  the cost. They have actually being alienated from financial aspect, barring small percentage of doctors, who are financially literate. Consequently, the doctors who will be unable to entrench themselves in the business milieu will be unfit  in future and hence extinct.

Save the doctor to save yourself: An era when genesis of diseases is not punished, but treatment is.


            “Young girl killed by doctors at Fortis Gurugram” and “alive baby declared dead by doctors at Max Hospital Delhi”. These two news items  have recently jolted everyone in medical fraternity. Doctors have  yet  to come to terms with harsh reality  in order to   realize about the  harm   that can happen to themselves, when they just  say yes to treat the complex cases. A worst form of dengue already complicated, or a premature delivery at 22 weeks. I am sure doctors will know, how many patients and pregnancies have survived at this stage in the world, in both of these conditions.

     We have all kind of preventable diseases happening around us. Thousands of people suffering and many loose life, just because of worthless causes. Even healthy people are killed because of preventable calamities like open pot holes, floods, heat or preventable fires, accidents and so on. But strangely when disease happens and gets complicated in one patient, death due to these complications in the hospital is taken very severely. Although it may  have been  just untreatable at some point, but whole burden of death and punishments are  passed  over to doctors very conveniently.

   In both these complex cases, there are no clear cut guidelines by government. In whatever way doctor will act, he can be blamed easily on some pretext or another. By such yardsticks,  all complicated cases and subsequent  deaths happening in hospital settings can be termed as ‘ negligence’ by a fault finding retrospective approach. Now doctors have become scared  to treat complex cases.  

   It is sad to see that our leaders, media and all stakeholders have no knowledge of complex medical issues. I do not see any solution to these kind of exploitation and extortion of medics in near future.  But   are all complicated cases and deaths in hospital are Negligence?  This is going to be tough time for doctors but subsequently for patients.  These are worst days for doctors, where genesis of disease is overlooked and unnatural death of hundreds is not taken care of. But doctor who is working with intentions to treat the complex situation is being punished.  But society should be able to count its losses after few years, if such trend continues.  Good doctors will easily quit or shift to safe positions. Society has to save doctors, if it wants to save it’s people.

     

Max Hospital Delhi handed over dead baby : Is “ Lazarus syndrome” a possibility?


 

        There are lot of discussion going on about live  baby handed over to parents by Max Hospital  Delhi, as dead.  Every one including  media has as usual  jumped on to the favorite  topic of  doctor bashing.  Facts are still under investigation. But as a doctor, I can not reach conclusions without scientific discussion, least possible by media  talking superfluously. There can be number of possibilities, which we will  know with time after proper investigation. But whatever the result, doctors bashing had already been done by media , with or without knowing facts.

Life and death are still far beyond the reach of science and obviously  of doctors as well. There are still a lot more unknown than known story about human life. I just wish to draw the attention of my readers about an entity, which is quite mysterious.  Condition is  called     “ Lazarus syndrome”. Also known as auto resuscitation after failed cardiopulmonary resuscitation, is the spontaneous return of circulation after failed attempts at resuscitation.

A little bit about  this rare phenomenon.      

 

Lazarus syndrome, also known as auto resuscitation after failed cardiopulmonary resuscitation, is the spontaneous return of circulation after failed attempts at resuscitation. Its occurrence has been noted in medical literature at least 38 times since 1982. It takes its name from Lazarus who, as described in the New Testament of The Bible, was raised from the dead by Jesus.

Occurrences of the syndrome are extremely rare and the causes are not well understood. One hypothesis for the phenomenon is that a chief factor (though not the only one) is the buildup of pressure in the chest as a result of cardiopulmonary resuscitation (CPR). The relaxation of pressure after resuscitation efforts have ended is thought to allow the heart to expand, triggering the heart’s electrical impulses and restarting the heartbeat. Other possible factors are hyperkalemia or high doses of epinephrine.

Cases

-A 27-year-old man in the UK collapsed after overdosing on heroin and cocaine. Paramedics gave him an injection, and he recovered enough to walk to the ambulance. He went into cardiac arrest in transit. After 25 minutes of resuscitation efforts, the patient was verbally declared dead. About a minute after resuscitation ended, a nurse noticed a rhythm on the heart monitor and resuscitation was resumed. The patient recovered fully.

-A 66-year-old man suffering from a suspected abdominal aneurysm who, during treatment for this condition, suffered cardiac arrest and received chest compressions and defibrillation shocks for 17 minutes. Vital signs did not return; the patient was declared dead and resuscitation efforts ended. Ten minutes later, the surgeon felt a pulse. The aneurysm was successfully treated and the patient fully recovered with no lasting physical or neurological problems.

-According to a 2002 article in the journal Forensic Science International, a 65-year-old  deaf Japanese male was found unconscious in the foster home he lived in. Cardiopulmonary resuscitation was attempted on the scene by home staff, emergency medical personnel and also in the emergency department of the hospital and included appropriate medications and defibrillation. He was declared dead after attempted resuscitation. However, a policeman found the person moving in the mortuary after 20 minutes. The patient survived for 4 more days.

-Judith Johnson, 61, went into cardiac arrest at Beebe Medical Center in Lewes, Delaware, United States, in May 2007. She was given “multiple medicines and synchronized shocks”, but never regained a pulse. She was declared dead at 8:34 p.m. but was discovered in the morgue to be alive and breathing. She sued the medical center where it happened for damages due to physical and neurological problems stemming from the event.

-A 45-year-old woman in Colombia was pronounced dead, as there were no vital signs showing she was alive. Later, a funeral worker noticed the woman moving and alerted his co-worker that the woman should go back to the hospital. A 65-year-old man in Malaysia came back to life two-and-a-half hours after doctors at Seberang Jaya Hospital, Penang, pronounced him dead. He died three weeks later.

-Anthony Yahle, 37, in Bellbrook, Ohio, USA, was breathing abnormally at 4 a.m. on 5 August 2013, and could not be woken. He was given CPR, and first responders shocked him several times and found a heartbeat. That afternoon, he coded for 45 minutes at Kettering Medical Center and was pronounced dead. When his son arrived at the hospital, he noticed a heartbeat on the monitor that was still attached. Resuscitation efforts resumed, and the patient was revived.

-Walter Williams, 78, from Lexington, Mississippi, United States, was at home when his hospice nurse called a coroner who arrived and declared him dead at 9 p.m. on 26 February 2014. Once at a funeral home, he was found to be moving, possibly resuscitated by a defibrillator implanted in his chest. The next day he was well enough to be talking with family, but died fifteen days later.

Implications  The Lazarus phenomenon raises ethical issues for physicians, who must determine when medical death has occurred, resuscitation efforts should end, and postmortem procedures such as autopsies and organ harvesting may take place.

Medical literature has recommended observation of a patient’s vital signs for five to ten minutes after cessation of resuscitation before certifying death.

In Popular Culture

In the TV show Grey’s Anatomy, a patient had a heart attack and after 42 minutes of resuscitation efforts they declared her dead. And 20 minutes after death has been declared, the patient vital signs returned and regained consciousness.

Source

Lazarus syndrome. (2017, September 2). In Wikipedia, The Free Encyclopedia. Retrieved 16:51, December 4, 2017, from https://en.wikipedia.org/w/index.php?title=Lazarus_syndrome&oldid=798456668

https://en.wikipedia.org/w/index.php?title=Lazarus_syndrome&oldid=798456668

Human Animal Interface of Swachh Bharat, infections and antibiotic resistance


   Patients are always curious and ask “doctor, why have I got infection? From where? I eat good, maintain good health?” there are no ready answers. But there are certain factors in environment, which cause infections. More infections will require more antibiotics to be used and hence make bacteria resistant and difficult to treat. In fact, this one factor can undo all the advancement of medical science and push us back by centuries to pre-antibiotic era. Not uncommonly, response to antibiotics is not good and doctors are blamed for not doing enough. It is hard for the patient to know and understand the complexity of situation.

Antibiotic resistance is the ability of a microorganism to withstand the effects of an antibiotic. Antibiotic resistance evolves naturally or could also be engineered by applying an evolutionary stress on a population. If stress (Antibiotic) is applied on bacteria, a mutation or gene is generated. In other words, evolve into highly resistance bugs because of use of antibiotics. If a bacterium carries several resistance genes, it is called multi resistant or a superbug. Antibiotic resistance is a consequence of evolution of bacteria.

The antibiotic action is an environmental pressure; those bacteria which have a mutation allowing them to survive will live on to reproduce. When these bacteria are cause of infection and severe illness, even the best medical care does not prevent death in every case.

Antimicrobial resistance is a major public health problem globally while all types of AMR are concerning, antibacterial resistance (ABR) is seen as currently posing the most serious health threat. India has some of the highest antibiotic resistance rates among bacteria that commonly cause infections in the community and healthcare facilities, shows the latest Department of Biotechnology (DBT) report. Antibiotic resistance among bacteria high in India, reveals report.

The Scoping Report on Antimicrobial Resistance in India, as it is called, was prepared for DBT and Research Councils United Kingdom (RCUK) by the Center for Disease Dynamics, Economics & Policy, India (CDDEP).The Antimicrobial resistance is spreading is popping up in India, from the fecal matter of animals to groundwater for drinking. This is a concern as microorganisms can spread from animals to people and from the environment to humans.  This contamination is one of the important cause of increased infections and hence use of more antibiotics in community.

Swachh Bharat  if truly applied can actually contribute and  solve problem of antibiotic overuse and hence resistance to antibiotic  to some extent. Garbage and undisposed poop of human and animals cause generation of infections and diseases, hence leading to increased need for antibiotics.  That requires heavy use of antibiotics and consequently leads to emergence of further antibiotic resistance bacteria. This cycle of production of infections and use of antibiotics perpetuates a vicious cycle.  Although as I mentioned    disposal of animal waste remains a challenge for Swachh Bharat as current policies  do not address this issue, which contaminates  air and water sources.

Stray animals still defecate at every place.  Poop of Stray dogs, cattle and pigs stays in environment and causes life threatening infections. Pet owners also do not show responsible behavior towards community in the absence of proper rules. Hundreds of diseases are described due to poor control of human animal interface.  My appeal to higher authorities is to form policies and create awareness in this regards can do wonders for community acquired infections and hence tackle with menace of antibiotic resistance as well. True application of Swachh Bharat  in controlling human animal interface can improve health of millions in the country.

Sign the petition

Swatch Bharat obstacle: declare “open defecation free zone” only if free of infectious, toxic dog & animal poop.

https://www.change.org/p/prime-minister-of-india-swachh-bharat-declare-open-defecation-free-zone-only-if-free-of-infectious-dog-animal-poop?recruiter=821371489&utm_source=share_petition&utm_medium=copylink&utm_campaign=share_petition

 

 

Swachh Bharat obstacle: declare “open defecation free zone” only if free of infectious, toxic dog & animal poop


I truly admire and applaud Mr Narender Modi, Hon’able Prime Minister for drawing attention of 100 billion people to the issue of cleanliness outside their homes. No one had ever thought that a Prime minister would refer to this so called trivial issue and make a heartfelt appeal to people. Lot of public interest has now been generated and there is a race among public officials to get their area declared as free from open defaecation. Even celebrities and movie actors like Amitabh Bachchan, Akshay Kumar have backed this cause. All these efforts are really appreciable, but the prime credit still goes to Modiji who spearheaded this movement.

But there is still a serious issue, which is a stumbling block to the realisation of a ‘Swatch Bharat’ dream and remains unattended. I want to draw attention of everyone  towards the problem of animal poo in our country. It is all around us. It is an obstacle to fulfilment of Swachh Bharat Abhiyaan and  a pan-Indian problem. It is actually even a bigger health problem than open defecation by humans. Humans defecate in country side and in open fields. But stray animals and dogs are everywhere. Owner of pet dogs make them defecate outside their own houses and on the roads and wherever their dogs chooses. This poop dried and mixed with dust, acts a source of infection to the community.

       Life threatening infections : As a doctor, I would like to bring to your notice that dog’s and animal faeces is a big health hazard. It is even worse than a dog bite since it spreads infection in entire community. A dog’s digestive system can handle just about anything that it eats and this makes its poop very toxic. Animal faeces contain pathogens, which are known to cause severe diseases, infections and organ failure. These heavy loads of bacteria increase the risk of infections in the community. But pregnant women, children and people with suppressed immune systems may are more prone to these infectionsMany diseases may be spread by millions of these dogs and other animals like pigs, cattle as their faeces contain parasites, bacteria and viruses. These include life threatening bacterial infections by E. coli, MRSA, Leptospira, Salmonellosis, Campylobacteriosis, brucellosis, Rickettsia and parasitic infections like  Giardiasis, Whipworm, Hookworm, Roundworms, Tapeworms,    Cryptosporidiosis, Echinococcosis, Leishmaniasis etc. Viral infections like rabies, influenza and other viruses may also spread through these animals.

Environmental health Hazard: Storm water runoff due to extensive rainfall can wash off all these droppings into drains, many of which are connected to river systems and water sources in our country. This can lead to a widespread source of waterborne illnesses. Dry  poop on the roads is mixed with dust particles and in the air. So everyone is living in a highly infectious environment.  This may be an important cause of high rates of community acquired infections among our population.

             Transform health of the country: Hence it should be mandatory that all the  dog and animal (stray or pet) droppings are properly collected and disposed off. This single step can do wonders as it will reduce infections, people’s suffering and eventually reduce use of antibiotics. It can help reduce mortality, morbidity, drug resistance and medical costs by preventing many infections. It is my request to highest authorities to create awareness, form policies about disposal and control of animal waste and implement them strictly  to  bring a turnaround in infection rates in our country.

      It is missing key component  TOWARDS A SWACHH BHARAT. My request is to create awareness and form proper policies by higher authorities to cure millions and reduce infections in whole country.

 

If you agree please sign the petition

 

https://www.change.org/p/prime-minister-of-india-swatch-bharat-declare-open-defecation-free-zone-only-if-free-of-infectious-dog-animal-poop?recruiter=821371489&utm_source=share_petition&utm_medium=copylink&utm_campaign=share_petition

 

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