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Administrative and infrastructure deficiencies in health care: fail and blame for doctors


Adverse outcome in patients  can be  because of  many factors. Most of the time it is  serious illness, natural poor prognosis of disease, genuine complications or infections. Sometimes, It can be deficiency of equipment, malfunction, lack of infrastructure or facilities. There can be poor training or lack of  proper human resource and many others. There may be unintentional or human errors  by doctors or staff.  Root cause for most of the problems  can be traced to  administrative and system deficiencies rather than mistake of doctor. But since doctor is universal final link, when a patient dies, who  is visible on the bedside. So by application of an average wisdom, it is the doctor who will be held responsible for any problem or adverse outcome. Administration and people who are responsible for building infrastructure, procurement of  equipment and allocating finances or manpower  are not visible in forefront. It is very common for the doctors  to find themselves in a helpless situation, specially  in presence of  deluge of patients, difficult circumstances, scarce resources  and other  administrative issues.  In cases of adverse outcomes,  administration can   pretend to hide behind the common escape route by punishing doctors and hold them  guilty for the adverse events, as no other cause or person   is visible. By retrospective analysis  and  wisdom of hindsight along with luxury of time , it is a cake walk to give  verdict of one’s choice later, by fault finding analysis.

Non availability of ventilators or  malfunctioning  is not an issue, for which doctors are responsible. Procurement and allocation of funds is an  administrator’s domain.  But it is common that  doctors can be accused for not saving a life. They can be punished, dragged to court and even assaulted physically by crowds.  Dismal percentage of availability  of ventilators in Delhi Hospitals is a tip of the iceberg. This can be even  worse in other parts of the country. Ironically crowds visiting the hospitals only see and blame  the doctor, who is present on bedside and trying to save the patient. Patients hold them responsible for  malaise of the system  and fail to see the presence of  large  administration and industry,   that is behind  the scene. An unfortunate era,  when  the  doctors are blamed on  individual basis for system failure. In present circumstances, Lack of medical wisdom among masses is a cause of  huge discouragement for doctors.

With  High court being proactive in asking about the number of ventilators, the administration can not pretend to hide behind any more, but masses need to know the real truth.

Only 3.4% beds on Delhi Govt Hospitals have ventilator facility against the minimum requirement of 10% in every state run medical center. For  over 10,000 beds,  only 348 ventilators are there. That is an extremely low number.

52 of 400 ventilators in Delhi hospitals non-functional, state tells HC.

After 3-year-old Farhan died in the national Capital for an alleged want of proper ventilator care earlier this month, the state government of Delhi has told the High Court that a substantial number of ventilators in its government hospitals are not working. The state also told the HC on Tuesday that they were aiming to have a web portal up and running within two months, which would provide an online daily update on ventilator and bed availability across Delhi’s government hospitals.

After directions were issued by the HC, the state asked all its hospitals to provide a status update on ventilators and according to the information received from the government hospitals, up to 52 ventilators (13 per cent) of the total of 400 ventilator beds (including 300 ICU and 100 non-ICU) available in the hospitals are non-functional. “Fifty-two ventilators are non-functional and efforts are being made to get them repaired. The procurement of 18 ventilators is under process,” said the reply filed by the state government in the High Court on February 12.

The state government also stated in its reply that as far as maintaining real-time information on the availability of vacant beds in Delhi government hospitals goes, it may not be feasible to implement real-time availability information in the initial phase and the Delhi State Health Mission should be advised to start uploading information on bed availability in all the hospitals once a day in the morning.

The state government also said the State Programme Officer (MIS) of the Delhi State Health Mission has been requested, in

a letter dated January 31, to prepare a web portal for online bed/ ventilator availability and that such a Web portal should be made functional within two months.

The state government through an email sent on February 7 has also requested all the hospitals to complete repair, condemnation and procurement of ventilators at the earliest, according to Nutan Mundeja, Director General of Health Services.

After the matter of alleged unavailability of healthcare to Farhan came to light, the High Court moved a motion against the Union of India and sought a reply.

The number of ventilators as compared to bed strength in government hospitals is meager. “In private hospitals, there is one ventilator bed for every four normal beds. In government set-ups though, even as we have over 10,000 beds, we have only 348 ventilators. That is an extremely low number. Also, these ventilators may not be evenly distributed across the city,” pointed out  stated U Jhamb, Director, Professor and Head, Department of Paediatrics at the hospital.

 

Leopard tortoise designed pill to administer insulin in diabetes


The discovery  has a potential to  transform  lives of millions of patients with diabetics.  It can  counter the availability and cost of insulin in future.  If successful , the new technology can even change the  delivery of other  drugs as well.

Scientists have developed a “needle pill” that could allow diabetics to take insulin without the need for daily injections.

The pea-sized capsule contains a small needle made of solid, compressed insulin, which is injected into the stomach wall after the capsule has been swallowed.

When tested in pigs, the device worked consistently and was able to deliver equivalent doses of insulin to those required by someone with diabetes.

Giovanni Traverso, an assistant professor at Harvard Medical School affiliated Brigham and Women’s hospital and a co-author of the study, said: “Our motivation is to make it easier for patients to take medication, particularly medications that require an injection. The classic one is insulin, but there are many others.”

Injections can be painful, cause injuries and be a barrier to people taking medication, he added.

The shape of the capsule is inspired by the leopard tortoise, found in Africa, which has a steep, domed shell that allows it to right itself if it rolls onto its back. In the case of the capsule, the domed shape ensures that the needle is continually reoriented towards the stomach wall. The needle is attached to a compressed spring that is restrained by a disk made from sugar. When the capsule is swallowed, water in the stomach dissolves the disk, releasing the spring and injecting the needle into the stomach wall.

The stomach wall does not have pain receptors, so it is unlikely that this would cause any discomfort. The insulin needle takes about an hour to dissolve into the bloodstream. In tests in pigs, the researchers said they were able to deliver five milligrams of insulin – comparable to the amount that a patient with type 2 diabetes would need to inject.

The metal spring and rest of the capsule passed through the digestive system, without seeming to cause any problems.

The team are now carrying out further tests in pigs and dogs and hope to start the first human trials within three years.

Modern medicine still primitive compared to “Superbugs”


Antibiotic resistant superbug gene discovered in remote Arctic area thought to be among ‘last pristine ecosystems’ on Earth, shocking study reveals

  • Antibiotic resistant gene first found in Delhi waters in 2010 now found in Arctic
  • Researchers say it likely spread through human activity and bird, animal waste
  • In recent years, antibiotic resistance has grown to be a global health crisis  

 

More the medical science has evolved,   more we realize the  primitiveness  in front of  natural phenomenon, the environmental systems and  life around us. The evolution and adaptation of microbes, which we have discovered  for just last hundred years, are in existence for millions of years, much before humans. Discoveries like this, just  make us realize about our primitiveness in front of a superpower, which is best known as “Nature”.  Scientists have found a gene linked to antibiotic-resistant superbugs in an area said to be one of the last ‘pristine’ locations on Earth.

These antibiotic-resistant genes (ARGs) were first detected outside of the lab in 2010 in surface waters in Delhi, India.

But now, experts say the genes have traveled roughly 8,000 miles through human activity and the fecal matter of birds and other wildlife to reach a remote area in the Norweigian archipelago, Svalbard.

The discovery doesn’t bode well for the fight against antibiotic resistance, which has grown to be a global health crisis in recent years.

In a new study published to the journal Environmental International, researchers form Newcastle University report the discovery of the gene blaNDM-1 and other antibiotic-resistant genes in Kongsfjorden, Svalbard.” 

This gene is carried in the gut of animals and people.

‘Polar regions are among the last presumed pristine ecosystems on Earth, providing a platform for characterizing pre-antibiotic era background resistance against which we could understand rates of progression of AR “pollution,”’ said David Graham, an environmental engineer at Newcastle University.

‘But less than three years after the first detection of the blaNDM-1 gene in the surface waters of urban India we are finding them thousands of miles away in an area where there has been minimal human impact.

‘Encroachment into areas like the Arctic reinforces how rapid and far-reaching the spread of antibiotic resistance has become, confirming solutions to AR must be viewed in global rather than just local terms.’

Strains carrying blaNDM-1 were first identified in the lab in 2008 before they were found in Indian waters just two years later.

In the few years since, it’s been detected in over 100 more countries.

‘What humans have done through excess use of antibiotics on global scales is accelerate the rate of evolution, creating a new world of resistant strains that never existed before,’ Graham said.

Through the overuse of antibiotics, fecal releases, and contamination of drinking water, we have consequentially speeded-up the rate at which superbugs might evolve.

‘For example, when a new drug is developed, natural bacteria can rapidly adapt and can become resistant; therefore very few new drugs are in the pipeline because it simply isn’t cost-effective to make them.’

For the new study, the researchers analyzed DNA from forty soil cores taken from eight locations across Kongsfjorden.

And, they found a total of 131 ARGs in the samples

The resistance genes detected were associated with nine major antibiotic classes, including aminoglycosides, macrolides and β-lactams, which are used to treat many infections,’ Graham said.

‘As an example, a gene that confers MDR in Tuberculosis was found in all cores, whereas blaNDM-1 was detected in more than 60% of the soil cores in the study.

‘Identifying an ARG ‘gradient’ across the study landscape, which varies as a function of human and wildlife impact, shows there are still isolated Polar locations where ARG levels are so low they might provide nature’s baseline of antimicrobial resistance.’

According to the team, improvements in waste management and water quality around the world will be keep in staying on top of the spread of ARGs.

The gradient of resistance genes closely reflects corresponding indicators of wastes in the geochemistry, which suggests a novel basis for identifying sites for further AMR research,’ said lead author Dr Clare McCann.

 

Pharma industry sale growth rate doubles: reason to rejoice or matter of concern?


While for pharma  industry, news is  a matter  to rejoice, but for common man and doctors, there may be something  to worry or concern. The  advancements in medical science & knowledge should lead to  prevention of diseases ,  the use of medicines need to decline. With more mechanisms for diseases are discovered,  should lead to lesser occurrence of  diseases (preventive). There can be good reasons for pharmaceutical growth like more people using the medical systems and thereby  consumption of medicine has increased, that can be a simple argument to support the growth. There can be scientific and pharmaceutical  advancements, leading to healthy growth.

But there can be complex and thought provoking counter arguments, like more number of  people suffering from  diseases. There can be system failures  and inability  to prevent diseases resulting in  more people falling sick and forced to take more medicines. If  diseases like cardiac  , respiratory and cancer are on the rise ,  a common man should be worried about life style, stress  and our environment. What if infections are on the rise leading to more consumption of antibiotics?  There can be chances that antibiotics are overused and misused. There can be other uncomfortable thoughts in few minds, which worry all the patients and many among medical fraternity. These are like overuse of medicines by  doctors or even unauthorized physicians.  There  can be possibility of people indulging in   crosspathy or aggressive marketing by pharma companies.

The domestic pharma retail market registered a robust growth rate of around 10% in 2018, nearly doubling year-on-year, buoyed by higher volumes and launch of new drugs. In 2017, the market was impacted by the introduction of GST, resulting in a meagre growth rate of 5.5% – the lowest in recent years. Anti-diabetics, cardio-vascular, respiratory and derma medicines ended the year with strong double-digit growth, while overall drivers of the Rs 1.29-lakh-crore market include higher volumes (4.8%), price increase (2.2%) and new launches (2.4%), data from market research firm AIOCD-Awacs said. For December alone, the market showed 9.8% growth, higher than in November.  In fact, growth has been consistently above 9% over the last four quarters.Expansion was driven by top domestic companies mainly by  Anti-diabetic therapy, Ayurvedic hepatic protector Liv 52,  Anti-infectives ,  cardiac, gastro-intestinal.

Be it any reason for pharmaceutical growth, people need to know about reasons for rocket trajectory growth of pharma companies . It indirectly  depicts the health of the people and unfortunately inversely proportional to it. So there may be  more matter to worry than rejoice.

 

Thousands Healthy deaths vs one hospital death. Perception of moral burden of negligence (# SUPREME COURT on pothole deaths)


There is a  infernal  difference in  the kind of  media  projection, burden of negligence and accountability of preventable multiple healthy deaths by civic negligence   as compared to one hospital death occurring due to severe  disease. In fact the burden of   negligence here in healthy deaths is massive and  these deaths are unpardonable. But reality is opposite.  Strangely  “alleged and perceived negligence” ( with no proof and no investigation )  in death of someone already having disease  and death in hospital  during treatment attracts more scrutiny and   stringent  punishment   as compared to a naked “negligence  in deaths of healthy people” in such cases  of civic negligence.  

Massive civic negligence  leading to  entirely preventable loss of lives. These incidents bring fore the misplaced priorities of media and society which too have  contributed to  some extent to these unabated ongoing preventable   deaths  of  thousands of  healthy people.

 

Deaths due to potholes ‘unacceptable’,  Supreme court

The bench,  said the number of deaths from 2013 to 2017 in accidents due to potholes indicated that the authorities concerned were not maintaining the roads. The Supreme Court Thursday expressed concern over 14,926 people being killed in road accidents due to potholes in last five years and termed it “unacceptable”. A bench said the large number of deaths caused due to potholes across the country was “probably more than those killed on border or by the terrorists”. Terming the situation as frightening, the top court had asked the Supreme Court Committee on Road Safety to look into the matter. The bench had also said that people who have lost their lives as a result of accidents due to potholes should be entitled to compensation. 

 

Multiple  Deaths  in healthy people by civic negligence :

Large numbers of death and morbidity happen amongst absolutely healthy population due to preventable causes like open manholes, drains, live electric wires, water contamination, dengue, malaria, recurring floods  etc. These deaths  of people are in thousands, and are almost entirely of healthy people, who otherwise were not at risk of death. In fact the burden of   negligence here is massive and  these deaths are unpardonable

 

       Single  Death in Hospital due to disease:

The media has always, instead, focused on the stray  and occasional incidents of perceived alleged negligence  in hospital deaths which could have occurred due to critical medical condition of patient. However an impression is created as if the doctors have killed a healthy person. It is assumed without any investigation that it was doctor’s fault.  Media has been responsible for creating a misunderstanding about the whole process of treatment and creating  something sensational out of nothing.

 

Point to ponder-Misplaced priorities:

Who is to be  blamed for  the deaths of healthy people which occur because of civic negligence? Here relatives may be helpless and  the vital questions  may go unanswered or taken as a routine.  There are no punching bags like doctor  for revenge. But on the contrary, any stray incident of death of an already ill patient is blown out of proportion by media forgetting the fact that thousands of patients are saved everyday by  doctors. But media instead chose to defame medical profession by igniting the emotions of people by sensationalizing death of diseased and ill,  who probably were already at risk of death and did not give due importance to highlighting prevention of healthy  and absolutely 100% preventable deaths.

Right issues raised at right time will save thousands of healthy preventable deaths. Multiple  healthy deaths should carry more burden of negligence than  one death due to disease.

      

Global corrupt medical (#implant) market & unholy nexus: tip of iceberg revealed


With aberrant  evolution of modern medicine and advancement  of  medical procedures, everything appears to be   controlled by medical industry. The  investors have gained  control of  the financial  game.  How large companies  create a web of  corrupt practices, and earn   huge profits, is a common prevalent sentiment.  Tip of the Iceberg has been revealed indicating inducements to  some doctors and dubious deals with hospitals. If these are the hallmarks of the big unregulated medical bazaar in India and some others, a rare case involving a global major has put a figure to it.

In a filing two months ago, the top financial regulator in the USA, the Securities and Exchange Commission (SEC), ordered the world’s leading manufacturer of orthopaedic implant devices, Stryker, to pay $7.8 million (over Rs 55 crore) in settlement for violating its corruption norms in India, China and Kuwait, documents accessed by The Indian Express reveal.

The settlement, recorded by the SEC on September 28, came after the Commission’s “accounting and audit enforcement” proceedings noted a number of “violations” by the company’s Indian subsidiary and its dealers. These “violations” include questionable payments to doctors for “consulting fees, travel, and other benefits” and “inflated invoices” issued to “mostly large, corporate hospitals”.

And that’s not all. In 2012, the anti-monopoly regulator, Competition Commission of India (CCI), fined an authorised distributor of Stryker India and two other firms Rs 3 crore for allegedly rigging bids, manipulating tenders and forming a cartel to sell equipment to the All India Institute of Medical Sciences (AIIMS) and Safdarjung Hospital, two of the largest government hospitals. In its scrutiny of Stryker’s India operations, including the findings of internal audits between 2010 and 2015, the US SEC concluded: “Payments intended to benefit HCPs (Health Care Providers) also lacked sufficient documentation, such as consulting fees paid to doctors without adequate explanation of the doctors’ consulting services or hours billed, and payments for HCP travel with documentation that appeared falsified…

“Additionally, the forensic review found missing or inaccurate documentation for numerous other transactions flagged as high-risk, including expenses related to consulting fees, travel, and other benefits to health-care professionals in India.”

The US regulator’s severe indictment of Stryker’s India operations is one of the most startling findings to emerge from the Implant Files investigation by The Indian Express and the International Consortium of Investigative Journalists (ICIJ) on the medical bazaar, where pharma majors hard sell their products without any regulation via a dubious nexus with hospitals and doctors.

Stryker India has four offices in the country — Delhi NCR, Mumbai, Chennai and Kolkata — and an annual turnover of Rs 300 crore in FY 2017-18, mainly from selling hip and knee implants, and medical devices for spine and neuro surgeries. The US-based parent company has a market cap of $58.87 billion with operations spread across 100 countries covering Asia, Europe, Africa and Latin America.

Dubious deals with hospitals:

Private hospitals that “requested inflated invoices from dealers  profited from their purchase of Stryker orthopaedic products by passing on the higher (invoiced) prices to their patients or their patients’ insurers, even as the hospitals paid the lower prices previously negotiated with Stryker India to Stryker India’s dealers”, the US SEC found.

In doing so, the SEC said, the dealers “allowed these private hospitals to gain a windfall from passing on the higher (invoiced) prices to their patients or their insurance companies”.

Linking Stryker to these deals, the regulator said: “Stryker India authorized these dealer transactions only after Stryker India’s management negotiated and approved the price that the hospitals would pay to the dealers. Thus, in determining the price charged to dealers, Stryker India’s management and the dealers specifically  negotiated the profit margin such dealers would stand to earn based on the difference between what hospitals paid the dealers and what the dealers paid Stryker India.”

SEC records do not identify the dealers involved. But documents maintained by CCI show that it had fined PES Installations, an authorised distributor, and two other firms, MDD Medical System and Medical Product Services (MPS), Rs 3 crore in April 2012 for a number of alleged irregularities in sale of equipment to AIIMS and Safdarjung Hospital, both in Delhi.

Responding to a questionnaire from The Indian Express on the SEC findings, Stryker said in a statement: “We are committed to working with our customers to make healthcare better while operating ethically and in compliance with all applicable laws and regulations.”

The US SEC, meanwhile, found a number of similar violations in Stryker’s operations in China and Kuwait, too. According to the SEC, it took into consideration “Stryker’s cooperation and remedial acts undertaken” while deciding to accept the company’s settlement offer to be paid “within 14 days”.

Unlike in India, the US has robust anti-corruption checks in place with the Foreign Corrupt Practices Act (FCPA), enacted in 1977, prohibiting the payment of bribes to foreign officials to assist in obtaining or retaining business, and mandating companies “to maintain accurate books and records”. In Stryker’s case, the SEC decided on a settlement after issuing a “cease-and-desist” offer to the company.

WHAT THE US REGULATOR FOUND

Inadequate oversight of dealers

* In 2012, in response to allegations of misconduct concerning Stryker India’s dealers, Stryker exercised its audit rights over three dealers in India. Those audits revealed insufficiencies in the financial record-keeping and internal accounting controls of all three dealers. Additionally, Stryker identified suspicious expenses by one dealer and instances of another dealer over-billing a hospital upon the hospital’s request. While Stryker took some corrective actions in response to these audits, including terminating one of the three dealers, the actions were limited to the three dealers audited.

* (The)deficiencies violated Stryker India’s agreements with its dealers. Specifically, the deficiencies in dealers’ financial record-keeping violated dealers’ obligation to “maintain complete and accurate records relating to [their] promotion, marketing, use and distribution of [Stryker] Products,” and the over-billing violated Stryker’s business conduct policy prohibiting participation in any improper payments. Despite the red flags raised during the 2012 audits, and numerous complaints reported to Stryker of dealer misconduct, Stryker did not act to determine the scope of dealer-inflated invoices until 2015.

* In 2015, Stryker performed audits of other dealers in India. The audits revealed that the practice of Stryker India’s dealers inflating invoices for the sale of Stryker orthopaedic products to certain private hospitals — an improper practice identified three years earlier in connection with the 2012 audits — had become more widespread.

Lack of accurate books, records

* From 2010 through 2015, Stryker India failed to make and keep complete and accurate books and records that reflected its transactions and disposition of assets. In particular, Stryker India recorded potentially problematic payments to its dealers and to HCPs, some of which lacked any supporting documentation reflecting a clear  business purpose.

* A forensic review of Stryker India’s general ledger for the period 2010 through 2015 found a complete lack of documentation for 144 out of 533 transactions selected as a sample of Stryker India’s highest-risk and most compliance-sensitive accounts.

* During the period of 2010 through 2015, Stryker was unable to provide any documentation for 27% of sampled high-risk transactions on Stryker India’s general ledger.

The SEC ordered Stryker to appoint an independent consultant, review and evaluate the company’s internal controls, record-keeping and anti-corruption policies, and procedures relating to use of dealers, agents, distributors, sub- distributors, and other such third parties that sell on behalf of the company. The SEC noted in its official filing: “Stryker fortified its existing compliance program, which is designed to prevent, detect, and remediate potential misconduct. This program develops, maintains, and implements corporate policies and standard operating procedures setting forth specific due diligence and documentation requirements for relationships with foreign officials, health care professionals, consultants, and distributors.”

The company has also retained an independent consultant to “formulate a work plan: that will be evaluated by the agency and Stryker to address the SEC’s findings”.

WHAT INDIA’S REGULATOR FOUND

Dealers rigging bids, forming cartel

* In April 2012, the CCI fined PES Installations, MDD Medical System and Medical Product Services for “bid-rigging and forming a cartel” in tenders for procurement of a Modular Operation Theatre (MOT) and other medical equipment at AIIMS and Safdarjung Hospital.

* The CCI also examined a contentious question: did the dealership agreement between Stryker India and PES violate sections of the Competition Commission Act? According to the official website of the Ministry of Corporate Affairs, the Act, enacted in 2002, aims “to

prevent practices having adverse effect on competition, to promote and sustain competition in markets, to protect the interests of consumers and to ensure freedom of trade carried on by other participants…”

* In its final order issued on April 16, 2014, based on the documents placed before it, CCI ruled that “according to the agreement struck with the dealer (PES Installations), Stryker could appoint any other firm as its dealer”. “However, according to the agreement, in this case PES Installations, the dealer could not sell products of any other company without the permission of Stryker,” the order said.

* The Director General appointed by CCI, under section 26 of the CCI Act, to conduct the investigation noted that the agreement that restricts PES to Stryker alone “impeded and restricts competition” and “constitutes violation of the law”.

* However, the CCI ruled in its final order that the agreement was “not violative of the law” on the grounds that “there are other competing products in the market” that are available to other “similarly placed” distributors.

The point to ponder here is that, with such unholy scenario and  milieu developing, where business deals and investors decide the treatment with  aberrant medical evolution taking place. Doctors involved with such big  companies will be promoted,  projected and survive. Will the honest doctors, who are not part of the game, be able to survive, sustain themselves or ultimately alienated  to  extinction?

source

 

Nurse/doctor vs Filmy superstar: Reel Heroes or Real Heroes. what does the society Need/desire/deserve?


The old adage  “All that glitters is not Gold” is particularly relevant  in current era of media domination where media  projection shapes the perception and may defy  the  reality.  Media has dominated our lives and can sway the  opinion formation of masses.  Written media, television, social media  can collectively influence the mass opinion.

Society, in general, needs to be wise  enough  to realize the importance   of  getting  rid of  these blinders in  real life . One such factor that causes an illusional mist in the  thoughts of masses is projection in films. They create a mirage of illusional glitter wherein  there is blurring of real life from the reel life of heroes. The larger-than-life unreal persona of the celebrities on screen looks too charming and sometimes becomes undeniable and dominates mind of masses. The super-human characters played out in films appear to be real. The problem arises when the imaginary characters of the reel life stories are emulated in real life. Individuals as projected character fill in  peoples’ imagination and are perceived as real and   becomes ingrained in mind. The naivety of masses to perceive the projected character as real one  goes beyond a reasonable thought process and imagination.

 

These roles played in films are  not  really act of   inspiration  in real life  as  the actual purpose accomplished in the end of a movie  is entertainment of society and business for themselves. A recent  candid  admission  by the actor Mr Irrfan Khan  that film stars should  not be role models  was impressive (Hindustan times) .

   At the best, a particular projected character  (and  not individual acting star) may be a  role model. An actor or super star, is simply doing his work of “acting” in  the end. This work of acting may bring an entertainment of few hours at the most.

One  cannot stray away from the wisdom to  choose between what we consume merely for our entertainment and  what we believe or face in real life. One needs to differentiate between rationale truth behind the celebrity gimmicks in the media and exaggerated sensationalism. Sensation created merely for a commercial successful venture should not be allowed to overpower the judgments of real life.

 

But the problem starts, when these false perceptions created merely   by a projected  glimmer    takes the shimmer  away from the real worthy. The real  professionals and people who are worthy of glory become invisible behind  the glittery mist, a haze, which is unreal and unhelpful in real life.

   A  soldier contributes to our society much more in real terms. Even a junior doctor saves many lives in a  day in emergencies as compared to work of a superstar in films.  A teacher, nurse or scientist have contribution which is more fruitful to our generation. Also the scientists, who contribute immensely and bring about the  real change in our lives. Their contribution is huge to our society and much more than doing just acting on screen. The reel actor merely imitates the real life lived and actual work done by real heroes like soldier, doctor or teacher. Someone who only acts and  behaves like one, is respected and paid thousand times or more than the real one. In reality, people need  more than mere entertainment and reel role models and actors in their real lives.

 

Compare the trivial  amount of  remuneration, fame  and respect the real worker  gets  as compared to the film stars, who merely imitate their actions. Reel projection for purpose  of entertainment is more easier to enact and more profitable  than actual performance  in real life.  It is easier to become a reel hero, as it requires little hard work or just connections to get an opportunity.  Some one can be a reel hero just  by  dynastic factor  easily. Hard work is definitely required but that may or may not be prerequisite.

 

Even good films  may raise some social problem, which everyone knows already and offer no practical solution in reality. Therefore what good it brings to the public, beyond entertainment, is any body’s guess. The persona, actors usually  project on screen, may actually be far from his or her real personality. In most of cases, what he does in movies and reel life, is actually away from  possibility of real life . But strangely in present era, people lose sight of what is mere perception. It is clearly a story, tale, a drama, a myth and is not the real identity of the people, we see on-screen.

 

 

In present era, real contributions by people, who are saviours of human life and  the real heroes, remain unappreciated. People are so besotted by  fame and money that they fail to appreciate the sacrifices made by real heroes. Filmy super hero  just imitates  a doctor, soldier,  dacoit or a street hooligan and just pretends to be one on the screen.

 

But there are  real life heroes that exist around us. Doctors awake at night saving lives every minute or soldier in freezing cold are worthy  of more respect and are real heroes.  And it is up to the society  to look beyond the superficial and reel story, and focus on the real life actors. There has to be an true effort to make, respect and appreciate  real heroes.

Point to  ponder  is that whether society needs people  just  acting like   doctors,  soldiers  and not the  actual and real ones, who saves lives. Does Society need  only  entertainment, because respect  which is paid to someone who is  just  an   actor, is  not extended to real doctors, soldiers or other altruistic professions.

 A reel hero who acts like a soldier, is famous  and richer and than the  actual soldier, who dies unnamed and in penury.   Children of today’s times will strive  to become, who is worshiped and paid respect  by society and  therefore will prefer  to become reel heroes.

 

A  society truly needs the real people, who work and act for them, more than just entertainment. It will need total change in attitude of people to deconstruct the perceptions, which are based on mere projections and are away from reality.

It is time to recreate and worship real heroes, who have become invisible behind the glittery mist.

Society needs to envisage the bigger real picture, and should not be mistaken for another projected story.                          

The perception of the projection will decide, what does the   society actually  need- or desire-or deserve , “Reel Heroes or Real Heroes”.

Made in India coronary stents non inferior to international stents


In a major advancement, a study shows that made in India coronary stents are as good as those manufactured in other countries by multinational companies, according to a recent scientific trial.

The study’s findings were presented at the prestigious international conference on Non Surgical Cardiac interventions—TCT (Trans Catheter Interventions)—on September 22 in San Diego, USA.

The study, which involved around 1,500 patients, was conducted in various countries of Europe and monitored by an international reputed clinical research organisation (CRO), Cardialysis.

The scientific study had the acronym TALENT.

The study dispels the perception among many doctors and patients that stents made in India may not be as safe and efficacious as those manufactured in foreign countries.

The TALENT trial was conceived by Prof Upendra Kaul, a well known interventional cardiologist who is currently the chairman of Batra Heart Centre, New Delhi, and Prof Patrick Serruys, an internationally acclaimed researcher in this field from the Netherlands.

 

Coronary stents are devices made of metal, usually chromium cobalt and coated with polymers and drug to treat blocked coronary arteries and also with a good and safe long-term performance.

In the recently conducted randomised trial to compare an India-made stent Supraflex with the world leader Xience stent from Abbott Vascular, the Supraflex sirolimus-eluting coronary stent manufactured by SMT in Surat emerged to be as good as the Xience stent made in Europe and the USA.

The study was sufficiently powered to give the final answer regarding non-inferiority of the Supraflex sirolimus-eluting stent versus the best-in class Xience stent from Abbott. The study was done in all comers with no exclusions, Prof Kaul said.

“The aim of the study was to test the hypothesis that both stents are equal in performance and safety. To dispel the belief that imported coronary devices are better, it needed a scientific study without any bias,” he explained.

In February, last year, when the Indian government decided to cap the prices of coronary stents, there was a dramatic reduction in prices from an average of USD 1,800 for the drug-eluting stent (DES) to USD 480 irrespective of the country they were manufactured in.

This resulted in increase in the usage of domestic stents because they offered it at lower prices, Dr Kaul said.

“However, the users still had the belief that India made stents may not be as good (as the imported ones). This required an acceptable scientific trial to draw a comparison between the two stents,” he claimed.

“The study was done in Europe to remove any bias and it was monitored by an international clinical research organisation (CRO), Cardialysis, which is world reputed,” Dr Kaul added.

The study showed that the composite end points consisting of cardiac death, target-vessel MI and clinically indicated repeat procedures at 12 months were similar for both.

Thus proving that the India made stent Supraflex was as good as the market leader Xinence, Dr Kaul claimed.

The study has important economic implications in countries where cost of the stent is an important issue. The full paper of this trial will soon be published in the Lancet, he said.

Dr Kaul further called upon other Indian manufacturers to do similar clinical trials to prove that their devices are worthy competitors to those made abroad.

source

Dengue, Chickungunya (vector ¬borne) preventable till bite of mosquito


Vector borne diseases have assumed greater significance, as they are causes for preventable death. But presently they are preventable till a mosquito bite. Usually they cause fever for few days and discomfort. But in many cases they present a life threatening disease process, which is rapid and  difficult  to treat. Therefore prevention of mosquito bite is of great importance. Dengue shock syndrome, Dengue Hemorrhagic fever or encephalitis, ARDS present life threatening situations and difficult to treat.

Dengue

  • Dengue is a viral infection spread by the bite of the aedes aegypti mosquito and does not spread directly from person to person.
  • The symptoms start within five to six days after person you’re bitten by an infected mosquito.

            Chikungunya

It is a viral infection spread by the bite of the aedes aegypti mosquito.

The word “chikungunya” means “to become contorted” in Kimakonde, a language spoken in parts of Tanzania and Mozambique, which refers to the contorted walk of infected persons who develop severe joint pain.

Symptoms appear between 4 and 7 days after being bitten by the infected mosquito.

Routine fogging is dangerous as it can lead to increased resistance to the insecticides rendering them useless during outbreak situations

With increasing cases of mosquito-borne diseases, like dengue and chikungunya, being reported from the country, the government and scientists are looking at newer ways of controlling the vector and preventing the spread of infections

 

Outdoor fogging provides only short ­term benefits and can also affect non ­target organisms, such as honeybees, moths and butterflies, say experts.

Dengue and chikungunya, which together affected close to 46,000 people in the country this year, do not have any cure currently.

Patients infected with the diseases transmitted by day-biting aedes aegypti mosquitoes usually receive symptomatic treatment for fever, joint aches, internal bleeding, and in severe cases, organ failure.

For malaria, which is transmitted by the anopheles mosquitoes that bite at dusk, it is essential to detect cases early and start treatment.

However, the best method of preventing the disease is to control breeding.

This does not always happen properly on time as pointed out by a 2016 report by the Comptroller and Auditor General.

The report found that the existing number of domestic breeding checkers was so less that it was possible to revisit a house in Delhi only after 44 days, as opposed to every six days as per the norm set by the municipal corporations.

And, several houses remain unchecked because either nobody is home or they deny the breeding checkers entry. The implementation has to be better for effective control of vector

The report states that only 30% of all health institutions in Delhi were reporting cases of dengue defeating the purpose of surveillance and early detection of an outbreak. Cases were also being under-reported.

In 86% of the houses that were treated for breeding, the method or the chemical formulations used were not prescribed or recommended by national agencies responsible for setting guidelines.

Routine outdoor fogging was also carried out by the corporations  that is recommended only for emergency situations. Routine fogging is dangerous as it can lead to increased resistance to the insecticides rendering them useless during outbreak situations.

“Pesticides have been a cornerstone of vector-borne disease control. Use of chemicals on a vast and increasing scale has led to the widespread development of resistance,” according to a report by the World Health Organisation.

“Outdoor fogging with insecticides looks dramatic and hence provides visible evidence that the government is doing something. Fogging requires considerable resources, provides only short-lasting benefits, and has been severely compromised by the spread of vectors resistant to the available insecticides. Fogging can also affect non-target organisms, such as honeybees, moths, and butterflies,” said a study.

A growing resistance by anopheles mosquitoes to pyrethroids threatens to reverse all gains made since 2000, according to another study which reported an increasing mosquito survival.

“This is a concern not just for malaria but all mosquito-borne diseases, given that insecticides play a major role in vector control. This has led to a three pronged effort to develop new vector control tools as quickly as possible,” the study said.

Resistance is known to affect all major malaria vector species and all four recommended classes of insecticides. Since 2010, a total of 61 countries have reported resistance to at least one class of insecticide, with a 50 of those countries reporting resistance to 2 or more classes, according to WHO.

There are, however, newer measures for preventing vector borne diseases.

THE WOLBACHIA TRIAL

India has collaborated with researchers from Australia to created modified mosquitoes that have been infected with Wolbachia bacterium. The bacterium ends the disease transmitting capability of aedes aegypti mosquitoes that transmit dengue and chikungunya. A lab trial is currently underway at Vector Control Research Centre, Puducherry. Studies have also shown that the wolbachia bacteria resists the malaria causing parasites in anopheles too.

DENGUE VACCINE

Dengvaxia by French drugmaker Sanofi Pastuer is currently the only vaccine against dengue available in the world. It is not yet available in Indian markets as the Indian Council of Medical Research in in the process of conducting research to check the level of seroprevalence (the number of people who have at least once been infected with dengue).

“The subset of trial participants who had not been exposed to dengue virus infection prior to vaccination had a higher risk of more severe dengue and hospitalisations due to dengue compared to unvaccinated participants,” according to WHO.

India has also developed a dengue vaccine candidate, which confers protection against all four strains of dengue without increasing the risk of lethal secondary infections from different strains. There are several other dengue vaccine candidates under development.

MALARIA VACCINE

Mosquirix developed by GlaaxoSmithKline is the world’s first malaria vaccine and has been shown to provide partial protection against malaria in children against malaria caused by plasmodium falciparum, that can cause cerebral malaria. It has been recommended by WHO for pilot introduction in three African countries

 

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