Tuesday, December 22, 2015

National Brain Week 18 to 24 December 2015 -Neurological diseases in India- Need more awareness

National Brain Week 18 to 24 December 2015


Neurological diseases in India- Need more awareness


Dr M A Aleem
Vice President
Tamilnadu and Pondycheery States Association of Neurologists (TAN)


Former Vice Principal and
HOD and Professor of Neurology
KAPV Govt. Medical College and MGM Govt. Hospital
Trichy


Neurologist and Epileptologist
ABC Hospital
Trichy

December 18-24, 2015 as the
National Brain Week, to commemorate the Foundation of the Indian Academy of Neurology (IAN) on December 18, 1991. This year happens to be the Silver Jubilee year of the IAN.

Indian Academy of Neurology (IAN), the professional registered body of neurologists across India was founded on December 18, 1991. The Academy completes 25 years on December 18, 2015. It is only appropriate to celebrate December 18-24 as the “National Brain Week”. To begin with, the IAN had only 250 members comprising of the few trained neurologists that existed in the country. Over 25 years, it has grown by leaps and bounds to 1677 members across the country.

At present, DM/DNB (Neurology), the post-graduate qualification requisite for practicing as a neurologist is available at 89 medical institutes with a total of 205 seats through-out the country, which means approximately 200 qualified practicing neurologist will be added every year. The average number of neurologists per 100, 000 population across different income group countries also varies: In the United States, there are five neurologists per 100, 000 population where as in India this ratio is only 0.01 neurologist per 100, 000 population.

Burden of disease largely underestimated:

The burden of brain disorders and neurological diseases is largely underestimated. “Stroke and traumatic brain injuries are two most important causes of disability around the globe, one to two percent of the global population suffers from some kind of disability related to traumatic brain injury. Worldwide, stroke is the second commonest cause of death after Islamic heart disease and ahead of chronic obstructive pulmonary disease. According to WHO data, neurological diseases alone are responsible for between 4.5 and 11 percent of all burden of disease, depending on whether you look at low- or high-income economies. This is far higher than the number of respiratory ailments, gastrointestinal disorders or malignant tumours.”

Neurological diseases are a major cause of death. According to the WHO, they account for 12 percent of deaths worldwide, a figure that varies according to levels of economic development. Lower-middle-income countries are the hardest hit. They account for nearly 17 percent of deaths attributable to neurological causes because both infectious and non-communicable neurological diseases contribute to mortality. Of all neurological illnesses, stroke and other cerebrovascular disorders are by far the commonest cause of death, accounting for 85 percent of all fatalities.


Neurological diseases in India- Need more awareness

India, with a population of more than one billion, is facing new challenges in the health sector due to a paradigm shift in disease burden. Added to the burden of communicable diseases with emerging and re-emerging infections and nutritional deficiency disorders, there is epidemiological transition with increasing incidence of non-communicable disorders (NCD), some attributable to lifestyle and others to increased life expectancy. Amongst the NCDs, neurological disorders have been recognized to lead to significant mortality, morbidity, disability and socioeconomic loss. Epilepsy, cerebrovascular disorders, migraine, dementia, Parkinson's disease, motor neuron disorder, traumatic injuries, brain damage due to birth trauma, neuromuscular disorders, demyelinating disorders and neurological disorders consequent to nutritional deficiency and exposure to neurotoxic substances contribute to significant burden. Further, widely prevalent infections of the nervous system such as tuberculosis, malaria, cysticercosis and viral infections, particularly Japanese encephalitis and HIV also lead to neurological deficits.

The unique characteristics of neurological disorders such as chronicity, progressive degeneration, limited therapeutic options and lack of specific treatment for many diseases, further contribute to the disease burden and morbidity. The effect of stigma associated with epilepsy, particularly in developing countries, on disease burden cannot be easily estimated since it leads to complexities in diagnosis and management and a large treatment gap. Redeeming features are recent developments including (i) advances in diagnostic modalities of imaging, immunological and molecular tests, (ii) introduction of new therapeutic strategies such as thrombolysis, immunomodulating agents (immunoglobulins, interferon) and (iii) use of new drugs for treatment of epilepsy, Parkinson's disease and neuroinfections which have ushered a sea change in the clinical practice of neurology, enabling early diagnosis and more effective treatment leading to improved outcome of the disease.






Population-based neuroepidemiologic surveys during the last 15 years, using standardized WHO questionnaire with modifications, in different regions of our country have shown the prevalence rate of neurological disorders to vary from 967 to 4070 per 100000 population. The Parsis, a distinct ethnic group, have an unusually high prevalence rate, but they do not represent the general population of the country. In these surveys, infections of the nervous system and traumatic injuries of brain, spinal cord and peripheral nerves have not been included and therefore it would be an underestimate of the total burden of neurological disorders.

All age groups are affected with peaking in the elderly above 60 years of age. In India according to the 2001 census there are 77 million people above the age of 60 years and it is expected that by 2025 there will be a huge increase to 177 million with consequent significant rise in age-related disorders such as cerebrovascular disorders, Parkinson's disease and dementia. Contradicting the perception of the policy-makers and administrators that neurological disorders are seen mostly in the urban population, neuroepidemiologic surveys have demonstrated that the prevalence in the rural population is significantly higher than in the urban population. In a large community-based survey in Bangalore of a population of 102557 comprising an urban population of 51502 and rural population of 51055, the prevalence rates were 2190 and 4070, respectively, with a ratio of 1:1.85. This fact is critical for planning infrastructure and trained manpower for providing equitable neurology care in the country. Prevalence of some common disorders . Based on the prevalence studies, it may be estimated that in India there are 20 to 30 million people with neurological disorders and the common disorders include epilepsy (6 to 8 million), headache (10-12 million), strokes (1 to 2 million). Transient ischemic attacks are not included in surveys and hence the actual burden of cerebrovascular disorders will be higher than these projected figures.

Special mention needs to be made regarding care of people with epilepsy in view of the associated stigma, the myths and misconceptions about the nature of the disorder and the consequent burden to the patients and their family members, factors which are not considered while determining the disability adjusted life years (DALYS). Some of the crucial factors leading to a wide treatment gap of 38 to 80% in the country are stigma associated with epilepsy preventing patients seeking medical advice, lack of awareness that epilepsy is a brain disorder and that it can be treated. It is therefore important to move forward from descriptive neuroepidemiologic studies to interventional strategies for prevention and treatment of neurological disorders.


Neurological disorders such as stroke, epilepsy and migraine are the commonest reason for disability at a global scale.

Stroke

In India, approximately six people suffer from a stroke every minute amounting to 1.5 million people with stroke in a year. One person dies of stroke every three minutes. Anyone with symptoms of stroke should be rushed to a hospital where facilities for thrombolysis with intravenous tissue plasminogen activator (tPA) are available to burst the arterial clot. The latter can be administered only within a 4.5 hours window period after the onset of stroke. In this time period many investigations including a CT scan of the brain needs to be done before thrombolysis. Thrombolysis requires special expertise and neurologists are best equipped to take the decision whether to thrombolyse or not. When given after 4.5 hours, tPA can produce unwanted harmful effects. So then, how does one recognize symptoms of stroke? It is easy to recognize stroke with a FAST test.

Epilepsy

The estimated number of people with epilepsy in India is 5.5 million. Approximately 65% of newly diagnosed people with epilepsy have no obvious cause. However, 80% of these 5.5 million people with epilepsy in India do not receive treatment as epilepsy medications are not available in Dispensaries and Pharmacies. This is perhaps the highest treatment gap for epilepsy in the world apart from few African countries. This treatment gap can be reduced by:

1. Educating people about epilepsy

2. Increasing awareness among public about the different treatments available including medications, surgery and diet.

3. Making epilepsy medications easily available in all pharmacy and dispensaries.

For complicated cases of epilepsy patients should be refereed to comprehensive epilepsy center. At present less than ten centers where treatment with epilepsy surgery is available. To further enhance the care for uncontrolled epilepsy patients, more number of comprehensive epilepsy centers should be set up across the country.

Migraine

Migraine is the most common cause for headache noted in the population. Approximately 6% of men and 18% of women suffer migraine attacks and over 80% of these suffer had some degree of headache-related disability. Women have more frequent and more severe attacks than men. Having three migraine attacks per month is equivalent to three days of work lost

Treatment choice depends on the frequency and severity of attacks, the presence and degree of temporary disability and associated symptoms such as nausea and vomiting. For migraine management greater emphasis is on the avoidance of identifiable trigger factors (Box 2) and non-pharmacological techniques. These include biofeedback, relaxation technique, physical medicine, yoga, pranaayaam and counseling.

These non-pharmacologic treatments must be combined with drug therapy to achieve better clinical improvement for migraine relief.

National Brain Week 18 to 24 December 2015 -Neurological diseases in India- Need more awareness

National Brain Week 18 to 24 December 2015


Neurological diseases in India- Need more awareness


Dr M A Aleem
Vice President
Tamilnadu and Pondycheery States Association of Neurologists (TAN)


Former Vice Principal and
HOD and Professor of Neurology
KAPV Govt. Medical College and MGM Govt. Hospital
Trichy


Neurologist and Epileptologist
ABC Hospital
Trichy

December 18-24, 2015 as the
National Brain Week, to commemorate the Foundation of the Indian Academy of Neurology (IAN) on December 18, 1991. This year happens to be the Silver Jubilee year of the IAN.

Indian Academy of Neurology (IAN), the professional registered body of neurologists across India was founded on December 18, 1991. The Academy completes 25 years on December 18, 2015. It is only appropriate to celebrate December 18-24 as the “National Brain Week”. To begin with, the IAN had only 250 members comprising of the few trained neurologists that existed in the country. Over 25 years, it has grown by leaps and bounds to 1677 members across the country.

At present, DM/DNB (Neurology), the post-graduate qualification requisite for practicing as a neurologist is available at 89 medical institutes with a total of 205 seats through-out the country, which means approximately 200 qualified practicing neurologist will be added every year. The average number of neurologists per 100, 000 population across different income group countries also varies: In the United States, there are five neurologists per 100, 000 population where as in India this ratio is only 0.01 neurologist per 100, 000 population.

Burden of disease largely underestimated:

The burden of brain disorders and neurological diseases is largely underestimated. “Stroke and traumatic brain injuries are two most important causes of disability around the globe, one to two percent of the global population suffers from some kind of disability related to traumatic brain injury. Worldwide, stroke is the second commonest cause of death after Islamic heart disease and ahead of chronic obstructive pulmonary disease. According to WHO data, neurological diseases alone are responsible for between 4.5 and 11 percent of all burden of disease, depending on whether you look at low- or high-income economies. This is far higher than the number of respiratory ailments, gastrointestinal disorders or malignant tumours.”

Neurological diseases are a major cause of death. According to the WHO, they account for 12 percent of deaths worldwide, a figure that varies according to levels of economic development. Lower-middle-income countries are the hardest hit. They account for nearly 17 percent of deaths attributable to neurological causes because both infectious and non-communicable neurological diseases contribute to mortality. Of all neurological illnesses, stroke and other cerebrovascular disorders are by far the commonest cause of death, accounting for 85 percent of all fatalities.


Neurological diseases in India- Need more awareness

India, with a population of more than one billion, is facing new challenges in the health sector due to a paradigm shift in disease burden. Added to the burden of communicable diseases with emerging and re-emerging infections and nutritional deficiency disorders, there is epidemiological transition with increasing incidence of non-communicable disorders (NCD), some attributable to lifestyle and others to increased life expectancy. Amongst the NCDs, neurological disorders have been recognized to lead to significant mortality, morbidity, disability and socioeconomic loss. Epilepsy, cerebrovascular disorders, migraine, dementia, Parkinson's disease, motor neuron disorder, traumatic injuries, brain damage due to birth trauma, neuromuscular disorders, demyelinating disorders and neurological disorders consequent to nutritional deficiency and exposure to neurotoxic substances contribute to significant burden. Further, widely prevalent infections of the nervous system such as tuberculosis, malaria, cysticercosis and viral infections, particularly Japanese encephalitis and HIV also lead to neurological deficits.

The unique characteristics of neurological disorders such as chronicity, progressive degeneration, limited therapeutic options and lack of specific treatment for many diseases, further contribute to the disease burden and morbidity. The effect of stigma associated with epilepsy, particularly in developing countries, on disease burden cannot be easily estimated since it leads to complexities in diagnosis and management and a large treatment gap. Redeeming features are recent developments including (i) advances in diagnostic modalities of imaging, immunological and molecular tests, (ii) introduction of new therapeutic strategies such as thrombolysis, immunomodulating agents (immunoglobulins, interferon) and (iii) use of new drugs for treatment of epilepsy, Parkinson's disease and neuroinfections which have ushered a sea change in the clinical practice of neurology, enabling early diagnosis and more effective treatment leading to improved outcome of the disease.






Population-based neuroepidemiologic surveys during the last 15 years, using standardized WHO questionnaire with modifications, in different regions of our country have shown the prevalence rate of neurological disorders to vary from 967 to 4070 per 100000 population. The Parsis, a distinct ethnic group, have an unusually high prevalence rate, but they do not represent the general population of the country. In these surveys, infections of the nervous system and traumatic injuries of brain, spinal cord and peripheral nerves have not been included and therefore it would be an underestimate of the total burden of neurological disorders.

All age groups are affected with peaking in the elderly above 60 years of age. In India according to the 2001 census there are 77 million people above the age of 60 years and it is expected that by 2025 there will be a huge increase to 177 million with consequent significant rise in age-related disorders such as cerebrovascular disorders, Parkinson's disease and dementia. Contradicting the perception of the policy-makers and administrators that neurological disorders are seen mostly in the urban population, neuroepidemiologic surveys have demonstrated that the prevalence in the rural population is significantly higher than in the urban population. In a large community-based survey in Bangalore of a population of 102557 comprising an urban population of 51502 and rural population of 51055, the prevalence rates were 2190 and 4070, respectively, with a ratio of 1:1.85. This fact is critical for planning infrastructure and trained manpower for providing equitable neurology care in the country. Prevalence of some common disorders . Based on the prevalence studies, it may be estimated that in India there are 20 to 30 million people with neurological disorders and the common disorders include epilepsy (6 to 8 million), headache (10-12 million), strokes (1 to 2 million). Transient ischemic attacks are not included in surveys and hence the actual burden of cerebrovascular disorders will be higher than these projected figures.

Special mention needs to be made regarding care of people with epilepsy in view of the associated stigma, the myths and misconceptions about the nature of the disorder and the consequent burden to the patients and their family members, factors which are not considered while determining the disability adjusted life years (DALYS). Some of the crucial factors leading to a wide treatment gap of 38 to 80% in the country are stigma associated with epilepsy preventing patients seeking medical advice, lack of awareness that epilepsy is a brain disorder and that it can be treated. It is therefore important to move forward from descriptive neuroepidemiologic studies to interventional strategies for prevention and treatment of neurological disorders.


Neurological disorders such as stroke, epilepsy and migraine are the commonest reason for disability at a global scale.

Stroke

In India, approximately six people suffer from a stroke every minute amounting to 1.5 million people with stroke in a year. One person dies of stroke every three minutes. Anyone with symptoms of stroke should be rushed to a hospital where facilities for thrombolysis with intravenous tissue plasminogen activator (tPA) are available to burst the arterial clot. The latter can be administered only within a 4.5 hours window period after the onset of stroke. In this time period many investigations including a CT scan of the brain needs to be done before thrombolysis. Thrombolysis requires special expertise and neurologists are best equipped to take the decision whether to thrombolyse or not. When given after 4.5 hours, tPA can produce unwanted harmful effects. So then, how does one recognize symptoms of stroke? It is easy to recognize stroke with a FAST test.

Epilepsy

The estimated number of people with epilepsy in India is 5.5 million. Approximately 65% of newly diagnosed people with epilepsy have no obvious cause. However, 80% of these 5.5 million people with epilepsy in India do not receive treatment as epilepsy medications are not available in Dispensaries and Pharmacies. This is perhaps the highest treatment gap for epilepsy in the world apart from few African countries. This treatment gap can be reduced by:

1. Educating people about epilepsy

2. Increasing awareness among public about the different treatments available including medications, surgery and diet.

3. Making epilepsy medications easily available in all pharmacy and dispensaries.

For complicated cases of epilepsy patients should be refereed to comprehensive epilepsy center. At present less than ten centers where treatment with epilepsy surgery is available. To further enhance the care for uncontrolled epilepsy patients, more number of comprehensive epilepsy centers should be set up across the country.

Migraine

Migraine is the most common cause for headache noted in the population. Approximately 6% of men and 18% of women suffer migraine attacks and over 80% of these suffer had some degree of headache-related disability. Women have more frequent and more severe attacks than men. Having three migraine attacks per month is equivalent to three days of work lost

Treatment choice depends on the frequency and severity of attacks, the presence and degree of temporary disability and associated symptoms such as nausea and vomiting. For migraine management greater emphasis is on the avoidance of identifiable trigger factors (Box 2) and non-pharmacological techniques. These include biofeedback, relaxation technique, physical medicine, yoga, pranaayaam and counseling.

These non-pharmacologic treatments must be combined with drug therapy to achieve better clinical improvement for migraine relief.

National Brain Week 18 to 24 December 2015Neurological diseases in India- Need more awareness

National Brain Week 18 to 24 December 2015

Neurological diseases in India- Need more awareness


Dr M A Aleem
Vice President
Tamilnadu and Pondycheery States Association of Neurologists(TAN)

Former Vice Principal and
HOD and Professor of Neurology
KAPV Govt. Medical college and MGM Govt Hospital
Trichy

Neurologist
ABC Hospital
Trichy

December 18-24, 2015 as the
National Brain Week, to commemorate the Foundation of the Indian Academy of Neurology (IAN) on December 18, 1991. This year happens to be the Silver Jubilee year of the IAN.

Indian Academy of Neurology (IAN), the professional registered body of neurologists across India was founded on December 18, 1991. The Academy completes 25 years on December 18, 2015. It is only appropriate to celebrate December 18-24 as the “National Brain Week”. To begin with, the IAN had only 250 members comprising of the few trained neurologists that existed in the country. Over 25 years, it has grown by leaps and bounds to 1677 members across the country.

At present, DM/DNB (Neurology), the post-graduate qualification requisite for practicing as a neurologist is available at 89 medical institutes with a total of 205 seats through-out the country, which means approximately 200 qualified practicing neurologist will be added every year. The average number of neurologists per 100, 000 population across different income group countries also varies: In the United States, there are five neurologists per 100, 000 population where as in India this ratio is only 0.01 neurologist per 100, 000 population.

Burden of disease largely underestimated:

The burden of brain disorders and neurological diseases is largely underestimated. “Stroke and traumatic brain injuries are two most important causes of disability around the globe, one to two percent of the global population suffers from some kind of disability related to traumatic brain injury. Worldwide, stroke is the second commonest cause of death after Islamic heart disease and ahead of chronic obstructive pulmonary disease. According to WHO data, neurological diseases alone are responsible for between 4.5 and 11 percent of all burden of disease, depending on whether you look at low- or high-income economies. This is far higher than the number of respiratory ailments, gastrointestinal disorders or malignant tumours.”

Neurological diseases are a major cause of death. According to the WHO, they account for 12 percent of deaths worldwide, a figure that varies according to levels of economic development. Lower-middle-income countries are the hardest hit. They account for nearly 17 percent of deaths attributable to neurological causes because both infectious and non-communicable neurological diseases contribute to mortality. Of all neurological illnesses, stroke and other cerebrovascular disorders are by far the commonest cause of death, accounting for 85 percent of all fatalities.



Neurological diseases in India- Need more awareness




India, with a population of more than one billion, is facing new challenges in the health sector due to a paradigm shift in disease burden. Added to the burden of communicable diseases with emerging and re-emerging infections and nutritional deficiency disorders, there is epidemiological transition with increasing incidence of non-communicable disorders (NCD), some attributable to lifestyle and others to increased life expectancy. Amongst the NCDs, neurological disorders have been recognized to lead to significant mortality, morbidity, disability and socioeconomic loss. Epilepsy, cerebrovascular disorders, migraine, dementia, Parkinson's disease, motor neuron disorder, traumatic injuries, brain damage due to birth trauma, neuromuscular disorders, demyelinating disorders and neurological disorders consequent to nutritional deficiency and exposure to neurotoxic substances contribute to significant burden. Further, widely prevalent infections of the nervous system such as tuberculosis, malaria, cysticercosis and viral infections, particularly Japanese encephalitis and HIV also lead to neurological deficits.

The unique characteristics of neurological disorders such as chronicity, progressive degeneration, limited therapeutic options and lack of specific treatment for many diseases, further contribute to the disease burden and morbidity. The effect of stigma associated with epilepsy, particularly in developing countries, on disease burden cannot be easily estimated since it leads to complexities in diagnosis and management and a large treatment gap. Redeeming features are recent developments including (i) advances in diagnostic modalities of imaging, immunological and molecular tests, (ii) introduction of new therapeutic strategies such as thrombolysis, immunomodulating agents (immunoglobulins, interferon) and (iii) use of new drugs for treatment of epilepsy, Parkinson's disease and neuroinfections which have ushered a sea change in the clinical practice of neurology, enabling early diagnosis and more effective treatment leading to improved outcome of the disease.






Population-based neuroepidemiologic surveys during the last 15 years, using standardized WHO questionnaire with modifications, in different regions of our country have shown the prevalence rate of neurological disorders to vary from 967 to 4070 per 100000 population. The Parsis, a distinct ethnic group, have an unusually high prevalence rate, but they do not represent the general population of the country. In these surveys, infections of the nervous system and traumatic injuries of brain, spinal cord and peripheral nerves have not been included and therefore it would be an underestimate of the total burden of neurological disorders.

All age groups are affected with peaking in the elderly above 60 years of age. In India according to the 2001 census there are 77 million people above the age of 60 years and it is expected that by 2025 there will be a huge increase to 177 million with consequent significant rise in age-related disorders such as cerebrovascular disorders, Parkinson's disease and dementia. Contradicting the perception of the policy-makers and administrators that neurological disorders are seen mostly in the urban population, neuroepidemiologic surveys have demonstrated that the prevalence in the rural population is significantly higher than in the urban population. In a large community-based survey in Bangalore of a population of 102557 comprising an urban population of 51502 and rural population of 51055, the prevalence rates were 2190 and 4070, respectively, with a ratio of 1:1.85. This fact is critical for planning infrastructure and trained manpower for providing equitable neurology care in the country. Prevalence of some common disorders . Based on the prevalence studies, it may be estimated that in India there are 20 to 30 million people with neurological disorders and the common disorders include epilepsy (6 to 8 million), headache (10-12 million), strokes (1 to 2 million). Transient ischemic attacks are not included in surveys and hence the actual burden of cerebrovascular disorders will be higher than these projected figures.

Special mention needs to be made regarding care of people with epilepsy in view of the associated stigma, the myths and misconceptions about the nature of the disorder and the consequent burden to the patients and their family members, factors which are not considered while determining the disability adjusted life years (DALYS). Some of the crucial factors leading to a wide treatment gap of 38 to 80% in the country are stigma associated with epilepsy preventing patients seeking medical advice, lack of awareness that epilepsy is a brain disorder and that it can be treated. It is therefore important to move forward from descriptive neuroepidemiologic studies to interventional strategies for prevention and treatment of neurological disorders.


Neurological disorders such as stroke, epilepsy and migraine are the commonest reason for disability at a global scale.

Stroke

In India, approximately six people suffer from a stroke every minute amounting to 1.5 million people with stroke in a year. One person dies of stroke every three minutes. Anyone with symptoms of stroke should be rushed to a hospital where facilities for thrombolysis with intravenous tissue plasminogen activator (tPA) are available to burst the arterial clot. The latter can be administered only within a 4.5 hours window period after the onset of stroke. In this time period many investigations including a CT scan of the brain needs to be done before thrombolysis. Thrombolysis requires special expertise and neurologists are best equipped to take the decision whether to thrombolyse or not. When given after 4.5 hours, tPA can produce unwanted harmful effects. So then, how does one recognize symptoms of stroke? It is easy to recognize stroke with a FAST test.

Epilepsy

The estimated number of people with epilepsy in India is 5.5 million. Approximately 65% of newly diagnosed people with epilepsy have no obvious cause. However, 80% of these 5.5 million people with epilepsy in India do not receive treatment as epilepsy medications are not available in Dispensaries and Pharmacies. This is perhaps the highest treatment gap for epilepsy in the world apart from few African countries. This treatment gap can be reduced by:

1. Educating people about epilepsy

2. Increasing awareness among public about the different treatments available including medications, surgery and diet.

3. Making epilepsy medications easily available in all pharmacy and dispensaries.

For complicated cases of epilepsy patients should be refereed to comprehensive epilepsy center. At present less than ten centers where treatment with epilepsy surgery is available. To further enhance the care for uncontrolled epilepsy patients, more number of comprehensive epilepsy centers should be set up across the country.

Migraine

Migraine is the most common cause for headache noted in the population. Approximately 6% of men and 18% of women suffer migraine attacks and over 80% of these suffer had some degree of headache-related disability. Women have more frequent and more severe attacks than men. Having three migraine attacks per month is equivalent to three days of work lost

Treatment choice depends on the frequency and severity of attacks, the presence and degree of temporary disability and associated symptoms such as nausea and vomiting. For migraine management greater emphasis is on the avoidance of identifiable trigger factors (Box 2) and non-pharmacological techniques. These include biofeedback, relaxation technique, physical medicine, yoga, pranaayaam and counseling.

These non-pharmacologic treatments must be combined with drug therapy to achieve better clinical improvement for migraine relief.

Monday, December 21, 2015

Growing vehicle density creates many killer roads-THE HINDUTIRUCHI, December 21, 2015


THE HINDU
TIRUCHI, December 21, 2015

Growing vehicle density creates many killer roads

R. Rajaram



The number of fatal cases and casualty crossed 100-figure mark in 2015

The death of a police head constable on Chennai Bypass here recently in a road accident is yet another fatal case to have got reported within the city limits this year.

Attached to the Fort Traffic Regulation Wing, the head constable, in his early forties, riding a two-wheeler was on his way to work when a trailer lorry hit him from behind and crushed him to death.

Amid burgeoning vehicle density in the city and mounting violations, the city has been witness to many fatal accidents on different stretches this year. The number of fatal cases and casualties crossed the 100 figure mark in 2015.

A view of the recent accident at Palpannai traffic junction in Tiruchi where a Tamil Nadu State Transport Corporation bus overturned.

According to police statistics, the number of fatal cases to have got reported within the city limit till date from January was 122 with the casualty figures being 131.

The only consolation for the police was that the number of fatal cases and the casualty figures have come down till now this year as compared to 2014.

The fatal cases reported in 2014 (January to December) were 168 and in respect of casualties it was 180. Many victims in road accident cases reported in city limits were two-wheeler riders, say the police.

A combination of factors is attributed to accidents that include negligence, rash driving, road rage, and over-speeding.

Police sources say some spots prone to accidents within the city limits include Sanjeevi Nagar, Mannarpuram, ‘Y’ Road, and Palpannai roundabout where vehicular movements are heavy.

Centrally located in the State, Tiruchi has been witness to increasing vehicle density over the years putting pressure on the existing road space.

This definitely calls for some long-term traffic management plan to effectively manage vehicular movements and check accident rate without resorting to cosmetic measures, say city residents.

Parking along the roadside shrinks the space and the absence of pavements along many thoroughfares forces pedestrians to walk on the road exposing them to speeding vehicles.

Constant awareness on disciplined and controlled driving along with strict enforcement of rules and a long-term traffic management plan alone can check the accident rate, says Dr. M.A. Aleem, former Vice Principal of K.A.P. Viswanatham Government Medical College and a city –based neurologist.

There are no proper markings on the speed breakers established along different stretches of the main roads which could cause accidents.

Furthermore, speed-breakers are unscientifically designed causing back breaking experience for the two-wheeler riders, says M. Sekaran, a consumer activist. Wrong-side driving on highways and drunk driving also result in accidents.

Many decisions taken at the periodic Road Safety Council meetings continue to remain unimplemented, says Mr. Sekaran. The corporation, highways, and the police should jointly come out with a traffic management plan keeping in mind the rising number of vehicles to check accidents.

More In: TAMIL NADU | NATIONAL

Growing vehicle density creates many killer roads


THE HINDU
TIRUCHI, December 21, 2015

Growing vehicle density creates many killer roads

R. Rajaram



The number of fatal cases and casualty crossed 100-figure mark in 2015

The death of a police head constable on Chennai Bypass here recently in a road accident is yet another fatal case to have got reported within the city limits this year.

Attached to the Fort Traffic Regulation Wing, the head constable, in his early forties, riding a two-wheeler was on his way to work when a trailer lorry hit him from behind and crushed him to death.

Amid burgeoning vehicle density in the city and mounting violations, the city has been witness to many fatal accidents on different stretches this year. The number of fatal cases and casualties crossed the 100 figure mark in 2015.

A view of the recent accident at Palpannai traffic junction in Tiruchi where a Tamil Nadu State Transport Corporation bus overturned.

According to police statistics, the number of fatal cases to have got reported within the city limit till date from January was 122 with the casualty figures being 131.

The only consolation for the police was that the number of fatal cases and the casualty figures have come down till now this year as compared to 2014.

The fatal cases reported in 2014 (January to December) were 168 and in respect of casualties it was 180. Many victims in road accident cases reported in city limits were two-wheeler riders, say the police.

A combination of factors is attributed to accidents that include negligence, rash driving, road rage, and over-speeding.

Police sources say some spots prone to accidents within the city limits include Sanjeevi Nagar, Mannarpuram, ‘Y’ Road, and Palpannai roundabout where vehicular movements are heavy.

Centrally located in the State, Tiruchi has been witness to increasing vehicle density over the years putting pressure on the existing road space.

This definitely calls for some long-term traffic management plan to effectively manage vehicular movements and check accident rate without resorting to cosmetic measures, say city residents.

Parking along the roadside shrinks the space and the absence of pavements along many thoroughfares forces pedestrians to walk on the road exposing them to speeding vehicles.

Constant awareness on disciplined and controlled driving along with strict enforcement of rules and a long-term traffic management plan alone can check the accident rate, says Dr. M.A. Aleem, former Vice Principal of K.A.P. Viswanatham Government Medical College and a city –based neurologist.

There are no proper markings on the speed breakers established along different stretches of the main roads which could cause accidents.

Furthermore, speed-breakers are unscientifically designed causing back breaking experience for the two-wheeler riders, says M. Sekaran, a consumer activist. Wrong-side driving on highways and drunk driving also result in accidents.

Many decisions taken at the periodic Road Safety Council meetings continue to remain unimplemented, says Mr. Sekaran. The corporation, highways, and the police should jointly come out with a traffic management plan keeping in mind the rising number of vehicles to check accidents.

More In: TAMIL NADU | NATIONAL

Growing vehicle density creates many killer roads - TAMIL NADU - The Hindu

Growing vehicle density creates many killer roads - TAMIL NADU - The Hindu

Tuesday, December 15, 2015

Dangerous Chemsex.Aleem M A .BMJ⁠ 2015;351:h5790

Editorials

What is chemsex and why does it matter?

BMJ⁠ 2015⁠; 351⁠ doi: http://dx.doi.org/10.1136/bmj.h5790 (Published 03 November 2015)⁠

Cite this as: BMJ⁠ 2015;351:h5790

Rapid response

Re: What is chemsex and why does it matter?

Dangerous Chemsex

Chemsex is one of the dangerous acts that may lead to addiction to drugs. This type of sex can also end up in trauma to the involved body parts and even in murderous acts and death in all ages and genders. Sometimes people involved in this may also be involved in drug and human trafficking and other anti social activities so chemsex should be banned.

Competing interests: No competing interests

12 December 2015

M A Aleem

Neurologist

ABC Hospital

Annamalainagar,Trichy 620018.Tamilnadu.India

Monday, December 14, 2015

Corporation submits Smart City proposal - Trichy The Hindu 15.12.2015

The Hindu
TIRUCHI, December 15, 2015

Corporation submits Smart City proposal


C. Jaisankar

The Tiruchirapalli City Corporation (TCC), which is aspiring to be figured among the top 20 municipal corporations in the country for implementing smart city programme during the current year, has submitted its Smart City Plan to the Tamil Nadu Urban Finance and Development Corporation (TUFIDCO).

Commissioner of Tiruchirapalli City Corporation M. Vijayalakshmi told The Hindu that the proposal was reviewed by a High Power Steering Committee on Saturday. It sought a few clarifications and suggestions. They had been clarified. The proposal had dealt in detail the retrofitting and pan city components.

The Ministry of Urban Development of the Centre had fixed December 15 the deadline for submitting smart city proposals.

It is said the TUFIDCO, which was the nodal agency for all 12 corporations that were chosen for the smart city programme in the State, will despatch the smart city proposal of Tiruchi to the Union Ministry of Urban Development in a day or two.

As per the proposal, Rockfort, Thillai Nagar, Gandhi Market, Thennur, Puthur, N.S.B. Road, Woraiyur, and Ammamandapam Road have been chosen for retrofitting (Area Based Development) component. Providing various solutions such as tourism corridor, heritage protection, water supply, sanitation, and civic aspects are part of the retrofitting component.

Introduction of a bus rapid transit system (BRTS) on a 24-km from Srirangam to Airport via Chathram Bus Stand will be the pan city component. There will be two routes in the BRTS. The first route will be 17 km from Central Bus Stand to Srirangam. The second route will cover 7 km from Central Bus Stand to Airport via K.K. Nagar. There will be three terminals at Central Bus Stand, Srirangam, and Airport. As many as 30 bus rapid transport stations will be set up. The BRTS will enable fast travel, citizens’ comfort, safe, and secure travel and improved connectivity.

Round the clock Closed Circuit Television surveillance at all bus stops and public places, WiFi connectivity at all public places, digital signages, and e-library at public places have found their place in the smart city proposal.

Recent Trichy Smart News In The Hindu Trichy

The Hindu
TIRUCHI, December 14, 2015

Contest winners

Special Correspondent



Former Vice Principal of K.A.P. Viswanatham Medical College, M.A. Aleem, has won the first prize in essay competition (citizen category) for his writing on My City-My Dream topic.

The second prize went to Nalliah, former Deputy Collector, of Cantonment and third prize to P.K. Raman of Ayyappa Nagar. It was conducted by the Tiruchi Corporation as a part of its efforts to involve citizens on preparation of smart city proposal.

In the essay competition for student category, Safiyulla of E.V.R. College received the first prize. While Rohini of Little Flower School, Manaparai, got the second prize, Delphia of Bharathidasan Arts and Science College secured the third prize.

In the competition for offering suggestions, Rema of SASTRA University bagged the first prize. Aasin of Class-IX of St. Marys Higher Secondary School, Abinaya of Saranathan College won the second and third prizes respectively.



The Hindu
TIRUCHI, December 10, 2015

Updated: December 10, 2015 05:42 IST

Draft Smart City plan moots BRTS, bicycle sharing


A majority of respondents want Rockfort and Thillainagar area for the project

The Thillai Nagar-Rockfort area is likely to be taken up for retrofitting under the Smart City Plan for Tiruchi.

Area-based retrofitting (development of an existing area of 500 acres) will be one major component of the Smart City initiative, apart from pan-city development.

The area has been favoured by a majority of respondents in the online public consultation exercise. While the Thillai Nagar-Rockfort area was favoured by 55 per cent of the online respondents, about 25 per cent favoured the NSB Road/Puthur area and 15 per cent of respondents considered Woraiyur-Amma Mandapam area to be ideal.

Forty-five per cent of people who gave their suggestions off line favoured the Gandhi Market area for development and 30 per cent were in favour of Thillai Nagar-Rockfort, according to Simon Selvaraj, associate director-strategic consulting, Jones Lang LaSalle (JLL).

Speaking at a stakeholders meeting to discuss the draft Smart City proposal drawn up based on the public consultation process here on Wednesday, Mr. Selvaraj said that an area covering the Rockfort, N.S.B. Road, Thillai Nagar, Gandhi Market, Thennur, Puthur, Woraiyur, and Amma Mandapam is being considered for the retrofitting plan under which various smart solutions would be implemented in terms of transportation, tourism promotion, heritage protection, water supply, sanitation, and other civic aspects.

He said the draft plan envisages smart tourism initiatives around the Rockfort and Amma Mandapam areas, redevelopment of Gandhi Market as a well organised retail market, establishment of multi-level parking, creation of pavements, smart feeder transportation services, uninterrupted water supply, underground cabling for electricity, improved solid waste, and wastewater management and promotion of solar rooftops.

Under the pan-city development initiative, the establishment of an integrated bus stand with a skywalk to connect the Railway Junction and the Central Bus Stand had been suggested.

Introduction of a bus rapid transit system (BRTS) on a 24-km Srirangam-Chathram Bus Stand-Central Bus Stand-K.K. Nagar-Airport route has been proposed. A bicycle sharing system had been mooted.

An investment of Rs. 1,149 crore had been proposed for the development projects under the area based retrofitting plan and projects estimated at Rs. 617 crore had been planned for pan-city development.

Mr. Selvaraj pointed out the allocation under the plan was Rs. 1,000 crore and preparation of the detailed project report and selection of specific projects would be done later. The draft plan would be submitted by the Centre by December 15 and Tiruchi would vie for selection of the first 20 cities for implementation of the Smart City Plan.

M. Sekaran, president, Federation of Consumer and Service Organisations, urged the consultant to focus more on pan city development.

A representative of Namma Tiruchi suggested that Central Bus Stand area should be taken for retrofitting rather than the well developed Thillai Nagar area. A member of Thaneer, a voluntary organisation, suggested use of recycled wastewater in parks rather than letting out in rivers.

Swaminathan, Dean, Planning and Development, National Institute of Technology, called for prioritisation of the challenges for implementing appropriate solutions.

R. Manoharan, chief whip, M. Paranjothi, and S. Valarmathi, MLAs, A. Jaya, Mayor, and M. Vijayalakshmi, Corporation Commissioner, were present


TIRUCHI, December 10, 2015

Updated: December 10, 2015 05:42 IST

Smart city plan envisages extension of underground drainage network

C. Jaisankar

Consultants present final draft proposal to the councillors

Extension of the underground drainage network of the city will be a major component to be executed under the Smart City Plan for Tiruchi.

The salient features of the draft proposal, which is to be submitted to the Ministry of Urban Development within December 15, were explained to the councillors at the corporation on Wednesday.

In a presentation, Simon Selvaraj, associate director-strategic consulting, Jones Lang LaSalle (JLL), said that extension of underground drainage system had been included in the retrofitting model. As per the plan, the UGD system would be extended to 16 more wards in the city. The existing system covered 98.7 km. The new plan would cover 30 km. Moreover, special emphasis would be on recycle and reuse of treated water. The efficiency of treatment plant would be enhanced to 100 per cent so as to ensure recycle and reuse of treated water.

A few councillors urged the corporation to include the areas of Vekkaliamman Temple and Vayalur Road in the tourism corridor component of the retrofitting plan. Some of them stressed the need for including their wards.

Intervening in the discussion, S. Nagesh, City Engineer, said the proposal had been finalised as per the established procedure and guidelines of the smart city initiative. There was a possibility of extending the smart city plan in the next phase. Left out areas would be included in it.

Mr. Selvaraj said there would not be big changes in the final plan except fine tuning. It would be submitted with the prescribed format to the Union Urban Development Ministry within December 15

Friday, December 11, 2015

My City My Dream smart city Trichy Corporation Compitition

Trichy corporation has conducted an essay competition for suggestion about smart city with the theme of "My city My dream" in three category sir. In My city My dream for citizen category Dr Aleem got first prize

Monday, December 7, 2015

CM orders relief packages - TAMIL NADU - The Hindu

CM orders relief packages - TAMIL NADU - The Hindu

TN govt. announces Rs.10,000 for flood victims - The Hindu

TN govt. announces Rs.10,000 for flood victims - The Hindu

Problem based and economy related approaches are the need of the hour to meet climate changes. Aleem M A. BMJ⁠ 2015;351:h6178

Editorials

Combating climate change

BMJ⁠ 2015⁠; 351⁠ doi: http://dx.doi.org/10.1136/bmj.h6178 (Published 18 November 2015)⁠

Cite this as: BMJ⁠ 2015;351:h6178

Rapid response

Re: Combating climate change

Problem based and economy related approaches are the need of the hour to meet climate changes

Different approaches are required for developed , developing and underdeveloped countries at different level to mitigate and prevent climate related catastrophes. Some countries depends on coal and other countries on diesel and wood. Health outcome are also different in every countries due to climate changes. So. Problem based and economy related approaches are the need of the hour for each country to face climate changes today and tomorrow

Competing interests: No competing interests

06 December 2015

M A Aleem

Neurologist

ABC Hospital

Annamalainagar .Trichy 620018 . Tamilnadu . India

Problem based and economy related approaches are the need of the hour to meet climate changes. Aleem M A. BMJ⁠ 2015;351:h6178

Editorials

Combating climate change

BMJ⁠ 2015⁠; 351⁠ doi: http://dx.doi.org/10.1136/bmj.h6178 (Published 18 November 2015)⁠

Cite this as: BMJ⁠ 2015;351:h6178

Rapid response

Re: Combating climate change

Problem based and economy related approaches are the need of the hour to meet climate changes

Different approaches are required for developed , developing and underdeveloped countries at different level to mitigate and prevent climate related catastrophes. Some countries depends on coal and other countries on diesel and wood. Health outcome are also different in every countries due to climate changes. So. Problem based and economy related approaches are the need of the hour for each country to face climate changes today and tomorrow

Competing interests: No competing interests

06 December 2015

M A Aleem

Neurologist

ABC Hospital

Annamalainagar .Trichy 620018 . Tamilnadu . India
Editorials

Combating climate change

BMJ⁠ 2015⁠; 351⁠ doi: http://dx.doi.org/10.1136/bmj.h6178 (Published 18 November 2015)⁠

Cite this as: BMJ⁠ 2015;351:h6178

Rapid response

Re: Combating climate change

Problem based and economy related approaches are the need of the hour to meet climate changes

Different approaches are required for developed , developing and underdeveloped countries at different level to mitigate and prevent climate related catastrophes. Some countries depends on coal and other countries on diesel and wood. Health outcome are also different in every countries due to climate changes. So. Problem based and economy related approaches are the need of the hour for each country to face climate changes today and tomorrow

Competing interests: No competing interests

06 December 2015

M A Aleem

Neurologist

ABC Hospital

Annamalainagar .Trichy 620018 . Tamilnadu . India

Roadside eateries cause havoc- THE HINDUTIRUCHI, December 7, 2015

THE HINDU
TIRUCHI, December 7, 2015

Roadside eateries cause havoc


C. Jaisankar

Tiruchi Corporation has not dealt with the issue with due importance



The failure of health authorities in checking the hygiene of roadside eateries in Tiruchi has raised concern among the people.



Similar to many other cities, Tiruchi is no exception to the mushrooming growth of roadside eateries. A section of unemployed youths and experienced “parotta” masters continue to set up roadside eateries in different places of the town. They invariably set up eateries at thickly populated places and busy commercial streets. Since it requires just a few foldable chairs and tables or rented carts, they find it convenient to set up eateries wherever they want.

A large number of roadside eateries are functioning in Central bus stand, Chathiram bus stand, Gandhi Market, Big Bazaar street, Singarathope, Chinthamani, Srirangam and Thiruvanaikoil. They run eateries in some of the upscale residential locations such as Thillai Nagar, K.K. Nagar, Cantonment and others as well. The number of eateries has reportedly doubled in the recent years thanks to the good patronage among the people, particularly poor, labourers, construction workers and load men. The eateries continue to spring up in and around Central Bus stand.

Besides roadside snack vendors, it is learnt that more than 300 roadside eateries and restaurants are functioning in Tiruchi. Several of them transact business only in the evening. Many of them function near clogged canals and garbage dumps. The vendors keep the cooked dishes uncovered. Moreover, dishes are prepared on pavements. The vendors and servers seem to be uncared for healthy and hygienic practices. Repeated use of oil, non-permitted colours and poor quality of water are some of the unhygienic practices followed by the eateries. The ongoing rain has compounded the issue. In spite of rain, many of them transact business in poor environment as usual.

M.A. Aleem, former Vice Principal of K.A.P.V. Medical College, Tiruchi, said that eating at unhygienic eateries and restaurants could lead to bacterial and viral infection. Cases of food poisoning had increased since the onset of monsoon season. Many of them had become sick after eating out at roadside eateries. Consumers blame the health and civic authorities for the issue. Though there are sufficient laws to ensure hygiene at roadside eateries, consumers rue that they have not been enforced properly.

Pointing out the role of civic authorities in ensuring hygienic in restaurants and road side eateries, they said that the Tiruchi Corporation has not dealt with the issue with due importance.



Saturday, December 5, 2015

Flooding and communicable diseases- Preventive measures

Flooding and communicable diseases

Preventive measures

Dr M A Aleem
Former Vice Principal
KAPV Govt Medical College and MGM Govt Hospital
Trichy




Communicable disease risks from flooding can be greatly reduced if the following WHO recommendations are followed.

Short-term measures

Chlorination of water

Ensuring uninterrupted provision of safe drinking water is the most important preventive measure to be implemented following flooding, in order to reduce the risk of outbreaks of water-borne diseases.

Free chlorine is the most widely and easily used, and the most affordable of the drinking water disinfectants. It is also highly effective against nearly all waterborne pathogens (except Cryptosporidium parvum oocysts and Mycobacteria species). At doses of a few mg/litre and contact times of about 30 minutes, free chlorine generally inactivates >99.99% of enteric bacteria and viruses.

For point-of-use or household water treatment, the most practical forms of free chlorine are liquid sodium hypochlorite, solid calcium hypochlorite and bleaching powder (chloride of lime; a mixture of calcium hydroxide, calcium chloride and calcium hypochlorite).

The amount of chlorine needed depends mainly on the concentration of organic matter in the water and has to be determined for each situation. After 30 minutes, the residual concentration of active chlorine in the water should be between 0.2-0.5 mg/l, which can be determined using a special test kit.

Vaccination against hepatitis A

The use of hepatitis A vaccines for mass immunization is not recommended.

Vaccination of high-risk groups, such as persons involved in the management of drinking water, waste water or sewage might be considered.

In case of an outbreak of hepatitis A consider immunization of contacts. The use of immunoglobulins is not recommended.

Diagnosis of acute hepatitis A is confirmed by anti-HAV IgM antibodies.

Malaria prevention

Insecticides: flooding does not necessarily lead to an immediate major increase in mosquito numbers, and there may still be time to implement preventive measures such as indoor residual spraying, or the retreatment/distribution of ITNs in areas where their use is well-known. This will also have an effect on other mosquito-borne diseases.

Early detection: it is important to track weekly case numbers and provide laboratory-based diagnosis (perhaps only for a % of fever cases to track the slide/test positivity rate), to pick up the early stages of a malaria epidemic.

Free medical care: with artemisinin-based combination therapy should be provided when a falciparum malaria epidemic is confirmed, and an active search for fever cases may be necessary to reduce mortality in remote areas with reduced access to health care services.

Health education

Promote good hygienic practice.

Ensure safe food preparation techniques.

Ensure boiling or chlorination of water.

Vital importance of early diagnosis and treatment for malaria (within 24 hours of onset of fever).

Handling corpses

Burial is preferable to cremation in mass causalities and where identification of victims is not possible.

The mass management of human remains is often based on the false belief that they represent an epidemic hazard if not buried or burned immediately. Bodies should not be disposed of unceremoniously in mass graves and this does not constitute a public health a public health measure, violates important social norms and can waste scarce resources.

Families should have the opportunity to conduct culturally appropriate funerals and burials according to social custom.

Where customs vary, separate areas should be available for each social group to exercise their own traditions with dignity.

Where existing facilities such as graveyards or crematoria are inadequate, alternative locations or facilities should be provided.

The affected community should also have access to materials to meet the needs for culturally acceptable funeral pyres and other funeral rites.

For workers that routinely handle corpses

Graveyards should be at least 30m from groundwater sources used for drinking water

The bottom of any grave must be at least 1.5m above the water table with a 0.7m unsaturated zone. Surface water from graveyards must not enter inhabited areas.

Ensure universal precautions for blood and body fluids

Ensure use and correct disposal of gloves (no re-use)

Ensure use of body bags

Ensure hand-washing with soap after handling bodies and before eating

Ensure disinfection of vehicles and equipment


Bodies do not need to be disinfected before disposal (except in case of cholera)

Vaccinate workers against hepatitis B

Long term measures

Legislative/administrative issues

Create Disaster-Preparedness Programmes and Early Warning Systems.

Improve surveillance on a local, national, international and global level.

Promote tap-water quality regulation and monitoring.

Enforce high standards of hygiene.

Technical issues

Improve water treatment and sanitation.

Keep infectious disease control programmes active and efficient.

Thursday, December 3, 2015

Rain and Flood Related Health Issues: Prevention is better than Cure-DOs and DON'Ts

Rain and Flood Related Health Issues: Prevention is better than Cure-
DOs and DON'Ts

Dr M A Aleem
Former Vice Principal
KAPV Govt Medical College and MGM Govt Hospital
Trichy



There are some common monsoon diseases – some are easily treated, while a few can be life threatening.

Monsoon Season not only refresh every living being after dealing with the sizzling heat of summers but even brings diseases along with it. Due to warn, wet and humid climate, Skin infections become common during the Monsoons. A few Tips how to prevent from Monsoon Diseases.

Malaria: 

This is the most common disease that catches you in the rainy season. This disease is spread by Female Anopheles mosquito. Since, there is a problem of water logging during the rainy season, mosquitoes get conducive conditions to bread. This is the most dangerous disease in India with highest number of deaths credited to it. Fever at regular intervals, bouts of shivering, muscle pain and weakness are the symptoms that a patient shows while suffering from Malaria.

Prevention:

Since this disease is spread by mosquitoes, so mosquitos’ repellents and net should be used to prevent it. Make sure that water does not stagnate in your area as mosquitoes breed in stagnant water. 

ABCD prevention of Malaria:

Awareness of risk of Malaria

Bite Prevention 

Antimalarial medication – Chemoprophylaxis (taking antimalarial 

Prompt Diagnosis and treatment.

Cholera: 

Cholera is another deadly disease. The bacterium that causes cholera is usually found in food or water contaminated. Also poor hygienic conditions help this disease to spread.

Normally spreads in places with poor sanitation facilities. Severe diarrhoeas with water stools is the most common symptom of cholera. There could also be vomiting with immediate water loose and muscle cramps.

Prevention: 

It always wise to get vaccinated as it lasts secures you for almost six months. 

Wash hands with soap and water frequently.

Drink only safe water including bottled water or boil water. Hot beverages are generally safe, as are canned or bottled drinks, but wipe the outside before you open them.

Eat food that’s completely cooked and hot and avoid street food vendor food.

Avoid sushi, as well as raw or improperly cooked fish or seafood of any kind.

Stick to fruits and vegetables that you can peel yourself.

Be wary of dairy foods including ice cream, which is often contaminated and unpasteurized milk.

Typhoid: 

Typhoid is a water-borne disease, and is very common during monsoon seasons. It is caused by S typtic bacteria, which is transmitted through consuming contaminated water and food. The worst part of that the infection of this disease can remain in the gall bladder of the patient even after it is cured. Most common symptom of this disease is prolonged fever, severe pain in abdomen and headache also indicate towards this disease.

Prevention: 

This is highly communicable disease so that patient should be isolated from the rest of the family. Getting Homoeo treatment helps. The patients should get high intake of fluid to prevent dehydration. Precautions should continue even after apparent recovery.

Viral Fever: 

Viral disease is a common disease all over the world, but during monsoon it’s more prevalent. Constant sneezing, sore throat and fever are the common symptoms of this disease.


Prevention: 

The easiest way is to avoid getting yourself wet in rain. The best home made remedy is a glass of hot turmeric milk. Gargles with warm water give relief to your sore throat. If things don’t improve then it is always better to see a doctor.

Gastrointestinal Infection: 

Unpleasant disease during monsoon is Stomach Infections such as gastroenteritis, which causes severe vomiting and diarrhea. In gastroenteritis, stomach and intestines are irritated and inflamed. The cause is typically a viral or bacterial infection.

Prevention: 

Wash your hands thoroughly after using the bathroom or changing diapers to prevent stomach infection.

Do not eat or drink foods or liquids that might be contaminated.

Thoroughly were fruits, vegetables which have been kept in the open for a while.

Keep your cutting board clean and keep separate cutting board for meat and vegetables.

Every day drink a lot of water to stay well hydrated and ensure that the water is clean and filtered.

Avoid consuming food that is spicy and rich in sugar.

Dengue - 

Mosquitoes are always a problem for us. When a mosquito bites a person infected by dengue virus, the virus enters the mosquito. When the infected 

mosquito then bites another person, the virus enters that person's bloodstream. Anopheles mosquito, dengue fever is caused by tiger mosquito.

Prevention: 

Mosquito bed could be used when the room is not air-conditioned. 

Aerosol and liquid spray has to be applied directly to the mosquito foe effective 

killing i.e. . Household pesticides.

Wear long-sleeved clothes and long trousers when going outdoors. Bodies could be protected from mosquito bite by applying insect repellent on clothes and exposed  part of the body especially when you travel to Dengue fever.

Chikungunya: 

Chikungunya is transmitted by the bite of infected Aedes albopictus mosquitoes. These mosquitoes breed in the stagnated water and bite during bright daylight.

Prevention:

Use air conditioning or window / door screens to keep mosquitoes outside. If you are not able to protect yourself from mosquitoes inside your home or hotel, sleep under a mosquito bed net.

Wear long - sleeved shirts and long pants.

Use insect repellents.

You can use Sunscreen and insect repellent, apply the sunscreen first and then repellent.

“Insect Repellent Use Safety”

Jaundice: 

Jaundice, is a yellowish tinge to the skin and sclerae (the white part of the eye) that is caused by hyperbilirubinemia (an excess of bilirubin in the blood). 

Body fluids may also be yellow. The color of the skin and sclerae varies depending on levels of bilirubin; mildly elevated levels display yellow skin and sclerae, while highly elevated levels display brown. 

Prevention: 

Vaccines for hepatitis (hepatitis A, hepatitis B)

Avoid heavy alcohol use

Take medications which prevent malaria before travelling to high-risk regions.

Avoid potentially contaminated food/water and maintain good hygiene

Leptospirosis: 

Leptospirosis is a fairly uncommon bacterial infection caused by a strain of Leptospirosis. It is most commonly transmitted from animals to human. It is often transmitted by animal urine or water containing animal urine coming into contact with breaks in the skin the eyes, mouth, nose or vagina 

Prevention: 

At work - If you have an occupation where you come into contact with animals sources of contaminated water, such as farming or working with sewers or drains, wear adequate protective clothing. This could include waterproof gloves and boots, goggles and a mask. 

Travelling abroad -

If you are travelling to parts of the world where leptospirosis is widespread, you may wish to limit your exposure to freshwater sources, such as 

rivers, ponds or lakes. If you are unable to avoid these, you should ensure you wear adequate protective clothing. You should also only drink sealed bottled water or fresh water that has been boiled. Try to minimise your exposure to animal urine by avoiding areas where animals may have urinated.Never touch a dead animal with your bare hands.

Animal vaccination - At the moment, there isn't a vaccine that protects humans from leptospirosis, but it is possible to vaccinate cattle, dogs and some other animals. If you think you may be at risk of contracting leptospirosis from one of your animals, you may want to consider getting them vaccinated.


PREVENTION OF WATER BORNE DISEASES IN RAINY SEASON-
DOs and DON'Ts



With the onset of monsoon come water-borne diseases. Gastroenteritis, Jaundice, Typhoid Fever, Cholera and Diarrhea are some very common water-borne diseases in rainy seasons. To be in the pink of health, it is important to take necessary precautions against these diseases. To do this, individuals and their family members should keep the following in mind :

DO's
· Nails should be cut short once every three days.
· Only filtered / branded bottle water should be consumed.
· Wash hands properly with soap and water before consuming food.
· If a person does not have a water purification system, he/she should drink water after boiling and cooling it .
· If a person is suffering from loose motions, he/she should immediately see a Doctor and drink ORS (Oral Re-hydration Solution) to prevent dehydration.
· ORS should be continued till loose motions stops.
· If a person is suffering from vomiting, he/she should not eat/drink anything, otherwise the frequency of vomiting will increase which will cause further water loss and electrolyte imbalance. Doctor should be consulted immediately.
· The expiry date of all packed eatables / drinks should always be checked before consumption.
· Drinking water container should be washed everyday.
· Only warm and fresh cooked food should be consumed.
· Plenty of water and fluids should be consumed before stepping out in the heat.

DONT'S
· Consumption of water, milkshakes and fruit juices from roadside vendors should be avoided.
· Avoid eating cut fruits, Chat and food material from roadside Vendors.
· Oily and spicy food should be avoided.
· Half cooked / pre-cooked / refrigerated food should not be consumed.
· Leaving home/office empty stomach should be avoided.
· Avoid sharing utensils while consuming food.
· Do not bite nails with the help of teeth.
· Do not expose food and beverages to flies.

· Never do self-medication. Neither take medicines directly from chemist shop. Medicines should always be taken after getting proper advice from a qualified doctor.

Rain and Flood Related Health Issues: Prevention is better than Cure-DOs and DON'Ts

Rain and Flood Related Health Issues: Prevention is better than Cure-
DOs and DON'Ts

Dr M A Aleem
Former Vice Principal
KAPV Govt Medical College and MGM Govt Hospital
Trichy



There are some common monsoon diseases – some are easily treated, while a few can be life threatening.

Monsoon Season not only refresh every living being after dealing with the sizzling heat of summers but even brings diseases along with it. Due to warn, wet and humid climate, Skin infections become common during the Monsoons. A few Tips how to prevent from Monsoon Diseases.

Malaria: 

This is the most common disease that catches you in the rainy season. This disease is spread by Female Anopheles mosquito. Since, there is a problem of water logging during the rainy season, mosquitoes get conducive conditions to bread. This is the most dangerous disease in India with highest number of deaths credited to it. Fever at regular intervals, bouts of shivering, muscle pain and weakness are the symptoms that a patient shows while suffering from Malaria.

Prevention:

Since this disease is spread by mosquitoes, so mosquitos’ repellents and net should be used to prevent it. Make sure that water does not stagnate in your area as mosquitoes breed in stagnant water. 

ABCD prevention of Malaria:

Awareness of risk of Malaria

Bite Prevention 

Antimalarial medication – Chemoprophylaxis (taking antimalarial 

Prompt Diagnosis and treatment.

Cholera: 

Cholera is another deadly disease. The bacterium that causes cholera is usually found in food or water contaminated. Also poor hygienic conditions help this disease to spread.

Normally spreads in places with poor sanitation facilities. Severe diarrhoeas with water stools is the most common symptom of cholera. There could also be vomiting with immediate water loose and muscle cramps.

Prevention: 

It always wise to get vaccinated as it lasts secures you for almost six months. 

Wash hands with soap and water frequently.

Drink only safe water including bottled water or boil water. Hot beverages are generally safe, as are canned or bottled drinks, but wipe the outside before you open them.

Eat food that’s completely cooked and hot and avoid street food vendor food.

Avoid sushi, as well as raw or improperly cooked fish or seafood of any kind.

Stick to fruits and vegetables that you can peel yourself.

Be wary of dairy foods including ice cream, which is often contaminated and unpasteurized milk.

Typhoid: 

Typhoid is a water-borne disease, and is very common during monsoon seasons. It is caused by S typtic bacteria, which is transmitted through consuming contaminated water and food. The worst part of that the infection of this disease can remain in the gall bladder of the patient even after it is cured. Most common symptom of this disease is prolonged fever, severe pain in abdomen and headache also indicate towards this disease.

Prevention: 

This is highly communicable disease so that patient should be isolated from the rest of the family. Getting Homoeo treatment helps. The patients should get high intake of fluid to prevent dehydration. Precautions should continue even after apparent recovery.

Viral Fever: 

Viral disease is a common disease all over the world, but during monsoon it’s more prevalent. Constant sneezing, sore throat and fever are the common symptoms of this disease.


Prevention: 

The easiest way is to avoid getting yourself wet in rain. The best home made remedy is a glass of hot turmeric milk. Gargles with warm water give relief to your sore throat. If things don’t improve then it is always better to see a doctor.

Gastrointestinal Infection: 

Unpleasant disease during monsoon is Stomach Infections such as gastroenteritis, which causes severe vomiting and diarrhea. In gastroenteritis, stomach and intestines are irritated and inflamed. The cause is typically a viral or bacterial infection.

Prevention: 

Wash your hands thoroughly after using the bathroom or changing diapers to prevent stomach infection.

Do not eat or drink foods or liquids that might be contaminated.

Thoroughly were fruits, vegetables which have been kept in the open for a while.

Keep your cutting board clean and keep separate cutting board for meat and vegetables.

Every day drink a lot of water to stay well hydrated and ensure that the water is clean and filtered.

Avoid consuming food that is spicy and rich in sugar.

Dengue - 

Mosquitoes are always a problem for us. When a mosquito bites a person infected by dengue virus, the virus enters the mosquito. When the infected 

mosquito then bites another person, the virus enters that person's bloodstream. Anopheles mosquito, dengue fever is caused by tiger mosquito.

Prevention: 

Mosquito bed could be used when the room is not air-conditioned. 

Aerosol and liquid spray has to be applied directly to the mosquito foe effective 

killing i.e. . Household pesticides.

Wear long-sleeved clothes and long trousers when going outdoors. Bodies could be protected from mosquito bite by applying insect repellent on clothes and exposed  part of the body especially when you travel to Dengue fever.

Chikungunya: 

Chikungunya is transmitted by the bite of infected Aedes albopictus mosquitoes. These mosquitoes breed in the stagnated water and bite during bright daylight.

Prevention:

Use air conditioning or window / door screens to keep mosquitoes outside. If you are not able to protect yourself from mosquitoes inside your home or hotel, sleep under a mosquito bed net.

Wear long - sleeved shirts and long pants.

Use insect repellents.

You can use Sunscreen and insect repellent, apply the sunscreen first and then repellent.

“Insect Repellent Use Safety”

Jaundice: 

Jaundice, is a yellowish tinge to the skin and sclerae (the white part of the eye) that is caused by hyperbilirubinemia (an excess of bilirubin in the blood). 

Body fluids may also be yellow. The color of the skin and sclerae varies depending on levels of bilirubin; mildly elevated levels display yellow skin and sclerae, while highly elevated levels display brown. 

Prevention: 

Vaccines for hepatitis (hepatitis A, hepatitis B)

Avoid heavy alcohol use

Take medications which prevent malaria before travelling to high-risk regions.

Avoid potentially contaminated food/water and maintain good hygiene

Leptospirosis: 

Leptospirosis is a fairly uncommon bacterial infection caused by a strain of Leptospirosis. It is most commonly transmitted from animals to human. It is often transmitted by animal urine or water containing animal urine coming into contact with breaks in the skin the eyes, mouth, nose or vagina 

Prevention: 

At work - If you have an occupation where you come into contact with animals sources of contaminated water, such as farming or working with sewers or drains, wear adequate protective clothing. This could include waterproof gloves and boots, goggles and a mask. 

Travelling abroad -

If you are travelling to parts of the world where leptospirosis is widespread, you may wish to limit your exposure to freshwater sources, such as 

rivers, ponds or lakes. If you are unable to avoid these, you should ensure you wear adequate protective clothing. You should also only drink sealed bottled water or fresh water that has been boiled. Try to minimise your exposure to animal urine by avoiding areas where animals may have urinated.Never touch a dead animal with your bare hands.

Animal vaccination - At the moment, there isn't a vaccine that protects humans from leptospirosis, but it is possible to vaccinate cattle, dogs and some other animals. If you think you may be at risk of contracting leptospirosis from one of your animals, you may want to consider getting them vaccinated.


PREVENTION OF WATER BORNE DISEASES IN RAINY SEASON-
DOs and DON'Ts



With the onset of monsoon come water-borne diseases. Gastroenteritis, Jaundice, Typhoid Fever, Cholera and Diarrhea are some very common water-borne diseases in rainy seasons. To be in the pink of health, it is important to take necessary precautions against these diseases. To do this, individuals and their family members should keep the following in mind :

DO's
· Nails should be cut short once every three days.
· Only filtered / branded bottle water should be consumed.
· Wash hands properly with soap and water before consuming food.
· If a person does not have a water purification system, he/she should drink water after boiling and cooling it .
· If a person is suffering from loose motions, he/she should immediately see a Doctor and drink ORS (Oral Re-hydration Solution) to prevent dehydration.
· ORS should be continued till loose motions stops.
· If a person is suffering from vomiting, he/she should not eat/drink anything, otherwise the frequency of vomiting will increase which will cause further water loss and electrolyte imbalance. Doctor should be consulted immediately.
· The expiry date of all packed eatables / drinks should always be checked before consumption.
· Drinking water container should be washed everyday.
· Only warm and fresh cooked food should be consumed.
· Plenty of water and fluids should be consumed before stepping out in the heat.

DONT'S
· Consumption of water, milkshakes and fruit juices from roadside vendors should be avoided.
· Avoid eating cut fruits, Chat and food material from roadside Vendors.
· Oily and spicy food should be avoided.
· Half cooked / pre-cooked / refrigerated food should not be consumed.
· Leaving home/office empty stomach should be avoided.
· Avoid sharing utensils while consuming food.
· Do not bite nails with the help of teeth.
· Do not expose food and beverages to flies.

· Never do self-medication. Neither take medicines directly from chemist shop. Medicines should always be taken after getting proper advice from a qualified doctor.

Rain and Flood Related Health Issues: Prevention is better than Cure-
DOs and DON'Ts

Dr M A Aleem
Former Vice Principal
KAPV Govt Medical College and MGM Govt Hospital
Trichy



There are some common monsoon diseases – some are easily treated, while a few can be life threatening.

Monsoon Season not only refresh every living being after dealing with the sizzling heat of summers but even brings diseases along with it. Due to warn, wet and humid climate, Skin infections become common during the Monsoons. A few Tips how to prevent from Monsoon Diseases.

Malaria: 

This is the most common disease that catches you in the rainy season. This disease is spread by Female Anopheles mosquito. Since, there is a problem of water logging during the rainy season, mosquitoes get conducive conditions to bread. This is the most dangerous disease in India with highest number of deaths credited to it. Fever at regular intervals, bouts of shivering, muscle pain and weakness are the symptoms that a patient shows while suffering from Malaria.

Prevention:

Since this disease is spread by mosquitoes, so mosquitos’ repellents and net should be used to prevent it. Make sure that water does not stagnate in your area as mosquitoes breed in stagnant water. 

ABCD prevention of Malaria:

Awareness of risk of Malaria

Bite Prevention 

Antimalarial medication – Chemoprophylaxis (taking antimalarial 

Prompt Diagnosis and treatment.

Cholera: 

Cholera is another deadly disease. The bacterium that causes cholera is usually found in food or water contaminated. Also poor hygienic conditions help this disease to spread.

Normally spreads in places with poor sanitation facilities. Severe diarrhoeas with water stools is the most common symptom of cholera. There could also be vomiting with immediate water loose and muscle cramps.

Prevention: 

It always wise to get vaccinated as it lasts secures you for almost six months. 

Wash hands with soap and water frequently.

Drink only safe water including bottled water or boil water. Hot beverages are generally safe, as are canned or bottled drinks, but wipe the outside before you open them.

Eat food that’s completely cooked and hot and avoid street food vendor food.

Avoid sushi, as well as raw or improperly cooked fish or seafood of any kind.

Stick to fruits and vegetables that you can peel yourself.

Be wary of dairy foods including ice cream, which is often contaminated and unpasteurized milk.

Typhoid: 

Typhoid is a water-borne disease, and is very common during monsoon seasons. It is caused by S typtic bacteria, which is transmitted through consuming contaminated water and food. The worst part of that the infection of this disease can remain in the gall bladder of the patient even after it is cured. Most common symptom of this disease is prolonged fever, severe pain in abdomen and headache also indicate towards this disease.

Prevention: 

This is highly communicable disease so that patient should be isolated from the rest of the family. Getting Homoeo treatment helps. The patients should get high intake of fluid to prevent dehydration. Precautions should continue even after apparent recovery.

Viral Fever: 

Viral disease is a common disease all over the world, but during monsoon it’s more prevalent. Constant sneezing, sore throat and fever are the common symptoms of this disease.


Prevention: 

The easiest way is to avoid getting yourself wet in rain. The best home made remedy is a glass of hot turmeric milk. Gargles with warm water give relief to your sore throat. If things don’t improve then it is always better to see a doctor.

Gastrointestinal Infection: 

Unpleasant disease during monsoon is Stomach Infections such as gastroenteritis, which causes severe vomiting and diarrhea. In gastroenteritis, stomach and intestines are irritated and inflamed. The cause is typically a viral or bacterial infection.

Prevention: 

Wash your hands thoroughly after using the bathroom or changing diapers to prevent stomach infection.

Do not eat or drink foods or liquids that might be contaminated.

Thoroughly were fruits, vegetables which have been kept in the open for a while.

Keep your cutting board clean and keep separate cutting board for meat and vegetables.

Every day drink a lot of water to stay well hydrated and ensure that the water is clean and filtered.

Avoid consuming food that is spicy and rich in sugar.

Dengue - 

Mosquitoes are always a problem for us. When a mosquito bites a person infected by dengue virus, the virus enters the mosquito. When the infected 

mosquito then bites another person, the virus enters that person's bloodstream. Anopheles mosquito, dengue fever is caused by tiger mosquito.

Prevention: 

Mosquito bed could be used when the room is not air-conditioned. 

Aerosol and liquid spray has to be applied directly to the mosquito foe effective 

killing i.e. . Household pesticides.

Wear long-sleeved clothes and long trousers when going outdoors. Bodies could be protected from mosquito bite by applying insect repellent on clothes and exposed  part of the body especially when you travel to Dengue fever.

Chikungunya: 

Chikungunya is transmitted by the bite of infected Aedes albopictus mosquitoes. These mosquitoes breed in the stagnated water and bite during bright daylight.

Prevention:

Use air conditioning or window / door screens to keep mosquitoes outside. If you are not able to protect yourself from mosquitoes inside your home or hotel, sleep under a mosquito bed net.

Wear long - sleeved shirts and long pants.

Use insect repellents.

You can use Sunscreen and insect repellent, apply the sunscreen first and then repellent.

“Insect Repellent Use Safety”

Jaundice: 

Jaundice, is a yellowish tinge to the skin and sclerae (the white part of the eye) that is caused by hyperbilirubinemia (an excess of bilirubin in the blood). 

Body fluids may also be yellow. The color of the skin and sclerae varies depending on levels of bilirubin; mildly elevated levels display yellow skin and sclerae, while highly elevated levels display brown. 

Prevention: 

Vaccines for hepatitis (hepatitis A, hepatitis B)

Avoid heavy alcohol use

Take medications which prevent malaria before travelling to high-risk regions.

Avoid potentially contaminated food/water and maintain good hygiene

Leptospirosis: 

Leptospirosis is a fairly uncommon bacterial infection caused by a strain of Leptospirosis. It is most commonly transmitted from animals to human. It is often transmitted by animal urine or water containing animal urine coming into contact with breaks in the skin the eyes, mouth, nose or vagina 

Prevention: 

At work - If you have an occupation where you come into contact with animals sources of contaminated water, such as farming or working with sewers or drains, wear adequate protective clothing. This could include waterproof gloves and boots, goggles and a mask. 

Travelling abroad -

If you are travelling to parts of the world where leptospirosis is widespread, you may wish to limit your exposure to freshwater sources, such as 

rivers, ponds or lakes. If you are unable to avoid these, you should ensure you wear adequate protective clothing. You should also only drink sealed bottled water or fresh water that has been boiled. Try to minimise your exposure to animal urine by avoiding areas where animals may have urinated.Never touch a dead animal with your bare hands.

Animal vaccination - At the moment, there isn't a vaccine that protects humans from leptospirosis, but it is possible to vaccinate cattle, dogs and some other animals. If you think you may be at risk of contracting leptospirosis from one of your animals, you may want to consider getting them vaccinated.


PREVENTION OF WATER BORNE DISEASES IN RAINY SEASON-
DOs and DON'Ts



With the onset of monsoon come water-borne diseases. Gastroenteritis, Jaundice, Typhoid Fever, Cholera and Diarrhea are some very common water-borne diseases in rainy seasons. To be in the pink of health, it is important to take necessary precautions against these diseases. To do this, individuals and their family members should keep the following in mind :

DO's
· Nails should be cut short once every three days.
· Only filtered / branded bottle water should be consumed.
· Wash hands properly with soap and water before consuming food.
· If a person does not have a water purification system, he/she should drink water after boiling and cooling it .
· If a person is suffering from loose motions, he/she should immediately see a Doctor and drink ORS (Oral Re-hydration Solution) to prevent dehydration.
· ORS should be continued till loose motions stops.
· If a person is suffering from vomiting, he/she should not eat/drink anything, otherwise the frequency of vomiting will increase which will cause further water loss and electrolyte imbalance. Doctor should be consulted immediately.
· The expiry date of all packed eatables / drinks should always be checked before consumption.
· Drinking water container should be washed everyday.
· Only warm and fresh cooked food should be consumed.
· Plenty of water and fluids should be consumed before stepping out in the heat.

DONT'S
· Consumption of water, milkshakes and fruit juices from roadside vendors should be avoided.
· Avoid eating cut fruits, Chat and food material from roadside Vendors.
· Oily and spicy food should be avoided.
· Half cooked / pre-cooked / refrigerated food should not be consumed.
· Leaving home/office empty stomach should be avoided.
· Avoid sharing utensils while consuming food.
· Do not bite nails with the help of teeth.
· Do not expose food and beverages to flies.

· Never do self-medication. Neither take medicines directly from chemist shop. Medicines should always be taken after getting proper advice from a qualified doctor.

Friday, November 27, 2015

No Clinical Knowledge No Confidence in Clinical Practice. Aleem M A.BMJ⁠ 2015;351:h6321

Views & Reviews

No Holds Barred

Margaret McCartney: Why less confidence may be a good thing

BMJ⁠ 2015⁠; 351⁠ doi: http://dx.doi.org/10.1136/bmj.h6321 (Published 25 November 2015)⁠

Cite this as: BMJ⁠ 2015;351:h6321

Rapid response

Re: Margaret McCartney: Why less confidence may be a good thing

No Clinical Knowledge No Confidence in Clinical Practice

Before a drug is going to be prescribed to a patient a doctor should know the details of that drug dosage, its usage, its side effects, adverse effect in a particular age and gender including transgender. Then only will doctors get the confidence to prescribe and fulfill the patients need. So without proper pharmacological knowledge and the patient's history and the expected complication with hormone replacement therapy we may not give a excellent health care. So guidelines are important along with regular updates to get confidence in clinical practice.

Competing interests: No competing interests

27 November 2015

M A Aleem

Neurologist

ABC hospital

Annamalainagar Trichy 620018 Tamilnadu India

Thursday, November 26, 2015

Dr M A Aleem Elected as Vice President for TAN

The Hindu TIRUCHI, November 27, 2015

Elected

M.A. Aleem, neurologist, ABC hospital, Tiruchi, and former Vice Principal of KAPV Government Medical College, has been elected vice-president of the Tamil Nadu and Pondicherry Association of Neurologists. He will hold the office for 2015-2017.



More In: TAMIL NADU | NATIONAL

Elected - TAMIL NADU - The Hindu

Elected - TAMIL NADU - The Hindu

Tuesday, November 24, 2015

International Day for the Elimination of Violence against Women-25th November 2015: Prevention



International Day for the Elimination of Violence against Women-25th November 2015

Everyone has a responsibility to prevent and end violence against women and girls, starting by challenging the culture of discrimination that allows it to continue.

2015 Campaign

Prevention is the 2015 theme of the International Day for the Elimination of Violence against Women on 25 November and of the UNiTE to End Violence against Women Campaign’s 16 days call for action.

A staggering one in three women have experienced physical or sexual violence in their lifetime—a pandemic of global proportions. Unlike an illness, however, perpetrators and even entire societies choose to commit violence—and can choose to stop. Violence is not inevitable – it can be prevented. But it’s not as straightforward as eradicating a virus. There is no vaccine, medication or cure. And there is no one single reason for why it happens.

As such, prevention strategies should be holistic, with multiple interventions undertaken in parallel in order to have long-lasting and permanent effects. Many sectors, actors and stakeholders need to be engaged. More evidence is emerging on what interventions work to prevent violence—from community mobilisation to change social norms, to comprehensive school interventions targeting staff and pupils, to economic empowerment and income supplements coupled with gender equality training.



16 days to “Orange the world”

From 25 November through 10 December, Human Rights Day, the 16 Days of Activism against Gender-Based Violence aim to raise public awareness and mobilising people everywhere to bring about change. This year, the UN Secretary-General’s UNiTE to End Violence against Women campaign invites you to “Orange the world,” using the colour designated by the UNiTE campaign to symbolise a brighter future without violence. Organise events to orange streets, schools and landmarks!

In India

A crime against a woman is committed every three minutes.

848 Indian Women Are Harassed, Raped, Killed Every Day

In 2013 over three lakh women were kidnapped, raped, molested—and in some extreme cases, killed—by men across the country. That's almost a 27 percent increase since 2012—and a year since

The picture in 2014 is no less grim. If you are a woman, whether you grew up in a rural or urban setting, lived at home or ventured into a new city away from family, work in an office or manage your house full-time—the fear of sexual harassment is real and constant.

According to data from the National Crime Records Bureau—the government agency that keeps track of the country’s crime rate—cases of violent abuse of women have steadily increased since 2009. By 2013, the number of such cases has increased by over 50 percent. That's over 848 women who are either harassed, raped or killed after abduction every single day. Some are sold off to traffickers.

Delhi is the worst offender in such cases. India's capital city is the epicenter of almost thrice the amount of sexual crimes against women than the national average. Though Andhra Pradesh in south India and Uttar Pradesh in the north register more than one-fifth of the total crimes against women, Delhi has by far the worst crime rate. It has also recorded the highest increase in percentage of rape cases across the country.

In 2013, almost 34,000 women were raped. That's a 35.2 percent rise from 2012, with the highest rate of increase in Delhi.


A sizeable portion of the rape survivors—over 13 percent—are under the age of 14 years. If you count all the women who are raped by the time they turn 18, that's almost 40 percent of the entire demographic of women rape survivors. Worse, almost all of these women are raped by their neighbours, parents, a close family member or other relatives. Rapes in 15 out of India's 35 states and Union Territories are only committed by people known to the survivor.

Delhi in the north, Assam and Tripura in the northeast, and Rajasthan in the west are the most unsafe states for women in India.


In December 2012, thousands of protesters flooded the streets of cities across India, demanding a safer environment for women. A 23-year-old female student had died from injuries sustained 13 days earlier, when six men raped and savagely beat her on a Delhi bus. The case gained international attention, and since then South Asian media have reported dozens more horrifying instances of violence against women, several involving tourists: a Danish woman was gang-raped in Delhi after asking for directions back to her hotel, and an American was raped while hitchhiking in the Himalayas.



These cases may reveal an increase in violence—or perhaps they reflect increased reporting by women to police, or heightened media attention. But they have certainly made a big impact on policy discourse in India.

In his first Independence Day speech, India’s current prime minister, Narendra Modi, chided the entire country, saying, “Today when we hear about these rapes, our heads hang in shame.” And since December 2012, numerous policies have been proposed (and several enacted) to stop this “war on women.”

In Tamilnadu


Violence against women in Tamil Nadu includes molestation, abduction, dowry-related violence, and domestic violence. In Usilampatti Taluk, around 6,000 female children were killed in a span of 2 years during 1987-88, accounting to the single largest instance of recorded female infanticide.


A major underlying cause of violence against women is the perception that married women are the property of their husbands. Alcohol use and the portrayal of women in the society and cinemas as sex objects are also believed to be major factors.

Tamil Nadu is the first Indian state to set up "all women police stations" to deal with crimes against women.

After the 2012 Delhi gang rape case in 2013, in which a girl was gang-raped in a moving bus, leading to her death, the Tamil Nadu government unveiled a 13-point action plan including installation of closed-circuit television (CCTV) in all public buildings and booking offenders in Goondas Act of 1982, that gives non-bailable retention up to 1 year.

Female infanticide



Female infanticide was more common during the 1980s in the southern districts of Tamil Nadu. In Usilampatti taluk, a taluk in Madurai District, around 6,000 female children were killed in a span of 2 years during 1987-88. The crime was detected in one of the maternity homes that reported loss of 95% female children born during the period. The female infants were fed with the poisonous juice of oleander plant almost on the day of the birth of the child. The practice was reported even during 1993. The other districts which had prevalence were Salem, Dharmapuri, Vellore (formerly North Arcot), Erode, Dindigul and Madurai, with North Salem, South Dharmapuri, South Dindigul and West Madurai accounting for 70 per cent of all cases. The people considered marrying the girl in the future a menace on account of their financial constraints.

The then government headed by Jayalalitha launched a cradle baby scheme in 1992 in Salem district that urged the parents to drop the child in the cradles instead of killing them.

There were educational programmes launched by the child health and welfare department of the state to create awareness. Dharmapuri district recorded as many as 1,002 registered cases of infanticide, the highest in the state during the year and it reduced to one during 2012. During the simultaneous period, the cradles baby scheme had 1,338 children having 1,272 girls.

The Tamilnadu government also launched another campaign in which the parents of girls undergoing sterilisation were compensated and a gold ring was presented to the girl on her 20th birthday to ease her marriage expenses.
Acid attack

The attack involves throwing acid to dismember or mutilate women. As per a report published on the attacks between March 2014 to September 2015, 200 attacks were recorded, 70.2% were on women. The major reason cited for 51% of the cases involved disgruntled persons who were denied love by the women involved and 42% were attacked by anonymous persons. The state had three fatalities during the period of 2012-14.

Causes

An analysis by the government of Tamil Nadu states that a major underlying cause of violence against women is the perception that married women are the property of their husbands. Within this cultural context, suspicions of infidelity, alcoholism, antagonism over dowries, a couple's infertility, and instigation by a man's relatives can lead to episodes of violence against women. Violence in films and media portrayals of women as sex objects are also cited as contributing to violence against women. In Tamil Nadu's patriarchal society, women sometimes have been punished by men for not producing a male heir. .



Prevention of Violence against women In Tamilnadu



TamilNadu is the first state in India to set up "all women police stations" (AWPSs) to deal with crimes against women.

The scheme was initiated by the then-chief minister of the state, J Jayalalithaa, during her first tenure in 1991-95. As of 2003, the state had around 188 AWPSs all over the state, most of which were located in the same building as the regular police station.


The AWPSs were set to handle cases related to women like sexual harassment, marital discord, child abuse, eve teasing, trafficking, suicides and dowry harassment. Activists believed that after the establishment of AWPSs, women were able to come out and report dowry-related crimes freely to the police women. The police women also reported that they received complaints related to sex tortures, which otherwise went unreported to their male counterparts.

To prevent Crime against women J Jayalalithaa, Chief Minister of Tamil Nadu, announced in assembly on 23 February 2013 a 13 points program to prevent violence against women for first time in India. she said
"We will strictly implement the requirement of installing CCTV in key public places and buildings as it enables surveillance of sexual harassment against women and catching the culprits."


There is a wide consensus across the world that crime against women is often under-reported. It is also reported that every twenty minutes, a woman is sexually assaulted. Some sections believe that there is a skew in the reported crime data against women.

The Tamil Nadu police have reported that the awareness among women has improved and they were less afraid to file complaints. The 2012 Delhi gang rape case in 2013, where a girl was gang-raped in a moving bus leading to her fatal death, was reported to have increased the awareness. Activists in that state have reported that the police who were earlier not registering such cases, have started registering them.

The Chief Minister of the State, J Jayalalithaa, announced in the assembly that a 13 point action plan was unveiled by the government post the Delhi Gang Rape like installation of Closed Circuit Television (CCTV) in all public buildings and booking offenders in Goondas Act of 1982, that provides for non-bailable retention up to one year. The government ruled that educational institutions, hospitals, cinema theatres, banks, ATM counters, shopping malls, petrol bunks and jewellery shops would be covered under the Tamil Nadu Urban Local Bodies (Installation of Closed Circuit TV Units in Public Buildings) Rules, 2012. It also ruled that state and central government offices with 100 employees or more and having an area of 500 square metres (0.12 acres) or more would be covered under the rule. The rule also stipulated a time period of six months for the installation in existing buildings, failing which, the licenses would remain cancelled or suspended. During 2013, the state government also launched a 24 *7 women's helpline monitored by senior police officials. The government also ordered speedy investigation in all the pending cases related to crime against women and setting up of fast track district courts to speed justice. The state also proposed to the centre to modify existing rules to render heavy punishments to the offenders to the tune of death and chemical castration.


Violence Against Women is Preventable

Physical, sexual and psychological violence strikes women in epidemic proportions worldwide. It crosses every social and economic class, every religion, race and ethnicity. From domestic abuse to rape as a weapon of war, violence against women is a gross violation of their human rights. Not only does it threaten women's health and their social and economic well-being, violence also thwarts global efforts to reduce poverty.

Violence is, however, preventable. Although no silver bullet will eliminate it, a combination of efforts that address income, education, health, laws and infrastructure can significantly reduce violence and its tragic consequences. First and foremost, abusive behavior towards women must be viewed as unacceptable. Communities need to have an important role in defining solutions to violence and providing support to victims. And men must be engaged in the process too, as agents of change standing alongside women to end violence.