RAKSHA

28 March, 2009

The male foreskin is dangerous- Circumcision protects .

Health information politicized

Doesn't the public have the right to know that male circumcision protects against HIV?

In 2007, the ethical landscape surrounding medical male circumcision (MC) suddenly lurched and shifted when the World Health Organization and UNAIDS declared unequivocally that the `efficacy of male circumcision in reducing female to male transmission of HIV has been proven beyond reasonable doubt.The male foreskin has been shown to have a high number of cells that were targeted by the HIV virus

Interestingly, evidence that MC had medical benefits has been mounting for more than 20 years. Not only does the procedure reduce the risk of HIV infection, it also has been shown to prevent urinary tract infections, sexually transmitted diseases, and penile and prostate cancers.

Researchers have even found that MC reduces the risk of cervical cancer in current female partners . In spite of that growing list of medical benefits, the issue has hovered just below the radar screen until several large randomised controlled studies from Africa showed that circumcision offered a 60% to 70% protective effect against the heterosexual acquisition of HIV. The evidence was so compelling that three of the studies were stopped early, on the recommendation of Data Safety and Monitoring Boards

The Government of India has been reluctant to approach an issue that promises to be controversial among conservative Hindus. MC is considered a marker of religious identity since Muslims routinely circumcise their male children, and Hindus do not. It has been suggested that at times, circumcision status may even have been used to identify people`s religious affiliation during communal riots. Popular wisdom holds that even the mention of MC in some communities will trigger sectarian violence. Predictably, some opponents have argued that the greater good of society must be protected by withholding information about MC from the population.

This is a joke, surely?

They wont tell the benefits of circumcision because they want to use it to identify Muslims?

The benefits of circumcision include:

• Decrease in physical problems involving a tight foreskin [Ohjimi et al., 1995].

• Lower incidence of inflammation of the head of the penis [Escala & Rickwood, 1989; Fakjian et al., 1990; Edwards, 1996].

• Reduced urinary tract infections.

• Fewer problems with erections, especially at puberty.

• Decrease in certain sexually transmitted infections (STIs) such as HIV, HPV, genital herpes, syphilis and other micro-organisms in men and their partner(s).

• Almost complete elimination of invasive penile cancer.

• Decrease in urological problems generally.

Other proofs of advantages of circumcision

Removal of the foreskin of the penis (male circumcision, MC, C) is known to significantly reduce female-to-male HIV transmission through sex, which then decreases male-to-female transmission. Three recent randomized controlled studies from Africa have shown that circumcision offers a 60% to 70% protective effect against heterosexual acquisition of HIV. The protective effect of circumcision against HIV, known since the 1980s, has been confirmed by more than 30 studies before these three famous randomized controlled trials, which are the criterion standard of clinical research.

-Distance education in Medical and paramedical sciences

Image by interplast via Flickr

In a developing country such as India, where an optimal level of health service is a dream to many, there are far too few health workers in training and the number of training institutions is far too few. To understand the gravity of the situation, ther r r re are more than 365,000 doctors, 264,000 nurses and 350,000 allied health professionals which includes Multipurpose Health Workers, Village Health Guide, etc. Whereas, proper training facilities exist only at a few institutions like National Institute of Health and Family Welfare (NIHFW), State Health and Family Welfare Training Centers. With a limited number of available training institutions, it is nearly impossible to train large numbers of medical officers and paramedical workers. Nearly 47 Health and Family Training Centers (HFWTC's) and seven Central Training Institutes (CTIS) provide health and family welfare training to all categories of health functionaries in the country. These long-duration training programs attract a limited number of clients, and hence most of the institutions also organize in-house short-term training programs which has less than the desired impact on their functionaries.

Distance education is a relatively new concept which not only has the ability to train a large number of health care workers in a short time in a cost effective way but can also attend to skills of health care without diluting the quality.Distance teaching-learning often involves a multi-media approach to design, develop and implement independent learning programs through self-instructional materials, both in print and electronic media forms. Distance study allows self pacing for convenience and also facilitates learners having control over their learning. The various media used for distance education delivery include among others, print materials, audio and video programs, radio and television programs, tutoring and counseling, field visits, laboratory practicals, extended contact programs, and teleconferencing.

The following issues need to be addressed and considered for successful application of distance education programs for health professions:

1. Since health sciences deal with life and death and are therefore are more skill-oriented (rather than more knowledge-based), it is felt that providing basic beginning or early training in the field of health may not be feasible through distance learning. Being an innovative and flexible system, and having the ability to respond to emerging training and educational needs, distance education is more appropriate for inservice training of health personnel.

2. The academic programs have been confined to a limited area of health education and training. In order to meet the diversified and emerging needs of health workers, the programs and courses have to go beyond medical graduates to include a wide variety of need-based functional areas ranging from simple awareness programs to more complicated skill-oriented courses on epidemiology and health economics.

3. Application of sophisticated communication technology has to be done cautiously, keeping in view clients needs, cost, media behavior and infrastructure and facilities at the receiving end. In the developing countries including India, audio and television programs seem to be more feasible and promising. Furthermore, multi-media packages need to include a large amount of hands-on and field experience.

4. An issue to be deliberated is the provision of student support services for health workers and professionals. While compulsory counseling and extended contact increase the effectiveness of programs, these on the other hand pose problems to both providers as well as the receivers of health education. More practical-oriented courses need to have compulsory built-in face-to-face components; and work centers or practice centers at grassroots level with required instructional provisions would be more feasible than regular study centers.

In conclusion, it is worth noting that distance education has tremendous potential for providing education and training programs to different categories of medical and paramedical personnel as a means of helping achieve the goals of HFA. In addition to the national agencies such as the Ministry of Human Resources Development, the Ministry of Health & Family Welfare and Indira Gandhi National Open University, international agencies such as WHO and UNICEF need to play increasingly prominent roles in facilitating the achievement of national and institutional targets. Proper use of ISRO provided satellite communication facilities can make distance education courses an important aspect of ongoing medical education.

17 February, 2009

-New test to say if dengue vaccine is safe

Image via Wikipedia

Researchers have developed a test to determine whether vaccines against dengue virus would really protect patients from infection, or would make it more dangerous for them.

"Our stNew test to say if dengue vaccine is safeudy shows that the new test is likely superior to the standard test in its ability to tell whether a patient's response to a vaccine is safe," Associate Professor of Medicine at the University of Rochester Medical Centre (URMC) and co-author of the study Xia Jin said.

Cases of tropical, mosquito-borne dengue fever have been expanding globally for more than 50 years, with nearly a third of the human population in 100 countries now at risk of infection with the four types of dengue virus.

Infection with the dengue flavivirus, which is related to West Nile Virus and Yellow Fever, annually results in an estimated half a million hospitalisations and 22,000 deaths, mostly among infants, according to World Health Organisation (WHO).

After decades of absence in the US, the disease is causing illness again along the Texas-Mexico border, experts say and add that widespread dengue infection in the continental US is a real possibility, reports IANS.

A typical dengue infection confines a patient to bed for more than a week with fever and severe limb pains, but most recover. In less than five per cent of cases, however, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), often deadly complications, develop just as the fever breaks.

Mostly affecting babies between five and eight months, DHF causes victims to vomit and pass blood in their feces and urine. If diagnosed quickly, patients respond to intensive hospital treatment and fluids, but mortality can reach 15 per cent when undiagnosed.

DSS comes when the infection has caused so much fluid to leak out of capillaries that there is not enough blood to supply organs. As of 2008, there were no antiviral drugs designed to treat dengue and no drug candidates in late-stage development, an URMC release said.

09 February, 2009

-Mobile healthcare in Punjab

Image via Wikipedia

Mobile healthcare unit launched

Chandigarh: In a bid to increase accessibility of the rural people for getting better healthcare, the Chandigarh Administration has started a Mobile Medical Unit (MMU) to provide healthcare services at the door steps of the rural people.

MMU not only facilitates access to basic services of healthcare, but also provides essential knowledge and information on the kind of services under the umbrella of National Rural Health Mission (NRHM).

The Unit, a hospital on wheel under the flagship programme of NHRM, has been pressed into service in the union territory (UT) as joint venture with the Guru Granth Sahib Sewa Society.

A team consisting of eye specialist, gynaecologist and dentist will provide specialist services from within the van. Two doctors of Health Department along with RCH staff will provide primary health care facilities including MCH and immunisation services.

Initially, 10 villages have been identified which will be visited by the team fortnightly.

Information, education and communication (IEC) material on health education including personal hygiene, proper nutrition, hazards of tobacco consumption would be displayed and health awareness about various ongoing national programmes will be imparted.

04 February, 2009

-Prozac- Things to know before you use it.

Prozac What You Should Know Before You Use
Prozac or ( Fluoxetine Hydrochloride ) is a commonly used antidepressant in clinical practice. It has shown excellent results and is often used by people/patients even without proper prescriptions. Is that safe??

Below is a slideshow i have prepared detailing a few important facts about Prozac use. Also incorporated is a video which will further enhance comprehension about this widely used drug.

View more presentations from Neelesh Bhandari. (tags: bhandari neelesh)

02 January, 2009

-Human rights abuses contribute to Malaria

Human rights abuses contribute to malaria

Medecins Sans Frontieres

recently listed 10 top crisis areas that highlight in many instances the interrelation between human rights abuses and poor health. Recent news on two of these areas, Zimbabwe and Burma, shows even stronger links to malaria.ZWNews quotes an IRIN report: “‘There is no food, we have malnutrition, there is cholera, now we are expecting a malaria outbreak,’ said an exasperated Amanda Weisbaum, the emergency manager for Save theChildren, UK, in Zimbabwe.” After suffering cholera and malnutrition, “With the onset of rain, there are mounting concerns of a possible malaria outbreak ravaging immune systems weakened by cholera and malnutrition, ‘especially among those aged under five,’ said Weisbaum.”The government even recognizes the threat of the rainy season. The Herald reports that …

HARARE City Council has embarked on a programme to
clear stormwater drains with the assistance of residents under the
food-for-work programme at a time the United Nations Children’s Fund
has contracted trucks to speed up the removal of refuse in the city as
a measure to curb the spread of malaria and cholera.Under the
programme, residents in high-density suburbs are paid for clearing the
drainage systems in their respective areas.

A BBC reporter notes that, “The country that was once the jewel in Africa’s crown, able to feed itself, heal its sick and educate its people to the highest standards on the continent, is now in a pitiful state.” The BBC has been showing the link between Zimbabwe’s current problems and its
human rights violations that contributed to the present economic, political and health crises.

In eastern Burma “Access to maternal health-care is extremely limited and poor nutrition, anemia and malaria are widespread in eastern Burma, which increases the risk of pregnancy complications,” was a finding of researchers from the Johns Hopkins University, as reported in Medical News Today. The full article in PLoS Medicine reported that, “Few women had received iron supplements or had used insecticide-treated bednets to avoid malaria-carrying mosquitos.
Consequently, more than half the women were anemic and 7.2% were infected with malaria parasites.”

The Burma situation results from “Human rights violations - such as displacement and forced labor - (that) are also widely present, and in some communities forced relocation doubled the risk of women developing anemia and greatly decreased their chances of

receiving any antenatal care.”

A disregard for human rights and a breakdown of health services, especially for the most vulnerable, appear to go hand in hand. Another call for peace in 2009 is urgent.

01 January, 2009

- The best medical blogs of 2008.

Medgadget.com is sponsoring "The Best Medical Weblog Awards of 2008.".

My blog drneelesh@Raksha has made it to the Final list of Nominees as Best NEW Medical blog of 2008.. At stake is the title and a PDA. In all, Fifteen entries were chosen as the final nominees in this category..Other categories include Best Clinical sciences,

Image by drneelesh via Flickr Health policies,Best blog on Medical ethics, Best Literary Medical, Health IT, Patient centered, e.t.c. Now the final "awardees" will be chosen via an internet voting system. All you have to do to vote is scroll to the bottom of the nomination-list page and write in a comment here about my blog or simply second my blogs nomination.

My Blog looks at Medical issues from the eyes of a pathologist , e.learning enthusiast and a Health Rights pro-activist. My page may take some time to load ( the left half of the page is slightly data heavy, but be patient. The wait will be worth it!).There are a number of ways to interact with me. You can also search my virtual library (my references, bookmarks,images,articles,blogs, etc). via this website.

So do check out my blog and don't forget to comment on Medgadget.com. I would love to get my hands on this piece of electronics.

Dr.Neelesh Bhandari
M.B.B.S (AFMC),M.D (Path)
P.G.P in Human Rights

Chief Mentor ( RAKSHA)
Registered society for knowledge and health activities.

Chat: