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HIV AIDS: Where government has gone wrong, What government can do

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HIV Aids in India where government has gone wrong

Photo: The Hindu

As another world AIDS day passes by and the epidemic shows no sign of end, we need to evaluate the status of AIDS in India. Our country is one of the hotspot of acquired immunodeficiency syndrome (AIDS), an incurable syndrome that eventually befalls on large fraction of human immunodeficiency virus (HIV) positive individuals. While globally the number of AIDS patients has started to stabilize but epidemic is nowhere close to being over. This global epidemic has already turned out to be a major killer of humankind on an epic scale comparable to black death and smallpox. As per the latest estimates by UNAIDS, it is the fourth leading cause of death. In India, the state of affairs is so unsatisfactory that we still have frequent cases of mass infection of poor patients due to the negligence of hospitals, horrible mistreatment of HIV positive individuals and lack of even basic care for millions of AIDS patients. While the problems of AIDS in India are manifold and would require efforts from all the sectors of Indian society, in this article we want to bring forward key failures of the Indian government. We focus on five core issues that require immediate attention, if we wish to see the tail of this AIDS epidemic:

  1. Demographic and epidemiological understanding
  2. Awareness
  3. Screening and counselling
  4. Treatment facilities and medicines
  5. Need to develop indigenous cures

Demographic and epidemiological understanding: In India, it is difficult to trust the total number of AIDS patients, as grossly contradicting government figures makes one wonder if the actual magnitude of the epidemic is even larger than what is currently reported. The latest estimates released by the National AIDS Control Organization (NACO), an organization run under the auspices of the ministry of health, indicates that national adult HIV prevalence in India is approximately 0.29%, which corresponds to an estimated 3.4 million plus people living with HIV in our country (Annual report NACO 2009-2010). In contrast in 2005, NACO reported 5.21 millions HIV positive individuals. One can only wonder if such a change in the figures is an effort to put lipstick on the pig or there was a fundamental error in one of the two estimates. There has been some beating around the bush, blame laying and unsatisfactory explanations in response to this contradiction but if there was a genuine error then what is conclusively being done to avoid future errors, is currently not clearly known. Apart from getting the right overall numbers, what is also needed, is detailed demographic and epidemiological data. Different strains of HIV are prevalent in the different parts of the world and progression of AIDS is also different in people of different genetic background, for example there is a very small fraction of people that innately do not contract AIDS. Such trends of immunity to AIDS are either absent or currently not known in the Indian population. It is rather appalling that in India, the land that holds genetic diversity next to the continent of Africa, we for some silly reasons have been using data solely from the White Caucasian populations. This over dependency on western data is wrong for three reasons: 1) The strains of HIV prevalent in different regions are different, 2) The genetic diversity of India makes comparison to one ethnic group meaningless and 3) Apart from the Anglo-Indians with significant European heritage, no ethnic group in India, whatever be their surname and notions of self identity, share that close of genetic identity with the European populations to justify the current usage. What is needed is to understand the spread of different strains of HIV in India and the progression of diseases in individuals with a different genetic background.

Awareness: The first case of AIDS in India was diagnosed way back in 1986. Subsequently some apparent movement of bureaucratic and political machinery took place that in the following year resulted in the formation of National AIDS control program (NACP). In reality, the understanding of Indian government and media on the danger of this disease was largely missing until recently and is still rather poor. Even till late nineties, it was not entirely uncommon to hear voices in the Indian media claiming that AIDS is likely a trouble of promiscuous foreign lands and not of a conservative India. The media and the government forgot that this land of billion plus is first the land of Kamasutra and then of Gandhian moral curtains. Such ethnic biases that come wrapped in moral judgments cost lives everywhere. Even in the United States, initially AIDS was largely thought to be a disease of homosexuals and Afro-Americans, a curse of God for the decadent. In India, the lackadaisical approach in dealing with AIDS was also due to undermining the spread of HIV through blood transfusion and not realizing the severity of needle sharing by drug addicts and poor hospital administrative/clinical measures. As an addition to the existing policy, firstly the government needs to be aware of the full cost of AIDS and then it needs to take action to better inform the health care professionals and public at large. Media also adds to the trouble by rarely looking beyond less glamorous issues than some odd cricketing century of Tendulkar or birth of Bachchan granddaughter, occasionally mentioning somewhat sensational denial of basic services to HIV positive individuals or some innocent people being infected at a mass scale, instead of serious discussion of issues. Serious discussions, even when managing to creep in from the nooks and crannies of the sensational mainstream news, fails to gather attention beyond one media cycle.

Is this lack of information spread, a result of lack of resources or is it due to lack of political will? A significant chunk of taxpayer’s money on AIDS, like any other resource in India has been squandered with significant chunks making it to the chauffeurs of the corrupt. Lack of adequate money is definitely a problem, but a relatively minor one, compared to the mismanagement of the available resources. An approach for awareness, with low cost and huge promise, is the proper training of health care professionals. Mandatory improvements in the syllabus of medical schools and compulsory training of health care professionals to be better deal with immunocompromized AIDS patients, providing all medical services to HIV positive patients and to counsel patients on screening and precautions can be a game changer. While some namesake changes have been made in some medical curricula of advanced training but none to the internationally acceptable standards and barely any that impact primary care providers dealing with majority of patients. Formulation and implementation of laws against discrimination of HIV positive patients is also needed urgently. Another dimension of information dissemination and care is to focus on special groups. Recent international attention and support from charitable organizations along with government of India’s initiatives on free distribution of condoms to sex workers has been very productive. Successful select programs are currently targeting high-risk populations like truck drivers and sex workers but the biggest group with this affliction is currently ignored. This group is of the displaced urban poor migrant workers who are forced to work in non-native cities and seek sexual favours in questionable places. In a nation, that is busy unsuccessfully dealing with the symptoms of poverty and displacement, by the means of handouts that reach only select few and harassment to silence dissent, one needs to cure the actual disease of poverty that accentuates problems such as AIDS by means of holistic socio-economic development.

Screening and counselling: Roughly 85% of new infections are via the heterosexual route and efforts towards premarital counselling for HIV can reduce half to three fourth of this spread. In Goa and Andhra, the high prevalence states, the state governments proposed bills in 2006 to make HIV testing compulsory before marriage, but ethical concerns and political issues have thus far stopped the actual implementation. This issue of mandatory testing poses a real ethical concern as on one hand we do not have any patient confidentiality where people are denied their due rights due to their HIV status and on the other hand, who can justify the infection to innocent spouses, mostly females via their less than faithful counterparts? One needs to evolve a system where an employer and an insurer, cannot know the HIV status of the patient but a spouse can. It is not going to an easy nut to crack for any government, leave alone Indian, but the administration has not even started inching in the right direction of evolving such a mechanism.

Treatment facilities and medicines: National AIDS control program (NACP-III, 2007-2012) of India has a total budget of about 2.6 billion dollars but only a minor fraction of it is for the treatment. This is unacceptably low amount of money being spent on treatment, especially the amount that finally trickles down the bureaucratic apparatus. One may wonder what do we mean by treatment of an incurable syndrome? The progression of HIV positive individuals to AIDS is very different. Once patient contracts full blown AIDS his/her survival can vary from months to decades. This survival, apart from patient to patient variability, depends on the availability of antiviral drugs and treatment facilities. It is possible that India may have lost much of its potential to produce generic and cheap anti-retroviral relief due to twists in the international politics and India’s easy compliance with pressures. It is possible that recent aid to African countries to counter AIDS, has likely come with strings attached as they have almost stopped use of cheaper generic anti-retroviral drugs. Indian anti-retroviral drugs that were much cheaper than Western products have not just lost a market in Africa but their share in India is also tapering. We would recommend evolution of an informed policy that considers efficacy and costs of all compounds with the goal to save as many lives as possible.

Need to develop indigenous cures: Let us focus on vaccines, a preventative approach that actually holds a long-term cure of AIDS. While there have been some sporadic islands of successes in the ocean of failure in finding vaccine for AIDS, the international efforts are finding new promises and ruling out failed ideas with every passing day. We wonder why not a single significant effort worthy of mention is being pioneered in India? Given that we as Indians have become comfortably numb to the thought of India as a second or third grade country that is a recipient of high-end technology and fruits of scientific research, an average Indian, even if bluntly reminded of the state of affairs, howsoever offended, will not break sweat for long about the lack of innovation. The concern is far graver than the lack of innovation and the lack of national pride. If we need vaccine for AIDS, as soon as it is available in the West, unlike the case with polio or smallpox, we cannot take our begging bowl to world as we did in early years after independence or grossly overpay our way out, as we frequently do to procure any technology, ranging from our medicines to our warplanes. The problem with HIV vaccine stems from to the issues of demographics and epidemiology. Different strains of HIV are prevalent in different parts of the globe. HIV is very diverse, in fact some strains only show 40% homology between each other, not that different of genetic homology between you and a banana and in fact less than you and an earthworm. Thus to combat a hyper-mutable virus one needs to work on local strain and keep local population genetic profile and overall epidemiology in mind to solve the AIDS epidemic in India.

Will India rise to the challenge novel anti-retrovirals and indigenous vaccine? Likely not. Even in the well developed sectors like information technology, India only delivers small software packages for foreign products and does not manufacture a single major internationally recognizable product. This is not due to dearth of scientists or of money. In fact, India has very high numbers of biomedical scientists and research institutions spread across the country for the size of its economy. The problem is of incompetence, lack of management, corruption and nepotism. The political infestation of research is palpable in Delhi where corruption and lack of accountability permeates all levels of research epithet. One need not go into the obvious appointment of unqualified vice chancellors and administrators of universities and directors of research institutes based on proximity to political parties in power. A look at say, the University of Delhi University, a supposed prime University of India, can give you an idea of the political stooges running the show of research in India. Apart from corrupt management, there exist a large number of the so-called scientists who do not have a single major internationally known finding to their name but are busy sliding papers in “friendly” obscure journals and frequently get awarded national and regional honours. This abysmal state of affairs keeps very successful and patriotic scientists out of this Indian swamp that is sure to kill any good science.

In summary, current government efforts are either missing or misplaced and are largely wrought with corruption and inefficiency. A significant blow can be landed to AIDS epidemic with effective government policies. We hope that this article along with many other efforts raises awareness of public and its representatives for better combating the scourge of AIDS.

Dr. Sukant Khurana is a New York based scientist, artist and writer of Indian origin. His basic research involves neurophysiology, computational neuroscience, sensory perception, addiction, learning and memory, while his applied research extends into many areas of drug discovery and problems of the developing world. Both his visual art and writing explore the issues of modernization, displacement and identity.

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Things that you need to consider before having a lumbar disk replacement surgery

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lumbar disk spinal chord

In the world are many people who have difficult or problem with their spine. For that reason, is very common to see people having a lumbar disk replacement surgery recovery, after having had an intervention in the operating room to improve their health conditions. This kind of surgery usually doesn’t represent a risk for patients, but sometimes is necessary to know aspects that need to be considered before having this surgery.

A surgery is needed?

Spine problems can generate pain and make people have an unhealthy posture. This makes necessary to solve any problem associated with it to have a great life condition and to avoid any risk associated with spine diseases. Unfortunately there are many people who, for one reason or another, need an intervention in the operating room, due to the wear on their spine

Is a solution to many spine problems that could be generating difficulties or pain to patients. Recovery from lumbar disc replacement surgery requires that the patient receive rehabilitation for a few months for optimal results. This surgery has a fast recovery and doesn’t represent any risk of having it. It is a way to ensure the recovery of the spine; even about 80% of people can return to sports.Therefore, it’s normal that professionals recommend it as the first way to cure any disease related to the spine.

Despite all this, there are some indications or information that people need to know before having a lumbar disk replacement surgery. This will make the patient be more confident about this surgery and will make them to pass all this process with no difficulty. 

Here you will find full information about some things that need to be present before having this type of surgery. This will be essential to have the best process and have a fast surgery recovery.

What kind of things are necessary to consider before having a lumbar disk replacement surgery?

The degeneration of the parts of the spine can cause many health problems that, in the long run, they can bring serious health diseases. Therefore, having a lumbar disk replacement will be beneficial to patients. Despite this, is recommended to consider some aspects before decide or not to have this type of surgery.

Some main aspects that you need to think about before having this type of surgeries, are:

  • Find the best center: it’s necessary to consider many spine centers that can do this surgery with no problem. Also, is recommended to compare all options to determine which will be the best for your needs. This will help you in the surgery recovery and to avoid any possible risk.
  • Collect any information about the surgery: it’s indispensable to collect all the information about this surgery. For example, any risk, costs, recovery plan and the knowing about if this replacement will fix any health problem or disease.
  • Determine the quality of the artificial lumbar disc: it’s necessary to know the quality of the object that will be used on the surgery. This will understand any possible risk using this artificial product and will let you know if is the best option at this moment.
  • Ask for not intrusive solutions: if you have any problem with the lumbar disk or the spine, it’s recommended to have a not intrusive treatment, instead of having a surgery or disk replacement. Therefore, try to only have surgery at the last option. 
  • Find a plan of recovery and prevention: have a lumbar disk replacement has its problems and risk. Therefore, always it’s recommended to follow some recommendations and plans to keep your spine healthy. All this can be determined by a professional in this area, which will give you the correct information and indications about the after surgery treatment. 
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Treatment of Bunions and Claw Toes

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Bunions have some obvious signs, such as a deviation of the big toe and a bony protuberance in the joint. Claw toes are the result of anatomical imbalances, which cause the deformity. Do you know what is the best treatment for bunions and claw toes? Keep on reading and take notes! 

Bunions and Claw toes Facts

When suffering with bunions it is common to have joint swelling and pain, caused by the deviation of the first toe towards the second toe, accompanying the bone prominence on the outside of the foot. Further deformities may also develop, such as hammer or claw toes. Bunions and claw toe deformities do not appear from one moment to another; the deformity develops gradually throughout life, although in some cases it can evolve fast.

Are bunions and claw toes common all over the world? No, because bunions occur almost exclusively in people who wear shoes. So it may be strange to find similar cases in populations that walk barefoot. 

The bunion deformity, or hallux valgus, can be classified in different ways. The Manchester scale is the most common one, it classifies bunions into four grades of deformity. Grade 1 is when the person does not have any deformity, grade 2 is a mild form, grade 3 corresponds to a moderated one, and grade 4 corresponds to the most severe form.  

Why does the deformity develop? The enlargement of this deformity is caused by a combination of factors. The most common one is the continuous friction and pressure of the shoe on the bone protrusion. Although, other factors can affect its growth, such as the foot type, abnormal shortening of the first metatarsal bone, trauma, hypermobility, inflammatory diseases and footwear with narrow toebox and heels. 

How to Deal With Bunions

Did you know bunions are also transmitted from one generation to the next? In some cases a generation is skipped. According to Coughlin & Jones (2007), up to 83% of patients who suffer hallux valgus have a family history. This alteration in the foot structure could be due to  the bone, soft tissue, or both. Which does not mean that all inherited alterations will develop bunions.

On one hand, women are seven-to-nine times more likely to suffer from bunions than men. It increases if they have a low body mass index and wear high heels habitually. On the other hand, men with flat feet and high body mass index are more likely to have them. 

Treating bunions is recommended because with time the deformity can affect the other toes, and unfortunately, they cannot be resolved or corrected without surgery. There are silicone separators which can align the big toe slightly, and orthotics which can be used to stabilize the joint of the first toe. But there is no way to fully correct the problem.

Minimal Invasive Surgery Technique 

The best way to correct bunions and claw toes is by performing minimal invasive surgery. This operation is accomplished by medical specialists and podiatrists with extensive experience in this field. 

The minimal invasive surgery technique has been used for about 40 years. These are some of its advantages:

  • Avoids complications that may arise from general anaesthetics.
  • Ambulatory surgery: this allows patients to come and leave walking unaided from the clinic.
  • Great long term results.
  • A faster recovery due to a minimal incision, which leaves little post-operative pain.
  • Better scar healing and low risk of infection.
  • No screws or implants are required.

Consult a foot specialist on time, such as Dr. I. San Román Sirvent or Dr. José Manuel San Román Pérez, who are specialists in minimal incision surgery at Clínica San Román. You will have a complete exam of the foot performed. X-rays will establish the degree of bunion deformity and other problems that may have developed.

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Cryotherapy, the hidden beauty secret of celebrities to burn 600 calories in 3 minutes

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exercise sports woman

Cold and ice have been used as a treatment for physical ailments for a long time. In ancient Greece, famous physicians like Hippocrates use ice for anesthetic purposes as to reduce inflammation.

Nowadays, is used as a fundamental therapeutic treatment of physical complaints such as sprains, dislocations, contractures, spams, pulled muscles and swollen tissues.

As well, to manage diverse pathologies symptoms as fibromyalgia, psoriasis, chronic pains, among others.

Cryotherapy benefits have gone way beyond of what we can imagine. Not only is a pain management treatment but has become a top model treatment of celebrities and supermodels.

Film stars, high performance athletes and celebrities like Tom Cruise, Jennifer Aniston, Cristiano Ronaldo and Kim Kardashian are a few example of the many followers of this therapy that recommend it in their social media by showing their experience after each session because of it multiple benefits

What is cryotherapy?

Cryotherapy is the exposure of the skin surface of the body to very low temperatures (between -110ºC and -196ºC) by using a cryotherapy cabin which uses “vaporized” liquid nitrogen.

Because nitrogen has a very low temperature without applying extra cold, it can easily achieve the extreme temperature required for this treatment.

At a room temperature, liquid nitrogen can easily pass from a liquid state to a gaseous state. This is the reason of nitrogen use in this kind of treatments and this is why it is said that uses nitrogen “vaporized”.

When exposing the body to very low temperatures because of liquid nitrogen evaporation, the body responds at different levels involving the circulatory system, muscles and the neuroendocrine system. This happens because the brain receives a cold shock caused by a drastic reduction of body’s temperature. The hypothalamus releases series of substances in our body to combat an imminent hypothermia situation. Among these substances we can find dopamine, serotonin and endorphins, which increases blood flow, lipolysis and the production of free radicals catalytic enzymes, while reducing the production of inflammatory cytokines.

Cryotherapy benefits

One of the main benefit of cryotherapy -and the reason why it is so popular, is the burn of calories. The extreme cold application causes a decrease in body’s temperature, and to compensate this situation the body generates energy by burning localized fat deposits –such as the fat in the belly, therefore a loss of weight occurs togheter with a swelling in the lower abdomen. This same process works for all the body fat deposits. It also reduces, considerably, the annoying cellulite giving an appearance of youth to the body. Additionaly, cryotherapy builds up tissues tone and prevents flaccidity, allowing the body to remain firm and giving the skin a smoothly and healthy look.

Among other benefits, cryotherapy has been proven to be a non-invasive treatment helping to manage and alleviate symptoms of chronic skin diseases such as psoriasis, neurodermatitis, dermatitis, seborrheic complex syndrome, eczema, erythematosis and scleroderma. This due to the peripheral vasodilatation that occurs because of the decreasing in body’s temperature, carring a large amount of oxygen to the body and increasing the blood flow.

Experts explain that there are several and diverse cryotherapy benefits:

  • It helps fight migraine and insomnia.
  • It improves blood circulation and inhibits varicose veins.
  • It reduces inflammation, stress, anxiety and fatigue.
  • It accelerates metabolism generating a boost of energy.
  • It increases the caloric expenditure -between 500 and 800 kilocalories in the next few hours after a 3-minute session.

Finally, research show that cryotherapy helps in recovery processes and chronic pain issues, and it is also recommended for diseases such as fibromyalgia, arthritis, or multiple sclerosis.

Is cryotherapy dangerous?

Like any other medical-aesthetic treatment, if handled properly there is no risk for our health and integrity.

Provided temperatures reached by liquid nitrogen are very low, it could cause burns when used incorrectly. This is why the skin is only exposed for a very short period of time on the skin -from 2 minutes to 4 minutes, and always in a controlled environment under medical supervision.

As a general rule, cryotherapy is a safe treatment for everybody. However there are exceptional cases where the use of cryotherapy is not recommended:

  • People with heart problems and serious health problems, because the sudden decrease in temperature could have a negative effect on the health of people suffering from heart problems.
  • People with little resistance to cold, as they would suffer excessively during the session due to the low threshold of pain towards the cold.
  • Pregnant women and children. This due to negative effects this treatment could have on fetus of a pregnant women and in children it is not advised because of they are still developing their bodies.
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