Thursday 26 November 2020
Tuesday 6 October 2020
AMAR UJALA
दुनियाभर में कोरोना वायरस का संक्रमण काफी तेजी से फैल रहा है। कई जगहों पर तो संक्रमण के मामले नहीं के बराबर आ रहे थे, लेकिन अब एक बार फिर उन जगहों पर संक्रमण की रफ्तार बढ़ गई है। इस वायरस से दुनियाभर में अब तक तीन करोड़ 57 लाख से भी अधिक लोग संक्रमित हो चुके हैं जबकि 10 लाख 45 हजार से अधिक लोगों की मौत हो चुकी है। इस बीच विश्व स्वास्थ्य संगठन ने कोरोना के संक्रमण को लेकर एक डराने वाला खुलासा किया है। संगठन लीडर्स की एक विशेष बैठक में कहा गया है कि हो सकता है कि दुनिया में हर 10 में से एक व्यक्ति कोरोना वायरस से संक्रमित हुआ हो। मीडिया रिपोर्ट्स के मुताबिक, संगठन के एक वरिष्ठ अधिकारी का कहना है कि इसका मतलब है दुनिया की कुल आबादी का एक हिस्सा खतरे में है।
स्विट्जरलैंड के जेनेवा स्थित विश्व स्वास्थ्य संगठन के मुख्यालय में हुई बैठक में संगठन ने कहा कि कोरोना संक्रमण का असली आंकड़ा 80 करोड़ के करीब हो सकता है जबकि अभी तक करीब साढ़े तीन करोड़ लोगों के ही संक्रमित होने की पुष्टि हुई है। कई विशेषज्ञ भी पहले से ही ये कह रहे हैं कि संक्रमण के पुष्ट मामलों की अपेक्षा संक्रमण का असली आंकड़ा कहीं अधिक हो सकता है।
कोरोना वायरस के संक्रमण का पहला मामला पिछले साल चीन के वुहान में दर्ज किया गया था और तब से लेकर अब तक 10 महीने का वक्त बीत चुका है, लेकिन कोरोना का संक्रमण घटने के बजाए बढ़ता ही जा रहा है। कुछ देशों में इसे रोकने के लिए कई तरह के प्रतिबंध लगाए गए थे, लेकिन अब समय के साथ उसमें ढील दी गई है, जिसका नतीजा ये है कि महामारी की दूसरी लहर देखने को मिल रही है और संक्रमण की रफ्तार में काफी तेजी आ गई है।
कोरोना के संक्रमण से सबसे ज्यादा प्रभावित देशों की सूची में अमेरिका शीर्ष पर बना हुआ है। वहां 76 लाख 79 हजार से अधिक लोग कोरोना वायरस से संक्रमित हो चुके हैं जबकि मरने वालों का आंकड़ा दो लाख के पार है। वहीं भारत की अगर बात करें तो यहां भी संक्रमितों की संख्या 66 लाख 85 हजार से अधिक हो गई है जबकि मृतकों की संख्या एक लाख के पार है और यह संख्या दिन-ब-दिन बढ़ती ही जा रही है। हालांकि सुखद बात ये है कि यहां संक्रमण से ठीक होने वालों की संख्या भी तेजी से बढ़ रही है। यहां अब तक 56 लाख से अधिक लोग इस वायरस से ठीक हो चुके हैं।
कोरोना वायरस से निपटने के लिए वैक्सीन बनाने का काम तेजी से चल रहा है। उम्मीद जताई जा रही है कि अगले साल भारत को वैक्सीन मिल जाएगी। हाल ही में केंद्रीय स्वास्थ्य मंत्री डॉ. हर्षवर्धन ने कहा है कि सरकार का लक्ष्य है कि अगले साल जुलाई तक 20-25 करोड़ नागरिकों को कोरोना का टीका लग जाए और इसके लिए वैक्सीन की 40-50 करोड़ डोज हासिल करने की योजना बनाई जा रही है।
हालांकि जब तक वैक्सीन नहीं आ जाती है, तब तक लोगों को बेहद ही संभल कर रहने की जरूरत है। वैज्ञानिकों और विशेषज्ञों द्वारा कोरोना से बचने के लिए बताए गए नियमों का पालन करें, जिसमें समय-समय पर हाथों को साबुन-पानी से धोना, मास्क पहनना और सामाजिक दूरी आदि शामिल हैं
Wednesday 12 August 2020
The Myth of Immune-Boosters
The Myth of Immune-Boosters
Artificial immune boosting may not be the right strategy to fight against COVID-19. Staying calm, maintaining social distancing and hygiene and using protective gear will help us in the long run.
The human immune system (inherited from gazillions of its preceding species in evolution) consists of a rather well-endowed immune response network. A network composed of cells (neutrophils, eosinophils, T cells, B cells, macrophages, and other cells) and non-cellular molecules (cytokines, leukotrienes, enzymes, etc.) form a formidable resistance, which intensely and strategically defend the wonderful bulwark that the human body is. This network however is useful and wonderful so long as it starts and ends on cue and does not overstay its welcome or overdo what is expected of it. In other words, balance is the key. “Immune boosting” would therefore mean artificially getting it all excited and ready to fight. Fight it must but only when it is necessary against a defined adversary, as much and as long as it requires to reinstate a desired state of health.
Not The Myth of Immune-Boosters Artificial immune boosting may not be the right strategy to fight against COVID-19. Staying calm, maintaining social distancing and hygiene and using protective gear will help us in the long run. more. Not less. This well-orchestrated response by a disciplined battalion of the immune army requires a band of welltrained scouts, elite strategists, and some seriously effective mobilisation of foot soldiers (granulocytes), mounted soldiers (antibody-dependant cell cytotoxicity), archers (inflammatory mediators and their receptors), powerful cannons (histamine, bradykinin), missiles (IL-6, IL-1, TNF-α, IFN-γ, chemokines), and target-locked nukes (antibodies). This arsenal in the immune repertoire (as is apparent from the analogies) must be kept under check. If not, tremendous and uncontrolled bombardment by its own defence system shall devastate the body’s ramparts (auto-immune response). We do not want that to happen under any circumstances because that will be disastrous! Now, to define "boosting" we revisit the original task, that of keeping the body in a state of preparedness but not draw first blood. Thus, (i) a "well-oiled" group of scouts (cells that are part of the first line of defence in our innate immune network and generally shoot from the hips but do manage to come back with useful information about a novel enemy) must be maintained such that even if an insidious attack is able to breach the body’s security system, it will not be allowed to penetrate too deep; (ii) the level of co-ordination among this network of immune players (innate and acquired immunity, long-term and short-term immunity, memory-directed immune stratification and new game plan against an unforeseen intruder) must be clear and specific such that no confusion (usually created by an intruder to set off false alarms) maybe unduly provoked. Thus, no immunosuppressant, no immunedepletion to red herring signals staged by sneaky pathogenic microbes maybe unduly evoked; and (iii) when the time comes, action is swift and lethal and cleanly eliminates the intruder. At last we come to the main point of this long prologue—SARS-CoV-2 and its pet scourge COVID-19. SARS-CoV-2 enters the human cell via a membranebound enzyme angiotensin converting enzyme 2 (ACE-2) and a transmembrane serene protease 2 that its spike protein combines efficiently with to initiate a smooth endocytosis reaction and the viral payload gains unobstructed entry into the cell. The receptor-binding spike making up its corona is the key to the host cell’s aforementioned lock. The dropletborne virus enters through the lung and quickly infiltrates circulation via its chosen portal and spreads systemically. ACE-2 being a blood pressure regulator, for the host humans, COVID-19 that may start with all the hallmarks of pneumonia, quickly and silently takes over multiple organs entering their cells via the endothelial lining of blood vessels, all of which express its chosen receptor protein. And all hell breaks loose! A severe “cytokine storm” starting with low levels of IFN-γand high levels of IL-6, TNF-α, IL-1β, CCL2, CCL3, CCL5 in huge amounts like a tsunami of powerful missiles by the body’s own defence
system completely overwhelms the immune system. This is what kills us—a total failure of our espionage system (scout cells), all the trained commandos, the diplomats, the strategists, and the entire security is breached and arson of the main weapon’s manufacturing units of the body leads to mayhem. Complete immune depletion due to foolish and explosive squandering of precious defensive resources turns into our own nemesis. And a final fatal blow jeopardises the thing called life from the poor human host. Thus, immune boosting, I feel, maybe accomplished simply by leading a balanced life—good nutrition (building, repairing and maintaining all the important faculties of the body and not just the immune system since it is not an isolated one), optimum and enjoyable activities (moderate exercise such as walking, swimming, yoga, pranayam and intellectually or creatively stimulating tasks that generate the happy 'hormones') and sufficient and quality sleep (that recharges, replenishes and regenerates the expenditure in the aforementioned enterprises). Ayurvedic knowledge (curcumin in turmeric, fisetin in apple and strawberry, piperine in black pepper, etc.), local and seasonal food (raw fruits and coloured vegetables high in flavonoids, phenolic compounds rich in anti-oxidants), clean lifestyle sans the redundant practices (avoiding nothing but excess), and effective armament (of offensive attack against the infectious agents) supplemented by western medicine (antiviral drugs such as avifavir, ritonavir, remdesivir, and others like hydroxychloroquine and azithromycine combination therapy, convalescent plasma therapy, intravenous immunoglobulin (IVIG) by recombinant DNA technology and support from ventilator, extracorporeal membrane oxygenation (ECMO) and excellent supportive care) may yet save us even if that wicked and troublesome rogue virus the SARS-CoV-2 manages to gain entry. A vaccine (such as Moderna’s mRNA1273 or Oxford University’s ChAdOx1, which are in various stages of clinical trial) may take long to come and offer a shield against COVID-19. And while we are at it, may I warn against frivolous advertisements claiming immune boosting because there is nothing to gain from a “boosted” immunity other than expediting and intensifying a pro-inflammatory disease like COVID-19. We do not want our immunity to be unnecessarily boosted. We want it to stay calm and in a state of preparedness so that it will not be fooled and respond to provocation and spend itself unnecessarily. We want the casualties of war (immune maintenance and immune surveillance circuits) to be efficiently replenished, replaced and regenerated and rejuvenated to remain healthy and balanced. We want capacity to generate and maintain a diverse immune weaponry, not necessarily in a state of preparedness but skilled and fit and there in case they are called into action. And most importantly, we want the regulatory mechanisms to remain alert and effective such that even if we need to go into a well-thought-out war (innate and acquired immunity including but not limited to inflammation and T and B cell-mediated cytotoxicity or humoral response, the designated cells with very specific and specialised immune functions, signalling peptides, receptors that regulate intercellular cross-talk, etc.) they are efficiently regulated and brought down to normal levels when it is over. Thus, balance is the key to a healthy ability to mount anti-viral immunity, rather than “boosting” it. I’d say, stay calm, stay safe, and stay alert, but most importantly, stay clean (social distancing, protective gear, hygiene) and “immune boosting” or not, we shall be able to keep the COVID-19 at bay. Dr Ena Ray Banerjee is Professor, Dept of Zoology, University of Calcutta, Immunology and Regenerative Medicine Research Unit, Translational Outcomes Research. Email: erb@caluniv.ac.in
COVAXIN
With the announcement of COVAXIN by Bharat Biotech and ZyCov-D Vaccine by Zydus Cadila the proverbial silver line in the dark clouds of COVID-19 appears at the horizon. The nod given by the Drug Controller General of India CDSCO (The Central Drugs Standard Control Organisation) for the conduct of the human trial for the vaccines marks the beginning of the end. More than 140 candidate vaccines are under various stages of development. One of the leading candidates is AZD1222 developed by Jenner Institute of University of Oxford and licensed to AstraZeneca BritishSwedish multinational pharmaceutical and biopharmaceutical company headquartered in Cambridge, England. Parallelly, Indian institutions have also engaged in R&D for the development of vaccines in India. With the primary scientific inputs coming from ICMR’s Pune-based institution National Institute of Virology and Hyderabadbased CSIR institution Centre for Cellular and Molecular Biology, six Indian companies are working on a vaccine for COVID-19. IIT Mandi develops 98% efficient face masks from waste plastic bottles at nearly one tenth the cost . Researchers at Indian Institute of Technology (IIT) Mandi developed high-efficiency face masks out of waste plastic bottles. The PET bottles were successfully converted into a nanofibre membrane. This membrane can be layered with nylon on both sides to create the mask. Research scholars Ashish Kakoria and Sheshang Singh Chandel produced the mask under the guidance of Prof Sumit Sinha Ray. The nanofibre membrane is 250 times thinner than a human hair and can remove minute particles with 98% efficiency.
SUB HEALTH CENTRES
Cuba offers UK salutary lesson in ‘shoe-leather’ epidemiology:
COVID-19: Cuba offers UK salutary lesson in ‘shoe-leather’ epidemiology:
Cuba’s successful containment of COVID-19 through door-to-door screening of every home in the country, shows how ‘shoe-leather’ epidemiology could have averted the dramatic failure of the UK’s response to the pandemic. In Cuba there have been 2,173 confirmed cases and 83 deaths, with no reported deaths throughout the first week in June.
The term ‘shoe leather’ epidemiology, where much of the work is carried out on foot in the community, was first demonstrated during the Soho cholera epidemic in 1854.
Writing in the Journal of the Royal Society of Medicine, Professor John Ashton describes how, when China first reported the emerging epidemic in Wuhan in January 2020, Cuba promptly drew up a cross-government contingency plan. When the first cases of the virus were confirmed in the country among three tourists from Italy on 11 March, the plan was immediately put into action.
Screening was carried out in Cuba by tens of thousands of family doctors, nurses and medical students on foot, with testing, tracing and quarantining of suspected cases in state-run isolation centres for 14 days.
Prof Ashton said: “Cuba has long been renowned for its ability to turn in world beating health statistics while continuing to struggle economically. With a health system grounded in public health and primary care, the country invests heavily in producing health workers who are primarily trained to work in the community. Their efforts with COVID-19 have been outstanding.”
He added: “Cuba was one of the first countries to send health workers to support the control of the epidemic in Wuhan, back in January, just one example of its unrivalled commitment to international solidarity in humanitarian disasters.”
Shoe leather epidemiology in the age of COVID: lessons from Cuba (DOI: 10.1177/0141076820938582) by John Ashton is published the Journal of the Royal Society of Medicine
The failure of the UK government to follow the advice of the World Health Organization to ‘Test, Test, Test’ for COVID-19 has cost the country dear. Having been slow to treat the pandemic with due urgency once the initial Public Health Emergency of International Concern had been called at the end of January, the country of John Snow and the Broad Street pump was left playing an embarrassing and fatal game of catch-up as the disease spread.
For those trained in the proud tradition of UK public health, this disaster has proved all the more galling in its neglect of the basic lessons of 1854 and the Soho cholera epidemic, when shoe leather epidemiology first demonstrated its worth. It was from walking the streets from house to house and business to business that Snow was able to demonstrate the concentration of cases among those drinking water from the street pump and persuaded the select vestry to remove the pump handle.
This very practical and local approach to public health provided the leit motif for its effective practice for generations until the disastrous reorganisation of the National Health Service, and with it public health, in England in 2013. The creation of a flawed agency, Public Health England, with its unremitting centralisation and undermining of local and regional public health, paved the way for the dramatic failure of response to COVID-19 in 2020. The inability to undertake large-scale testing for the coronavirus and to follow through with contact tracing, triaging, isolation and treatment followed as light follows day. Local capacity of the skilled workforce and local knowledge was run down and along with it the ability to mobilise the rich network of laboratory assets. Over-dependence on prominent London figures, institutions and laboratories, together with fly-by-night private sector contractors operating from anonymous call centres, were no substitute for hands-on experience with local knowledge and established networks of collaboration. The result was chaos and incompetence.
Comparison with one country that has performed exceptionally in response to the emergency illustrates what might have been possible had we not seemed hellbent on destroying a functioning public health system and had instead played to national strengths in primary care. Cuba has long been renowned for its ability to turn in world beating health statistics while continuing to struggle economically. With a health system grounded in public health and primary care, the country invests heavily in producing health workers who are primarily trained to work in the community, with only a small proportion going on to specialise in hospital medicine. Their efforts with COVID-19 have been outstanding.
When China first reported that a new coronavirus had been identified as the cause of the emerging epidemic in Wuhan in January 2020, Cuba promptly drew up a cross-government contingency plan and was ready to act. The first cases were confirmed among three tourists from the high disease incidence area of Lombardy in Italy on 11 March, the same day that World Health Organization declared that COVID-19 qualified as a pandemic, the patients were immediately hospitalised and the plan put into action. Tens of thousands of family doctors, nurses and medical students screened all homes in the country for cases on foot, with testing, tracing and quarantining suspected cases in state-run isolation centres for 14 days. The epidemic was soon contained after a total of 2173 confirmed cases and 83 deaths with no reported deaths throughout the first week in June. In addition, Cuba had been one of the first countries to send health workers to support the control of the epidemic in Wuhan, back in January, just one example of its unrivalled commitment to international solidarity in humanitarian disasters.
As the pandemic in the UK enters a new phase and we wait to see whether there will be a second and third wave, as happened in the Spanish flu of 1918–1920, or whether it just disappears as happened with its close relative SARS in 2003, the time for reflection has already begun. Let us hope that we can put to one side the Little England mentality that has been so much in evidence in the handling of COVID-19 and be willing to learn from others who still understand and value the ‘shoe leather epidemiology’ that was invented in Broad Street 170 years ago!
Friday 7 August 2020
NEWS CLICK
Friday 24 July 2020
Sunday 19 July 2020
गाँव के स्तर पर की जाने वाली गतिविधियाँ
महिलाओं के प्रति मानवीय समतावादी रूख अपनाएं ।
33. अपनी अपनी डायरी लिखने का काम अपने हाथ में लें
34. गाँव की रिसोर्स मैपिंग का काम करना। भूमि व पानी साक्षरता का काम हाथ में लेना ।
35. दहेज़ समस्या, घूंघट की समस्या, नशाखोरी, बेरोजगारी, आदि सामाजिक मुद्दों पर सेमिनारों का आयोजन करना ।
36. सूचना का अधिकार मौलिक अधिकार हो इसके लिए दबाव बनाना।
37. देश की एकता ,आत्म निर्भरता, राष्ट्र विकास, आदि मुद्दों को समझना तथा लोगों तक इनका अलग अलग ढंग से सम्प्रेषण करना।
38. जातिवाद , धार्मिक कट्टरता , सांस्कृतिक पिछड़ापन , जैसी समस्याओं पर समूहों में चर्चा करना।
39. हरियाणा के विकास की - कृषि क्षेत्र, औद्योगिक क्षेत्र, मानव संसाधन की समस्याओं पर समूहों में चर्चा करना।
40. हरियाणा को जानो हरियाणा को बदलो - नारे के तहत सर्वेक्षण व स्टेट्स पेपर तैयार करवाने में मदद करना
रणबीर
9812139001
dahiyars@rediffmail.com
SOCIAL DETERMINANTS OF HEALTH
2. EDUCATION.
3. RACEAND ETHINICITY
4. TRANSPORTATION
5. HOUSING
6. FOOD ACCESS
7. COMPLEX Health NEEDS
8. INSURANCE
THE CONDITIONSIN WHICH PEOPLE BORN,GROW,WORK, AGE
STRUCTURAL DETERMINANTS ---
--GOVERNANCE
--ECONOMICS
--SOCIAL AND PUBLIC POLICIES
--CULTURE ANDSOCIETAL VALUES
--SOCIAL CLASS
--GENDER ETHINICITY
--EDUCATION
--OCCUPATION
--INCOME AND PLACEOF LIVING
INTERMEDIATARY DETERMINANTSOF HEALTH
--MATERIAL CIRCUMSTANCES--Like Living and working conditions,food availabilityetc, exposure to risks, risk behaviours,bilogical and psychological factors .
हरियाणा में स्वास्थ्य सेवाओं का ढांचा
Friday 17 July 2020
कुछ बिंदु
दुनिया के स्तर पर
1 . संसार की कम से कम आधी आबादी जरूरी स्वास्थ्य सेवाओं से वंचित है।
2 . करीब १० करोड़ लोग 100 मिलियन प्रतिदिन 1 . 90 पोंड पर गुजारा करते हैं।
3 . 80 करोड़ लोग (दुनिया की जनसंख्या का लगभग 12 %) का 10 % परिवार के स्वास्थ्य पर खर्च करते हैं।
भारत के स्तर पर
1 . प्राइवेट सेक्टर 80 % opd सेवाएं और 60 % दाखिल मरीजों की सेवाएं प्रदान है।
2 . 77 % ग्रामीण और 70 % अर्बन में आउट ऑफ़ पॉकेट स्वास्थ्य खर्च का सिर्फ दवाओं पर होता है।
3 . इस आउट ऑफ़ पॉकेट स्वास्थ्य खर्च के कारण पिछले साल 5 . 5 करोड़ लोग गरीबी रेखा से नीचे चले गए
लोक सभा में प्रस्तुत --अगस्त 28 , 2019
. जन स्वास्थय सेवाएं और स्वास्थ्य के सामाजिक निर्णायक
1 . जन स्वास्थ्य सेवाओं पर बहुत कम खर्च
2 . जरूरत से कम स्वास्थ्य सेवाओं का ढांचा --उप स्वास्थ्य केंद्र प्राथमिक स्वास्थ्य केंद्र और सामुदायिक स्वास्थ्य केंद्र-- डाक्टरों और नर्सों की कमी --1000 पर 0 . 7 और 1. 7 हैं
3 . स्पेशलिस्ट्स की कमी --- जनरल सर्जन , स्त्री रोग विशेषज्ञ, शिशु रोग विशेषज्ञ , फिजिसियन और बेहोशी विशेषज्ञ
Deccan Hearald .com Dec 22, 2017
सुपर स्पेशलिस्ट्स
4000 कार्डियोलॉजिस्ट हैं 88000 की जरूरत है, 315 पीजी सीट्स 3375 होनी चाहियें । नेफ्रोलोजी --1200 डाक्टर , 40000 की जरूरत। शिशु रोग विशेषज्ञ --23000 हैं , जरूरत --230000 . एंडोक्रिनोलोजिस्ट --650 हैं। 28000 की जरूरत है। USA --20000 UG , 40000 PG . भारत --62000 UG , 14500 PG सीट्स
Physicians per 1000 population --0.7
Nursesper 1000 population --1.7
Hospital beds per 1000 population --0.7
Institutional Delivary per 100,000 live births --190
Life expectancy--66.2 years
4 . स्वास्थ्य पर जेब से खर्च बहुत ज्यादा है।
5 स्वास्थ्य सेवाओं तक पहुंच की कमी और स्वास्थ्य सेवाएं प्राप्त करने के सामर्थ्य की कमी।
6 . शहरी और ग्रामीण विभाजन --periodic labour force survey (2017 --18 ) प्रति ७ डाक्टरों में से सिर्फ 1 डाक्टर ग्रामीण क्षेत्र में है 6 शहरी क्षेत्र में हैं।
7 . अमीर -- गरीब विभाजन
8 . जेंडर विभाजन व जात आधारित विभाजन
9 . स्वास्थ्य कर्मियों के क्षमता निर्माण की कमी ( ट्रेनिंग की कमी )
10 अपने स्वास्थ्य के बारे जनता जागरूकता की कमी
11 . टेक्नोलॉजी अपग्रडेशन की कमी
12 . वातावरण प्रदूषण --कीटनाशकों का अंधाधुंध इस्तेमाल
13 . Govt Funded Health Insurance (GFHI)Schemes like Prime Minister Jan Arogya Yojna
UTTRAKHAND/ Uttranchal
POPULATION--2020--1.17 crore
13 districts
dehradoon largest district
BJP Govt.