Thursday, December 31, 2009

Another year has passed ...


Happy New Year to y’all ! What a coincidence that we have reached 2010 and my blog visitor counter installed in September this year says that there have been 201 visitors from around the world since. Just a ‘zero’ away from the number of the year and I hope I reach there by the ‘zero’ hour of the next year. Ah! How valuable is a zero when placed in the right place. (Reminds me of a dialogue in a recent movie that I watched – purportedly the most disastrous box office failure of the year 2009 – Rocket Singh wasn’t really that bad. In fact it was pretty good – but I guess it will take another decade before the regular Bollywood audience starts appreciating movies of this genre.)

Another year has passed and I am yet to understand why we celebrate a ‘New Year’ or a ‘Birthday’ when life continues the very same manner the very next day. Call me a pessimist but look at it in this way - if we would spare all the money and time that we spend in celebrating these events and channelize them to bring some happiness in the lives of the sick, poor or destitute will we not be able to make the world a much better place than it was last year? If you don’t spend that Rs. 3000 to attend that club tonight for the zero hour party and buy a blanket and some rice for one of the homeless would it not bring more satisfaction to you? You have fed your pet dog or cat all these years, why not spend some tonight for that stray dog/ cow? If you cut down on the fire crackers tonight and call in those poor little kid in rags that you saw playing the drum for his sister while she danced and somersaulted to grab your attention while your car stopped by the traffic signal and offer them a scrumptious meal and a few toys would that not make you happier and the world a little lesser polluted?

I am writing this entry on the train back home and I had a very pleasant experience a few moments back. Coincidentally I had an acquaintance from CRS office, Pradeep, on my neighbouring seat. Having rushed from Dr. Sen’s farewell to the station, I hadn’t had my lunch but I already had something in my lunchbox that I had carried to the office. I didn’t feel like having that so I bought myself something on the train instead. Pradeep suggested I give it to one of those kids that keep the floors clean and so when one of them did come to sweep, he asked him if he would like to have some food. It was as if the poor kid was waiting for someone to ask him that – the ‘yes’ came instantly and we emptied the lunch box on a piece of paper for him. The happiness that was so evident on his face filled my heart with glee and I have to thank my friend Pradeep here for arousing the goodness in me and giving me a joy that transcends any other pleasure that I have experienced since a while. Sometimes we need people to bring out the nicer side of us through their goodness – they are like ‘mediators’ of goodness. It’s nice to have mediators around you and its good to be one yourself sometimes.

When the year begins, we all make resolutions, most of which we break but regardless of how they end, they are usually things that we do for our own betterment – like stopping to smoke or going on a healthy diet. Only a few of us tend to think selflessly for others and make resolutions that bring joy or betterment in the lives of a larger population or bring a positive change for the world that we live in. Why not make a resolution this year to plant at least 10 trees this year or use lesser petroleum run vehicles and use your legs for distances that you know are walkable or use lesser paper than usual ( what are computers for after all?) or share your knowledge and educate one illiterate. You have probably been a good person and donated in various organizations but have you been responsible enough to know if every penny that you have donated has been used in the right manner? Why not put your money this year where you can bring a change in someone’s life not just by donating but also by doing things yourself? Wouldn’t that bring a greater pleasure and satisfaction? We all are busy in things that we do and the downturn in the global economy has pinched all our pockets but you don’t need time or money to be a good Samaritan; all you need is a caring heart. Care for someone this year – make that your New Year resolution.

Caring for your family is your duty but caring for the underprivileged would create a better world.

Wednesday, December 23, 2009

Bombing the city

We were invited to a Christmas celebration today at one of our partner organization's place. The ambience was joyous and many people from many backgrounds had turned up for the event. There were gifts being shared with the employees and partners (including us at CRS and CBCI) and then there were games to keep everyone on their foot. They had one very interesting game amongst all those with a name that went something like “Bombing the city” – a slight diversion from our conventional Musical Chair. The place had been divided into quadrants and each of them were named as one of the four metros – “Bombay” ( I am not in the city so I believe Raj Thackeray’s men can’t hurt me just because I didn’t call it Mumbai), Kolkata, Delhi, and Chennai respectively. We were supposed to move around in circles when one person rang the bell like Santa and then we were supposed to stop at one of those quadrants when the bell stopped with a siren. Then, they would randomly pick a chit with a name of the city – whatever name it would have would get “Bombed”. So, all in that quadrant will be counted “Out” of the game. The last man standing would be the winner. Interesting, ain’t it? … and scary too.

What an interesting concept for a game?  It’s as if we have gradually learnt to find pun in the most horrifying of events. “Bomb blasts” have been so common in the last two decades that it seems we have learnt to live with it as if it were just another event that happens in our daily lives. The game here had people counted out of the game when bombed as if they had been killed during the bombing. Fun as it was to be a part of that game, I could not but help think to myself – how times have changed and how it does not bother us anymore – bombs, deaths and suffering.

It must have been around 4 o’clock in the evening of one of those wonderful Saturdays after a long stressful week in Delhi last year, I had stepped out of the house to visit Nehru Place to get myself a couple of 512 MB RAMs as my desktop had gotten a bit slow. I would have never remembered that day had it not been for the events that would follow. I am forgetful enough to forget what date today is but I still remember it was the 13th of September. I had initially thought of calling up one of my friends and going to CP (Connaught Place). I could have visited the Planet M there and then walked through the Central Park to the other side and got myself one of those nice “Chococcinos” at CCD ( for the unitiated, that’s what we call Café Cofee Day – a retail coffee café chain in India). But then it crossed my mind that my desktop wasn’t running the way it should since quite a while and the weekend was my only chance to go to Nehru Place to grab those RAMs. By the time I was usually done with my office work it was always around 7:00 PM and that place closes down by that time.

By the time I got dressed up and caught an autorickshaw it was around 5:00. By the time I reached one of my usual stores in Nehru Place and bargained over the RAM, it was almost around 6:00. I made the payment and left for my apartment. I was alone so there was no point staying there. I reached home by 6:30 and immediately switched on the TV like I always did as a habit when I reach home to catch the evening news on CNN-IBN while changing into my casual wear. There was something that was being covered live – you can make that out from the way they were reporting it. I had moved to my bedroom to change my shirt but I walked back to my drawing room where the TV was placed to catch a glimpse of what was going on. When I saw what was playing, my mouth was left agape and I sat down on the chair for a minute. They were reporting a bomb blast in Ghaffar market that had happened at around 6:00 PM and then the news that just came in was that of two more at Connaught place – one at Barakhamba road and the other at Central Park between 6:30 and 6:35. And in minutes there were two more at GK-1. GK-1 was very close to Nehru Place. Five bombings in a span of just 15 – 20 minutes and they were saying Nehru Place could strategically and most probably be the next target. I was glued to the TV for the next hour and fortunately nothing happened. 15 minutes and 30 killed with more than 100 injured. It was surreal – I was just around a kilometre away from the place where the GK-1 blasts occurred just a few minutes back. They kept playing those footages of blood bathed men, women and children lying on the ground, carried on arms of other people, ambulances, police – it was absolute chaos and it was on every news channel - Images that could make the mightiest of hearts sore from watching all that pain and suffering.


That evening, I called Ma like I always did every other evening and she immediately asked where I was and if I was safe. I replied that I was home and safe. I didn’t share that I was not at home when it all happened and that I was just around a kilometre away from where the blasts occurred in GK-1. I knew she would be worried and she would also tell me about how I shouldn’t be outside in Delhi during the weekends – but aren’t weekends meant for going out and having some fun? Anyway, that’s a topic for discussion some other time.  

I was restless all night that day thinking what if ... What if I went to CP that day instead of Nehru Place as I had previously planned? Logically I would have been right at the point of bombings calculating this that it takes around 45 minutes to reach CP  and after a 15-20 mins in Planet M, I would have landed up at Central Park between 6:10 – 6:30. What if they had planted one in Nehru Place? GK-1 was not too far and Nehru Place is very well known and stays crowded during those hours with absolutely no police for security. Strategically, from a bomber’s point of view, it would have been a perfect place for attack but it didn’t happen. I was lying on my bed thinking all night – are the events in our lives predecided? Should I thank my stars that they didn’t bomb at Nehru Place or that I was reminded of those RAMs and changed my plans of visiting CP thus avoiding a fateful end to my predominantly uneventful (barring events like these) and useless life?

2008 was a year of Bomb Blasts – India had become a terrorist haven. It started with the Jaipur blasts in May followed by Bangalore, Ahmedabad, Delhi and ended with the now infamous 26/11 terrorist attacks in Mumbai. It was as if the complete security system of the country was asleep and there was a need for hard hitting events like these to shake them awake from their slumber. It’s not just the cops or the Border security force or the Government to blame, it’s us – the citizens of this country who are more to blame and so is the media. We crib, pout and grumble when we have to pass through security checks at the airports and malls, we complain when our celebrity is detained and has to go through a bit of frisking for security purposes and we are never alert of what’s going on around us. And to top all of that, we have grown callous to what happens when there are security breaches and bomb blasts and we have grown callous to all those pain and suffering. A year from the bombings, I was enjoying a game on Bombing – should I have found it offensive? No one else did and it was all for fun anyway but still …

Thursday, December 17, 2009

Flower Frenzy

In the last few weeks I went wild with my camera taking pics of flowers anywhere and everywhere I spotted them ... that is, only when they looked beautiful to my eyes. Here are a few picks from the lot -




Now a few more from our roof-top garden -




More pics from the Amazing Jalpaiguri

If you thought I was kidding when I said Jalpaiguri was Nature's Paradise , then take a look at some of the pics that I had clicked. You have to see it to believe it ...

Swan's Tale at Jalpaiguri Seva Sadan




The Beautiful forests of Kalchini



Have you ever seen a prettier tree create a better arch above the road?




You rarely get to see bluer water than this in India ... River Torsa flowing calmly underneath a railway track.




Sunset on River Torsa



Sunset on the Tea Gardens of Jalpaiguri



Sunset from the car



Monday, December 14, 2009

Reality Check


before I let you guys read this article, I must admit that i have not written IT but i found it so compelling that I felt everyone i know should read this and do some soul searching on their part. the valuable questions that the author of this article has asked at the end are pertinent to relationships and priorities in the lives of everyone of us.





Reality Check

Author - Dr. Debadutta Parija


There is no point of getting a promotion on the day of your breakup. There is no fun in driving a car if your back hurts. Shopping is not enjoyable if your mind is full of tensions.
"Life is one of those races in nursery school where you have to run with a marble in a spoon kept in your mouth. If the marble falls, there is no point coming first. Same is with life where health and relationships are the marble. Your striving is only worth it if there is harmony in your life. Else, you may achieve the success, but this spark, this feeling of being excited and alive, will start to die.


Speech by Chetan Bhagat at Symbiosis

Recently my dear cousin, Poopsie, forwarded this article to me and I promptly forwarded this to some of my outlook contacts. But when I reread this it struck me that isn’t the thought amazing? We all seem to be running the race of our lives without realizing that our marbles have dropped off en route (no pun intended). Human beings are amazing in the sense that a single man can be a father, a son, a brother, a brother in law, a husband, a son in law, a teacher, a student, a friend, a mentor, a boss, an employee and so on 
all at the same time!! However with the gradual disappearance of the concept of joint families, with the lack of opportunities in one’s own area of expertise in one’s home town / state / country, peer pressure and the need to keep up with the Joneses, everyone is in this mad scramble for …….God knows what.

Take my own case. I worked in a Primary Health Center in a remote tribal district of the State on a salary of roughly Rs. 8000 per month from 2000 – 2003. Apart from catering to daily OPD load of around 150, we used to carry out deliveries, minor surgeries and so on. And the patients we catered to were real patients – sick people in need of medical help and not just rich people with imagined pains and aches mostly due to wrong lifestyle practices. I hardly got time to sleep and yet I was supremely happy. Money was never a problem and I seemed to always have a surplus. I could spend as much time I wanted with my parents and family. They too were very happy.

Then I got an opportunity to work with WHO on an assignment. Money was good and the brand name was the best in the industry. I jumped at the chance. It has been six years since. Money has got better over this period of time. But somehow, when I look back, the satisfaction levels have not even come close to my previous job at the village level primary health center. I had to stay away from my ageing parents. I missed my family, my patients and simple things like Mom’s cooking, long discussions with Dad on religion and politics, being able to talk in Oriya at office, adda / khatti with my friends.. small things.. banal things…Recently Dad passed away and I wished I had stayed some more with him when he needed me most (though he would have been the last one to admit it). Then I realized that life is a lot like my class 10th examination with 6 subjects. You score 90% in 4 subjects but 20% in the remaining two and you fail. However you score 40% in all six and you pass!!.

But the thing with this race is that in most cases it is a one way street. One requires lots of courage to give it all up and do what needs to be done (a la The Monk Who Gave Up His Ferrari). What we do instead is rationalize…. mostly to convince ourselves. Better education for children, better career, growth opportunities, better pay packages, better perks, better places to live in and so on.

Isn’t it funny: we love our children the most… in majority of cases even more than our parents. Then it has to be true that our parents have to be the ones who love us the most. I firmly believe that pure unselfish love cannot exist. However the love that comes closest to it has to be the love we feel for our own children…. which 
is the same as the love our parents must feel for us. Would we leave our sick child and go off to a better career opportunity? No way. Would we leave our ageing and sick parents to go off to a better career opportunity? You bet we would !!

Some unpleasant questions that we might consider answering:
1- Are there jobs where our expertise can be used closer home (if not in the same town at least in the same State)? If yes what are the major reasons for us not taking up the same so that we can stay closer to our parents?
2- Would it be wise to uproot our parents from the place where they have spent a lifetime and transplant them to a foreign place (where they would be like fish out of water) where we work just so that we can assuage our moribund conscience?
3- Try and remember the salaries our dads received and the pain and sacrifices they must have undertaken to give us the best of everything on that meager salary. Are we doing enough to repay that?
4- Is just sending money home to old and sick parents enough?
5- Do we call them up daily and discuss their fears and insecurities?
6- If our child treats us the same way that we treat our parents (when we are old, retired, sick and alone)… would we be happy?
7- Are we doing enough for our parents, our family, our friends, for our neighborhood, our town, our State, our country, our religion, our society or for anything other than ourselves?


Source: http://debu-musings.blogspot.com/2009/12/random-thought.html

Friday, December 11, 2009

Lopinavir dose might have to be increased during pregnancy - British HIV Association article


Lopinavir protein binding in HIV-1-infected pregnant women
FT Aweeka 1 A Stek 2 BM Best 3 C Hu 4 D Holland 3 A Hermes 5 SK Burchett 6 J Read 7 M Mirochnick 8 EV Capparelli 3 and the International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) P1026s Protocol Team
1 University of California, San Francisco, CA, USA, 2 University of Southern California, Los Angeles, CA, USA, 3 University of California, San Diego, CA, USA, 4 Statistical and Data Analysis Center, Harvard School of Public Health, Boston, MA, USA, 5 Abbott Laboratories, Abbott Park, IL, USA, 6 Children's Hospital Boston, Boston, MA, USA, 7NICHD, Bethesda, MD, USA and 8 BU School of Medicine, Boston, MA, USA
Correspondence: Francesca T. Aweeka, Drug Research Unit, University of California, 521 Parnassus Ave, San Francisco, CA 94143-0622, USA. Tel: +1 415 476 0339; fax: +1 415 476 0307; e-mail: faweeka@sfghsom.ucsf.edu
ABSTRACT

Background

Pregnancy may alter protein binding (PB) of highly bound protease inhibitors due to changes in plasma concentrations of albumin and α-1 acid glycoprotein (AAG). Small changes in PB can greatly impact the fraction of drug unbound (FU) exerting pharmacological effect. We report lopinavir (LPV) PB during third trimester (antepartum, AP) compared to ≥1.7 weeks postpartum (PP) to determine if FU changes compensate for reduced total concentrations reported previously.

Methods

P1026s enrolled women receiving LPV/ritonavir, soft gel capsules 400/100 mg or 533/133 mg twice daily. LPV FU, albumin and AAG were determined AP and PP.

Results

AP/PP samples were available from 29/25 women respectively with all but one woman receiving the same dose AP/PP. LPV FU was increased 18% AP vs. PP (mean 0.96±0.16% AP vs. 0.82±0.21% PP, P=0.001). Mean protein concentrations were reduced AP (AAG=477 mg/L; albumin=3.28 mg/dL) vs. PP (AAG=1007 mg/L; albumin=3.85 mg/dL) (P<0.0001 for each comparison). AAG concentration correlated with LPV binding. Total LPV concentration did not correlate with LPV FU AP or PP. However, higher LPV concentration PP was associated with reduced PB and higher FU after adjustment for AAG.

Conclusions

LPV FU was higher and AAG lower AP vs. PP. The 18% increase in LPV FU AP is smaller than the reduction in total LPV concentration reported previously and is not of sufficient magnitude to eliminate the need for an increased dose during pregnancy.

Accepted 23 July 2009

Pics from Tea Gardens of Baghdogra

A hectic day of travelling but I couldn't resist stopping the car and taking some pics of this lovely tea garden on my way to the Holy Cross Healthcare Centre



Miles and miles of it - this one's from the car.



This one's to prove that I was there and I didn't pick these beautiful pictures from the internet ... LOL



When I turned around from posing as a model in the tea garden, this is what I saw -




Its sad ... but Child Labor continues to exist in our country ... these kids seemed to be around 7 or 8 years old. There's just too much poverty in these beautiful tea gardens and in our country to counter eradicating this social evil easily.

Wednesday, December 09, 2009

Podophyllotoxin better treatment option for anogenital warts - Medscape article


Topical Treatment of Anogenital Human Papillomavirus Infection in Male Patients

Donna P Ankerst; Helmut Diepolder; Sophia Horster
Posted: 12/01/2009; Future Virology. 2009;4(6):531-541. © 2009 Future Medicine Ltd.


Abstract

Background: Human papillomavirus (HPV)-associated anogenital warts have a prevalence of up to 78% in sexually active men. Some HPV subtypes bear a considerable oncogenic potential.

Materials & methods: Original papers on the treatment of external anogenital warts were included in a meta-analysis to assess the most effective topical treatment.

Results: Clearance rates were 0–6.5% for placebo treatment, 76.6% for podophyllotoxin 0.15% cream administered for 4 weeks, 61.5% for podophyllotoxin 0.5% solution (2–6 weeks) and 53.7% for imiquimod 5% cream (12–16 weeks). For male patients, the intent-to-treat analysis demonstrated statistically significant superiority of podophyllotoxin preparations versus imiquimod (p < 0.0001 and p < 0.005, respectively). Clearance rates of locally ablative treatments, such as surgery, cryotherapy, electrocautery and carbon dioxide laser, differed widely without clear superiority of a specific ablative technique. In HIV-positive patients, all treatment options yielded lower clearance rates and higher recurrence rates.

Conclusion: While preventive vaccines might reduce HPV-associated morbidity for future generations, those with active HPV disease still need to be treated with customary treatment options. In male patients, podophyllotoxin preparations yielded higher response rates than imiquimod.

Pics from the woods of Jalpaiguri

South Khairbari Nature Park





Sunset from the car



Tuesday, December 08, 2009

Winter Mist

Have you ever had a dream about something and experienced it later in the very same manner? Have you ever woken up with a song running in your mind and ended up hearing it everywhere you go that day? Did you ever think of a friend you haven't spoken to since a long time and get a phone call or e-mail from him/her moments later? We have coincidences every single day of our lives - some strange interesting ones and some boring forced ones. But one thing is certain about coincidence - the phenomenon fascinates believers and skeptics alike. It's a porthole into one of the most interesting philosophical questions we can ask: Are the events of our lives ultimately objective or subjective? Is there a deeper order, an overarching purpose to the universe? 


It has been happening since yesterday - a sense of deja vu and a connection between each of those incidents. I woke up yesterday morning at 4:40 from a dream (a nightmare precisely) that I had my Medicine viva-voce of my Final MBBS exams in the morning. Phew! Thank God! Its just a dream and all that is over years back. A couple of hours later I was travelling from Sealdah to Jalpaiguri - a district in the northern part of West Bengal known for its forests where Rhinos meander fearlessly. A couple of hours from Sealdah station, as I was looking through my train compartment's window at a lush green pasture with trees and a river flowing close by, the weather outside seemed unlike the sunny weather of Kolkata and it seemed as if the sunrays were trying hard to find their way to the ground through the winter mist. The view was amazing - as if painted on a canvas. But as I looked at it, all of a sudden it hit me - I have been there before - I have seen this view before - the pasture, the river, the sun, winter mist et al. But where? It was probably during my med school (VSS Medical College) - possibly one of those places that we went to during our class picnics in winter. Haven't figured out which one though but the weather was certainly identifiable - winter in Sambalpur looked exactly the same.


A few moments later, I heard someone speak in hindi with a slight Bihari twang and the voice sounded extremely familiar. I could tell from his conversation with his friend that he was an engineer. I turned around to see who it was and was left agape with wonder. I knew that face yet something was not the same. One of my juniors from VSS - Avasthi ! But it wasn't him - this guy was a lot fairer, a lot younger and of course, he was an engineer - it can't be him but what uncanny resemblance - looks, voice and mannerism - FREAKY!


It was 6:35 p.m. by the time we reached New Jalpaiguri Junction - I had to get a ticket for Jalpaiguri Road from here. You can't get a reservation at this hour, so what I got was a 2nd class ticket. I rushed back to the next train starting at 6:50 for Jalpaiguri Road. After I squeezed my way through the human mesh and found a small strip to support my derrière on, I looked around to acquaint myself with the people who will be travelling with me for the next couple of hours or so and there we go again - another familiar face. A woman in her late forties or early fifties who looked freakishly similar to the mother of one of my closest friends in VSS, Smita. Had it not been for her speaking in Bengali and the looks and activities of the rest of her family in the train, I would have immediately initiated a conversation with her. 


Although I have always made connections between such incidents in my life, I have never tried to interprete what they meant because I believe, certain things ought to be left to unfold for themselves. If there is a meaning to this, then time will tell what it is. As of now, I am pleasantly surprised by each of the events and so no matter how tiring the journey was, I was left with a smile in the end of the day.


After around 14 long hours of train journey followed by a ride on a rickshaw in the cold densely foggy night with minimal visibility (we could barely see beyond a couple of feet) again reminding me of the VSS winters, I finally reached Jalpaiguri Seva Sadan where Fr. Sudarshan and his team guided me to a nice cozy room and offered me a scrumptious dinner. I am truly touched by their hospitality. 


I couldn't wait to see the foggy dawn and the sunshine piercing through the winter mist. Finally its here now - but its cold out here - really cold - so cold that I thought I'll die of a vasovagal attack as I washed my face after I woke up. I am writing this blog while I wait for Fr. Sudarshan to return from his prayers so that we can discuss regarding today's travels. I couldn't but help use my cellphone camera to take a picture of this wonderful place and its enhanced beauty in this amazing weather. I end this blog now sharing this picture with all you folks - soothe your eyes with the greenery of rural India!





Tuesday, December 01, 2009

New HIV/AIDS Treatment guidelines issued by WHO


The WHO on Monday issued new recommendations on the eve of World AIDS Day that patients living with HIV/AIDS begin receiving antiretrovirals (ARVs) earlier than current HIV treatment.
The recommendations – an update to 2006 treatment guidelines – come after several studies showed "people with HIV who start drugs earlier than recommended have a better chance of surviving.






There are 3 Key Recommendations for ART as per the revised guidelines
1. Earlier diagnosis and treatment of HIV in the interest of a prolonged and healthier life.
2. Greater use of more patient-friendly treatment regimens.
3. Expanded laboratory testing to improve the quality of HIV treatment and care. However, access to laboratory tests should not be a prerequisite for treatment.


REVISIONS:
I. ELIGIBILITY FOR TREATMENT
The best time to start ART is before patients become unwell or develop their first opportunistic infection. The best method to determine when to start treatment is through CD4 testing, which measures the strength of the immune system.
The 2006 guidelines recommended that ART be started for all patients with advanced clinical disease and/or a CD4 count of 200 cells/mm3 or less. The 2009 recommendations promote earlier treatment for all patients, when their CD4 count falls to 350 cells/mm3 or less, regardless of symptoms.


II.TREATMENT REGIMENS
The 2006 guidelines recognized the critical role of Stavudine (d4T)-containing regimens due to its low cost, limited need for laboratory monitoring, initial tolerability and widespread availability. However, they recommended that countries plan to move away from d4T.
The 2009 recommendations propose that countries progressively phase out the use of Stavudine as a preferred first-line therapy option and move to less toxic alternatives such as Zidovudine (AZT) and Tenofovir (TDF).


III.ROLE OF LABORATORY TESTING
There are well recognized limitations to relying only on clinical monitoring1 to determine when people need to start ART and when they are beginning to fail to respond to their treatment regimen.
The 2009 recommendations outline an expanded role for laboratory monitoring, including both CD4 testing and viral load monitoring2, to improve the quality of HIV treatment and care. They promote greater access to CD4 testing and the strategic introduction of viral load monitoring. Access to ART must not be denied if these monitoring tests are not yet available.
Clinical monitoring: The monitoring of a patient’s health by a trained health professional. This typically involves taking a patient’s medical history on a regular basis and conducting routine clinical examinations.
Viral load monitoring: Measuring the concentration of HIV in the bloodstream.


BENEFITS
The new recommendations are based on a solid body of evidence indicating that rates of death, morbidity and HIV and TB transmission are all reduced by starting treatment earlier. This prolongs and improves quality of life.
An earlier start to treatment reduces a person’s viral load much earlier in the course of their HIV infection, and thereby reduces the risk of onward HIV transmission and could potentially avert a significant number of new HIV infections.
Earlier treatment would boost the immune system, making it less likely that the patient falls sick with TB and other opportunistic diseases which prey on weakened immune systems. This would benefit both the individual concerned and help protect the wider community against the risk of infectious TB.
The prospect of earlier treatment could also act as an incentive for more people to undergo voluntary counselling and testing without waiting to develop symptoms and fall sick.
The incremental costs due to an additional one to two years on ART may be partly offset by decreased hospital and death costs, increased productivity due to fewer days sick, fewer children orphaned by AIDS and a drop in new HIV infections.
The phasing out of Stavudine would enable new and existing patients to avoid disabling and disfiguring side effects and reduce the costs of managing these toxicities.
Expanding CD4 testing will enable people to access earlier treatment, before they become unwell, and it is critical to identifying pregnant women who need ART. Wide-scale access to CD4 testing among HIV-positive pregnant women would help to prevent the bulk of mother-to-child transmission of HIV (see also Rapid advice on PMTCT). The introduction of targeted and/or routine viral load testing may reduce premature switching to costly second-line regimens.


CHALLENGES
The main challenge is to increase access to treatment in low- and middle-income countries and to encourage people to receive voluntary HIV testing and counselling before they have any symptoms. Currently, many HIVpositive people are waiting too long before they seek treatment, usually when their CD4 threshold falls below 200 cells/mm3.
Raising the CD4 threshold to 350 cells/mm3 may mean an average 1–2 years’ additional exposure to ART, prompting some concern about the risk of ART toxicity.
By choosing a limited number of treatment regimens that suit the majority of people in need of ART, governments can achieve economies of scale through the purchase of larger quantities of a smaller number of drugs.
It is unclear if HIV-positive patients who feel well will be willing start ART and whether they will have more difficulty adhering to treatment than those who are showing symptoms. However, the prospect of a prolonged and healthier life could act as inducement for earlier treatment.
The WHO ART guidelines committee concluded that the benefits of adopting these new treatment recommendations outweighed the potential risks.

Thursday, November 19, 2009

Agneepath ( with translation)

One of my favorite pieces of hindi poetry and probably one of the most famous and inspiring ones ever written by Late Harivansh Rai Bachchan (Father of Amitabh Bachchan):-

Vriksh ho bhale khade, 

ho ghane ho bade,
Ek pat chhav ki mang mat, mang mat,
Agneepath Agneepath Agneepath.

Tu na thakega kabhi,

tu na thamega kabhi, 
tu na mudega kabhi,
Kar shapath, kar shapath, kar shapath,
Agneepath, Agneepath, Agneepath.

Ye mahaan drishya hai, chal raha manushya hai,
Ashru shwet raqt se lathpath, lathpath, lathpath,
Agneepath, Agneepath, Agneepath. 



Translated by me - I am not very good with words so this is all that I could come up with trying to keep the essence and punch of the hindi version intact:


There may be trees all around 
Standing proudly dense and tall
Don't seek for the shade of a single leaf
Walk on the Path of Fire, the Path of Fire

That you will not tire

That you will not halt
That you will not retreat
Take this vow, take this vow
On the Path of Fire, the Path of Fire

This is a noble sight, 

that of a man marching forth
Swathed in tear ,sweat and blood, he moves forth
Walking on the Path of Fire,  the Path of Fire

Kaiser Daily Global Health Policy Report