¿Deberían los adultos mayores someterse a cirugías invasivas? Nueva investigación ofrece guía
Casi 1 de cada 7 adultos mayores muere dentro del año después de someterse a una cirugía mayor, según un nuevo estudio que arroja luz sobre los riesgos que enfrentan las personas mayores cuando tienen procedimientos invasivos.
Casi 1 de cada 7 adultos mayores muere dentro del año después de someterse a una cirugía mayor, según un nuevo estudio que arroja luz sobre los riesgos que enfrentan las personas mayores cuando tienen procedimientos invasivos.
Los pacientes mayores con probable demencia (33% mueren dentro del año) y fragilidad (28%), así como aquellos que se someten a cirugías de emergencia (22%) son los más vulnerables.
La edad avanzada también aumenta el riesgo: los pacientes de 90 años o más tienen seis veces más probabilidades de morir que los de 65 a 69.
El estudio, de investigadores de la Escuela de Medicina de Yale, publicado en JAMA Surgery, aborda una importante brecha: aunque en Estados Unidos los pacientes de 65 años y más representan casi el 40% de todas las cirugías, faltan datos nacionales detallados sobre los resultados de estos procedimientos.
“Como campo, hemos sido realmente negligentes al no comprender los resultados quirúrgicos a largo plazo para los adultos mayores”, dijo la doctora Zara Cooper, profesora de cirugía en la Escuela de Medicina de Harvard y directora del Centro de Cirugía Geriátrica en Brigham and Women’s Hospital de Boston.
La información sobre cuántas personas mayores mueren, desarrollan discapacidades, ya no pueden vivir de forma independiente o tienen una calidad de vida significativamente peor después de una cirugía mayor es crítica.
“Lo que los pacientes mayores quieren saber es: ‘¿cómo será mi vida?'”, dijo Cooper. “Pero no hemos podido responder antes con datos de calidad”.
En el nuevo estudio, el doctor Thomas Gill y sus colegas de Yale examinaron datos de reclamos de Medicare Tradicional y de encuestas del estudio Nacional de Tendencias de Salud y Envejecimiento que abarcan de 2011 a 2017.
Se contabilizaron como cirugías mayores los procedimientos invasivos que se realizan en quirófanos con pacientes bajo anestesia general. Los ejemplos incluyen cirugías para reemplazar caderas rotas, mejorar el flujo sanguíneo en el corazón, extirpar cáncer del colon, extirpar vesículas biliares, reparar válvulas cardíacas y hernias, entre muchas más.
Los adultos mayores tienden a experimentar más problemas después de la cirugía si tienen afecciones crónicas como enfermedades cardíacas o renales; si ya están débiles o tienen dificultad para moverse; si su capacidad para cuidar de sí mismos está comprometida; y si tienen problemas cognitivos, apuntó Gill, profesor de medicina, epidemiología y medicina de investigación en Yale.
Hace dos años, el equipo de Gill realizó una investigación que mostró que 1 de cada 3 adultos mayores no había vuelto a su nivel básico de funcionamiento a los seis meses de una cirugía mayor. Los más propensos a recuperarse fueron los adultos mayores que se sometieron a cirugías electivas para las que podían prepararse con anticipación.
En otro estudio, publicado el año pasado en Annals of Surgery, su equipo encontró que se realizan 1 millón de cirugías mayores en personas de 65 años o más cada año, incluido un número significativo cerca del final de la vida.
“Esto abre todo tipo de preguntas: ¿estas cirugías se hicieron por una buena razón? ¿Cómo se define la cirugía adecuada? ¿Se consideraron las metas del paciente?”, dijo el doctor Clifford Ko, profesor de cirugía en la Escuela de Medicina de UCLA y director de la División de Investigación y Atención Óptima del Paciente en el Colegio Estadounidense de Cirujanos.
Como ejemplo de este tipo de toma de decisiones, Ko describió a un paciente que, a los 93 años, se enteró que tenía cáncer de colon en etapa temprana además de una enfermedad preexistente del hígado, el corazón y los pulmones. Después de una discusión en profundidad y de que se le explicara que el riesgo de malos resultados era alto, el paciente decidió no realizar un tratamiento invasivo.
Pero la mayoría de los pacientes eligen la cirugía. La doctora Marcia Russell, cirujana del Sistema de Atención de Salud del Área de Asuntos de Veteranos de Los Ángeles, describió a un paciente de 90 años que recientemente se enteró de que tenía cáncer de colon durante una internación prolongada por una neumonía.
“Hablamos con él sobre la cirugía y su meta era vivir el mayor tiempo posible”, dijo Russell. Para prepararlo en casa para la futura cirugía, le recomendó que hiciera fisioterapia y comiera más alimentos ricos en proteínas, para fortalecerse.
“Es posible que necesite de seis a ocho semanas para prepararse para la cirugía, pero está motivado para mejorar”, dijo Russell.
Las decisiones que toman las personas mayores acerca de someterse a una cirugía mayor tienen amplias implicaciones sociales.
A medida que crece la población de más de 65 años, “cubrir la cirugía va a ser un desafío fiscal para Medicare”, señaló el doctor Robert Becher, profesor asistente de cirugía en Yale y colaborador de investigación de Gill.
Un poco más de la mitad del gasto de Medicare se deriva a la atención quirúrgica para pacientes hospitalizados y ambulatorios, según un análisis de 2020.
Además, “casi todas las subespecialidades quirúrgicas experimentarán escasez de profesionales en los próximos años”, dijo Becher. Señaló que en 2033 habrá casi 30,000 cirujanos menos de los necesarios para satisfacer la demanda esperada.
Estas tendencias hacen que los esfuerzos por mejorar los resultados quirúrgicos para los adultos mayores sean aún más críticos. Sin embargo, el progreso ha sido lento. El Colegio Estadounidense de Cirujanos lanzó un importante programa de mejora de la calidad en julio de 2019, ocho meses antes de la pandemia de covid-19.
Requiere que los hospitales cumplan con 30 estándares para lograr una experiencia reconocida en cirugía geriátrica. Hasta ahora, están participando menos de 100 de los miles de hospitales elegibles.
Uno de los sistemas más avanzados del país, el Centro de Cirugía Geriátrica del Brigham and Women’s Hospital, ilustra lo que es posible. Allí, se examina a los adultos mayores candidatos y, aquellos a los que se considera frágiles se someten a una evaluación geriátrica exhaustiva y se reúnen con una enfermera que ayudará a coordinar la atención después del alta.
También se evalúa a los seniors tres veces al día en busca de delirio (un cambio agudo en el estado mental que a menudo afecta a los pacientes mayores hospitalizados), y se usan analgésicos no narcóticos. “El objetivo es minimizar los daños de la hospitalización”, dijo Cooper, quien dirige el esfuerzo.
Cooper comentó sobre una paciente a quien describió como una “mujer sociable de poco más de 80 años que todavía usaba jeans ajustados e iba a cócteles”. Esta mujer llegó a la sala de emergencias con diverticulitis aguda y delirio. Se llamó a un geriatra antes de la cirugía para ayudarla a controlar sus medicamentos y su ciclo de sueño y vigilia, y para recomendar intervenciones no farmacéuticas.
Con la ayuda de los miembros de la familia que la atendieron, “ella está muy bien”, dijo Cooper. “Es el tipo de resultado que trabajamos muy duro para lograr”.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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2 years 8 months ago
Aging, Medicare, Noticias En Español, Hospitals, Study
98% of neurosurgery advances apply to DR patients
According to Dr. José Orlando Bidó Franco, technologies are used in neurosurgery to reduce morbidity and improve patient’s quality of life. In neurosurgery, the country is at the forefront of surgical procedures to treat complex brain conditions, working in tandem with non-invasive technologies that allow access to deep brain areas without opening the skull.
To provide a more precise description of the extent of advances in this field of medicine, consider neuronavigation, a piece of equipment that uses GPS technology to trace inside the brain to identify areas close to the area where the surgery will be performed while avoiding collateral damage.
Gamma Knife radiosurgery is another non-invasive radiation-based procedure that does not damage the skin or the brain that it passes through. There is 3 Tesla magnetic resonance equipment in the diagnostic section, which allows real-time analysis of brain behavior and study of the main nerve connection pathways. These encouraging details are provided by neurosurgeon José Orlando Bidó Franco, who admirably describes how technology has allowed neurosurgery to advance.
“I would say that 98% of the procedures done in neurosurgery in the world are done in our country, even though some emerging technologies have not yet arrived.” Dr. Bidó Franco discusses the main tools available to neurosurgeons in the country that make surgeries and other procedures more effective by reducing morbidity and improving patients’ quality of life. In this regard, he cited stereotaxic, a technique that allows access to deep brain structures with submillimeter precision while causing minimal damage to the surrounding tissue.
2 years 8 months ago
Health
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
WBMCC notifies on AYUSH Counselling, Check Out schedule, all Details
West Bengal: The West Bengal Main Computerized Counselling (WBMCC) announced the tentative counseling schedule for UG AYUSH admission.
S.no of
Events
Events in
counseling
Days and date
and time
1
Publication
of Notice cum Information Bulletin and Schedule
24-11-2022
West Bengal: The West Bengal Main Computerized Counselling (WBMCC) announced the tentative counseling schedule for UG AYUSH admission.
S.no of
Events
Events in
counseling
Days and date
and time
1
Publication
of Notice cum Information Bulletin and Schedule
24-11-2022
2
Online
Registration, Fee payment, by "eligible" candidates qualified
through NEET UG 2022
From
12 noon of 25-11.2022 till Midnight of 27-11-2022 as per server time
3
After
successful Registration and Fee payment, Verification of Candidates in the
already designated College and time slot by the software
From
11 am till 4 pm on both 28-11-2022 and 29-11-2022 as per server time
4
Publication
of Provisional List of Successfully verified candidates
After
6 pm of 29-11-2022
5
Publication
of Seat Matrix and college Information for Round 1
After
2 pm of 30-11-2022
6
Publication of Final
List of Successfully verified
After
4 pm of 30-11-2022
7
Online
Choice filling and Choice Locking by the verified candidates in Final List
From
6 pm of 30-11-2022 till 7 am of 02-12-2022 as per server time
8
Publication
of allotment Result Round 1
After
4 pm of 05-12-2022
9
The
Reporting and Admission of allotted Candidates to the allotted Institute with
requisite original documents , college requisite fee, bond after physical
document verification (Once Successfully re-ver•fied they can get admitted in
the allotted seat)
From
11 am till 4 pm of 06-12- 2022; 07-12-2022 and 08-12- 2022 all 3 days as per
server time)
10
Round
2: Online Registration Fee Payment , by the candidates qualified through NEET
UG 2022 (who have not done it before or for the candidates who are
initialized upon application by system)
From
12 noon of 09-12-2022 till midnight of 11-12-2022
11
After
successful Registration and Fee payment , verification of candidates in the
already designated college and time slot by the software (for in-service and
NRI candidates verification will be done at Swasthya Bhavan)
From
11 am till 4 pm on 12- 12-2022 and 13-12-2022 both days as per server time
12
Publication of
provisional List of successfully Verified candidates
After 6 pm of
13-12-2022
13
Publication of Seat Matrix Round 2
After 4 pm of
14-12-2022
14
Publication of final list of successfully verified candidates
After 4 pm of
14-12-2022
15
Online
Choice filling and choke locking by the successfully Verified candidates
From
6 pm of 14-12-2022 till Midnight of 15-12-2022 as per server time
16
Publication of Result of provisional allotment for
round 2
After
4 pm of 17-12-2022
17
The
reporting admission of allotted candidates to the allotted institute with
requisite original documents, college requisite fee, bond after physical
document re-verification. (Once successfully re-verified they can get
admitted in the allotted seat.)
From
11 am till 4 pm on 19- 12-2022; 20-12-2022 and 21-12-2022
Notice for NEET UG 2022 counseling in West Bengal for Under Graduate AYUSH State Quota, MUSH Private College Management Quota and AYUSH Pvt. College Central Quota seats 2022.
The candidates who have qualified through NEET UG 2022 conducted by National Testing Agency (NTA) and want to participate in the counseling in West Bengal Under Graduate MUSH State Quota, MUSH Private College Management Quota and AYUSH Pvt. College Central Quota seats 2022, have to follow certain steps as listed below:-
1. State Quota
The qualified candidate through NEET UG 2022 who want to participate for WB State Quota UG seats must note that either the candidate or his/her parentis must be domicile in the State of West Bengal. They have to download the domicile certificate proforma from counseling website https://www.wbmcc.rLic.in and have to fill appropriate form and get it signed and stamped by the appropriate authority.
Once they are allotted seat then during document verification at the allotted college before admission, such certifitate in original has to be produced by the allotted candidate before the verifying authority of the college.
Only after successful verification of such certificate, the allotted candidate shall be considered for such State Quota seat provided the other required documents (as discussed later in this Notice) are properly in place.
The types of domicile certificate proforma that are uploaded in the website https://www.wbmcc,nic.in is described herewith:-
Proforma al: Residential/Domicile Certificate for candidates residing in the State of West Bengal continuously for at least last 10 years as on 315' December of 2021. They must also have passed both class 10/equivalent and class 12/equivalent from the State of West Bengal.
Proforma a2: Residential/Domicile Certificate for candidates residing in the State of West Bengal continuously for at least last 10 years as on 315' December of 2021 where the candidate has passed 10+2 Examination in the year 2022 from West Bengal.
Proforma b: Residential/Domicile Certificate for candidates NOT residing in the State of WB continuously for at least last 10 years as on 31.12.2021 (for that matter have passed either class 10 or class 12 or both from outside West Bengal) but whose parent/s are permanent resident/s of West Bengal having their permanent home address within West Bengal and living continuously for at least last 10 years in West Bengal as on 31st December of 2021.
Domicile Certificate obtained from the West Bengal e-district portal (https://edistrict.wb.gov.in/PACE) will also be accepted as the proof of domicile provided the clause shall remain as stated above for the proforma al or proforma b, as applicable.
In case proforma b or e-district domicile of the parent is furnished, it is required to produce any two of the following original ID proof (Voter ID card, Aadhar Card, Passport) of the concerned parent during the stage of document verification where the said ID cards show that the residential address is in West Bengal.
Who are authorized to sign the domicile certificate:-
Proforma al or b must be signed and certified by any of the following competent authorities of State Govt. or Central Govt. having local jurisdiction of the place of permanent residence of the candidate or the parent as the case may be e.g.:-
I. District Magistrate, Additional District Magistrate, Deputy Magistrate, Deputy Collector, Sub Divisional Officer, Block Development Officer.
2. Superintendant of Police, Additional Superintendant of Police, Deputy Superintendant of Police, Sub Divisional Police Officer.
3. Commissioner, Additional Commissioner, Joint Commissioner, Deputy Commissioner and Assistant Commissioner of Police Commissionerate.
4. Judicial Magistrate of any rank or position in the concerned district or Metropolitan locality or Hon'ble High Court at Calcutta or Hon'ble Supreme Court of India.
5. Corporation area: Commissioner, Additional Commissioner, Joint Commissioner,
Deputy Commissioner and Assistant Commissioner.
6. Assistant Secretary or above in the Secretariat of Govt. of West Bengal (including GTA) or Central Govt.
7. Deputy Director or above in the Directorate of Govt. of West Bengal or Central Govt.
Every official certifying the domicile status of candidate or parent must provide his/her FULL NAME, DESIGNATION, PLACE OF POSTING WITH ADDRESS, LANDLINE or MOBILE Number. He/she should also provide his/her identity card number if available.
Certification from any other authority other than those enumerated above will not be accepted.
Domicile certificate issued by the people's representative like Councilor of Municipal Corporation/Municipality, Member of three tier panchayet system or GTA, Member of Legislative Assembly or Member of Parliament are not accepted.
Proforma a2 must be signed and certified by the Head Master/Principal/Director/ Head of the Institution in the State of West Bengal from which the candidates have passed 10+2 Examination in the year 2022 only.
The candidate who is domicile to the West Bengal are eligible to participate in State Quota, AYUSH Private College Management Quota seats and AYUSH Private college Central quota seats in WB provided they are otherwise eligible for such seats as discussed later in this notice.
Management Quota in the Private AYUSH colleges in West Bengal in 2022 are also going to be filled up by online counseling which is to be conducted by WBMCC. The candidates qualified for NEET UG 2022 (UR/EW5 cut off 50 percentile; UR PwD/EWS PwD cut off 45 percentile; SC/ST/OBC/OBC A/OBC B/SC PwD/ST PwD/OBC PwD/OBC A PwD/OBC B PwD cut off 40 percentile) are eligible for management quota seats. Their documents will also be verified at the time of admission. The candidates who are not domicile in the State of West Bengal are eligible for Management Quota seats in Private AYUSH colleges in West Bengal. They are also eligible for AYUSH Private College Central quota seats in West Bengal. For admission in Management Quota seats the domicile certificate is not required for the allotted candidate. However they are required to produce other essential original documents as discussed in the later part of the notice for verification before securing admission in the allotted seat, It must be kept in mind by the candidates that allotment in the Management Quota is based purely on combined merit rank of NEET UG 2022 as there is no caste or PwD reservation in such seats.
Caste status of candidate: - if the candidate, who is domicile in the State of West Bengal, selects SC or ST or OBC A or OBC B during enrollment, then the candidate will have to answer whether the certificate WAS ISSUED BY AUTHORITY IN West Bengal. If the answer to the question is YES, then the candidate will be considered as reserved category candidate for West Bengal State Quota seats provided their caste certificate is successfully verified before admission at the allotted college. If the answer to the question is NO, then the candidate is treated as Unreserved for allotment of seats in State Quota Counseling provided the candidate has obtained 50 percentile marks (that is the cut off marks for UR [Unreserved] candidate in NEET UG 2022 exam).
The OBC A or ()BC B candidates if belong to creamy layer, will not be considered as reserved category candidates. If the OK A or OBC B certificate is issued before 01.04.2021, then the candidate has to provide the income certificate issued by same authority who issued earlier caste certificate. WB Domicile OBC A or OBC B candidate, who belong to creamy layer or who do not provide proper income certificate in support of being non creamy layer, shall be considered as Unreserved for allotment of seats in State Quota counseling provided the candidate has obtained 50 percentile marks (that is the cut off marks for UR [Unreserved] candidate in NEET UG 2022 exam).
If the candidate is not domicile to the State of West Bengal then he/she shall not be considered for State Quota seats irrespective of the caste status or PwD status. Such candidates are eligible to fill up choice for Private AYUSH college management quota seats and also for the Central quota seats of AYUSH Private colleges.
Candidates who belong to Economically Weaker Section (EWS) of West Bengal (with or without PwD status) and are domicile to the State of West Bengal, shall be considered as reserved category candidate for West Bengal State Quota seats provided their EWS certificate is successfully verified before admission at the allotted college. If the answer to the question is NO, then the candidate is treated as Unreserved for allotment of seats in State Quota Counseling provided the candidate has obtained 50 percentile marks [that is the cut off marks for UR (Unreserved) candidate in NEET UG 2022 exam]. The EWS certificate is to be provided by such candidate issued by the appropriate authority and such certificate shall be issued on or after 01-04-2021 and preferably in the year 2022.
PWD status: The candidates who are eligible as per cut off limits of the 21 benchmark disabilities as envisaged under the Regulations of "The Rights of Persons with Disabilities Act 2016" will only be considered in PwD (Person with Disability). The detailed information is uploaded in the website https://www.wbmcc.nic.in along with the disability certificate format. Such candidates have to verify their PwD status from the Medical Board of IPGME & R Kolkata (Address-244, A.IC Bose Road, Kolkata 700020) during the stipulated days. Certificate from any other institute will not be considered for eligibility as PwD candidate.
Mark sheet of 10+2 examination:- In Physics, Chemistry and biology taken together in 10+2 Examination, UR/EWS candidates, UR-PwD/EWS-PwD category candidates, and SC/ST/OBC-A/OBC-B (with or without PwD status) candidates must obtained 50%, 45% and 40% marks respectively in order to be eligible for taking part in counseling. They must also pass Physics, Chemistry, Biology & English individually in 10 + 2 examination. This is an essential criterion to become eligible for counseling.
Age: - Age should be at least 17 years by 31.12.2022. Date of birth must be on or before 01.01.2006 to become eligible. This is an essential criterion to become eligible in counseling.
Medical fitness certificate: - The format is provided in the counseling website and candidate has to obtain fitness in the same format from Registered Medical Practitioner to become eligible for admission in the seat allotted through counseling. The medical fitness is an essential criterion.
After the above information is furnished by the candidate, if the candidate is eligible for fee payment then he/she will be directed to the online payment gateway where he/she can pay the NON REFUNDABLE counseling fee ONLINE only through credit card/debit card or net banking/UPI facilities. Online Counseling fees is Rs 2000/- for Unreserved candidates and Rs 1500/- for SC/ST/OBC/OBC A /OBC B/PwD/EWS candidates. Bank transaction cost if any is to be borne by the candidate concerned in addition.
Once the fee is paid successfully, the candidate will receive transaction ID, of which a print out shall be taken for future correspondence. Online Acknowledgement receipt will be generated after successful submission of information and fee payment which is also needed to be printed by the concerned candidate for document verification at the allotted college. The acknowledgement receipt shall contain the date time and venue of document verification which has to be attended by the candidate physically with the original credentials and one set self attested photocopy mandatorily for becoming eligible for choice filling after successful verification.
The following documents are required to be produced by the allotted candidates in original with self attested photocopy for verification at the allotted verification venue [who qualified through NEET UG 2022 and successfully registered, filled application details, paid fee online, generated acknowledgement receipt from the software of NIC] within scheduled date and time of physical original document verification:-
For State Quota:-
a. Acknowledgement slip generated online after successful payment online
b. Domicile certificate (al, a2, b) or domicile certificate from e-district website as applicable
c. Voter card/Aadhar card/Passport of parent's in case of domicile certificate of parent is given showing address as West Bengal (any 2 of the three ID cards as mentioned above)
d. Caste certificate as applicable. ( issued in the State of West Bengal)
e. NEET UG 2022 admit card.
f. NEET UG 2022 Rank card.
g. PwD certificate issued from IPGMER Kolkata as applicable.
h. Payment of counseling fees proof (generated online).
i. Age Proof ( age should be 17 years by 31.12.2022)
j. Class 10+2 mark sheet for verification of marks
k, Medical Certificate ( from Registered Medical Practitioner)
For Management Quota:-
a. Acknowledgement slip generated online after successful enrollment
b. NEET UG 2022 admit card.
c. NEET UG 2022 Rank card.
d. Payment of counseling fees proof (generated online).
e. Age Proof ( age should be 17 years by 31.12.2022)
f. Class 10+2 mark sheet for verification of marks
g. Medical Certificate ( from Registered Medical Practitioner)
h. Caste certificate as applicable (for NEET UG qualification assessment and caste certificate of other state also allowed)
i. PwD certificate issued from IPGMER Kolkata as applicable (for NEET UG qualification assessment)
For Private AYUSH college Central quota:-
a. Acknowledgement slip generated online after successful enrollment
b. Caste certificate as applicable.(caste certificate of other state also allowed)
NEET UG 2022 admit card.
NEET UG 2022 Rank card.
PwD certificate issued from IPGMER Kolkata as applicable Payment of counseling fees proof (generated online). Age Proof ( age should be 17 years by 31.12.2022)
Class 10+2 mark sheet for verification of marks
Medical Certificate ( from Registered Medical Practitioner)
The eligible and qualified candidates through NEET UG 2022 examination and after successful verification shall be enlisted at first for provisional list for choice filling. A short time interval shall be provided for grievance redressal at the verification venues and following that the final list of candidates for choice filling shall be published for a particular round. It is understood that provisional list and final list may differ due to obvious reasons and shall not be disputed by the candidates. Only the final listed candidates for that round shall be eligible for choice filling, choice saving, choice maneuver and choice locking. Once the choices are locked, they cannot be unlocked. Only the locked choices shall be processed by the system for allotment for a particular round.
Thus the eligible and qualified candidates through NEET UG 2022 examination after successful verification can go for online Choice filling4Choice locking+Seat allotment by the Software as per Inter se merit4another Round of Physical Document Verification at the Allotted College Level4Admission at the Allotted College Level, as per schedule being provided in the website https:llwbmcc.nic.in
For any kind of suppression of facts/ mis-information related to admission in AYUSH courses in West Bengal through counseling 2022 for State Quota, MUSH Private college Management Quota or Private AYUSH college Central quota, or fabricated information furnished by candidate at any stage; will lead to cancellation of the candidature with immediate effect. Candidates are requested to visit the website https://www.wbmcc.nic.in frequently for updates and information.
The Online Registration and Online Application stage issues and outcomes of verification in details:-
During the Online Registration and Online Application stage, the candidate shall be asked about his/her domicile status in WB. If not domicile then candidate can participate for Management Quota seats only. If the candidate is domicile then the type of form filled shall be enquired that is al or a2 or b form as per notification. This is subject to verification before online choice filling and allotment by the NIC software.
If the candidate fails to provide valid or appropriate domicile certificate during verification, then the candidate shall be considered as non domicile to the State of WB, then he/she can participate for Management Quota seats of Private colleges in the same round if such candidate requests in pen and paper before the nodal officer of concerned verification center.
The candidates shall be asked to provide the caste status afresh. if the candidate fails to provide valid document in favor of his/her caste status the candidate shall be considered as un-reserved category from that round for entire counseling process, provided he/she is having the appropriate cut off as per the changed category status to remain eligible in counseling process.
It is understood that there is possibility that central and State list of caste and sub caste may be different so candidate who had stated himself/herself as UR in central list while filling up form of NEET UG 2022 but has valid caste/economically weaker section certificate issued in the State of WB, can declare themselves as SC/ST/OBCA/OBCH/EWS in WB. They can participate for caste state quota seats counseling provided he/she is also domicile in WB.
If a candidate is domicile in WB but the SC/ST/OBC/EWS certificate is of other state, then he/she would be treated as Unreserved for state quota counseling and can participate for UR seats in state quota if achieved UR cut off 50 percentile in NEET UG 2022. They can however participate also for management quota seats as per combined rank in NEET UG 2022 exam. They can however participate in central institute if any, as caste candidate.
Candidates who have opted for PwD shall be asked if they have certificate from IPGIVIER Kolkata for PwD status as per 21 benchmark disabilities as per Disability Act of 2016 and if the answer is affirmative then he/she can participate for PwD seats counseling provided he/she is successfully verified by the college authority and also the domicile in WB. If he/she cannot provide appropriate PD certificate issued by the IPGrVIER Kolkata Medical board, and then shall be considered as non PwD candidate, provided the candidate still remains eligible after the changed status.
If a candidate cannot provide domicile/caste/PwD appropriate certificate during verification and not want to participate as non domicile/changed caste status/changed PwD status as applicable, then he/she shall be rejected by the verifying authority. If the candidate after rejection wants to appear in next round afresh, then he/she has to request for the same in pen and paper before the nodal officer of the concerned verification center for initialization of candidature data so that he/she shall be able to participate in subsequent round only, by fresh application and payment of counseling fees.
Even after first round of Physical Document Verification before online choice fill up, during admission stage also there shall be another round of document verification and if it Is found that the candidate is not having appropriate caste or PwD certificate as was stated during online Registration and Application stage then the seat of that round shall be cancelled and the candidate can be considered as Unreserved or Non PwD case for subsequent round provided the candidate still remains eligible with the changed status.
The age must be at least 17 completed years by 31 Dec 2022. Else the candidature shall be cancelled. This cancellation by this criteria is irrevocable.
The candidate must obtain minimum qualification with pass marks in class XII Higher Secondary or equivalent examination as per his or her caste status in WB. Else the candidature shall be cancelled. The candidate has to pass in PCB and English separately with 50% marks in combination of PCB for UR/EWS candidates or 45% marks in combination of PCB for UR PwD/EWS PwD candidate or 40% marks in combination of PCB for SC/ST/OBCA/OBCB/SC PwD/ST PwD/OBC A PwD/OBC B PwD candidates (caste certificate must be issued in WB).
The cut off for Management quota seats shall be 50 percentile for UR/EWS candidates or 45 percentile for UR PwD/EWS PwD candidate or 40 percentile for SC/ST/OBC candidates with or without PwD status. There is no caste reservation in management quota seats. For such quota seats domicile certificate is not required but age and class XII exam result criteria is applicable.
The candidates for Central quota seats and Management quota seats in Private AYUSH colleges do not require any domicile certificate. However, the Central quota seats in Private AYUSH colleges have caste reservation. They are not however eligible for the state quota seats due to want of domicile certificate.
Candidates eligible for State quota seats are also eligible to participate for Central quota seats and Management quota seats in the Private AYUSH colleges.
If the candidate fails to provide valid or appropriate domicile certificate during verification, then the candidate shall be considered for Management Quota and Central quota seats of Private colleges in the same round, if such candidate requests for the same in pen and paper before the nodal officer of the concerned verification center.
Alternatively, If State quota candidate fail in verification of documents, then the candidate may request the verifying authority to initialize his/her data so that he/she can participate in next round by applying and paying counseling fee afresh.
Unless the candidate wants initialization, the Online Registration and Application shall be one time for a particular candidate. Fee payment shall be one time for a particular candidate unless the candidate remains not reported for Round 2 and again wants to participate in mop up round or the candidate wants initialization as discussed earlier. However fresh onlinp registration is allowed in round 1, 2 and mop up round and if any cut off is reduced by the Govt. of India during the counseling process. Furthermore, such registration may again be allowed in stray vacancy round only if the total previous non allotted and registered candidate list is less than 10 times the pooled vacancy for college round.
The candidate who does not register and fill choice in round 1 and save and lock such choice (or system auto locks the choice after the choice locking period is just over)—shall not be considered for allotment in Round 1. Choice filling shall be afresh in Round 2 for the registered candidate.
The non allotted candidate in Round 1; or the non reported candidate in Round 1; or the candidate who was allotted and admitted in round 1 and submitted willingness for participation in round 2; or the newly registered candidate in round 2 can fill choice afresh for round 2 allotment.
The candidates who are not registered, the candidates who failed during the document verification and became not eligible for subsequent round, the candidate who did not opt for subsequent round, the candidate who do not fill fresh choice in subsequent round or the candidate who surrendered seat after getting admission in earlier round –are not considered for allotment in Round 2.
Candidates cancelled due to want of essential documents or candidates who surrendered after admission or the candidates found to submit mis-information/falsification/fabrication of documents—shall be out of further counseling process.
Candidates are advised to contact the concerned college for details of fee and mode of payment before filling of such choices as after allotment in a particular round.
If the candidate fails to get admitted in the allotted seat after completing all necessary formalities within that round, the candidate shall be called as non reported candidate and such seat gets vacant for such round.
The counseling steps in nutshell:- A.) Round 1 counseling: -
• It may be mentioned here that individual eligible and NEET UG 2022 qualified candidate can do Online Registration. Online Application+ Online Fee
Payment4Acknowledgment slip generation.Physical document verification at College level as designated by NIC software4Choice filling4Choice locking4Seat allotment by the Software as per Inter se merit+Another Round of Physical Document Verification at the Allotted College Level-)Admission at the Allotted College Level, during Round 1 of the Counseling.
• It is hereby further mentioned that after the choices are placed and saved, the choices shall have to be locked by the candidates as only the locked choices for that particular round shall be processed for seat allotment as per inter-se-merit of the candidates.
• After generation of acknowledgment slip candidates can view the name of their colleges along with the date and time slot for Physical document verification. They need to attend physically at designated date and time slot and designated College with original credentials and one set self attested photocopy of documents for document verification.
• After successful verification, the candidate shall be handed over sever generated verified certificate. Initially provisional list will be published in the counseling website with an email Id for grievance redressal and then final list will be published. Only the candidate names which have been included in the final list shall be able to fill up choice/s for such round.
• Now after the inclusion in the Final Verified list, if the candidate gets allotment in a particular AYUSH College/Hospital, there shall be another round of Physical Document Verification of the allotted candidate in that allotted College/Hospital. During such if the admitting authority does not find adequate document if favor of Caste and Or PWD Status, the following situation/s might arise:
a. Candidate gets un-reserved seat if otherwise eligible as per cut off, then he or she will get admitted in that round as well and shall also be eligible for participation in Round 2 as un-reserved candidate.
b. Candidate gets reserved/PWD seat but could not produce required document in favor of that during such second phase of verification at the allotted college level, so the verifying authority will convert the category to un-reserved/Non-PWD as the case may be, and the allotted seat will be cancelled for that round and candidate shall be made eligible as per the changed category status in the subsequent round/s as unreserved/ Non-PWD candidate provided He or She still remains eligible for counseling with changed candidature status.
• Once successfully verified such candidate has to get admitted in the college and college authority shall hand over the system generated admission letter to the admitted candidate.
• During the admission process of round 1, the allotted candidate shall be asked to provide
willingness for participation in subsequent round at the allotted college. If the
willingness is affirmative, then only the candidate remains eligible to participate in round 2.
• The candidate who has Not been allotted or Not reported for admission in round 1 or Not provided choice in round 1 are also allowed to participate in round 2.
• Along with this, there shall be provision for fresh Registration.* Application.. Fee Payment4Acknowiedgment slip generation.Physical document verification at College level as designated by NIC software4Choice filling (after successful verification)4Choice locking4during Round 2 for the NEET UG 2022 qualified eligible candidates, who have not done so due to any cause during the round 1 counseling.
• The candidates who have not qualified in NEET UG 2022 as per the cut off marks are not allowed in counseling process. If cut off is subsequently reduced then only such candidates shall be allowed for counseling as per revised cut off provided by NTA/Govt of India.
• The eligible and qualified candidates who fail to get Acknowledgment slip or fail to get Physical document verification for round 1 or subsequent round as the case may be (even if they have paid counseling fee successfully) are not allowed to participate in round 1 counseling or subsequent round.
B.) Round 2 counseling:-
• Already verified candidate in Round 1 who have filled up choice in round 1 and were allotted and admitted in Round 1 and provided willingness for participation in Round 2 are allowed to participate in round 2.
• Already verified candidate in Round 1 who filled up choice in Round 1 but were not
allotted in Round 1 due to inter se merit position are allowed to participate in Round 2.
• Candidate who was NEET UG 2022 qualified and successfully verified in Round 1 but failed to provide choice during Round 1 are allowed to participate in Round 2.
• The candidates who were allotted in Round 1 but were not reported in the allotted institute for admission, they are allowed free exit that is they are allowed to participate in the round 2 counseling without penalty that is, they are not required to Register/Online Application/Pay fee again during round 2 counseling. They can straight away go for fresh choice filling during round 2 counseling.
• The opportunity for Fresh Registration, Application, Fee payment, Acknowledgement slip generation, Physical document verification for eligible and qualified NEST UG 2022 candidates who have not done it during round 1 counseling due to any cause, shall be again allowed during round 2 counseling.
• The candidates, whose allotted seats were cancelled in round 1 due to inadequate documentation but still remained eligible for subsequent round with changed candidature, are directly allowed to fill choice in subsequent round.
• Non verified candidate till Round 2 or, candidate who has not filled up choice in Round 2 is not allowed in Round 2 counseling. Candidate who have got admission in Round 1 and not provided willingness to participate in Round 2 during the admission process at the allotted institute, are not allowed in Round 2 counseling.
a The candidates who have surrendered seats after admission in round 1 are not allowed to participate in any further rounds of counseling including Round 2. They are out of the counseling process.
• Candidates who have admitted/joined the allotted seat in Round 2 and further rounds of counseling will not be allowed to resign/surrender and will also be ineligible to take part in further rounds of any type of counseling.
• Surrendering of seats is only allowed till Round 1 of counseling.
• The willingness for participation in subsequent round shall not be available during round 2 admissions or during any further rounds of admission process.
C.) Mop up round counselionlinet:
• The opportunity for Fresh Registration 4 ApplicatIon 4 Fee
Payment Acknowledgment slip generation 4 Physical document verification at College level as designated by NIC software 4 Cholce filling(after successful verification) Choice locking, who have not done it during round 1 and round 2 counseling due to any cause, shall be again allowed during Mop Up counseling.
The successfully verified candidates, who remain not allotted till round 2, are allowed to participate in Mop Up straight away by fresh choice filing; they do not need to pay the counseling fee again.
• Already successfully verified candidate in Round 1 or Round 2 who failed to provide choice during the round/5 are allowed to participate in Mop Up, they do not need to pay the counseling fee again.
• The candidates, whose allotted seats were cancelled in round 2 due to inadequate documentation but still remained eligible for subsequent round with changed candidature, are allowed in Mop Up counseling for fresh choice filling.
• The candidates who remain not reported during round 2 counseling are allowed to participate in mop up counseling but with penalty that is they have to do Fresh Fee Paynnent4Acknowledgment slip generation 4 Physical document verification at College level 4Choice filling(after successful verification} Choice locking,
• However, during the Physical document verification process if they fail to get verified themselves no initialization will be clone from this round onwards that is they are out of the counseling process.
• Registered candidate who have not filled up choice in Mop Up are not allowed in Mop Up counseling. The candidates who remain admitted after round 2 counseling, are not allowed any further for participation in mop up counseling or further counseling.
D.) Physical Stray Vacancy Round counseling:-
• No Fresh Registration or Fee payment is allowed in stray vacancy round. Only the candidates, who are already successfully verified and not allotted /not reported till mop up round, are allowed for such stray vacancy round by physical reporting with original documents and fees for college admission, details for such shall be notified later on.
• Only the candidates (not less than 10 times of the pooled vacancy) who are already verified in the previous round/s, Not-reported/ Non allotted till Mop-up round shall be allowed for this round. Allotment cum admission at the college with vacancy shall be possible as per merit by physical reporting of the candidate in this round.
• The candidates, who failed to verify themselves successfully during physical document verification in Mop Up round due to failure in submission of essential documents (domicile; caste status, PWD certificate, age criteria) , are out of the counseling process and they are not allowed to participate any further in counseling.
Online counseling (steps details):-
step]. (Online Registration& Application):-
• There will be provision of Online Registration and Online Application for participation in NEET UG MUSH Counseling 2022 in West Bengal State Quota, Private College Management Quota, Private College Central Quota seats. Candidates qualified through NEET UG 2022 conducted by NTA and eligible to participate in such counseling are hereby requested to apply through online link in the website https://wbmcc.nic.in strictly within scheduled time.
• It is pertinent to mention that the NEET UG 2022 qualified candidates who have already got admitted in All India Quota Medical/Dental seats or State Quota Medical/Dental seats and remain admitted after Round 2 of All India Quota counseling 2022 or Round 2 of State Quota counseling ( in any state of India) 2022 in Medical/Dental seats, are hereby excluded/barred from participation in the NEET UG WS AYUSH counseling 2022 process.
IIIThe qualified and eligible candidate through NEET UG 2022 will put his/her Roll No, Name, Date of birth in the New Registration click button in the on-line counseling system. If the record matches with the result handed over to the State by National Board of Examinations through Ministry of Health and Family Welfare, Govt. of India, New Delhi, then the Candidate has to put his/her mail id where OTP will be sent. After OTP validation the candidate has to fill up additional information like fathers name, mothers name, and address, phone no, etc. After submission of such details registration process will be completed. Once successful registration is completed the candidate has to further login as already registered candidate by putting Roll no and Password created by the candidate himself or herself in the earlier mentioned steps. During the process if by mistake candidate fills up any wrong information there is also provision for editing the registration details further in the "edit registration details" button. After completion of registration process such candidate will also be asked If Physically challenged having the valid PWD certificate form IPGMER hospital authority etc. Regarding further step by step details please see the user manual uploaded in the WBMCC official website.
• It is hereby further mentioned that The Caste Status and EWS status would be asked to provide afresh during the Online Application process of the counseling. Candidates who belong to SC, ST, OBC, EWS categories will be required to answer the question whether their caste certificates are issued/validated by authority in West Bengal. If not, they will be considered as Unreserved during seat allotment process of online counseling except for the central institutes if any in West Bengal. The OBC Candidates whose certificates are issued in West Bengal will be required to select sub caste as OBC A or OBC B as the case may be. Once selected the caste specific answers by candidates if there is any mistake done by candidate he/she can reset the application data in the "Reset Application for Modification" option button before final submission also. For claiming seats under OBC, OBC-A and OBC
B. the candidate has to submit non-creamy layer Certificate issued on/after 01.04.2021 by the same authority who issued OBC/OBC-A/OBC-B certificate, unless the OBC/OBC-A/OBC-B certificate has been issued on/after 01.04.2021; otherwise he/she will not be considered as under OBC/OBC-A/OBC-B category for seat allotment,
• if the cut off is reduced by Govt. of India or NTA then the candidate with reduced cut off shall also be able to register in counseling provided such cut off reduction occurs before Mop up of West Bengal counseling,
Step 2 [Payment of requisite fees, obtaining transaction 1D and then generation of acknowledgement Receipt1:-
• The qualified and eligible candidates through NEST UG 2022 after online Registration and Application will be directed to online payment system, Online Counseling fees is Rs 2000/- for Unreserved candidates and Rs 1500/- for SC/ST/OBC/OBC A /OBC 13/PwD/EW5 candidates. Bank transaction cost if any is to be borne by the candidate concerned in addition. The online deposition can be done through net banking or credit/debit card/UPI system. If the payment is successful the candidate can generate acknowledgement receipt from candidate log in, where all the transaction details are there. It is hereby further mentioned that generation of acknowledgment slip is mandatory for Physical Document verification of candidates, as the venue/date/time everything will be mentioned in that acknowledgment slip only. Candidates have to bring the hard copy of that slip also during Physical document verification otherwise no verification will be done.
• It may so happen that due to Internet server error during the payment process, the candidate fails to pay successfully and thus fails to generate transaction ID and or acknowledgement slip. The candidate is advised to be cautious and must check with his/her bank account before attempting to pay again since the payment once made for counseling process is non-refundable.
• The candidates who have not paid for counseling process successfully are not able to participate in counseling process. However if a candidate fails to pay successfully in Round 1 counseling gets further chance before Round 2 or Mop up round counseling. Such candidate must however keep in mind that he/she is eligible for allotment of only such seats that are available during that particular round, Step3 (Physical Document Verification of the successfully paid candidates):-
• After generation of acknowledgment slip candidates can view the name of their colleges along with the date and time slot for Physical document verification. They need to attend physically at designated date and time slot and designated College with original credentials and one set self-attested photocopy of documents for document verification.
• The verification of all candidates (state quota and private management quota), shall be done at software allotted five Medical Colleges of Kolkata within the stipulated time and date. No verification beyond the stated scheduled dates will be entertained for that particular round.
• After successful verification, the candidate shall be handed over server generated verified certificate. Initially provisional list will be published in the counseling website with an email Id for grievance redressal and then final list will be published. Only the candidate names which have been included in the final list shall be able to fill up choice for such round.
Step 4 (Choice filling and Choice locking of the successfully verified candidates):-
• The already Registered and Successfully Verified candidates from the published list have to click the Registered User Sign in button in the website, put the Roll no and Password to log in,
• After such step the candidate shall be able to see the available choices and fill the choices one by one in the choice basket. The Central Quota/Management quota candidates cannot see State Quota Choices. The candidates, who are non domicile to West Bengal and are belonging to Private management only, can see the Private management seats and Central quota seats of the Private College for obvious reasons.
• The following options are provided in the choice filling link like choice up and down, single deletion, choice interchange, choice move, multiple deletions etc. The candidate can fill all the viewed choices as per eligibility however the choices shall be processed only as per seat matrix for that round and seat conversion policy of the particular round. The candidates are requested to arrange choice as per willingness as choice processing shall be done by the computer system from the first choice downwards at his/her inter se merit rank.
• The candidates must save the choices as choices not saved shall not be available for consideration of allotment. After the choice arrangement is done the final step is to lock the choices after providing the password. Once the choices are locked they cannot be changed and no application shall be entertained in this regard. Only the locked choices shall be processed for allotment. If the candidate fails to lock the choices but is able to save them then the choices provided and saved shall be auto locked after the choice locking period is over by the system.
Step 4 (publication of processed Result of allotment based on eligibility of candidates):-
• The allotment shall be based on inter se merit of the candidates as per provided caste, PwD status, and category and shall be purely provisional.
• The allotted candidate has to pass another round of physical document verification process at the allotted college within stipulated time by providing the original documents and requisite college fee for securing the admission.
• The candidate who fail in the document verification process due to lack of essential documents and thereby become non eligible for further rounds shall be out of the counseling process.
• The candidate who does not appear for document verification (physical reporting) at the allotted college with requisite original documents and college fee within stipulated time shall be termed as non reported candidate.
Conversion Rule:-
The following conversion rule is available for vacant seats in Mop Up round Only:-
UR PwD 4 UR
EWS PwD - EWS SC PwD 4 SC
ST PwD 4 ST
OBCA PwD 4 OBCA OBCB PwD 4 OBCB SC<— 4ST and vice versa
OBCA (— 4 OBC B and vice versa
EWS 4 UR
No conversion of SC/ST seat to UR and no conversion of OBCA/OBCB seats to UR are possible without the permission of the Backward Class Welfare Department (MOND), Govt. of WB.
AYUSH UG Private Colleges with Central quota seats:-
Some AYUSH UG private colleges have Central Quota seats and counseling of such seats is to be done by the WBMCC. In such seats the rules apply of the All India Ayush Counseling latest guidelines for 2022-23 that is all such seats are Open in nature. If the candidate is qualified in NEET UG 2022 then he/she can participate in such seats as per combined merit rank. The Private Ayush college AUQ seats if any left vacant after 2 rounds of counseling shall be deemed to be converted to State Quota and State Quota rules shall be applicable for allotment in Mop Up.
All candidates have to sign the following undertaking beforehand and have to provide during admission process that:-
" I , NEET UG 2022 Roll No NEET UG 2022 rank
, solemnly undertake that the information provided during enrollment process are true to the best of my knowledge. I understand that if it is found that I have deliberately tried to provide mis-information or falsification or fabrication of documents or obtained unfair means then my candidature shall be cancelled at once and I shall not be allowed to participate further in counseling process of WB UG 2022. I also hereby state that am at present not admitted in any other course/college anywhere."
Details of admission procedure and further rounds of the counseling schedule shall be informed in the counseling website https://wbmcc.nic.in in due course. The candidates are requested to frequently visit the said website for further information because no individual communication in this regard can be provided.
To view the official Notice, Click here :https://medicaldialogues.in/pdf_upload/show-192196.pdf
2 years 8 months ago
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DNB Dermatology, Venereology and Leprosy: Admissions, Medical Colleges, Fees, Eligibility criteria
DNB Dermatology,
Venereology and Leprosy or Diplomate of National Board in Dermatology,
Venereology and Leprosy also known as DNB in Dermatology, Venereology and
Leprosy is a Postgraduate level course for doctors in India
that is done by them after completion of their MBBS. The duration of this
DNB Dermatology,
Venereology and Leprosy or Diplomate of National Board in Dermatology,
Venereology and Leprosy also known as DNB in Dermatology, Venereology and
Leprosy is a Postgraduate level course for doctors in India
that is done by them after completion of their MBBS. The duration of this
postgraduate course is 3 years, and it focuses on the study of various concepts related
to the field of diagnosis of different types of hair, nails, skin related diseases and including the management and prevention of the conditions.
The course is a full-time course pursued at various accredited
institutes/hospitals across the country. Some of the top accredited
institutes/hospitals offering this course are Base Hospital- Delhi, College
of Medicine and JNM Hospital- West Bengal, Darbhanga Medical College Hospital- Bihar, and more.
Admission to this course is done through the NEET PG Entrance exam
conducted by the National Board of Examinations, followed by counselling based
on the scores of the exam that is conducted by DGHS/MCC/State
Authorities.
The
fee for pursuing DNB (Dermatology, Venereology and Leprosy) from accredited
institutes/hospitals is Rs. 80,000 to Rs. 3,15,000 per year.
After completion of their respective course, doctors can either join the
job market or pursue a super-specialization course where DNB Dermatology,
Venereology and Leprosy is a feeder qualification. Candidates can take
reputed jobs at positions as Senior residents, Junior Consultants, Consultants, etc. with an approximate salary range of Rs. 8,00,000 to Rs.20,00,000 per year.
DNB is
equivalent to MD/MS/DM/MCh degrees awarded respectively in medical and surgical
super specialties. The list of recognized qualifications awarded
by the Board in various broad and super specialties as approved by the
Government of India are included in the first schedule of the Indian Medical
Council Act, 1956.
The Diplomate
of National Board in broad-specialty qualifications and super specialty
qualifications when granted in a medical institution with the attached hospital
or in a hospital with the strength of five hundred or more beds, by the
National Board of Examinations, shall be equivalent in all respects to the
corresponding postgraduate qualification and the super-specialty qualification
granted under the Act, but in all other cases, senior residency in a medical
college for an additional period of one year shall be required for such
qualification to be equivalent for the purposes of teaching also.
What is DNB in Dermatology,
Venereology and Leprosy?
Diplomate of National Board in Dermatology,
Venereology and Leprosy, also known as DNB (Dermatology, Venereology and
Leprosy) or DNB in Dermatology, Venereology and Leprosy is a three-year postgraduate
programme that candidates can pursue after completing MBBS.
Dermatology, Venereology and Leprosy
is the branch of medical science dealing with the study of skin, nails, hair, and
diseases.
The National
Board of Examinations (NBE) has released a curriculum for DNB in Dermatology,
Venereology and Leprosy.
The curriculum governs the education and training of DNB in Dermatology, Venereology and Leprosy.
PG education intends to create
specialists who can contribute to high-quality health care and advances in
science through research and training.
The required training done by a
postgraduate specialist in the field of Dermatology,
Venereology and Leprosy would help the specialist recognize the community's
health needs. The student should be competent to handle medical problems
effectively and should be aware of the recent advances in their speciality.
The candidate should be a highly
competent specialist in Dermatology,
Venereology and Leprosy possessing a broad range of skills
that will enable her/him to practice Dermatology,
Venereology and Leprosy independently. The PG candidate should also acquire
the basic skills in the teaching medical/para-medical students.
The candidate is also expected to
know the principles of research methodology and modes of the consulting
library. The candidate should regularly attend conferences, workshops, and CMEs
to upgrade her/ his knowledge.
Course Highlights
Here are some of the course highlights of DNB in Dermatology, Venereology and Leprosy
Name of Course
DNB in Dermatology, Venereology and
Leprosy
Level
Postgraduate
Duration of Course
Three years
Course Mode
Full Time
Minimum Academic Requirement
MBBS degree obtained from any
college/university recognized by the Medical Council of India (now NMC)
Admission Process / Entrance Process /
Entrance Modalities
Entrance Exam (NEET PG)
Course Fees
Rs. 80,000 to Rs. 3,15,000 per year
Average Salary
Rs. 8,00,000 to Rs.20,00,000 per year
Eligibility Criteria
The eligibility criteria for DNB in Dermatology, Venereology and Leprosy
are defined as the set of rules or minimum prerequisites that aspirants must
meet in order to be eligible for admission, which includes:
- Candidates must be in possession of an
undergraduate MBBS degree from any college/university recognized by the Medical
Council of India (MCI) now NMC.
- Candidates should have done a compulsory rotating internship of one year
in a teaching institution or other institution which is recognized by the
Medical Council of India (MCI) now NMC.
- The candidate must have obtained permanent registration of any State
Medical Council to be eligible for admission.
- The
medical college's recognition cut-off dates for the MBBS Degree courses and
compulsory rotatory Internship shall be as prescribed by the Medical Council of
India (now NMC).
- Candidates
who have passed the final examination, leading to the award of a Post Graduate
Degree (MD/MS) from an Indian University, which is duly recognized as per
provisions of the National Medical Commission (NMC) Act, 2019 and the first
schedule of the IMC Act can apply for the DNB Final examination in the same
broad specialty.
Admission
Process
The admission process contains a few steps to
be followed in order by the candidates for admission to DNB in Dermatology, Venereology and Leprosy. Candidates can view
the complete admission process for DNB
in Dermatology, Venereology and Leprosy mentioned below:
- The NEET PG or National Eligibility Entrance Test for Post
Graduate is a national-level master's level examination conducted by the NBE
for admission to MD/MS/PG Diploma Courses. - The requirement
of eligibility criteria for participation in counselling towards PG seat
allotment conducted by the concerned counselling authority shall be in lieu of
the Post Graduate Medical Education Regulations (as per the latest amendment)
notified by the MCI (now NMC) with prior approval of MoHFW.
S.No.
Category
Eligibility Criteria
1.
General
50th Percentile
2.
SC/ST/OBC (Including PWD of SC/ST/OBC)
40th Percentile
3.
UR PWD
45th Percentile
Fees Structure
The fee structure for DNB in Dermatology, Venereology and Leprosy
varies from accredited institute/hospital to hospital. The fee is generally
less for Government Institutes and more for private institutes. The average fee structure for DNB in Dermatology, Venereology and Leprosy is Rs. 80,000 to Rs. 3,15,000 per year.
Colleges offering DNB in Dermatology,
Venereology and Leprosy
Various
accredited institutes/hospitals across India offer courses for pursuing DNB (Dermatology, Venereology and Leprosy).
As per the
National Board of Examinations website, the following accredited
institutes/hospitals are offering DNB (Dermatology,
Venereology and Leprosy) courses for the academic year 2022-23.
Hospital/Institute
Specialty
No. of Accredited Seat(s)
(Broad/Super/Fellowship)
DNB- Post Diploma Seat(s)
Accreditation Valid up to*
Faculty for Accredited Programme
Base Hospital
Delhi Cantt.,
Delhi-110010
Dermatology, Venereology and Leprosy
2
2
Dec-2025
View Faculty
College of Medicine and JNM Hospital
P. O.: Kalyani District, Nadia
West Bengal-741235
Dermatology, Venereology and Leprosy
1
1
Dec-2026
View Faculty
Darbhanga Medical College Hospital
Laheriasarai P.O. -DMC, Laheriasarai, Darbhanga
Bihar-846003
Dermatology, Venereology and Leprosy
1
1
Dec-2025
View Faculty
Dr. Baba Saheb Ambedkar Hospital
Sector- 06 Rohini
Delhi-110085
Dermatology, Venereology and Leprosy
1
1
Dec-2025
View Faculty
Dr. R N Cooper Municipal General Hospital
(Associated with H B T (Hinduhridayasamrat Balasaheb Thackeray)
medical College) North South Road No.1, Juhu Scheme, Vile Parle (West), Mumbai
Maharashtra-400056
Dermatology, Venereology and Leprosy
1
1
Dec-2026
View Faculty
GMERS Medical College
Nr. Pathikasharam, Civil Hospital Campus, Sector-12,
Gandhinagar
Gujarat-382012
Dermatology, Venereology and Leprosy
1
1
Dec-2024
View Faculty
Government Medical College and Associated Hospital
Janglat Mandi, Anantnag
Jammu and Kashmir-192101
Dermatology, Venereology and Leprosy
1
1
Dec-2025
View Faculty
Government Multi Specialty Hospital
Sector-16,
Chandigarh-160016
Dermatology, Venereology and Leprosy
2
2
Dec-2025
View Faculty
Hindu Rao Hospital
Subzi Mandi, Malkaganj
Delhi-110007
Dermatology, Venereology and Leprosy
2
2
Dec-2026
View Faculty
Indira Gandhi Medical College and Research Institute
Vazhudavur Road, Kathirkamam Puducherry 9 Pondicherry
Pondicherry-605009
Dermatology, Venereology and Leprosy
2
2
Dec-2025
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JLNM Hospital
Rainawari Srinagar
Jammu and Kashmir-190001
Dermatology, Venereology and Leprosy
1
1
Dec-2026
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Medical Trust Hospital
M G Road, Kochi
Kerala-682016
Dermatology, Venereology and Leprosy
1
1
Dec-2027
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Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj
Hospital
Thane Belapur Road, Kalwa, Thane
Maharashtra-400605
Dermatology, Venereology and Leprosy
1
1
Dec-2025
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Sai Sudha Hospital
D No: 21-1-24, Jawahar Street, Salipeta, Kakinada
Andhra Pradesh-533001
Dermatology, Venereology and Leprosy
1
1
Dec-2025
View Faculty
SETH V. C. GANDHI and M. A. VORA MUNICIPAL GENERAL HOSPITAL
(RAJAWADI HOSPITAL)
NEAR POST OFFICE, GHATKOPAR EAST MUMBAI
Maharashtra-400077
Dermatology, Venereology and Leprosy
1
1
Dec-2026
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South Central Railways Hospital
Lallguda, Secunderabad
Andhra Pradesh-500017
Dermatology, Venereology and Leprosy
2
2
Dec-2023
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Syllabus
A DNB
in Dermatology, Venereology and Leprosy is a three years
specialization course that provides training in the stream of Dermatology, Venereology and Leprosy.
The
course content for DNB in Dermatology, Venereology and Leprosy
is given in the NBE Curriculum released by the National Board of Examinations, which can be assessed through the link
mentioned below:
DNB Dermatology, Venereology and Leprosy in India: Check out NBE released Curriculum
ANATOMY AND ORGANIZATION OF HUMAN SKIN
Must know
Should know
Good to know
♦ Components of normal human skin
♦ Epidermis
♦ Dermoepidermal Junctional
♦ Dermis
♦ Langerhan's cells
♦ Mast cells
♦ Nerves and sense organs
♦ Merkel cells
♦ Basophils
♦ Blood vessels
♦ Lymphatic systems
♦ Embryology
♦ Regional variation of lymphatic
FUNCTION OF THE SKIN
Must know
Should know
Good to know
♦ Barrier functions
♦ Temperature regulation
♦ Skin Failure
♦ Immunological function
♦ Mechanical function
♦ Sensory and autonomic function
♦ Bioengineering and the skin
♦ Socio sexual communication
DIAGNOSIS OF SKIN DISEASE
Must know
Should know
Good to know
♦ Fundamental of diagnosis
♦ Disease definition
♦ The history
♦ Examination of the skin
♦ Additional clinical investigation (Diascopy, Wood's light, F.N.A.C. of lymph nodes, etc.)
♦ Skin testing
♦ Radiological and imaging
♦ Commonly used laboratory tests examination
♦ Oral provocation test
EPIDEMIOLOGY OF SKIN DISEASE
Must know
Should know
Good to know
♦ What is epidemiology and why is it relevant to dermatology
♦ Describing the natural history and association of specific skin disease
How much of public health problem is a skin disease
What determines the frequency of skin disease
HISTOPATHOLOGY OF THE SKIN GENERAN PRINCIPLES
Must know
Should know
Good to know
♦ Biopsy of the skin
♦ Laboraory methods
♦ Artefacts
♦ The approach to the microscopic examination of tissue sections
MOLECULAR BIOLOGY
Must know
Should know
Good to know
♦ Basic Molecular biology of the cell
♦ Molecular techniques
♦ Cancer genetics
♦ Complex traits
♦ Strategies for identification of disease-causing genes
♦ Future strategies
INFLAMMATION
Must know
Should know
Good to know
♦ Characteristics of inflammation
♦ Phases of inflammation
♦ Innate defence mechanisms
♦ Apoptosis
♦ Major histocompatibility complex
♦ Vasculature and inflammation
♦ Mediators of inflammation
CLINICAL IMMUNOLOGY, ALLERGY, AND PHOTO IMMUNOLOGY
Must know
Should know
Good to know
♦ Innate immunity
♦ Acquired immunity
♦ Photo immunology
♦ Overview of the structure and function of the immune system
♦ Overview of immunological disease
♦ Overview of diagnostic testing for immunological and allergic disease
WOUND HEALING
Must know
Should know
Good to know
♦ Clinical aspects of wound healing
♦ Biological aspects of wound healing
GENETICS AND GENODERMATOSES
Must know
Should know
Good to know
♦ Genetics and disorders of the skin
♦ Histocompatibility antigens and disease association
♦ Chromosomal disorders – down's syndrome, trisomy 18, trisomy 13 (clinical features, diagnosis, management)
♦ Ectodermal dysplasias
o Hypohidrotic ED – definition, etiology, clinical features, diagnosis, treatment
o EEC syndrome
o Hidrotic ED
o Rapp Hodgkin syndrome
♦ Syndromes associated with DNA instability
o Xeroderma pigmentosa – definition, etiology, clinical features, diagnosis, treatment
o Bloom's syndrome
o Cockayane's syndrome
♦ Sex chromosomal defects – turner's, klinefelter's, noonan syndrome
o Familial multiple tumour syndromes – neurofibromatosis syndrome 1,2 – (definition, etiology, clinical features, treatment)
o Tuberous sclerosis complex
♦ Nosology of genetics in skin disease
♦ Principles of medical genetics
♦ Genetic counseling
♦ Poikilodermatous syndromes: dyskeratosis congenital, rothmund Thompson syndrome
♦ Gardner syndrome
♦ Cowden syndrome
♦ Miscellaneous syndromes
♦ Focal dermal
♦ hypoplasia
♦ Nail patella syndrome
♦ Pachydermoperi ostosis
PRENATAL DIAGNOSIS OF GENETIC SKIN DISEASE
Must know
Should know
Good to know
♦ Methods in prenatal diagnosis
♦ Complication of fetal skin biopsy
♦ Ethical aspects of prenatal diagnosis
♦ Current indications for fetal skin biopsy
♦ DNA techniques
♦ Preimplantation genetic diagnosis
THE NEONATE
Must know
Should know
Good to know
♦ Skin disorders in the neonate
♦ Collodion baby
♦ Eczematous eruption in the newborn
♦ Inflantile psoriasis and napkin psoriasis
♦ Disorders caused by transplacental transfer of maternal autoantibody
♦ Blueberry muffin baby
♦ Disorders caused by transfer of toxic
♦ Acute hemorrhagic oedema of childhood
♦ Infections
♦ Primary immunodeficiency disorders
♦ Disorders of subcutaneous fat
♦ Substances in maternal milk
♦ Neonatal purpura
NAEVI AND OTHER DEVELOPMENTAL DEFECTS
MUST KNOW
SHOULD KNOW
GOOD TO KNOW
♦ Definitions
o Etiology
o Classification
♦ Epidermal naevi
o Keratinocyte naevi
o VEN
o ILVEN
o Follicular naevi
o Comedonaevus
o Nevus sebaceous
o Epidermal naevus syndrome
♦ Vascular naevi
o Infantile hemangioma
o Kasabach merritt syndrome
♦ Vascular malformations
♦ Capillary
o Salmon patch
o Portwine stain
o Naevusanemicus
o Sturge weber syndrome
♦ Mixed vascular
♦ Klippel trenauny
♦ Parkas weber syndrome
♦ Cutis marmorata telangiectatica
o Angiokeratomas
♦ Angiokeratoma circumscriptum
♦ Angiokeratoma of Mibelli
♦ Solitary popular
♦ Angiokeratoma of scrotum
♦ Preauricular cyst and sinus
♦ Aplasia cutis congenita
♦ Linear porokeratosis
♦ Apocrine naevus
♦ Eccrine naevus
♦ Dermal and subcutaneous naevi
♦ Eruptive collagenoma
♦ Shagreen patch
♦ Knuckle pads
♦ Pseudoxanthoma elasticum
♦ Proteus syndrome
♦ Zosteriform venous malformation
♦ Branchial cyst
♦ Branchial sinus and fistula
PRURITUS
♦ Classification
♦ Measurement
♦ Pathophysiology
♦ Central itch
♦ Factors modulating itching
♦ Scratching
♦ Itching in non-inflamed skin
♦ Itching in disease states
♦ Aquagenic pruritus
♦ Psychogenic pruritus
♦ Postmenopausal pruritus
♦ Pruritus of atopic eczema
♦ Acquired immune deficiency syndrome
♦ Investigation of generalized pruritus
♦ Management of itching
♦ Important miscellaneous causes of intense itching
ECZEMAS
MUST KNOW
SHOULD KNOW
GOOD TO KNOW
♦ Definitions, classification, histopathology
♦ Secondary dissemination: mechanism, C/F
♦ Infective dermatitis
♦ Dermatophytide
♦ Seborrheic dermatitis: definition, etiology, C/F, morphology, variants, diagnosis, treatment
♦ Seborrheic folliculitis
♦ Asteatotic eczema
♦ Discoid eczema
♦ Hand eczema
♦ Pompholyx
♦ Hyperkeratotic palmar eczema
♦ Ring eczema
♦ Wear tear dermatitis
♦ Finger tip eczema
♦ Gravitational eczema
♦ Juvenile plantar dermatosis
♦ Pityriasis alba
♦ Diagnosis and treatment of eczemas
♦ Lichenification
♦ Lichen simplex
♦ Lichen chronicus
♦ Prurigo
♦ Nodular prurigo
♦ Prurigo pigmentosa
♦ Prurigo of pregnancy
♦ Actinic prurigo
♦ Neurotic excoriation
♦ Metabolic eczema
♦ Eczematous drug eruption
♦ Chronic superficial scaly dermatitis
♦ Papuloerythro derma of Ofujii
♦ Eosinophilic pustular folliculitis
ATOPIC DERMATITIS
MUST KNOW
SHOULD KNOW
GOOD TO KNOW
♦ Aetio pathogenesis
♦ Clinical features
♦ Associated disorders
♦ Complications
♦ Natural history and prognosis
♦ Diagnosis
♦ Differential diagnosis
♦ Investigation
♦ Treatment
♦ Disease prevention and occupational advice
CONTACT DERMATITIS: IRRITANT
MUST KNOW
SHOULD KNOW
GOOD TO KNOW
♦ Pathogenesis, Pathology
♦ Predisposing factors
♦ Clinical features
♦ Specific irritant
♦ Investigations
♦ Management
♦ Prevention
♦ Prognosis
CONTACT DERMATITIS: ALLERGIC
MUST KNOW
SHOULD KNOW
GOOD TO KNOW
♦ Pathogenesis, Pathology
o Predisposing factors
o Clinical features
♦ Photo allergic contact dermatitis
♦ Non-eczematous responses
♦ Differential diagnosis
♦ Allergic contact dermatitis
o to specific allergens (airborne contact allergens, plants, cosmetic, robber, latex.)
♦ Patch testing
♦ Photopatch testing
o Prevention
o Management
o Prognosis
♦ Oral desensitization
♦ Immune contact urticaria
♦ Multiple patch-test reaction
♦ Other test
OCCUPATIONAL DERMATOSES
MUST KNOW
SHOULD KNOW
GOOD TO KNOW
♦ Eczematous dermatoses
♦ Non-eczematous occupational dermatoses
♦ Medicolegal aspects of occupational dermatoses
♦ Specific occupational hazards
MECHANICAL AND THERMAL INJURY
MUST KNOW
SHOULD KNOW
GOOD TO KNOW
♦ Penetrating injuries
♦ Skin lesions in drug addicts
♦ Skin hazards of swimming and diving
♦ Vibration
♦ Reactions to internal mechanical stress
♦ Mechanical trauma and skin neoplasia
♦ Effects of heat and infrared radiation
♦ Burns
♦ Biomechanical considerations
♦ Effects of friction
♦ Pressure ulcer
♦ Effects of ction
♦ Miscellaneous reactions to mechanical trauma
□Foreign bodies
REACTIONS TO COLD
MUST KNOW
♦ Physiological reactions to cold
♦ Disease of cold exposure
♦ -Frostbite
♦ Trench foot
♦ Diseases of abnormal sensitivity to cold
♦ Perniosis
♦ Acrocyanosis
♦ Erythrocyanosis
♦ Livedo reticularis
♦ Raynaud's phenomenon
♦ Cryoglobulinaemia
♦ Cryofibrinogenaemia
♦ Cold agglutinins
♦ Cold haemolysins
♦ Cold urticaria
♦ Cold erythema
SHOULD KNOW
♦ Other syndromes caused by cold
♦ Neonatal cold injury
♦ Cold panniculitis
♦ Hypothermia
GOOD TO KNOW
BACTERIAL INFECTIONS
MUST KNOW
SHOULD KNOW
GOOD TO KNOW
♦ Normal flora of the skin
♦ Gram positive bacteria
o Staphylococcus aureus
o Streptococci
♦ Impetigo
♦ Ecthyma
♦ Folliculitis
♦ Furunculosis
♦ Carbuncle
♦ Sycosis
♦ Ecthyma
♦ Erysipelas
♦ Cellulitis
♦ Vulvovaginitis
♦ Perianal infection
♦ Streptococcal ulcers
♦ Blistering distal dactylitis
♦ Necrotising fasciitis
♦ Cutaneous disease due to the effect of bacterial toxin
o Staphylococcal Scalded Skin Syndrome
o Toxic Shock Syndrome
♦ Non-infective Folliculitis
♦Skin lesions due to allergic hypersensitivity to streptococcal antigens
♦ Erythema nodosum
♦Vasculitis
♦ bacteria
o Diphtheria
o Erythrasma
o Trichomycosis axillaris
o Pitted Keratolysis
♦ Erysipeloid
♦ Gas gangrene
♦ Gram negative bacteria
o Meningococcal infection
o Gonococcal infection
o Chancroid
o Salmonella infection
o Pseudomonas infection
o Rhinocleroma
o Plague & Yersinia infections
o Bacillary angiomatosis
o Anaerobic bacteria
o Tropical ulcer
o ranuloma inguinale
o Spirochetes & spiral bacteria
o Lyme disease
o Leptospirosis
o Botryomycosis
o Necrotising subcutaneous infections
o Mycoplasma infections
o Lymphogranuloma venerum
o Actinomycete infections
o Nocardiosis
♦ Dermatoses possibly attributed to bacteria
♦ Chancriform pyoderma
♦ Dermatitis vegetans
♦ Kawasaki disease
♦ Supurative hidradenitis
♦Tissue damage from circulating toxins
♦ Scarlet fever
♦ Toxic-shock-like syndrome
♦ Propionibacterium
♦ Anthrax
♦ Tularaemia
♦ Pasturella infection
♦ Brucellosis
♦ Rickettsial infections
♦ Listeriosis
MYCOBACTERIAL INFECTIONS
MUST KNOW
SHOULD KNOW
GOOD TO KNOW
♦ Mycobacterium tuberculosis-
♦ -Microbiology
♦ -Epidemiology
♦ -Immunology
♦ -The tuberculin test
♦ -Cutaneous tuberculosis-clinical features,classification,histopathology,prognosis, diagnosis,treatment,BCG vaccination,M.tuberculosis
♦ co-infection with HIV
♦ Non-tuberculous mycobacteria- classification, clinical features, diagnosis, and treatment
MYCOLOGY
MUST KNOW
SHOULD KNOWGOOD TO KNOW
♦Superficial and cutaneous mycoses- Dermatophytosis,laboratory investigations(KOH,Wood's light,culture),candidiasis,pityriasis versicolor, piedra,tinea nigra,onychomycosis
♦ Subcutaneous and deep fungal infections-lab diagnosis and management
♦ Sporotrichosis, mycetoma, chromoblastomycosis
♦ Phaeohyphomycosis, lobomycosis, rhinosoridiosis, subcutaneous zygomycosis, histoplasmosis, blastomycosis, coccidiomycosis, paracoccidio mycosis.
PARASITIC WORMS AND PROTOZOA
Must Know
Should Know
Good to Know
♦ Lymphatic filariasis, leishmaniasis- epidemiology, clinical features, diagnosis and treatment
Larva migrans
♦ Cutaneous amoebiasis
ARTHROPODS AND NOXIOUS ANIMALS
Must Know
Should Know
Good to Know
♦ Scabies and pediculosis- epidemiology, clinical features, diagnosis and management
♦ Cutaneous myiasis, Insect bites
DISORDERS OF KERATINIZATION
Must Know
Should Know
Good to Know
♦ ICHTHYOSIS –
definition, classification
♦ Congenital ichthyosis – histopathology, etiology, pathogenesis, clinical features, treatment
♦ Ichthyosis vulgaris
♦ X linked recessive ichthyosis
♦ Colloidan baby
♦ Non bullous icthyosiform erythroderma
♦ Lamellar ichthyosis
♦ Harlequin ichthyosis
♦ Bullous icthyosiform erythroderma
♦ Ichthyosis bullosa of Seimens
♦ Ichthyosis hystrix
♦ Netherton syndrome
♦ Acquired ichthyosis
♦ Ichthosis with malignancy
♦ Ichthosis with non malignant disease
♦ Drug induced ichthyosis
♦ Erythrokeratoderma
♦ Erythrokeratoderma variabilis
♦ Progressive symmetrical erythrokeratoderma
♦ Keratosis pilaris
♦ Keratosis follicularis spinulosa decalvans
♦ Pityriasis rubra pilaris
♦ Darier's disease
♦ porokeratosis
♦ PALMOPLANTAR KERATODERMA
diffuse, transgradient, focal, striate
♦ -ACANTHOSIS NIGRICANS
confluent and reticulate
pappilomatosis
♦ Multiple sulphatase deficiency
♦ Sjogren larrson syndrome
♦ Refsum's disease
♦ IBIDIS syndrome
♦ X linked dominant ichthyosis
♦ Pityriasis rotunda
♦ Peeling skin syndrome – acquired, familial
♦ Transient and persistant acantholytic dermatosis
♦ Acrokeratosis verruciformis
♦ Perforating keratotic disorders
♦ Neutral lipid storage disorders
♦ KID syndrome
♦ HID syndrome
♦ CHILD syndrome
♦ Ichthyosis follicularis with alopecia and photophobia
♦ Ichthyosis with renal disease
♦ Ichthyosis with immune defects
♦ Ichthyosis with cancer
♦ Keratoderma and associated disorders
PSORIASIS
Must Know
Should Know
Good to Know
♦ Epidemiology
♦ Aetiology and pathogenesis
♦ Histopathology
♦ Clinical Features
♦Complications
♦ Differential diagnosis
♦ Prognosis
♦ Management- topical, systemic and biologic therapies
♦ Pustular psoriasis and psoriatic arthropathy
NON-MELANOMA SKIN CANCER AND OTHER EPIDERMAL SKIN TUMOURS
Must Know
Should Know
Good to Know
♦ Epidemiology and risk factors
♦ Clinical features, diagnosis, and management of NMSC
♦ Basal cell carcinoma
♦ Squamous cell carcinoma
♦ Premalignant epithelial lesions- Actinic keratosis, Bowen's disease, Cutaneous horn
♦ -Erythroplasia of Queyrat, seborrheic keratoses, dermatoses papulosa nigra, skin tags, keratoacanthoma, pseudoepi theliomatous hyperplasia, milia
♦ Molecular and cellular biology-role of UVR and HPV
♦ -Arsenical keratoses, Disseminated superficial actinic porokeratosis, Bowenoid papulosis
♦ steatomacystoma multiplex
♦ epidermal cyst
♦ trichlemmal cyst
♦ keratoacanthoma
TUMOURS OF THE SKIN APPENDAGES
Must Know
Should Know
Good to Know
♦ Syringoma, trichoepithelioma, pilomat ricoma, Paget's disease
♦ Comedone nevus
♦ Other appendageal tumours
DISORDERS OF CUTANEOUS MELANOCYTE
Must Know
Should Know
Good to Know
♦ Ephelids, lentiginosis and its types
♦ Naevi – melanocytic, spitz, halo, congenital melanocytic
♦ Nevus of ota and ito
♦ Mongolian spot
♦ Malignant melanoma of the skin-
♦ etiology,variants,histopathology,staging,management and prevention
syndromes
DISORDERS OF SKIN COLOUR
Must Know
Should Know
Good to Know
♦ The basics of melanocytes- EMU,distribution,embryology,fine structure,melanogenesis
♦ Hypermelanosis- Lentiginosis, ephelides, hereditary disorders, hypermelanosis due to systemic disorders and drugs, postinflammatory hypermelanosis, erythema dyschromicum perstans, facial melanoses, dermal melanoses, treatment
♦ Hypomelanosis-Vitiligo, genetic and naevoid disorders
♦ Melanocyte culture, pathogeness of disorders of pigmentation Acquired hypomelanosis, endogeneous and exogeneous non- melanin pigmentation
BULLOUS ERUPTIONS
1) CONGENITAL AND INHERITED DISEASES
MUST KNOW
SHOULD KNOW
GOOD TO KNOW
♦ Epidermolysis Bullosa
o Classification, diagnosis
♦ EB simplex:
o Molecular pathology
o Clinical features
o Diagnosis, d/d
o Management
♦ Junctional EB:
o Molecular pathology
o Clinical features
o Diagnosis, d/d
o Management
♦ Dystrophic EB:
o Molecular pathology
o Clinical features
o Diagnosis, d/d
o Management
♦ Hailey-hailey disease:
o Etiopathogenesis
o Clinical features
o complications, treatment
Subtypes
Subtypes
Subtypes
Genetics
IMMUNOLOGICAL Blistering DISORDERS
a) Intra-epidermal blistering
Must know
Should know
Good to know
♦ Structure and functioning of Desmosome & Hemi desmosome
♦ Dermo - epidermal
♦ Pemphigus:
o etiopathogenesis,
o immuno - pathology,
o genetics,
o clinical features,
o diagnosis (differential),
o Management,
o prognosis
♦ P. Vulgaris: as above
♦ P. Vegetans: as above
♦ P. Foliaceus: as above
♦ P. Erythematosus: as above
Paraneoplastic pemphigus: as above
Molecular functional
anatomy
Molecular functional
anatomy
b) Sub-epidermal blistering
Must know
Should know
Good to know
♦ Bullous Pemphigoid:
o etiopathogenesis,
o immuno - pathology,
o genetics,
o clinical features,
o diagnosis
(differential),
o Management,
♦ oprognosis
♦ Cicatricial Pemphigoid: as above
♦ Pemphigoid (Herpes) gestationis: as above
♦ Linear IgA Immuno- bullous disease: as above
♦ Epidermolysis Bullosa Acquisita: as above
♦ Bullous SLE: as above Dermatitis
♦ Herpetiformis: as above
c) Miscellaneous Blistering Disorders
Must know
Should know
Good to know
♦ Sub-corneal Pustular
Dermatosis
♦ Acantholytic
dermatoses: transient &
persistent
♦ Bullae in renal disease
♦ Diabetic bullae
LICHEN PLANUS & LICHENOID DISORDERS
Must know
Should know
Good to know
♦ Lichen Planus & Lichenoid Disorders:
o etiopathogenesis,
o clinical Definition,
o features,
o variants,
o Differential diagnosis,
o histology,
o complications,
o associations,
o Treatment,
o prognosis,
♦ Lichenoid reactions,
♦ Drug induced LP
♦ Lichen nitidus
♦ Concept of Ashy dermatosis and lichen
planus pigmentosus
♦ GVHD
♦ Bullous LP & LP pemphigoides
♦ LP- Psoriasis overlap
♦ Nekam's disease
DISORDERS OF THE SEBACEOUS GLANDS
Must know
Should know
Good to know
♦ Sebaceous Gland
o Structure,
o Function
o distribution
o Functn of sebum
o Composition &
biosynthesis of sebum
♦ Acne Vulgaris
o definition
o etiology
o Clinical features
o factors affecting
o (differential) diagnosis
o Management
♦ Acne variants
o acne excoriee,
o acneiform eruptions,
o cosmetic,
o occupational,
o chloracne,
o acne conglobata,
o pyoderma faciale,
o acne fulminans,
o G-ve folliculitis
o Steroid acne
o Drug induced acne
o Adult onset acne
♦ Seborrhea
Ectopic sebaceous glands
o Histochemistry &
ultrastructure
o Development
o Endocrine control of
sebaceous gland
o Associations of acne
♦ Sebaceous gland tumors
o Classification
o Sebaceous cyst
o Measurement of sebaceous activity & sebum production
DISORDERS OF SWEAT GLANDS
Must know
Should know
Good to know
♦ Sweat Gland (Eccrine)
o Anatomy & Physiology
♦ Hyperhidrosis
o generalized
o PalmoPlantar & Axillary
o Asymmetrical
o Gustatory
♦ An/Hypo - hidrosis
o Definition,
o Etiopathogenesis,
o Classification
♦ Miliaria
o Etio- pathogenesis,
o Clinical features,
o Variants/types,
o Management
♦ Apocrine sweat
glands
o Chromhidrosis,
o Bromhidrosis
o Fox-Fordyce disease
♦ Naevus sudoriferous
♦ Compensatory hyperhidrosis
o Associations
o Heat stress
o Granulosis rubra nasi
o Diseases associated with abnormal sweat gland histology
o Fish odour syndrome
o Hematohidrosis
DISORDERS OF CONNECTIVE TISSUE
Must know
Should know
Good to know
♦ Cutaneous atrophy
o Causes / classification,
o Generalized cutn.
atrophy
o Striae
♦ Localized cutaneous
o atrophy
o Atrophoderma
o Anetoderma
o Facial hemiatrophy
o Poikiloderma
♦ Disorders of Elastin
o Lax skin
o Elastotic striae
♦ Pseudo Xanthoma
Elasticum
o Definition
o Etio - pathology
o Clinical features,
o Diagnosis
(differential)
o Management
Actinic elastosis
o Etio- pathogenesis
o Clinical features,
o Diagnosis
(differential)
o Management
Marfan syndrome—
o Etio - pathogenesis,
o Clinical features
♦ Ehlers – Danlos syndrome
Types/ Classification,
Dupuytren's contracture
♦ Knuckle pads
Keloid V/s Hypertrophic
scars
o local panatrophy
o Plantar fibromatosis
♦ Osteogenesis imperfecta
♦ Pachydermoperiostosis
♦ Relapsing polychondritis
♦Peyronie's disease
o Achenbach's syndrome
o Chronic atrophic acrodermatitis
o Linear focal elastosis
♦ Actinic granuloma
o Clinical features
♦ Elastofibroma
♦ Elastoderma
♦ Prolidase deficiency
PREMATURE AGEING SYNDROMES
Must know
Should know
Good to know
♦ Pangeria
♦ Progeria
♦ Acrogeria
♦ Perforating dermatoses:
o Types/classification,
o Clinical features,
o (Etio.) pathology,
o Management
♦ Colloid milium
♦ Congenital progeroid syndrome
♦ Diabetic thick skin
♦ Ainhum & pseudo- ainhum
♦ leprechaunism
DISORDERS OF BLOOD VESSELS
Must know
Should know
Good to know
♦ Erythemas
♦ Diffuse erythematous eruptions
♦ Annular erythemas
o Types,
o Etio - pathology,
o Clinical features,
o Diagnosis
(differential)
o Management
♦ Telangiectasias
o primary & secondary
o etio(pathology)
♦ Erythema multiforme:
o Etio- pathogenesis,
o Clinical features,
o Diagnosis (differential),
o Management
♦ Toxic Epidermal
Necrolysis
o Etio - pathogenesis,
o Clinical features,
o Differential diagnosis,
o Management &
prognosis
o Functional anatomy of Cutn. blood vessels
♦Well's syndrome
o (Etio) pathology,
o Clinical features
o Management
♦ Ataxia-Telengectasia
o Assessment of Cutn. blood vessels
o Capillary microscopy
FLUSHING & FLUSHING SYNDROMES, ROSACEA, PERIORAL DERMATITIS
Must know
Should know
Good to know
♦ Flushing
o Definition
o Etio-pathogenesis,
♦ Flushing syndromes
o Classification
♦ Rosacea
o Definition
o Etio-pathology,
o Clinical features,
o Diagnosis (differential),
o Management
♦ Perioral dermatitis—
o Etio-pathology,
o Clinical features,
o Diagnosis (differential),
o Management & prognosis
♦ Carcinoid syndrome—
o Etiopathogenesis,
o Management
URTICARIAS, ANGIOEDEMA, and MASTOCYTOSIS
Must know
Should know
Good to know
♦ Urticaria: Definition
o Classification
o Etio – pathogenesis
o Provoking factors
o Clinical features,
♦ Chronic urticarias
o Definition,
o Classification
♦ Mastocytosis
♦ classification
♦ clinical features
♦ histopathology
♦ investigations
♦ management
♦ Urticarial vasculitis
o Definition,
o Etiopathogenesis,
o Clinical features,
o Management
♦ Angioedema
o Classification
o Etio-pathogenesis
o Management &
prognosis
♦ Physical
o Classification,
♦ Cholinergic urticaria
♦ Cold urticaria
♦ Contact urticaria
♦ Aquagenic
♦ Solar
♦ Autoimmune urticaria
♦ Hereditary angioedema
♦ Etiopathogenesis of mastocytosis
♦Omalizumab
YSTEMIC DISEASES AND SKIN
Must know
Should know
Good to know
Endocrine disorders
o Cushings disease
o Adrenal
insufficiency
o Hyper and
hypothyroidism
Cutaneous markers of
internal malignancy
o Paraneoplastic syndromes
o Migratory erythemas
GI Tract
o Crohn's disease
o Ulcerative colitis
o Celiac disease
Liver diseases
o Hepatitis
o Dermatosis
associated with liver
diseases
Pancreatic diseases
Renal disease
o Dermatosis associated with renal failure and dialysis
Hematological
o Anemia
o DIC
o Antiphospholipid syndrome
Annular and figurate reactive erythemas
Skin complications of stones
Hemochromatosis
o Subcutaneous fat necrosis
o Migratory thrombophlebitis
o Necrolytic migratory erythema
o Hyper and hypopituitarism
o Parathyroid
o Multiple endocrinopathies syndrome
o Autoimmune polyglandular syndrome
Dermatosis associated with esophagus and stomach disorders
Bowel associated dermatitis arthritis syndrome Intestinal polyposis
o Other pancreatic tumours and glucagonoma syndrome
o Renocutaneous syndromes
Cardiac disease and respiratory disease
Lymphoma, leukemia
Skin disorders associated with bony abnormality
PURPURA
Must know
Should know
Good to know
♦ Purpuras:
o Classification, diagnosis
♦ Anaphylactoid purpura (HSP)-- definition,
o Etio-pathogenesis,
o Clinical features,
o Differential diagnoses,
o Management
♦ Capillaritis (pigmented purpuric dermatoses)
o Schamberg's
o Pigmented purpuric lichenoid dermatosis of Gougerot & Blum
o Lichen aureus
o Gravitational purpura
♦Thrombocytopenic purpuras
o I.T. Purpura
♦ Senile purpura
♦ Toxic purpura
♦ Itching purpura
♦ Majocchi's ds
♦ Disseminated Intravascular Coagulation
♦ Painful bruising syndrome
♦ Purpura simplex
♦ Neonatal purpura
CUTANEOUS VASCULITIS
Must know
Should know
Good to know
♦ Cutaneous Vasculitis
o Classification c/f
♦ Erythema elevatum diutinum
♦ Paniculitides
♦ Poly Arteritis Nodosa
♦ Hypersensitivity angiitis
Vascular lesions of rheumatoid diseases
o Etio, path
o Investigations
♦ Leucocytoclastic angitis
o Definition,
o Etio-pathogenesis,
o Clinical features,
o Management
♦ Henoch Schonlein Purpura
o Definition,
o Etio-pathogenesis,
o Clinical features,
o Management
♦ Pyoderma gangrenosum—
o Definition,
o Etio-pathogenesis,
o Clinical features,
o Management
♦ Purpura fulminans—
o Definition,
o Etio-pathogenesis,
o Clinical features,
o Management
♦ Sweet`s syndrome
o Definition,
o Etio-pathogenesis,
o Clinical features, Management
♦ Erythema nodosum—
o Definition,
o Etio-pathogenesis,
o Clinical features,
o Management
♦ Erythema induratum—
o Definition,
o Etio-pathogenesis,
o Clinical features,
o Management
♦ Wegener's granulomatosis
o Definition,
o Etio-pathogenesis,
o Clinical features,
o Management
♦ Granuloma faciale
♦ Degos` disease
♦ Giant cell arteritis
DISEASES OF VEINS & ARTERIES: LEG ULCERS
Must know
Should know
Good to know
♦ Signs & symptoms of
arterial diseases
♦ Investigations
♦ Erythromelalgia
♦ Veins
o Functional anatomy,
o pathology
♦ Atrophie- blanche
♦ Thrombophlebitis migrans
♦ Venous thrombosis
♦ Oedema
♦ Varicose veins
♦ Post phlebitic syndr
♦ Causes of leg ulcers
♦ Venous ulcer--
management
♦ Atherosclerosis
o Prognosis & management
♦ Thromboangiitis obliterans
♦ Ischaemic ulcer
DISORDER OF LYMPHATIC VESSELS
Must know
Should know
Good to know
♦ Lymphangiogenesis
♦ Functional Anatomy of skin lymphatics
♦ Identification of skin lymphatics
♦ Lymph transport
♦ Immune function
♦ Oedema/Lymphoedema
o Epidemiology
o Pathophysiology
o Aetiology and classification
o Clinical features and diagnosis
o Complication
o Investigation
D/d of the swollen limbs
Management of lymphoedema
o Physical therapy
o Drug therapy
o Surgery
o Provision of care
Congenital lymphatic malformation
Lymphangioma cirucmscriptum
Diffuse lymphangioma
Cystic hygroma
Acquired lymphatic malformation
Acquired lymphangioma
Lymphangitis
Kaposi sarcoma
♦ Primary lymphoedemas
♦ Inherited form
♦ Other genetic form
♦ Congenital non hereditary forms of lymphoedema
♦ Clinical patterns of pri.lymphoedema
♦ Sec. Lymphoedema
♦ Midline lymphoedema
♦ lymphangioma
♦ lymphangiomatosis
♦ lymphangiomyomatosis
♦ recurrent acute
inflammatory episode
♦ Lymphangiothrombosis
♦ Carcinoma erysipeloides
♦ lymphatic tumor
o acquired progressive
o lymphangiosarcoma
o Chylous sarcoma
o seroma
HISTIOCYTOSIS
Must know
Should know
Good to know
♦ Ontogeny & Function of histiocytosis
♦ Classification of histiocytosis
♦ Langerhans cell histiocytosis
♦ Class lla histiocytosis
♦ Dermatofibroma
♦ Juvenile xanthogranuloma
♦ Multicentric reticulohistiocytosis
♦ Generalized eruptive histiocytoma
♦ Papular xanthoma
♦ Progressive nodular histiocytosis
♦ Xanthoma disseminatum
♦ Class llb histiocytosis
♦ Diffuse plane xanthomatosis
♦ Familial haemophagocytic lymphohistiocytosis
♦ Malakoplakia
♦ Necrobiotic xanthogranuloma
♦ Sinus histiocytosis with
♦ massive lymphadenopathy
♦ Malignant histiocytosis
♦ Monocytic leukaemia
♦ True histiocytic lymphoma
♦ Benign cephalic histiocytosis
♦ Erdheim chester disease
♦ Fat storing hemartoma of dermal dendrocytes
♦ Familial sea blue histiocytosis
♦ Hereditary progressive mucinous histiocytosis
♦ Virus associated haemophagocytic syndrome
SOFT TISSUE TUMOURS AND TUMOURS LIKE CONDITIONS
Must know
Should know
Good to know
♦ Vascular tumours:
o Classification
Pyogenic granuloma
o Kaposi sarcoma
o Angiosarcoma
o Glomus tumour
♦ Peripheral
neuroectodermal
tumours
o Schwannoma
oSolitary neurofibroma
oPlexiform
neurofibroma
o Diffuse neurofibroma
♦ Tumours of muscle
♦ Skeletal muscle
tumours
♦ Tumours of uncertain
histogenesis
♦ Tumours of fat cell
♦ Osteoma cutis
♦ Cutaneous calculus
o Leiomyoma
o Leiomyosarcoma
o Rhabdomyoma
o Cutaneous
Rhabdomyosarcoma
♦ Fibrous and
myofibroblastic
tumors:
o Classification
o Nodular fasciitis
oFibrohistiocytic tumor
o Giant cell tumour of
tendon sheath
o Fibrous histiocytoma
o Angiomatoid fibrous
histiocytoma
o Plexiform fibrous
histiocytoma
o Atypical
fibroxanthoma
o Malignant fibrous
histiocytoma
oGlomeruloid
hemangioma
o Epitheloid
hemangioma
o Sinusoidal
hemangioma
o Dermal nerve sheath
myxoma
o Malignant peripheral
nerve sheath tumour
o Congenital smooth
muscle hamartoma
o Fibrous papule of face
o Pleomorphic fibroma
o Acquired digital
fibrokeratoma
o Fibro osseous
pseudotumour
o Ischemic fasciitis
o Fibrous hamartoma of
infancy
o Calcifying fibrous tumour
o Calcifying aponeurotic
fibroma
o Inclusion body
fibromatosis
o Fibroma of tendon sheath
o Collagenous fibroma
o Nuchal fibroma
o Myxofibrosarcoma
o Kaposiform hemangioendothelioma
CUTANEOUS LYMPHOMAS AND LYMPHOCYTIC INFILTRATES
A) PRIMARY CUTANEOUS T CELL LYMPHOMA
Must know
Should know
Good to know
♦ Mycosis Fungoides (MF)
♦ Follicular mucinosis
♦ Pagetoid reticulosis
♦ Granulomatous slack skin
♦ Sezary's syndrome
♦ Lymphomatoid papulosis
♦ Primary cutaneous CD30+ large cell lymphoma
CD30+ large cell cutaneous lymphoma with regional
nodal involvement
♦ Epidermotropic CD8+ cytotoxic lymphoma
♦ Large cell CD 30- cutaneous lymphoma
♦ Pleomorphic CD30- cutaneous lymphoma
♦ CD30+cutaneous lymphoproliferative disorder
♦ Regressing CD30+large cell cutaneous ltmphoma Secondary cutaneous CD30+anaplastic large cell lymphoma
B) SECONDARY CUTANEOUS LYMPHOMA
Must know
Should know
Good to know
♦ Subcutaneous panniculitis like T cell lymphoma
♦ Adult T cell leukaemia lymphoma
♦ Primary cutaneous B cell lymphoma
♦ Follicle centre cell lymphoma
♦ Leukaemia cutis
♦ Cutaneous Hodgkin s disease
♦ Extra nodal NK cell lymphoma
♦ Blastic NK cell lymphoma
Lennert's lymphoma
C) PRIMARY CUTANEOUS B CELL LYMPHOMAS
Must know
Should know
Good to know
♦ Follicle centre cell lymphoma
Cutaneous plasmacytoma
♦ Marginal zone lymphoma
♦ Large B cell lymphoma
D) PSEUDOLYMPHOMAS
Must know
Should know
Good to know
♦ Parapsoriasis
♦ Actinic reticuloid
♦ Lymphocytoma cutis Jessner's lymphocytic
infiltrate
SUBCUTANEOUS FAT
Must know
Should know
Good to know
♦ Obesity
♦ General pathology of adipose tissue
♦ Panniculitis
o Septal panniculitis
o Lobular paniculitis
o Mixed panniculitis
o Panniculitis with vasculitis
♦ Lipodystrophy
♦ Localized lipoatrophy
♦ Partial or generalized lipoatrophy
♦ Lipoma
♦ Angiolipoma
o Cellulite
o Frontalis associated lipoma
o Hibernoma
o Lipomatosis
THE CONNECTIVE TISSUE DISEASES
Must know
Should know
Good to know
♦ Lupus erythematosus
o Discoid lupus erythematosus
o Subacute cutaneous lupus erythematosus
o Systemic lupus erythematosus
o Neonatal lupus erythematosus
o The lupus anticoagulant, anti cardiolipin antibodies, and the antiphospholipid syndrome
♦ Scleroderma
o Localized morphea
o Gen. Morphea
o Pseudoscleroderma
o Occupational scleroderma
o Iatrogenic scleroderma
o Graft –versus –host disease
o Eosinophilic fasciitis
o Systemic sclerosis
♦ Mixed connective tissue disease
♦ Cold, flexed finger
♦ Lichen sclerosus
♦ Scleroedema
♦Dermatomyositis
♦ Sjogren syndrome
Rheumatic fever
♦ Dermatological manifestation of rheumatoid disease
♦ Still`s disease
NUTRITIONAL AND METABOLIC DISEASES
Must know
Should know
Good to know
♦ The cutaneous porphyrias
o Etiopathogenesis
o laboratory testing in porphyria
o Clinical features
o The individual porphyrias
o Porphyrias which cause cutaneous disease
o Porphrias which cause cutaneous disease and acute attack
♦ Mucinoses
o Classification of the cutaneous mucinoses
o Lichen myxoedematous
♦ Amyloid and the amyloidoses of the skin
o Primary localized cutn.
Amyloidosis
o Sec. Localized cutn.
Amyloidosis
o Systemic amyloidosis
o Primary and myeloma
associated cutn.
Amyloidosis
o Sec. Systemic amyloidosis
♦ Angiokeratoma corporis diffusum
♦ Xanthomas and abnormalities of lipid metabolism and storage
♦ Lipid metabolism
o Genetic primary Hyperlipidemias
o Lipid storage disease
♦ Nutrition and the skin
o Malabsorption
o Vitamins
♦ Kwashiorkor and marasmus
♦ Calcification and ossification of the skin
♦ Iron metabolism
♦ Skin disorders in diabetes mellitus
♦ Granuloma annulare
♦ Necrobiosis lipoidica
♦ Granuloma multiforme
o Reticular erythematous mucinosis
o Self healing juvenile cutaneous mucinosis
o Cutaneous mucinosis of infancy
o Papulonodular mucinosis associated with S.L.E.
o Cutaneous focal mucinosis
o Acral persistent papular mucinosis
o Mucinosis naevus
o Follicular mucinosis
o Secondary mucinoses
o Mucopolysaccharidoses
o Mucolipidoses
o Dialysis related amyloidosis
o Inherited systemic amyloidosis
o Gaucher's disease
o Niemann Pick disease
o Cutaneous mucinosis in the toxic oil syndrome G.K
o Neutral lipid storage disease
o Farbers disease
♦ Disorders of aminoacid metabolism
o Hyperphenylala ninaemia syndrome
o Tyrosinemia
o Alkaptonuria
o Homocysteinuria s
o Hartnup disease
SARCOIDOSIS
Must know
Should know
Good to know
♦ Sarcoidosis
o Definition
o Epidemiology
o Aetiology
o Histopathology
o Immunological aspects
♦ General manifestations of sarcoidosis
♦ Staging of the disease
♦ Systemic features
♦ Sarcoidosis of the skin
♦ Management
o Investigation
o Biopsy
o Kveim test
o Other investigation
o Treatment
o Topical therapy
Systemic therapy
♦ Unusual and atypical forms
♦ Associated disease
♦ Course and prognosis
♦ Other sarcoidal reaction
o Infection
o Foreign material
o Crohn's disease
o Whipple's disease
o Farmer's lung
o Other condition
THE SKIN AND THE NERVOUS SYSTEM
Must know
Should know
Good to know
♦ Skin innervations
o Sensory innervations
o Autonomic nervous system
o Wound healing and the trophic effects
♦ Postherpetic neuralgia
o Pathophysiology of pain
o Prevention of P.H.N.
o Management of P.H.N.
♦ Neuropathic ulcer
♦ Peripheral neuropathy
♦ HIV neuropathy
♦ Syringomyelia
♦ Tabes dorsalis
♦ Spinal dysraphism
♦Spinal cord injury
♦ Neuroimmunology
♦ Neurophysiological testing for skin innervations
♦ Disorders associated with autonomic abnormalities
♦ Hereditary sensory autonomic neuropathy
♦ Horner syndrome
♦ Gustatory hyperhidrosis
♦ Chronic skin pain
♦ Notalgia paresthetica
♦ Brachioradial pruritus
♦ Skin ache syndrome
♦ Burning feet syndrome
♦ Trigeminal trophic syndrome
♦ Peripheral injury
♦ Restless leg syndrome
PSYCHOCUTANEOUS DISORDERS
Must know
Should know
Good to know
♦ Introduction
♦ Emotional factors in diseases of the skin
♦ Psychological importance of skin
♦ Disability and quality of life
♦ Classification
♦ Delusions of parasitosis
♦ Cutaneous phobias
♦ Anorexia nervosa and bulimia
♦ Self inflicted and simulated skin disease
o Lichen simplex and neurodermatitis
o Acne excoriee
o Trichotillomania
♦ Factitious skin disease
o Malingering
♦ Cutaneous disease and alcohol misuse
♦ AIDS, HIV infection and Psychological illness
♦ Suicide in dermatological patients
o Treatment
♦ Body image
♦ Delusions of smell
♦ Body dysmorphic disorder
♦ Epidemic hysteria syndrome and occupational mass psychogenic illness
♦ Sick building syndrome
♦ Psychogenic excoriation
♦ Psychogenic pruritus
♦ Onycotillomania and onychophagia
o Psychogenic purpura
o Dermatitis simulate
o Dermatitis passivata
o Munchausen's syndrome
o Munchausen's syndrome by proxy
o Self-mutilation
o Psychotropic drugs
♦ Psychoneuroimmunology
o Mind-body efferent immune interaction
o Body- Mind afferent immune reactions
o Habituation to dressings
o Dermatological pathomimicry
o Hypnosis
o Misc. therapies
o Skin disease in patients with learning disability
DISORDERS OF NAILS
Must know
Should know
Good to know
♦ Anatomy and biology of nail unit
o Structure & Development and comparative anatomy
o Blood supply
o Nail growth
♦ Nail signs and systemic disease
o Abnormalities of shape
o Changes in nail surface
o Changes in colour
♦ Development abnormalities
♦ Infections- nail and nail folds
♦ Dermatoses of nails
♦ Nail surgery
o Patterns of nail biopsy
o Lateral matrix phenolization
♦ Traumatic nail disorders
o Acute trauma
o Chronic repetitive trauma
o The nail and cosmetics
o Nails in childhood and old age
o Abnormalities of nail attachment
♦ Tumours under or adjacent to the nail
o Benign tumours
o Other bone tumours
o Vascular tumours
o Myxoid cyst
o Squamous cell carcinoma
o Epithelioma cuniculatum
o Keratoacanthoma
o Melanocytic lesions
o Other surgical modalities
DISORDERS OF HAIR
Must know
Should know
Good to know
♦ Anatomy and physiology
o Development and distribution of hair follicles
o Anatomy of hair follicle
o Hair cycle and hormonal control
♦ Alopecia
o Common baldness and androgenetic alopecia
o Alopecia areata
o Acquired cicatricial alopecia
o Infections
o Scaling disorders
♦ Excessive growth of hair
o Hirsutism
♦ Variation in Hair
o pigmentation
o Types of hair
o Disturbance of hair cycle/shaft
o Developmental defects and hereditary disorders
o Congenital alopecia and hypotrichosis
o Hypertrichosis
o Shampoos
o Conditioners
o Cosmetic hair colouring
o Permanent waving
o Hair straightening (relaxing)
o Hair setting
o Complication
o Alopecia in central nervous system disorders
o Other abnormalities of shaft
THE SKIN AND THE EYES
Must know
Should know
Good to know
♦ Anatomy and physiology of the eye
♦ Chronic blepharitis, rosacea, and seborrhoeic dermatitis
o Immunopathogenisis
o Treatment
♦ Atopy and atopic eye disease
♦ Cicatrizing conjunctivitis and the immunobullous disorders
o Erythema multiforme major and toxic epidermal necrolysis
♦ Systemic disease with skin and eye involvement
♦ Ocular complications of dermatological therapy
o The eyebrows
o The eyelids
o The lacrimal glands
o The pre-corneal tear film
♦ Disorders affecting the eyebrows and eyelashes
♦ Infections
o Viral infections
o Bacterial infection
o Parasitic infection
♦ Inherited disorder
♦ Tumors
o Benign and malignant tumors of eyelids
EXTERNAL EAR
Must know
Should know
Good to know
♦ Dermatoses and external ear
♦ Systemic disease and the external ear
♦ Anatomy and physiology
♦ Examination
♦ Developmental defects
♦ Traumatic conditions
♦ Ageing changes
♦ Tumors of pinna and external auditory canal
THE ORAL CAVITY AND LIPS
Must know
Should know
Good to know
♦ Biology of the mouth
♦ Immunity in the oral cavity
o Examination of the mouth and perioral region
♦ Disorders affecting the oral mucosa or lips
♦ Genetic and acquired disorders affecting the oral mucosa or lips
o White or whitish lesions
o Pigmented lesions
o Red lesions
o Vesicoerosive disorders
o Lumps and swellings
o Various orocutaneous syndromes
♦ Oral manifestations of systemic diseases
♦ Acquired lip lesions
o Cheilitis
o Lupus erythematosus
o Sarcoidosis
♦ Disorders affecting the teeth and skin
o Ectodermal dysplasia
♦ Disorders affecting the periodontium
o Gingival disorders affecting the periodontium
o Genetic disorders affecting the peridontium
o Acquired disorders affecting the peridontium
THE BREAST
Must know
Should know
Good to know
♦ Gynaecomastia
o Physiological
o In endocrine disorders
o In nutritional, metabolic, renal and hepatic disease
o Drug-induced
♦ Morphea
♦ Silicone breast implant and autoimmune disease
♦ Cracked nipple in lactation
♦ Lupus panniculitis
♦ Sarcodosis of breast
♦ Sebaceous hyperplasia of areolae
♦ Breast abscess
♦ Basal cell carcinoma of nipple
♦ Seborrhoeic wart
♦ Mondor's disease
♦ Breast hypertrophy
♦ Gigantomastia
Management of gynaecomastia
♦ Hypomastia
♦ Rudimentary nipples
♦ Adnexal polyp of neonatal skin
♦ Inverted nipple
♦ Hyperkeratosis of nipple and areola
♦ Jogger's and cyclist's nipples
♦ Nipple piercings
♦ Artefactual breast disease
♦ Vasculitis of the breast
♦ Erosive adenomatosis of nipple
♦ Breast telangiectasia
♦ Supernumerary breast or nipples
THE GENITAL, PERIANAL AND UMBILICAL REGIONS
Must know
Should know
Good to know
♦ General approach
♦ Genitocrural dermatology
o Inflammatory
o Infections
♦ Male genital dermatology
o Structure and function
o Trauma and artifact
o Inflammatory dermatoses
o Non-sexually transmitted infections
o Precancerous dermatoses
o Squamous carcinoma
♦ Female genital dermatology
o Structure and function
o Trauma and artifact
o Inflammatory dermatoses
o Ulcerative and bullous disorders
o Non-sexually transmitted infections
o Benign tumours and tumor-like lesions of vulva
o Precancerous dermatoses
♦ Perineal and perianal dermatology
o Structure and function
o Infections
o Congenital and developmental abnormalities of male and female genitalia
o Other malignant neoplasms
o Vulval malignancy
o Benign tumours
o Premalignant dermatoses and frank malignancies
♦ Umbilical dermatology
o Structure and function
o Congenital and developmental abnormalities
o Trauma and artifact
o Inflammatory dermatoses
GENERAL ASPECTS OF TREATMENT
Must know
Should know
Good to know
♦ General measures in treatment like explanation, avoidance of aggravating factors, regimen, role of diet, food metabolites and toxins
♦ Topical therapy
-Cosmetic
-camouflage
♦ Dressings
♦ Systemic drug therapy
♦ Gene therapy
♦ Emergency treatment of anaphylaxis
♦ Treatment for anxiety and depressive states in dermatology
♦ Medicolegal aspects of dermatology
♦ Alternative therapies like
- Physiotherapy
- Acupuncture
- Biofeedback techniques
- Behaviour therapy
- Heliotherapy
- Actinotherapy
- Climatotherapy
- Homeopathy
DRUG REACTIONS
Must know
Should know
Good to know
♦ Classification and mechanism
♦ Histopathology
♦ Types of clinical reaction
o Exanthematous,
o purpuric,
o pityriasis rosea like,
o psoriasiform,
o exfoliative dermatitis,
o anaphylaxis,
o urticaria,
o drug hypersensitivity syndrome,
o fixed drug eruptions,
o lichenoid eruptions,
o photosensitivity,
o pigmentation,
o acneform eruption,
o bullous eruptions,
o vasculitis,
o LE like, DM like, scleroderma like
o erythema nodosum,
o anticonvulsant hypersensitivity,
o hair and nail changes
♦ Management of drug reactions
- Diagnosis
- Treatment
♦ Incidence
♦ Annular erythemas
♦ Acute generalized exanthematous pustulosis
♦ Serum sickness
♦ Eczematous
♦ Acanthosis nigricans
♦Erythromelagia
ERYTHEMA MULTIFORME, STEVENS JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS
Must know
Should know
Good to know
♦ Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis:
- Etiology
- Predisposition in HIV
- Pathology
- SCORTEN
- Diagnosis
- Treatment
- Prevention
♦ Incidence
RADIOTHERAPY AND REACTIONS OF IONIZING RADIATION
Must know
Should know
Good to know
♦ Indications
- Acute
- Chronic
♦ Radiodermatitis
♦ Role in benign diseases like psoriasis, keloids
♦ Role in malignant diseases
♦ Radiation induced tumors
LASERS
Must know
Should know
Good to know
♦ Basic principles
♦ Laser safety
♦ Target tissues
♦ Main types of lasers
-Enumeration
- Wavelengths
Indications
♦ Laser ablation
♦ Resurfacing
♦ Non-ablative skin remodeling
RACIAL INFLUENCES ON SKIN DISEASES
Must know
Should know
Good to know
♦ Classification of races and their main characteristics
♦ Racial variations in pigmentation, hair, and cutaneous appendages
♦ Diseases with distinct racial or ethnic predisposition
♦ Racial variation in common diseases
THE AGES OF MAN AND THEIR DERMATOSIS
♦ Somatic growth
♦ Sexual development and its effect on skin, especially sebaceous activity
♦ Puberty associated hormonal events and cutaneous changes
♦ Enumeration of puberty dermatosis and their clinical features
♦ Cutaneous changes with menstrual cycle
♦ Physiological changes related to pregnancy
♦ Vascular changes
♦ Pregnancy dermatoses
- Pruritus gravidarum
- Pemphigoid gestationis
- Pruritiuc urticarial papules and plaques of pregnancy
- Prurigo of pregnancy
- Pruritic folliculitis
♦ Premature and delayed puberty - causes and presentation
♦ Disorders of menopause
♦ Aging skin
-Concept of Geriatric patients & physiological changes in ageing skin
-Polypharmacy
-Management of late onset Vitiligo,Psoriasis.
-Skin disorders associated with aging
♦ Autoimmune progesterone dermatitis
♦ Enumeration and identification of common syndromes with short stature
SYSTEMIC THERAPY
Must know
Should know
Good to know
♦ Systemic steroids
♦ Antihistamines
♦ Retinoids
♦ Cyclophosphamide
♦ Methotrexate
♦ Mycophenolate mofetil
♦ Cyclosporin
♦ PUVA
♦ Intravenous immunoglobulin
♦ Penicillamine
♦ Antibiotics
♦ Antitubecular drugs
♦ Antileprosy drugs
♦ Antifungal drugs
♦ Antiviral drugs
- Acyclovir and its congeners
♦ Anti-retroviral drugs
♦ Ivermectin
♦ Drugs of peripheral circulation
- Pentoxyphyllin
- Calcium channel blockers
- Sildenafil citrate
- ACE-inhibitors and antagonists
♦ Antimalarials
♦ Thalidomide
♦ Colchicine
♦ Hormonal preparations
♦ NSAIDs
♦ Cytokines
♦ Interferons
♦ Essential fatty acids
♦ Bleomycin
♦ Fumaric acid esters
♦ Photopharesis
♦ Plasmapheresis
♦ Other anti-retroviral
♦ Dethylcarbamazine
♦ Sulfasalazine
♦ Interleukins
♦ Chlorambucil
♦ Dacarbazine
♦ Hydroxyuria
♦ Melphelan
♦ Gold
♦ Other antiviral drugs like Vidarabine, Idoxuridine
♦ Recent advances in therapeutics
TOPICAL THERAPY
Must know
Should know
Good to know
♦ General principles
- Choice of vehicle
- Frequency and mode of application
- Quantity to be applied
♦ Various formulation
- Enumeration with main characteristics
- Enumeration of vehicle components
♦ Anti-perspirants
♦ Topical antibiotics
- Fusidic acid
- Mupirocin
- Clindamycin
- Silver sulfadiazine
- Metronidazole
♦ Antifungals
- Allyamines
- Imidazoles
- Ciclopirox olamine
- Morpholines
♦ Antiparasitic agents
- Pyrethroids
- Malathion
- Benzyl benzoate
♦ Antiviral agents
- Acyclovir
♦ Astringents
- Potassium permanganate
- Aluminium acetate
- Silver nitrate
♦ Corticosteroids
- Mechanism
- Side effects (local and systemic)
- Classification
- Intralesional steroids
- Indications
♦ Cytotoxic and antineoplastic
agents
- Imiquimod
- Podophyllin andpodophyllotoxin
♦ Depigmenting agents
- Hydroquinone
- Retinoic acid
- Kligman cream
- Azelaic acid
- Kojic acid
♦ Emollients
♦ Immunomodulators
- Tacrolimus
- Pimecrolimus
♦ Retinoids
- Retinoic acid
- Adapalene
- Tazarotene
♦ Miscellaneous
- Dithranol
- Sunscreen
- Tars
- Vit D analogue
- Minoxidil
- Imiquimod
- Podophyllin andpodophyllotoxin
♦ Depigmenting agents
- Hydroquinone
- Retinoic acid
- Kligman cream
- Azelaic acid
- Kojic acid
♦ Emollients
♦ Immunomodulators
- Tacrolimus
- Pimecrolimus
♦ Retinoids
- Retinoic acid
- Adapalene
- Tazarotene
♦ Miscellaneous
- Dithranol
- Sunscreen
- Tars
- Vit D analogue
- Minoxidil
-- Erythromycin
- Polyenes
- Bleomycin
- 5-flurouracil
- Cyclocsporin
- Bexarotene
- Depilators
- Contact
sensitizers
- Capsaicin
- Bacitracin
- Gentamicin
- Polymyxin B
- Tetracyclines
- Tolnaftate
- Undecylenic acid
- Pencyclovir
- Idoxuridine
- Mechlorethamine
- T4 endonuclease
V
- Camphor
- Menthol
- Dyes
BASIC PRINCIPLES OF DERMATOSURGERY
Must know
Should know
Good to know
♦ RSTL
♦ Instruments used in dermatosurgery
♦ Methods of sterilization
♦ Suture materials:
o Classification,
o Suture size,
o Type and size of needle
♦ Types of suturing:
o simple interrupted,
o mattress, vertical & horizontal
o Intradermal buried,
o S.C. buried,
o Running subcuticular,
o Figure of 8
♦ Suture removal
♦ Preoperative workup:
o medication,
o part preparation
o relevant investigation
♦ Types of local anesthesia:
o Topical/surface,
o infiltration,
o tumescent,
o field blocks,
o nerve block
♦ Types of Anesthetic agents
♦ Waste segregation & disposal
♦ Patient counseling, psychological assessment and consent
♦ Emergencies and their management in dermatosurgery (vasovagal reaction, anaphylaxis, haemorrhage)
♦ Types of wound healing
♦ Wound management
o Tissue glues, staples, wound closure tapes,
STANDARD DERMATOSURGICAL PROCEDURES
Must know
Should know
Good to know
♦ Electrosurgery:
o Types (Electro- fulguration, -section, - cautery, etc.)
o Indications
♦ Curettage:
o Indications,
o Techniques:
combination with E.C.
♦ Intralesional steroid therapy:
o Indications
o Dosage
♦ Chemical cautery:
o Use of Agents (TCA, Phenol)
o Indications
♦ Cryosurgery:
o Mech. Of action,
o Cryogens and their properties,
o Techniques – dip stick, spray, probe,
o Indications
♦ Excision Bx
♦ Epidermal cyst excision – Indication and technique
♦ Corn enucleation
o Physics: basic principles
♦ Radiofrequency surgery:
o Physics, circuitry,
o Techniques,
o Types,
o Indications
o Agents other than TCA, Phenol
Intralesional
sclerotherapy
SPECIAL DERMATOSURGICAL PROCEDURES:
Must know
Should know
Good to know
♦ Dermabrasion:
o Preoperative work up,
o instruments used,
o indications,
o Techniques
o Post-op care
♦ Vitiligo surgery & skin grafting:
o Punch graft,
o Suction blister graft,
o ideal donor sites/sites to be avoided
o types of post operative dressing
♦ Nail surgery :
o Intra matrix injection,
o Nail matrix Bx,
o Nail unit Bx
o Partial & complete nail avulsion
♦ Hair restoration surgery
o Principles
o Types
o Indications
♦ Lasers
♦ Dermal fillers
–type and indications
♦ Iontophoresis:
o Mechanism, indications, contra-Indications
o Procedures
♦ Eletroepilation:
o Indications
o Contraindications,
o Types - electrolysis, thermolysis
o Facial cosmetic units
o Microdermabrasion
♦ Mechanism of action,
♦ Indications/Limitations
o Split-thickness graft
o Tattooing
♦ Chemical peel:
o Classification/types (AHA, BHA, others),
o Combination peels
♦ Scar revision – techniques
♦ Male genitalia –
o dorsal slit
♦ Botunimum toxin:
o Pharmacology& mechanism of action,
o Indications,
o contra indications,
o available preparation
♦ Instrument use,
♦ procedure,
♦ complication
o Noncultured Melanocyte- keratinocyte transfer technique
Keloid: debulking
o Methodology
o Pre- & Post-op care
o Circumcision
♦ Tissue Augmentation:
o Principles
o Materials
o Techniques
♦ Ear, nose and body piercing
♦ Ear lobe repair
o storage,
o dilution and dosage,
o procedure,
o complications
♦ Liposuction
STD CURRICULUM FOR POST GRADUATES
MUST KNOW
SHOULD KNOW
GOOD TO KNOW
Anatomy
♦ Anatomy of male and female genital tract (including blood supply and lymphatic drainage)
Microbiology & Immunology
♦ Normal/abnormal genital flora
Syndromic approach
♦ Etiology, clinical features, and management of the following STI syndromes:
Genital ulcer disease
Vaginal discharge
Urethral discharge
Inguinal bubo
Scrotal swelling
Lower abdominal pain
Ophthalmia neonatorum
♦ NACO guidelines for management of various STDs
Viral STDs
Genital herpes virus infection (HPG)
♦ Life cycle including latency & reactivation
♦ Clinical presentation
Primary episode
Non-primary first episode
Recurrent episode
♦ Lab diagnosis
Specimen collection
Cytology (Tzanck)
Culture
Histopathology
Serological diagnosis
Nucleic acid amplification tests (NAATs) including PCR & LCR
♦ Treatment
Drugs for HSV
NACO guidelines for treatment of primary & recurrent episodes in immunocompetent & immunocompromised host.
Neonatal herpes simplex infection
♦ Modes of transmission and relation with nature of maternal infection and immunity.
♦ Clinical presentation – asymptomatic, localized, disseminated disease.
Human papilloma virus infections (HPV)
♦ Clinical presentation – condyloma acuminata, papular, macular, giant warts (Buschke- Lownestein) etc.
♦ Lab diagnosis
Acetowhite test
Histopathology
♦ Treatment
Treatment options like chemical cauterization, physical modalities and other drugs.
NACO guidelines
Genital molluscum contagiosum (MC)
♦ Clinical features
♦ Lab diagnosis –
Microscopy – HP bodies
Pathology (biopsy)
♦ Treatment options for localized and disseminated lesions HIV
♦ Structure & biology of HIV
♦ Modes / risk factors for transmission
♦ Cutaneous manifestation of HIV (infective / non infective)
♦ PEP prophylaxis – indications, source code, exposure code, regimen, monitoring, side effects, adherence
♦ Sentinel surveillance Bacterial STDs Syphilis
♦ Structure of Treponema
pallidum
♦ Modes of transmission
♦ Natural history of disease (course of untreated syphilis)
♦ Classification of syphilis
♦ Clinical presentations of primary, secondary, tertiary syphilis
♦ Clinical features of different stages – primary chancre, variants of secondary stage (chancre redux, syphilis de emblee, pseudochancre redux), tertiary syphilis (gumma, other manifestations)
♦ Lab diagnosis – DGI, serological tests (treponemal and non treponemal tests), false positive VDRL / TPHA
♦ Treatment – NACO guidelines
♦ Congenital syphilis – clinical manifestations
Chancroid
♦ Morphology of H ducreyi
♦ Clinical features including variants
♦ Lab diagnosis
Microscopy
Culture
Serology
♦ Treatment – NACO guidelines
Gonococcal infections
♦ Morphology & biology of N gonorrhoea
♦ Clinical features & complications including acute urethritis, acute & chronic complications, anorectal, pharyngeal and disseminated infection
♦ Lab diagnosis –
Specimen collection & transport
Microscopy
Culture
Nucleic acid amplification tests (NAATs) including PCR & LCR
♦ Treatment – NACO guidelines for uncomplicated and
complicated gonococcal infections
Chlamydia trachomatis infections
♦ Clinical features & complications – entire spectrum of urethritis, cervicitis, proctitis, neonatal conjunctivitis, and related complications.
♦ Lab diagnosis –
Specimen collection & transport
Microscopy
Culture
Nucleic acid amplification tests (NAATs) including PCR & LCR
♦ Treatment – NACO guidelines
Lymphogranuloma venereum
♦ Clinical features – including different stages and complications
♦ Lab diagnosis –
specimen collection
cytology
culture
♦ Treatment
NACO guidelines
Surgical Donovanosis
♦ Morphology of organism
♦ Clinical features including clinical variants & complications
♦ Lab diagnosis-
specimen collection
microscopy
histopathology
isolation of organism
♦ Treatment
NACO guidelines
Surgical
Bacterial vaginosis (BV)
♦ Epidemiology & risk factors
♦ Pathogenesis including alteration of mucosal microflora and biochemical changes
♦ Clinical features
♦ Lab diagnosis – Amsel's criteria
♦ Treatment – NACO guidelines
Pelvic inflammatory disease (PID)
♦ Epidemiology & risk factors
♦ Microbiology of PID
♦ Clinical features & complications
♦ Lab diagnosis
♦ Treatment - NACO guidelines
Fungi, protozoa & arthropod infections
Genital candidal infections (VVC & CBP)
♦ Clinical features
VVC in females - uncomplicated and complicated disease
CBP in males
Candidal hypersensitivity
♦ Lab diagnosis – microscopy and culture
♦ Treatment
topical and oral drugs
NACO guidelines for uncomplicated & complicated disease (including pregnancy)
Trichomonas vaginilis infection
♦ Morphology of T vaginilis
♦ Clinical features
♦ Lab diagnosis
microscopy
♦ Treatment - NACO guidelines
Genital scabies
♦ Morphology & life cycle of the mite
♦ Epidemiology & transmission
♦ Clinical features – typical and special variants
♦ Lab diagnosis by microscopy
♦ Treatment –
Principles and options
NACO guidelines
Phthiriasis pubis
♦ Morphology & life cycle of the mite
♦ Clinical features
♦ Diagnosis
♦ Treatment – NACO guidelines Miscellaneous
♦ Role of lactobacilli
♦ Risk factors for transmission of STD
♦ Epidemiology & transmission
♦ Immune response
♦ Complications like aseptic meningitis, encephalitis, radiculomyelopathy dissemination etc.
♦ Lab diagnosis
Antigen detection by IF, IP, EIA etc.
DNA hybridization based molecular tests
♦ Treatment
Parenteral treatment for severe infection
Treatment of acyclovir-resistant herpes
Treatment of HPG in pregnancy
♦ HIV & genital herpes
♦ Laboratory diagnosis
♦ Treatment
♦ Epidemiology & transmission
♦ Immune response
♦ Lab diagnosis
Antigen detection
Molecular tests – DNA hybridization, PCR etc
♦Treatment in pregnancy
♦ HPV infection with HIV
♦Morphology of virus
♦ MC in HIV infection
♦ Lab diagnosis of HIV
♦ Disease classification / staging
♦ HAART
Classification of ART drugs
NACO guidelines on indications, first line regimens, patient monitoring
Side effects of ART drugs
♦ Management of HIV in pregnancy – regimen, doses, monitoring, side effects
♦ Prevention of mother to child transmission
♦ National AIDS control programme (NACP) - phases, goals, targets and achievements
♦ History of syphilis – Columbian and environmental theory
♦Pathogenesis of disease
♦ Immune response
♦ Malignant syphilis
♦ Cardiovascular syphilis
♦ Neurosyphilis- different stages
♦ Charcot joints
♦ Lab diagnosis - technique, monitoring & positivity of tests in different stages
♦ Treatment in pregnant patient
♦ Jarisch herxheimer reaction- etiology, clinical features, management
♦ Syphilis & HIV
♦ Congenital syphilis - management
♦ Growth characteristics
of H ducreyi
♦ Lab diagnosis
Histopathology
Molecular techniques like PCR
♦ Chancroid & HIV
♦ Genetic characteristics and strains
♦ Lab diagnosis –
Antigen detection tests
Serological tests
DNA hybridization based molecular tests like PACE etc.
♦ Gonorrhoea in pregnancy
♦ HIV & gonorroea
♦ Drug resistance in gonorrhoea
♦ Morphology & biology of C trachomatis
♦ Lab diagnosis –
Antigen detection tests
Serological tests
DNA hybridization based molecular tests like PACE etc
♦ Epidemiology & transmission
♦ Pathogenesis & pathology
♦ Lab diagnosis –
antigen detection
serological tests molecular tests like PCR, RFLP
♦ HIV & LGV
♦ Epidemiology & transmission
♦ Pathogenesis & spread of disease
♦ HIV & Donovanosis
♦ Complications
♦ Lab diagnosis – Nugent's criteria
♦ BV in pregnancy
♦ Epidemiology including risk factors
♦ Mycology of albicans and non-albicans candida
♦ Lab diagnosis – newer tests like PCR
♦Treatment of fluconazole resistant C albicans and non- albicans Candidiasis
♦ HIV & genital candidiasis
♦ Lab diagnosis – culture methods, molecular techniques.
♦ Trichomonas infection in pregnancy
♦ Immunity in scabies
♦ Lab diagnosis by newer techniques – epiluminiscence microscopy, PCR
♦ HIV & Scabies
♦ Epidemiology & transmission
♦ Epididymo-orchitis
♦ Dhat syndrome – etiology, clinical features, treatment
♦ Mucosal immune system in males and females
♦ Bacterial adhesins
♦ Strategies for development of mucosal immune response to control STI
♦ CDC guidelines for management of various STDs
♦ Morphology of virus
♦ Treatment - CDC guidelines
♦ HSV Vaccines
♦ Recent advances in diagnosis and treatment
♦ HPV induced carcinogenesis – high-risk serotypes, mechanism of neoplasia & screening
♦ Treatment - CDC guidelines
♦ HPV vaccines
♦ Recent advances in diagnosis & treatment
♦ Differential diagnosis of MC-like umblicated lesions
♦ Mechanism of depletion of CD4 cells, role of cytokines etc.
♦ HAART
ART failure & second line regimens
Pediatric ART – dose, regimens, side effects, monitoring
Adherence to ART & ART drug resistance
♦ Management of HIV patient in tuberculosis, hepatitis, injection drug abusers
♦ Immune reconstitution inflammatory syndrome (IRIS)
♦ Indications for CPT prophylaxis & management of opportunistic infections
♦ Kaposi's sarcoma – etiology, clinical variants, treatment modalities
♦ New drugs or approaches to target HIV
♦ Mechanism of motility
♦ Treponemal antigens
♦ Complications of primary and secondary stages
♦ Histopathology in different stages
♦ Treatment
CDC guidelines
Treatment of penicillin-allergic patients & desensitization
♦ Syphilis vaccines
♦ Endemic syphilis (yaws) - clinical features, diagnosis & treatment
♦ Drug resistance in chancroid
♦ Treatment – CDC guidelines
♦ Treatment – CDC guidelines
♦ Gonococcal vaccines
♦ Recent advances in diagnosis & treatment
♦ Treatment – CDC guidelines
♦ Treatment – CDC guidelines
♦ Treatment – CDC guidelines
♦ Treatment – CDC guidelines
♦ Differential diagnosis of acute pelvic pain
♦ Treatment - CDC guidelines
♦ Treatment - CDC guidelines
♦ Recent advances like newer topical and systemic anti- mycotic drugs (like voriconazole)
♦ Treatment – CDC guidelines
♦Treatment – CDC guidelines
♦Treatment – CDC guidelines
♦ Acute & chronic prostatitis
♦ Chronic pelvic pain syndrome
LEPROSY CURRICULUM FOR POST GRADUATE
MUST KNOW
SHOULD KNOW
GOOD TO KNOW
♦ History
Epidemiology
♦ Transmission
♦ Recent Status of Leprosy in India
♦ Leprosy control programmes
Microbiology & Immunology
♦ Structure of M leprae
♦ Humoral response
♦ Cell mediated immune response
♦ Tests for assessment of CMI
♦ Classification of leprosy
♦ Immunopathological spectrum of leprosy
♦ Ridley Jopling classification
♦ Paucibacillary and multibacillary leprosy Clinical features
♦ Cutaneous
♦ Nerve involvement
♦ Ocular involvement- causes, effects due to infiltration and inflammation and reactions
♦ Involvement of other mucosae
♦ Systemic Involvement in Leprosy-muskuloskeletal, hepatic, renal and reproductive
♦ Variants of leprosy like Neuritic, indeterminate, single skin lesion, lucio, histoid , lazarine Differential diagnosis of:
♦ Hypopigmental macules
♦ Erythematous skin lesions
♦ Nodules
♦ Peripheral nerve thickening
♦ Investigations
♦ Slit skin smear including bacterial index, morphological index
♦ Histopathology of skin according to Ridley Jopling classification
♦ Lepromin test
♦ Clinical tests for sensory, motor and autonomic functions
Treatment of leprosy
♦ Conventional drugs- dapsone, rifampicin and clofazamine – meachanism of action, pharmacokinetics and side effects
♦ Standard and alternative regimes
♦ Drug resistance
♦ Investigational drugs
♦ Vaccines in leprosy
Reactions in Leprosy
♦ Aetiopathogenesis
♦ Clinical features- cutaneous and systemic
♦ Differentiate between relapse and reversal
♦ Histopathology
♦ Treatment - corticosteroids, thalidomide, clofazamine, antimalarials etc
Special situations like
♦ Pregnancy
♦ Childhood Leprosy
♦ Leprosy and HIV
Experimental models in leprosy
♦ Mice
♦ Armadillos
Deformities in leprosy
♦ Types- anesthetic, motor
and specific deformities involving hands, feet (including trophic ulcer) and face
♦ Nerve damage- clinical features and management
♦ Assessment
♦ Prevention
♦ Management-
♦ medical, surgical and physiotherapy
Disability prevention & Rehabilitation
♦ Global scenario
♦ Important M.leprae antigens
♦ Role of macrophages in leprosy
♦ Difference Between Madrid and Ridley Jopling classification
♦ Sensory and motor dysfunction
♦ Histopathology of nerves
♦Serology in leprosy esp., PGL-1 ELISA
♦Newer and short duration regimes
♦Uniform MDT
GvTests for drug resistance
♦ Immunotherapy in leprosy
♦ Classify severity of type 2 reaction
♦ Management of nerve abscess
♦ Disability assessment
♦ Physical – prosthesis, surgical
♦ History of leprosy and treatments of historical interest
♦ Biochemical characteristics of M leprae
♦ Other classification systems in leprosy
♦ Histopathology of other tissues like kidneys, liver, lymph nodes, mucosae
♦ In-vitro testing of
♦ M. leprae
♦ Other non human primates
Vocational and social
Biostatistics, Research Methodology, and Clinical Epidemiology Ethics
Medico-legal aspects relevant to the discipline
Health Policy issues as may be applicable to the discipline
Career Options
After
completing a DNB in Dermatology,
Venereology and Leprosy, candidates will get employment opportunities in Government
as well as in the Private sector.
In the Government sector, candidates have various options to
choose from, including Registrar, Senior Resident, Demonstrator, Tutor, etc.
While in the Private sector the
options include Resident Doctor, Consultant, Visiting Consultant (Dermatology, Venereology and Leprosy), Junior Consultant, Senior
Consultant (Dermatology,
Venereology and Leprosy), Consultant Dermatology, Venereology and Leprosy Specialist, etc.
Courses
After DNB in Dermatology, Venereology and Leprosy Course
DNB in Dermatology, Venereology and Leprosy is a specialization course that can be pursued after
finishing MBBS. After pursuing a specialization in DNB (Dermatology, Venereology and Leprosy), a candidate could also
pursue super specialization courses recognized by NMC, where DNB (Dermatology, Venereology and Leprosy)
is a feeder qualification.
Frequently Asked Questions (FAQs) – DNB in Dermatology, Venereology and
Leprosy Course
Question: What is a DNB in Dermatology, Venereology and Leprosy?
Answer: DNB Dermatology, Venereology
and Leprosy or Diplomate of National Board in Dermatology, Venereology and
Leprosy also known as DNB in Dermatology, Venereology and Leprosy is a Postgraduate level course for doctors in India that is done by them
after completion of their MBBS.
Question: Is DNB in Dermatology, Venereology and Leprosy
equivalent to MD in Dermatology, Venereology and Leprosy?
Answer: DNB in Dermatology, Venereology and Leprosy is equivalent to
MD in Dermatology, Venereology and Leprosy, the list of recognized qualifications awarded by NBE in various broad and
super specialties as approved by the Government of India are included in the
first schedule of the Indian Medical Council Act, 1956.
Question: What is the duration of a DNB in Dermatology, Venereology and Leprosy?
Answer: DNB in Dermatology, Venereology and Leprosy is a
postgraduate programme of three years.
Question: What is the eligibility of a DNB in Dermatology, Venereology and Leprosy?
Answer: Candidates must be in possession of an undergraduate
MBBS degree from any college/university recognized by the Medical Council of
India (now NMC).
Question: What is the scope of a DNB in Dermatology, Venereology and Leprosy?
Answer: DNB in Dermatology,
Venereology and Leprosy offers candidates various employment opportunities
and career prospects.
Question: What is the average salary for a DNB in Dermatology, Venereology and Leprosy
postgraduate candidate?
Answer: The DNB in Dermatology, Venereology and Leprosy candidate's average salary is between Rs. 8,00,000 to Rs.20,00,000 per year depending on
the experience.
Question: Are DNB Dermatology, Venereology and Leprosy and MD
Dermatology, Venereology and Leprosy equivalent for pursuing teaching jobs?
Answer: The Diplomate of National Board in broad-speciality
qualifications and super speciality qualifications when granted in a medical
institution with attached hospital or in a hospital with the strength of five
hundred or more beds, by the National Board of Examinations, shall be
equivalent in all respects to the corresponding postgraduate qualification and
the super-speciality qualification granted under the Act, but in all other
cases, senior residency in a medical college for an additional period of one
year shall be required for such qualification to be equivalent for the purposes
of teaching also.
2 years 8 months ago
News,Health news,NBE News,Medical Education,Medical Colleges News,Medical Courses News,Medical Universities News,Medical Admission News,Latest Medical Education News,Medical Courses
Readers and Tweeters Decry Medical Billing Errors, Price-Gouging, and Barriers to Benefits
Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.
Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.
Envy for-profit US healthcare? Check out this MD whose wife is a medical billing expert who spent over a year challenging an egregious billing error. After it all they still paid $1200. These are resourceful knowledgeable people who got taken for a ride. https://t.co/fnlUz3KTJb
— Raghu Venugopal MD (@raghu_venugopal) October 26, 2022
— Dr. Raghu Venugopal, Toronto
A Plea for Sane Prices
I just read your story about the emergency room billing for a procedure that was not done (“A Billing Expert Saved Big After Finding an Incorrect Charge in Her Husband’s ER Bill,” Oct. 25). We too had a similar experience with an emergency room and a broken arm that was coded at a Level 5, and it was a simple break. No surgery needed, and it took them only 10 minutes to set and wrap the broken arm but charged us over $9,000. I disputed the charges, and it took six months to get them to reduce the bill but they never admitted that they coded a simple break incorrectly to jack up the price of the bill. If it had been a Level 5 issue, we would not have sat in the waiting room for six hours before being seen. It was a horrible experience, and I think ERs all over the nation are doing this to make up for the non-payers they treat every day. It is robbery.
— Terrence Campbell, Pocatello, Idaho
It would be great if the vaulted @KHNews would clearly distinguish between the ED pro fee billing & hospital charges as it is not entirely clear here w/ in network svs.—Billing Expert Saved Big After Finding an Incorrect Charge in Her Husband’s ER Bill https://t.co/jRFAYb5F0P
— Ed Gaines (@EdGainesIII) October 25, 2022
— Ed Gaines, Greensboro, North Carolina
As you said, CPT codes should always be examined. This case is probably more than “just an error.” As a retired orthopedic surgeon, chief of surgery, and chief of staff at a North Carolina hospital, I have seen care such as this coded exactly like this with the rationale that, “Hey, this was a fractured humerus and it was manipulated and splinted.” 24505 is correct IF that is the definitive treatment, which it was not here. Even code 24500 would indicate definitive treatment without manipulation. This was just temporary care until definitive care could be done later. It should be billed as a visit and a splint. The visit for this, if it was an isolated problem (no other injury or problems), would qualify only as a Level 2 visit. That frequently gets upcoded as well by adding a lot of non-pertinent family, medical, and social history and a complete physical exam (seven systems at least) and a whole lot of non-pertinent “medical decision making.” All of that should be documented in the medical records even if the hospital stonewalls on the CPT codes.
Look closely at medical records and you will find frequent upcoding, if you are familiar with the requirements for different levels of treatment.
— Dr. Charles Beemer, Arvada, Colorado
Never attribute to Baumol's cost disease that which is adequately explained by malice. https://t.co/RbKOlBgCmp
— Shashank Bhat (@shashank_ps) October 26, 2022
— Shashank Bhat, San Francisco
A number of years ago, I was billed using a code that described a treatment that was not carried out. In similar fashion, I talked with my insurance company, which basically said it did not care whether the treatment took place or not as all it required was for a valid code to appear. I also contacted the Virginia Bureau of Insurance, which approves the various policies, and it said it had no jurisdiction over claims. I decided to let the hospital sue me for the disputed amount and defended myself in district court. Despite their attorney and four “witnesses,” the case was thrown out because the hospital was both unwilling and unable to justify the charges to the satisfaction of the judge. They did not want anybody in power to testify because of the questions they would have been asked, so they left it to people who were completely clueless. The takeaways from this were:
- Hospitals make up the numbers and leave them grossly inflated so they can claim that they are giving away care when they give discounts on the made-up numbers.
- Hospitals turn employees into separate billing entities so they can double-charge.
- Hospitals open facilities such as physical therapy in hospital locations because insurance companies will pay higher amounts when treatment is carried out in a hospital environment.
- Insurance companies and state insurance agencies do not act as gatekeepers to protect their clients/taxpayers.
- The insurance companies and the providers have a shared interest in the highest possible ticket prices and outrageous charges because the providers get to claim how generous they are with “unremunerated care,” and if the prices were affordable then they could not justify the high prices for insurance premiums and the allowed administration/profit share of 20% would be based on a far smaller amount.
In any other industry, this would have resulted in multiple antitrust suits. U.S. health care is a sad example of government, health care industry, and insurers all coming together against the interests of consumers. After this court case, I wanted to form a nonprofit to systematically challenge every outrageous charge against people who, unlike myself, did not believe or know how to defend themselves. If hospitals and other providers were forced to go to court to justify their charges on a systematic basis, pricing sanity would eventually prevail.
— Philip Solomon, Richmond, Virginia
The obvious solution to prosecute the hospital for fraud followed by a civil suit"A hospital charged nearly $7,000 for a procedure that was never performed" https://t.co/wPNNZ5cZey
— Barry Ritholtz (@ritholtz) October 31, 2022
— Barry Ritholtz, New York City
Patients as Watchdogs
Thank you for the article on Lupron Depot injections (Bill of the Month: “$38,398 for a Single Shot of a Very Old Cancer Drug,” Oct. 26). Last year, I was diagnosed with prostate cancer, though my case is not anywhere as severe as that experienced by Mr. Hinds.
Last month my urologist scheduled an MRI update for me at a facility owned by Northside Hospital Atlanta. At the suggestion of my beloved wife, I called my insurance company, UnitedHealthcare, to make sure the procedure was covered. Fortunately, it was. That being said, the agent from UnitedHealthcare mentioned that Northside Hospital’s fee was “quite a bit higher than the average for your area.” It was. Before insurance, the charge for an MRI at Northside was $6,291. I canceled the appointment at Northside and had the MRI done by a free-standing facility. Their charge, before insurance, was $1,234.
Every single encounter that I have with the health care system involves constant vigilance against price-gouging. When I have a procedure, I have to make sure that the facility is in-network,. that each physician is in-network, that any attending specialist such as an anesthesiologist or radiologist is in-network (and their base-facility as well). If I have a blood test, I have to double-check if the cost is included in a procedure or if it is separate. If it is a separate fee, I have to ensure that the analysis is also covered, and, if it is not, that it is not done through a hospital-owned facility but instead through a free-standing operation.
I have several ongoing conditions in addition to my prostate cancer — Dupuytren’s contracture, a rare bleeding disorder similar to thrombocytopenia, and arthritis. Needless to say, navigating our byzantine, inefficient, and profit-driven health care system is a total nightmare.
Health care in the United States has become so exceedingly outrageous. I cannot understand why it is not an issue that surfaces during election years or something that Congress is willing to address.
Again, thank you for your excellent reporting.
— Karl D. Lehman, Atlanta
Why capitalism without guardrails is a pipedream. Own the patent, control the pricing, and this is the result: $38,398 for a Single Shot of a Very Old Cancer Drug https://t.co/BLes77QN7F via @khnews
— Brian Murphy (@NorwoodCDI) October 26, 2022
— Brian Murphy, Austin, Texas
I was a medical stop-loss underwriter and marketer for over 30 years. Most larger (company plans for 100-plus employees) are self-funded, meaning the carrier — as in this case, UnitedHealthcare — is supplying the administrative functions and network access for a fee, while using the employer’s money to pay claims.
Every administrator out there charges a case management fee, either as a stand-alone charge or buried in their fees. Either way, they all tout how they are looking out for both the employer and the patient.
Even if this plan was fully insured, wouldn’t it have been in the best interest of all parties when they became aware of the patient’s treatment (maybe after the first payment) to reach out to the patient and let them know there are other alternatives?
The question in these cases is who is minding the store for both the patient and the employer. The employer, the insurer, and the patient could have all saved a lot of money and pain, if someone from case management had actually questioned the first set of charges.
— Fred Burkacki, Sarasota, Florida
I did a few rounds of Lupron in my 20s for severe #endometriosis, and I had to fight my insurance company to get approved. Now, this is how much it costs for some people. https://t.co/UlB1TTtW40 #healthcare #prostatecancer
— Amanda Oglesby 🌊 (@OglesbyAPP) October 26, 2022
— Amanda Oglesby, Neptune, New Jersey
‘Bill of the Month’ Pays Off
I received a $1,075 refund on a colonoscopy bill I paid months earlier after listening to the KHN-NPR “Bill of the Month” segment “Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?” (May 31) and finding out the procedure should be covered under routine health care coverage. Thank you!
— Cynthia McBride, University Place, Washington
We have to close legal loopholes to make sure that cancer diagnostic procedures have the same insurance coverage as screening. Colonoscopies must be fully covered whether a polyp is found or not #ACA #colorectalcancer #CancerScreening https://t.co/slE6p3FvHe
— Erica Warner, ScD (@ewarner_12) May 31, 2022
— Erica Warner, Boston
Removing Barriers to Benefits
In the story “People With Long Covid Face Barriers to Government Disability Benefits” (Nov. 9), you stated: “Many people with long covid don’t have the financial resources to hire a lawyer.” This is incorrect. When applying for disability, you don’t need financial resources. There are law firms that specialize in disability claims and will not charge you until you win your claim. And, according to federal law, those law firms can charge only a certain percentage of the back pay you would get once the claim has been won. Also, if you lose the claim, and the law firm has appealed as many times as possible, you don’t owe anything. Please don’t make it more difficult for those who are disabled with misinformation.
— Lorrie Crabtree, Los Angeles
People unable to work due to Long Covid are facing barriers to obtaining government disability benefits.https://t.co/zWQfW5CkOS
— Ron Chusid (@RonChusid) November 10, 2022
— Ron Chusid, Muskegon, Michigan
Vaccine Injuries Deserve Attention, Too
I read your long-covid article with interest because many of the barriers and some of the symptoms faced by people with long covid are similar to those experienced by people with vaccine injuries. I’m really concerned about how there is even less attention and support for people who suffered adverse vaccine reactions.
Long covid and vaccine injuries are both issues of justice, mercy, and human rights as much as they are a range of complex medical conditions.
It’s nearly 20 months since someone I know sustained a serious adverse reaction, and it is heartbreaking how hard it has been for her to find doctors who will acknowledge what happened and try to help. There’s no medical or financial support from our government, and the Countermeasures Injury Compensation Program is truly a dead end, even as other countries such as Thailand, Australia, and the United Kingdom have begun to acknowledge and financially support people who sustained vaccine injuries.
I’ve contacted my congressional representatives dozens of times asking for help and sharing research papers about vaccine injuries, but they have declined to respond in meaningful ways. Similarly, my state-level representatives ignore questions about our vaccine mandate, which remains in place for state employees, despite at least one confirmed vaccine-caused fatality in a young mother who fell under the state mandate in order to volunteer at school.
There have been a few articles, such as …
- Why Is It So Hard to Compensate People for Serious Vaccine Side Effects?
- Feds Pay Zero Claims for Covid-19 Vaccine Injuries/Deaths
- Covid Vaccine Injury Plaintiffs Face Long Odds in U.S. Compensation Program
- Covid-19: Is the US Compensation Scheme for Vaccine Injuries Fit for Purpose?
… but no new ones have come to my attention recently, and it is concerning that the media and our political and public health leaders seem OK with leaving people behind as collateral damage.
Please consider writing a companion piece to highlight this need and the lack of a functional safety net or merciful response. My hope is that if long covid and vaccine injuries were both studied vigorously, new understanding would lead to therapeutics and treatments to help these people.
— Kathy Zelenka, Port Angeles, Washington
Given how long it took Congress to eventually approve "Agent Orange" and "Burn Pit" benefits for disabled veterans, it is at least a 15-20 year time frame and they don't have the backing or societal standing that veterans do. https://t.co/idt6tSioHc
— Matthew Guldin (@MRG_1977) November 11, 2022
— Matthew Guldin, West Chester, Pennsylvania
More on Mammograms
The article “Despite Katie Couric’s Advice, Doctors Say Ultrasound Breast Exams May Not Be Needed” (Oct. 28) does a disservice to women and can cause harm. An ultrasound is saving my life. I had two mammograms with ultrasounds this year. Although the first mammogram showed one cyst that was diagnosed as “maybe benign,” I knew it wasn’t. Why? Because I could feel the difference. I insisted on a second, and sure enough a large-enough cyst that’s definitely malignant was found. I had breast surgery on Oct. 31, followed by radiation treatment and, if needed, chemotherapy later. This article will deprive other, less aggressive and experienced women who do not have health care credentials or a radiologist for a husband to be harmed by being lulled into complacency.
— Digna Irizarry Cassens, Yucca Valley, California
Why do some women with dense breasts get additional screening while others do not? @CNN explains. @IronwoodCancer https://t.co/uFZZKo6RO4
— Patricia Clark (@patriciaclarkmd) October 27, 2022
— Patricia Clark, Scottsdale, Arizona
Your article on breast cancer screening neglected to present the supplemental option of Abbreviated Breast MRI (AB-MRI). The out-of-pocket cost at many clinics ranges from $250 to $500. For a national listing of clinics that offer this supplemental screening option, please go to https://timetobeseen.org/self-pay-ab-mri. For benefits, just Google “Abbreviated Breast MRI.”
— Elsie Spry, Wexford, Pennsylvania
Why didn’t more #SeniorCitizens leave for safer havens during Hurricane Ian as recommended? @judith_graham rightfully suggests that learning why is critical as the population of older people grows and #NaturalDisasters become more frequent. https://t.co/7k8bvNQxug
— Donald H. Polite (@DonaldPolite) November 2, 2022
— Donald H. Polite, Milwaukee
Preparation Plans for Seniors: All for One and One for All
At least 120 people died from Hurricane Ian, two-thirds of whom were 60 or older. This is a tragedy among our most vulnerable population that should have been prevented (“Hurricane Ian’s Deadly Impact on Florida Seniors Exposes Need for New Preparation Strategies,” Nov. 2).
Yes, coming together and developing preparedness plans is one way to protect seniors and avoid these kinds of tragedies in the future, but since this is not a one-size-fits-all situation, organizations that help seniors across the country must first look internally and be held accountable by making sure their teams always have a plan in place and are prepared to activate them at a moment’s notice.
During Hurricane Ian, I saw firsthand what can happen when teamwork and effective planning come together successfully to protect and prepare seniors with chronic health conditions like chronic obstructive pulmonary disease who require supplemental oxygen to breathe.
Home respiratory care providers and home oxygen suppliers worked tirelessly to ensure our patients received plenty of supplies to sustain them throughout the storm, and when some patients faced situations where their oxygen equipment wasn’t working properly inside their homes, staff members were readily available to calmly talk the patient through fixing the problem. After the winds receded, mobile vans were quickly stationed in safe spaces for patients or their family members to access the oxygen tanks and supplies they needed. If patients were unable to make it to these locations, staff members were dispatched to deliver tanks to their homes personally and check in on the patient.
Patients were also tracked down at shelters, and a team of volunteers was formed around the country to find patients who could not be reached by calling their emergency backup contacts, a friend, or family member. Through these established systems, we were able to remain in contact with all of our patients in Ian’s path to ensure their care was not impeded by the storm.
Organizations should always be ready and held accountable for the seniors they care for in times of disaster. I know my team will be ready. Will yours?
— Crispin Teufel, CEO of Lincare, Clearwater, Florida
Understanding the impact of #Climatechange on older people is critically important as the population expands and #naturaldisasters become more frequent and intense.https://t.co/RKB7pA28nr
— Ashley Moore, MS, BSN Health Policy (@MooreRNPolicy) November 2, 2022
— Ashley Moore, San Francisco
The Tall and the Short of BMI
I am amazed that in your article about BMI (“BMI: The Mismeasure of Weight and the Mistreatment of Obesity,” Oct. 12) you never mentioned anything about the loss of height. If a person goes from 5-foot-2 to 4-foot-10, the BMI changes significantly.
— Sue Robinson, Hanover, Pennsylvania
I've been against this since after gastric bypass surgery I got down to 164 pounds but at 5'7" BMI still considered me overweight. How an overreliance on BMI can stand between patients and treatment https://t.co/OawzhO0aOk
— Steve Clark (@blindbites) October 10, 2022
— Steve Clark, Lee’s Summit, Missouri
Caring for Nurses’ Mental Health
During the pandemic, when I read stories about how brave and selfless health care heroes were fighting covid-19, I wondered who was taking care of them and how they were processing those events. They put their own lives on the line treating patients and serving their communities, but how were these experiences affecting them? I am a mother of a nurse who was on the front lines. I constantly worried about her as well as her mental and physical well-being (“Employers Are Concerned About Covering Workers’ Mental Health Needs, Survey Finds,” Oct. 27). I was determined to find a way to honor and support her and her colleagues around the country.
I created a large collaborative art project called “The Together While Apart Project” that included the artwork of 18 other artists from around the United States. It originated during the lockdown phase of the pandemic, a time when we were all physically separated yet joined by a collective mission to create one amazing art installation to honor front-line workers, especially nurses. Upon its completion, this collaboration was recognized by the Smithsonian Institute, Channel Kindness (a nonprofit co-founded by Lady Gaga) and NOAH (National Organization of Arts in Medicine). After traveling around the Southeast to various hospitals for the past year on temporary exhibit, the artwork now hangs permanently in the main lobby at the University of Virginia Medical Center in Charlottesville, Virginia.
I wanted to do something philanthropic with this art project to honor and thank health care heroes for their dedication over the past two years. It was important to find a way to help support them and to ensure they are not being forgotten. Using art project as my platform, I partnered with the American Nurses Association and created a fundraiser. This campaign raises money for the ANA’s Well-Being Initiative programs, which support nurses struggling from burnout and post-traumatic stress disorder and who desperately need mental and physical wellness care. Fighting covid has taken a major toll on too many nurses. Some feel dehumanized and are not receiving the time off or the mental and physical resources needed to sustain them. Many are suffering in silence and have to choose between caring for themselves or their patients. They should not have to make this choice. Nurses are the lifeline in our communities and the backbone of the health care industry. When they suffer, we all suffer. Whether they work in hospitals, doctors’ offices, assisted living facilities, clinics or schools, every nurse has been negatively impacted in some way by the pandemic. They are being asked to do so much more than their jobs require in addition to experiencing greater health risks, less pay, and longer hours. Nurses under 35 and those of color are struggling in larger numbers.
The American Nurses Foundation offers many forms of wellness care at no charge. They rely heavily on donations to maintain the quality of their offerings as well as the ability to provide services to a growing number of nurses. I am an artist, not a professional fundraiser, and I have never raised money before. But I feel so strongly about ensuring that nurses receive the support and care they deserve, that I am willing to do whatever it takes to advocate and elevate these health care heroes.
The Together While Apart Project’s “Thank You Nurses Campaign” goal is $20,200, an amount chosen to reflect the numbers 2020, the year nurses became daily heroes. So far, I have raised over $15,500 through gifts in all amounts. For example, a $20 donation provides a nurse with a free one-hour call with a mental health specialist. That $20 alone makes a big difference and can change the life of one nurse for the better. The campaign has provided enough funding (year to date) to enable 940 nurses to receive free one-hour wellness calls with mental health specialists.
The online fundraiser can be found at https://givetonursing.networkforgood.com/projects/159204-together-while-apart-fundraiser.
— Deane Bowers, Seabrook Island, South Carolina
CEAPs, is it time to offer more #mentalhealth services? Nearly 1/2 of employers (w/ 200 workers) report a growing share of workers using mental health services. Yet 56% report they lack #behavioralhealth providers for employees to access to timely care. https://t.co/Vpkkwlq6C6
— EAPA (@EAPA) October 27, 2022
— Employee Assistance Professionals Association, Arlington, Virginia
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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2 years 8 months ago
Courts, COVID-19, Health Care Costs, Health Care Reform, Insurance, Mental Health, Pharmaceuticals, Bill Of The Month, california, Cancer, Doctors, Emergency Medicine, Hospitals, Letter To The Editor, Natural Disasters, Nurses, Obesity, Private Insurance, Treating Cancer, vaccines, Women's Health
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
Indian Experts' Viewpoint on Ranitidine Use in Symptoms Associated with Acid Reflux
Gastroesophageal reflux disorder (GERD) is commonly seen in both adults and children. Research data shows that GERD shows a peak incidence of 60-70% amongst 3-4 months old infants and reduces to about 5% by one year of age. (1)
A recent review of medical literature was conducted by a panel of 13 Indian experts, comprising of eminent pediatricians and pediatric gastroenterologists. Their consensus statement supports the therapeutic use of ranitidine in the pediatric population. These clinical practice recommendations have now been published in International Journal of Contemporary Pediatrics.
"Ranitidine proves to be efficacious and safe in reducing the symptoms of acid reflux in the pediatric population", this consensus paper stated.
The symptoms of GERD in children may not be as obvious as those seen in adults and thus require careful diagnosis and management.
Speaking to Medical Dialogues about the atypical presentations of GERD in infants, Dr. Uday A. Pai, Consultant Pediatrician and Neonatologist from Mumbai, who led the review panel, explained- "We see children coming with repeated bouts of vomiting, not feeding well, crying excessively and having colicky pain. When we review the parameters of growth and development of the child, the child is not thriving appropriately for their age. This is especially obvious in infancy".
He further added that GERD in infancy, can be severe enough to upset the feeding pattern of the child and push the child into a definitive deficiency of nutrition which may progress to "failure-to-thrive".
Dr. Arun Wadhwa, Senior Consultant Pediatrician from Delhi, and a panelist of the review explains that GERD is more evident in infants because they have a "lax" lower esophageal sphincter by nature.
"As they grow older, the sphincter strengthens and develops gradually and then the incidence of reflux reduces", he elaborated.
As per the recommendation, the consensus paper emphasizes that Ranitidine effectively prevents nocturnal acid reflux.
Dr. Arun Wadhwa emphasizes that the rapid onset and longer duration of action of Ranitidine make it the preferred treatment choice in cases of acid reflux, especially in pediatric age group. Additionally, its safety and ease of administration, are the other two other benefits.
"The calculation and titration of the dose of Ranitidine for an infant is much easier and more accurate in syrup form, and the medicine can be repeated every 12 hours to ensure efficacy, unlike proton pump inhibitors (PPIs), whose effect starts wearing off after 12 hours. This provides better coverage of symptoms of GERD in a child over 24 hours," he said.
Consultant Pediatric Gastroenterologist at Apollo Children's Hospital, Chennai, Dr. Dhanasekhar Kesavelu, also a member of the expert review panel, added that the use of Ranitidine is supported due to long-term evidence of the safety and efficacy of the drug in the Indian population.
"Symptoms of GERD in children are highly variable, including gastrointestinal manifestations and extra-gastrointestinal symptoms, such as cough and laryngitis. Most children need a short course of treatment with a drug that is safe, and the drug of choice, in that case, would be Ranitidine", Dr. Dhanasekhar said.
On the clinical usages of the drug, Dr. Dhanasekhar said, "Ranitidine can be used in two ways- one as "mono-therapy" where Ranitidine is used alone or it can be used as an additive drug along with PPIs-"adjunct therapy". Nocturnal reflux can be better handled using Ranitidine because its efficacy is well-proven".
Adding on the issue of dosage form, Dr. Uday Pai emphasized the need for a drug that can be administered in liquid form to children as young as 6 months.
"Reflux is more predominantly observed in infants. Ranitidine is a safe and efficacious drug, which can be given to infants and children below 1 year due to ease of administration as it is available in liquid formulation," noted Dr. Pai.
Reference:
[1] Pai UA, Kesavelu D, Shah AK, Manglik AK, Wadhwa A, Acharya B, et al. Ranitidine use in pediatrics: current evidence-based review and recommendations. Int J Contemp Pediatr 2022;9:987-97.
2 years 8 months ago
Editorial,Gastroenterology,Medicine,Pediatrics and Neonatology,Top Medical News,Gastroenterology Perspective,Medicine Perspective,Pediatrics and Neonatology Perspective
Health Archives - Barbados Today
Greater support for cancer patients, families
The Queen Elizabeth Hospital (QEH) in collaboration with the Cancer Support Services is intensifying its cancer treatment services to embrace a more patient-centered model.
The Queen Elizabeth Hospital (QEH) in collaboration with the Cancer Support Services is intensifying its cancer treatment services to embrace a more patient-centered model.
On Friday during the signing of another Memorandum of Understanding (MOU) between the two entities at the Martindale’s Road, St Michael facility, executive chairman of the QEH Juliette Bynoe-Sutherland said it was important that the hospital adjusted its approach to palliative care because of the emotional trauma and fear cancer could evoke.
She added that having a more patient-focused approach helped to create an environment where cancer patients would see that there was life beyond their diagnosis.
“Cancer evokes a tremendous amount of fear and emotional response. Some people don’t even want to call the word but what research shows and the Cancer Support Services has been able to demonstrate is that cancer diagnosis does not have to mean the end of the road. There are many people in Barbados who are living with cancer. who are coping… and meeting with others who are also going through these experiences,” she said.
“Understanding what it means to face this diagnosis has really enriched the whole arena of addressing cancer. There have been many people who have been able to live with a cancer diagnosis. What we are here doing at the hospital, we are working on the two spectrums – ensuring that we could provide treatment care and support for those who have a diagnosis . . . making sure they can live with the diagnosis and thrive.
“We are also, on the other end of things, recognising palliative care is also an important part, how we die and how we support persons as they transition is as important as how we bring them into this world.
“As an institution, we have a duty to make sure that we are providing the best quality services across the spectrum from birth through to the end of life and this is what our partnership with this organisation allows us to do.”
Director of Nursing Services Henderson Pinder said the QEH had trained about 80 medical practitioners in its palliative care enrichment programme. He made a case for the course to be conducted two or three times per year instead of once.
“Our palliative care enrichment programme has been one of the most successful ventures we have had with the Cancer Support Services. This programme enables healthcare workers – doctors, nurses and other support persons – to gain a new perspective of the care that they give.
“It gives them an opportunity to look at the care from the caregiver’s side and also from the patient’s side. It helps them to be able to see some of the sensitivities that they themselves have about cancer, about dying, about going through the process of end of life,” he said. “Medical persons who have been through this course, have reported that they have begun to be more sensitive to the needs of the patient and the families and putting them at the front of the care process.”
Bynoe-Sutherland added that the QEH has increased its provision of medical drugs and amalgamated the hematology oncology and nuclear medicine departments to allow for better synergy to attend to patients with cancer.
Executive director of Cancer Support Services Janette Lynton expressed pride at the work of both entities and said she wanted to strengthen her organisation’s relationship with the children on C7 and C8.
According to her, the doctors on those wards wanted more representatives from the Cancer Support Services to give parents with children who have been diagnosed with cancer more support. (SZB)
The post Greater support for cancer patients, families appeared first on Barbados Today.
2 years 8 months ago
A Slider, Health, Local News
More than 200 COVID infections in the last 24 hours: No fatalities
The General Directorate of Epidemiology of the Ministry of Public Health and Social Assistance reported 210 new COVID infections in the last 24 hours in the country. In its bulletin number 982, health authorities indicated that there are currently 1,586 active cases in the country.
For this bulletin, DIGEPI reported collecting 2,124 samples, of which 1,261 were taken for the first time and another 863 were taken in follow-up. As a result, daily positivity increased to 16.65 %, while positivity continued to rise in the last four weeks, marking 3.09 % this Saturday.
No new deaths were reported due to COVID, so the number of fatalities remains at 4,384 deceased.
Increased hospital occupancy was also reported, with the admission of 22 patients: 17 in standard wards and five in the Intensive Care Unit (ICU).
2 years 8 months ago
Health, Local
Biden as oldest US president at age 80: Nation deserves a 'full neurological assessment' of him
President Joe Biden turned 80 on Nov. 20, 2022 — and debate is ongoing, from a health perspective, about his advanced age and the capacity of individuals of that age to serve in the highest office in the land.
President Joe Biden turned 80 on Nov. 20, 2022 — and debate is ongoing, from a health perspective, about his advanced age and the capacity of individuals of that age to serve in the highest office in the land.
Biden has surpassed former President Reagan as the oldest president to serve in the White House — and the milestone has people wondering: Is there an age that is too old for someone to be president?
"I think it’s a legitimate thing to be concerned about anyone’s age, including mine," Biden himself told MSNBC in October.
BIDEN BECOMES FIRST PRESIDENT TO REACH 80 WHILE IN OFFICE
He added, "But I think the best way to make the judgment is to watch me."
When the Founding Fathers, who were mostly in their early 40s, were deciding the age of the president in 1787, they were more concerned with someone appearing "too youthful" than too old, according to History.com.
Article II of the U.S. Constitution specifies a minimum age — 35 — for someone to be president of the United States without setting a maximum age limit, the website added.
"I'm concerned about age-related dementia, which the job can accelerate given the pressure of the office," Gary J. Schmitt, resident scholar in strategic studies at the American Enterprise Institute, told History.
DRINKING COFFEE, TEA, CAN LOWER THE RISK OF DEMENTIA, STROKE: RESEARCHERS
"But I'm also concerned about the higher percentage of the chance of death while in office, meaning [the American people] will be voting for one candidate but getting someone else who we have not vetted as seriously."
President Biden has a past medical history significant for non-valvular atrial fibrillation, gastroesophageal reflux, seasonal allergies and mild sensory peripheral neuropathy of his feet, according to his November 2021 health summary.
What is atrial fibrillation, exactly? The heart is composed of two upper chambers, called the atria, that pumps blood into its two lower chambers, known as ventricles, per the American Heart Association.
HOW TO REVERSE YOUR BIOLOGICAL AGE AND FEEL YOUNGER WITHOUT SPENDING A FORTUNE
It normally contracts and relaxes to a regular beat. But in atrial fibrillation — or aFib — the atria beat irregularly so that blood does not flow into the ventricles efficiently, the association added.
This can lead to blood clots.
"If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results," the cardiology association noted on its website.
Depending on their risk factors, including advanced age, some patients are placed on blood thinners to prevent this complication — including Biden, who is on the blood thinner called Eliquis as of November 2021.
The medical report also noted a stiffened gait that was largely attributed to arthritis changes in his spine, although it was noted "to be perceptibly stiffer and less fluid than it has been in the past."
The report attributed his persistent coughing and throat-clearing to his acid reflux.
A comprehensive neurologic exam did not reveal any neurological disorder, the report noted, but it did confirm mild peripheral neuropathy in his feet.
The doctor attributed his subtle gait changes in part to "limp and compensation" changes after he suffered a fracture in his right midfoot the year before.
"President Biden remains a healthy, vigorous, 78-year-old male, who is fit to successfully execute the duties of the presidency, to include those as chief executive, head of state and commander in chief," wrote Dr. Kevin C. O’Connor, physician to the president.
Former President Ronald Reagan, the nation’s 40th president, was almost 78 years old at the end of his second term in January 1989, according to the History.com website.
While in office, he survived an assassination attempt as well as surgery to remove a cancerous polyp in the colon — proving resilience is a quality not reserved for only the youth, History added.
JOHN HINCKLEY APOLOGIZES FOR NEARLY KILLING REAGAN: I'M TRYING TO SHOW ‘I’M AN ORDINARY GUY'
Reagan famously deflected attention from his age with humor during the 1984 debate with Democratic opponent Walter Mondale, joking, "I am not going to exploit, for political purposes, my opponent’s youth and inexperience."
Biden’s predecessor, former President Donald J. Trump, was 74 years and 200 days old when he left office, according to History.
In an exclusive interview with Fox News medical contributor Dr. Marc Siegel in July 2020, Trump said he could successfully recall a sequence of five words on a cognitive screening test.
Dwight Eisenhower was 70 years and 98 days old when he left office in January 1961.
He survived a massive heart attack scare the year before he won reelection, per History's website.
But James Buchanan, our nation’s 15th president, had his health deteriorate while in office because of the stress of the job. He left office after only one term, at 69 years and 315 days old, the same source noted.
A 2011 study on aging of U.S. presidents found that the men in the White House tended to live longer once inaugurated compared to men of the same age — "even if they hypothetically aged at twice the normal rate while in office."
"All living presidents have either already exceeded the estimated life span of all U.S. men at their age of inauguration or are likely to do so," the study noted in 2011.
Not all experts, however, agree that the medical report in November 2021 was adequate to assess Biden’s functional and mental status.
"Most troubling was the report his gait had stiffened significantly over the prior year," Dr. Siegel, professor of medicine at NYU Langone Medical Center, recently wrote in the New York Post.
Biden's health report did not mention an MRI of the brain or a cognitive test, Siegel added.
A "stiffening gait can be associated with multiple conditions (including white matter damage or normal pressure hydrocephalus) that cause cognitive decline."
Siegel reminded readers that Biden had two brain aneurysms surgically clipped in 1988 and had a bleed in the head.
Both conditions can lead to long-term risks of cognitive decline in certain patients, according to the medical literature, Siegel added.
As another presidential annual physical is due, he advocates for Biden to have a comprehensive cognitive neuropsychiatric test — as Trump did with the Montreal Cognitive Assessment while in office — and to release it publicly, as his predecessor did.
"Of course, there’s substantial precedent for ill presidents hiding their ailments from the public, from Woodrow Wilson’s severe case of Spanish flu (which arguably affected the Treaty of Versailles) and subsequent stroke to Franklin Roosevelt’s heart failure to the extent of Dwight Eisenhower’s heart disease to John Kennedy’s Addison’s disease, all while still in office," Siegel wrote.
Other experts suggest Biden will continue to function well despite being in his golden years.
"The older people become the less like each other they become," Dr. John W. Rowe, professor of health policy and aging at Columbia University in New York, told Fox News Digital.
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"Factors beyond chronological age, such as race, gender, educational attainment, marital status (being alone is risky, especially for men), access to good health care and financial status, in addition, obviously, to general health status, have very important impacts," he added.
"By these criteria, President Biden is in a privileged group and is likely to continue to function very well for several years."
But Siegel requests full transparency because Biden’s "erratic" public behavior has called his mental fitness in question.
"Dr. O’Connor has an obligation based on medical ethics to determine the functionality of the president," Siegel noted. "This ongoing assessment should include a full neurological evaluation."
2 years 8 months ago
Health, lifestyle, joe-biden, geriatric-health, heart-health, white-house, mens-health
Fray lauds CODE CARE as more surgeries are done
MONTEGO BAY, St James — Clinical coordinator for the Western Regional Health Authority (WRHA) Dr Delroy Fray is praising the newly implemented CODE CARE programme by the Ministry of Health and Wellness (MOHW).
According to Dr Fray, CODE CARE, which was implemented to reduce the backlog of elective surgeries in the country, has greatly benefited patients living in the western region since its implementation earlier in September.
The programme was launched with the participation of four private health facilities: Hospiten Hospital, Montego Bay Hospital and Urology Centre, Baywest and GWEST.
Approximately $70 million is being spent to facilitate the arrangement in western Jamaica.
The clinical coordinator noted that through the initiative, more than 100 patients who spent years on the Cornwall Regional Hospital's (CRH) waiting list have had successful surgeries done through this public-private partnership. He told the Sunday Observer that he has since signed off on additional surgeries to be carried out before the end of this year.
"CODE CARE is one of the best innovations I have seen, after working in the Government service for 37 years, to help people in the public sector who were on a waiting list to have their surgery done," Dr Fray told the Jamaica Observer.
Pointing out that the health ministry was forced to scale back on non-COVID-related emergencies last year as the country grappled with a spike in cases of the virus, the clinical coordinator said that this waiting list also grew longer.
Dr Fray further told the Sunday Observer that after consulting with Health Minister Dr Christopher Tufton, he was able to identify a group of patients with severe health conditions needing emergency procedures to live a normal life.
"So patients needing surgeries for hernias, old men who have a catheter in, who need an operation to remove them, and young women with fibroids who were bleeding down their haemoglobin every month and need their surgery to address the problem, these were the main patients," Dr Fray explained.
"There were many others who needed surgery, but couldn't get it because it was not an emergency, so the minister of health contacted me and asked what the cases I would need to address at this point. I went back to the complaints that I got from the hospital and people who are on the waiting list, and I identified those areas," the clinical coordinator added.
A proud Dr Fray explained that through CODE CARE, patients are prepared for surgery at CRH before being transported to one of the four participating private institutions.
"It is one of the best initiatives I have seen so far to help. These are people who are on the waiting list with no insurance and no financial support to help them otherwise. That is why this is so good," he said.
Grateful for the implementation of CODE CARE is 81-year-old St James man Lloyd Griffiths who told the Sunday Observer that he has forgotten how long he has spent on the waiting list at Cornwall Regional. He has been living with a catheter for 21 years as he faces difficulty emptying his bladder.
Griffiths, who benefited from a transurethral resection of the prostate last Friday, said he is thankful for the assistance of the surgeons who carried out the procedure.
"I am not feeling any pain. I am feeling so good. I am giving thanks and praise to all of the people who assisted me. I am feeling a million times better than I used to feel," he told the Sunday Observer.
The elderly man added, "I am glad for all the people who are helping to do these operations and I am asking the good Lord to have mercy and compassion on them. I wish them all the best."
Stating that he also appreciates the kind gestures of a doctor whom he said took the time out to talk with him before surgery, Griffiths is now looking towards better days with a grateful heart.
"He told me to not be afraid and that he would take the best care of me, and that happened. Right now I am standing here and I feel so good. I am just waiting on the 30th of this month to take the tubes out. I hope that when the tubes come out I will have a flow again like when I was 16, but otherwise, I am feeling happy," Griffiths said.
CODE CARE, the brainchild of the health ministry, is designed to reduce wait time for elective surgeries to less than 180 days and to increase the number of surgeries conducted over the same period by at least 80 per cent, targeting about 2,000 surgeries over a 12-month period.
Speaking in the House of Representatives in late October, Tufton stated that a little over $1 billion has so far been spent on the CODE CARE programme.
Responding to questions from the Opposition spokesman on health, Dr Morais Guy, Tufton then gave a breakdown of the spending. He shared that $80 million was spent to rehabilitate operating theatres; $200 million for public-private engagement; $223 million on equipment; $279 million for nursing mission; $154 million for additional staff hours (overtime); $23.5 million for project management; and $59 million on the communications component.
Tufton told Guy that $200 million was budgeted for the public-private surgical partnership component of the programme for the financial year 2022/23. He said that three contracts, totalling $23 million each, were entered into with three health facilities on the western end of the island. The three are Montego Bay Hospital and Urology Centre, Hospiten and GWest Corporation.
He also disclosed that each of the expected 1,200 hernia surgeries that are being outsourced under CODE CARE will cost $270,000. Additionally, he expects 400 surgeries for fibroids as well as plastic surgeries which he explained are corrective surgeries for, among others, accident and burn victims.
Under CODE CARE, the health ministry will also work with the Diaspora of health-care professionals who visit Jamaica for special surgery sessions to provide more efficient arrangements and access to hospital facilities and target elective surgeries with the longest wait.
Those surgeries include arthroplasty, undescended testis, and pterygium.
2 years 8 months ago
You are what you eat
OF all the clichés we hear throughout our lives, "you are what you eat" may be among those that hold the most truth.
The things we ingest into our bodies affect how much energy we have, how focused we are, what our skin and hair look like and how well we avoid and recover from illness. It's the job of our immune system to defend our bodies against any outside threats. An automatic response is triggered and your white blood cells are used to help you heal quickly and fully.
In supporting your immune system, a well-balanced diet filled with nutritious foods is one of your strongest defences against chronic illness (such as heart disease, obesity, and diabetes) and common viruses (such as the flu and even COVID-19). Knowing what your body needs and at what amounts is crucial. Keep reading to learn about how to strengthen your immune system with foods.
What foods can I eat to strengthen my immune system?
Getting enough sleep, exercising frequently, and avoiding substance abuse are a few ways you can build up immunity. However, maintaining a nutritious diet is also extremely important. The following are five types of foods you can eat to help build a strong immune system:
1) Berries — These versatile fruits are packed with vitamins and antioxidants. You may enjoy blueberries, blackberries, strawberries, and more.
2) Citrus fruits — Citrus fruits have high levels of vitamin C which help fight infection by increasing your white blood cells. Oranges, grapefruit, lemons, and limes are some great options. Vitamin C may also help you have great skin.
3) Ginger — Ginger may help decrease inflammation. It may be useful to heal a sore throat, help with stomach pain and nausea, treat inflammatory illnesses and even control chronic pain. It may also help you lower your cholesterol.
4) Nuts and seeds — Nuts (such as almonds and walnuts) and seeds (such as sunflower seeds) contain several vitamins and minerals which help to regulate and maintain your immune system. They also contain healthy fats required to keep a balanced diet.
5) Leafy greens — Dark, leafy vegetables such as spinach and kale are known to have high levels of vitamin C and antioxidants. They contain properties that help fight off infection and are good for your heart, brain, and gut. They are also a good source of vitamin E.
While these specific foods are good to help support your immune system, several other foods are as well. You should try your best not to skip any meals to keep your body well-fuelled and protect your immune system. Continuing to stay hydrated by drinking plenty of water will also help you to flush out any unwanted toxins in your body that could cause illness. In maintaining a balanced diet, you must have the right amount of nutrients from all the food groups. The seven major classes of food nutrients are: carbohydrates, fibre, fats, protein, minerals, vitamins and water.
How can telemedicine help?
There is so much information available that teaches us about keeping a balanced diet and using food to help heal and prevent illness. It may feel overwhelming. Additionally, your dietary requirements may vary based on your age, weight, existing illnesses or deficiencies, and even food allergies and intolerances. Consulting a doctor to help create a specific diet for you may be extremely helpful.
Through telemedicine you can reach out to a doctor to go through your personal medical history and get a diet plan suited for you, taking into consideration your specifications. This can all be done over the phone, video call, or text on telemedicine platforms such as MDLink.
If the doctor thinks it's appropriate to test vitamin levels to identify a deficiency or to diagnose if you may be immuno-compromised, they can send you lab forms for you to get blood tests or any other tests through this telemedicine platform. MDLink's Drive-Thru in Kingston will also allow you to get lab tests done right there in the comfort and convenience of your vehicle.
Telemedicine is a convenient and reliable resource that is there to support you not just through illness but also through wellness. Guidance for maintaining a healthy lifestyle and avoiding illness is just one of the many things telemedicine can support you with.
Dr Ché Bowen, a digital health entrepreneur and family physician, is the CEO & founder of MDLink, a digital health company that provides telemedicine options. Check out the company's website at
www.theMDLink.com. You can also contact him at drchebowen@themdlink.com.
2 years 8 months ago
The Vagilangelo
COSMETIC gynaecology, which emphasises on enhancing the physiological function of the internal female genital structures and also the aesthetic appearances of the external genital structures (vulva), has been gaining tremendous popularity globally over the last 10 years.
The growing trend is synonymous to general cosmetic surgery which is dominating the field of medicine globally with people travelling to all corners of the globe to ensure that the best surgeons are performing their desired cosmetic procedures effectively, flawlessly and affordably. From dental veneers, botox, fillers, breast augmentations, tummy tucks to liposuctions and BBLS — individuals are choosing to look their best, feel their best and to also empower themselves. The list of these procedures can be quite extensive and evolutionary making the cosmetic medical speciality a thriving industry.
The most popular cosmetic surgical gynaecological procedures are the vaginoplasty (which involves the complete reconstruction of the vaginal canal, reducing its diameter, to improve sexual gratification) and labiaplasty (which involves the removal of excess skin of both the inner and/or outer lips of the vulva to achieve a more aesthetic appearance).
Cosmetic gynaecology also utilises non-surgical techniques such as energy (via ultrasound, laser or radio frequency energy) to improve function and aesthetics to these intimate areas. Additionally, the use of platelet rich plasma (PRP — portions of the patient's own blood) has been very beneficial in gynaecology for the treatment of female sexual dysfunction (O-Shot), stress urinary incontinence and underlying skin conditions.
Sounding very exotic and reminiscent of an ancient Roman artist is the latest cosmetic gynaecological procedure — The Vagilangelo — which is a perfect blend of surgical and non-surgical techniques. Coined by NYC cosmetic gynaecologist Dr Amir Marashi, the procedure is referred to as a "minimal invasive vaginoplasty".
To understand the Vagilangelo, one must first understand the anatomy of the vagina. Contrary to popular belief, the vagina is naturally positioned at a downward angle. The importance of this angle is to aid with the penis or toy in stimulating the "G zone"/G spot which is located close to the entrance of the vagina on its top wall. The "G zone" is a sensitive zone within the vagina filled with nerve endings which when stimulated can result in vaginal orgasms — which some women find difficult to achieve. With advancing age, decreasing hormones and child birth, the muscles of the vagina relax and this downward angle is lost and now becomes horizontal. What results is a lack of stimulation of the "G zone" and an even more greater difficulty in achieving vaginal orgasms.
Traditional vaginoplasty permanently rectifies this problem by recreating the vaginal angle, narrowing the diameter of the vagina (thus allowing greater stimulation of the G zone) and enhances the muscular tone of the entire vagina leading to a greater sexual experience. Though extremely successful (95 per cent success rate), there is an associated prolonged surgery time (mostly done at a surgery centre/hospital), strict post-operative instructions, inability to deliver vaginally in the future and also a prolonged healing time of six to eight weeks (No SEX!).
The Vagilangelo — offered locally by Gynae Associate's Dr Daryl Daley and Baywest Hospital's Dr Germaine Spencer — is a two-step procedure which can easily be done in office under local anaesthesia with little to no discomfort. It first involves using PRP injections to enhance the G zone, making it more sensitive, lubricated and physically swollen, thus more easily stimulated. The second step involves bringing the muscles of the entrance of the vagina closer together with sutures thus recreating the angle. The two work together to create a greater sexual experience. Though the level of satisfaction achieved is not as great as a traditional vaginoplasty, patient satisfaction is still high. The entire procedure takes around 30 minutes and is significantly less than a full vaginoplasty.
Intercourse can be resumed within three to four weeks, with minimal post-operative instructions. Patients will also be able to deliver vaginally in the future. The actual surgical procedure is permanent, (until future child birth) but yearly PRP injections can be used to re-enhance the G zone.
This procedure is ideal for women who don't have any other underlying pelvic floor problems such as pelvic organ prolapse (uterus, bladder or rectum protruding through vagina) and are enjoying a healthy sex life who wish to enhance their experience greater. The additional PRP enhancement will also help with vaginal lubrication, sensitivity and stress urinary incontinence.
Dr Daryl Daley is a cosmetic gynaecologist and obstetrician. His office is located at 3D Gynaecology Ltd. at 23 Tangerine Place, Kingston 10 and the office number is 876-929-5038/9. He can be contacted at ddaley@3dgynae.com
2 years 8 months ago
HEART ATTACK VERSUS CARDIAC ARREST
THERE often is confusion in the lay public as to the difference between a heart attack and a cardiac arrest. As physicians we sometimes contribute to this confusion by using these terms imprecisely when speaking to our patients.
A heart attack (or myocardial infarction) is the death of heart muscle because of impairment of blood flow usually resulting from acute rupture of a plaque, causing abrupt stoppage of blood flow in the coronary vessel. A cardiac arrest can be thought of as the cessation of the pumping function of the heart. A cardiac arrest can occur because of a heart attack but often occurs in the absence of a heart attack in patients who do not have coronary artery disease. Cardiac arrests are important as once the heart stops pumping, the organs of the body cease receiving the blood flow that they need to stay alive. Some organs of the body are relatively resistant to temporary disruptions in blood flow. For example, the muscle of the heart can recover normal function if flow is interrupted for less than two hours. In contrast, brain tissue starts to die within minutes of an absence of blood flow. Given this and the fact that absence of electrical activity in the brain is the gold standard for the definition of death, cardiac arrests that are untreated will almost uniformly lead to death. For some patients, cardiac arrest is expected as they are experiencing rapid progression of heart disease in a hospital setting. Most cardiac arrests, however, take place at home and are unexpected. This is called sudden cardiac death and in many developed and developing countries constitutes a significant percentage of total mortality.
Why does the heart stop pumping?
As we have discussed in previous articles, the heart has different systems that work together in synchrony to ensure that the heart can pump blood to meet the needs of the body. Simply put the heart beats because an electrical signal runs through it from the upper chambers to the lower chambers. This electrical signal results in muscle contraction which generates the force for pumping blood. Cardiac arrest almost always results from disturbances in the electrical activity of the heart. These disturbances can be divided into rapid heart rhythms abnormalities or rhythms with slowing/absence of the electrical signals. Rapid heart rhythms particularly involving the bottom chambers of the heart account for almost 90 per cent of cardiac arrest while slow heart rhythms or an absent heart rhythm account for the remainder. The fact that rapid heart rhythms are such a dominant cause does open the possibility for treatment to "restart the heart" and allow the return of a normal cardiac rhythm. If this is done before the brain and other organs suffer significant damage, then the patient can return to a normal life.
What are the possible outcomes of cardiac arrest?
The outcomes of sudden cardiac arrest tend to be best in places where the patient is being closely monitored and there is the ability to rapidly deliver an electric shock to the heart muscle. Of secondary importance is the ability to continue delivery of blood flow to the body in the absence of the pumping action of the heart. This is known as cardiac pulmonary resuscitation or basic life support. Patients who experience cardiac arrest in the emergency room, in the ICU or in procedure suites have relatively high rates of survival with normal neurological function. This improved outcome is related to the fact that cardiac arrest is quickly identified, personnel are available who can provide life support and cardiac rhythm abnormalities can be identified and treated. Studies have found survival after cardiac arrest of greater than 70 per cent in the coronary care unit and greater than 50 per cent in medical intensive care unit. In contrast, patients who have cardiac arrest at home normally have poor outcomes. Some studies have suggested that only six out of 100 patients survive a cardiac arrest at home. The percentage of patients who survive and are neurologically intact is even lower. Data from the Unites States of America suggests that some of the poor outcomes for patients at home is the fact that cardiac pulmonary resuscitation is performed only 40 per cent of the time.
What leads to cardiac arrest?
Most cardiac arrests occur in patients who have some form of cardiovascular disease. The risk of heart disease increases with age and thus so does the risk of cardiac arrest. Coronary artery disease is the most common heart disease that is seen in developed countries and many developing countries. Coronary disease can lead to cardiac arrest in several circumstances. If an individual is having a heart attack, the absence of blood flow to the heart will often cause the heart muscle to be irritable and to develop arrhythmias. These tend to be most common early in the heart attack course and are what the layman thinks of when someone is said to "drop dead" from a heart attack. Cardiac arrest can also commonly occur in patients who have sustained a heart attack in the past. When a heart attack heals the muscle tissue of the heart is replaced by scar or fibrous tissue which can serve as a focus for the development of abnormal heart rhythms particularly if the pumping function of the heart is reduced.
Patients who have heart failure, particularly when the main pumping chamber of the heart is enlarged and does not pump effectively, are at high risk of developing cardiac arrest. This risk increases when the pumping function of the heart is severely reduced. Other forms of heart muscle disease or cardiomyopathies are at risk including those with abnormally increased thickness of the heart muscle "hypertrophic cardiomyopathy", genetic abnormalities that increase the risk of heart arrhythmias, valvular heart disease and congenital heart disease.
How common is cardiac arrest?
The exact scope of the problem can be difficult to determine. Cardiac arrest is easy to diagnose in a medical setting where rhythm monitoring is available. Most cardiac arrests, however, occur outside of medical facilities. In these scenarios an exact diagnosis can be challenging even in those limited cases in which autopsy is performed. For epidemiologic studies sudden cardiac death is often defined as death occurring within an hour of symptoms. For example, someone falls to the ground and cannot be resuscitated. It is important to note that many deaths can take place where there are no witnesses to the events and the best that can be said is that the patient was alive last night. In the United States it is estimated that 36,500 cardiac arrests take place outside hospitals each year. The numbers for Europe are estimated to be approximately 340,000 per year. For the United States it is estimated that this represents 20 per cent of total mortality.
Can anything be done to lower the rates of cardiac arrest and to improve survival?
Lowering the rates of cardiac arrest and improving survival is a common goal of heart foundations and organisations worldwide, including our own Jamaica Heart Foundation. Research, improved diagnosis/management of cardiovascular disease, educational outreach at a population level and policy changes at the national level have the potential to improve the outcomes in this challenging clinical area. We will address some of these matters in future articles
Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Correspondence to info@caribbeanheart.com or call 876-906-2107
2 years 8 months ago
Health – Demerara Waves Online News- Guyana
New privately-owned, approved healthcare training institution opens doors
A privately-owned healthcare institution, Royalty Home-Care and Private Nurse Services, has expanded its operations and is now training patient care assistants at its Tuschen, East Bank Essequibo headquarters. Founder and Chief Executive Officer of Royalty Home-Care and Private Nurse Services, Nurse Alicia Solomon, who is also studying to become a medical doctor, said the institution ...
A privately-owned healthcare institution, Royalty Home-Care and Private Nurse Services, has expanded its operations and is now training patient care assistants at its Tuschen, East Bank Essequibo headquarters. Founder and Chief Executive Officer of Royalty Home-Care and Private Nurse Services, Nurse Alicia Solomon, who is also studying to become a medical doctor, said the institution ...
2 years 8 months ago
Education, Health, News
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
Arthroscopic debridement and drainage effective for lactational breast abscesses
Arthroscopic debridement and drainage are effective treatment methods for lactational breast abscesses suggest the latest study published in BMC Surgery.
The optimal treatment of breast abscesses has been controversial. Herein, we report an innovative method for the operative treatment of lactational mammary abscesses.
Arthroscopic debridement and drainage are effective treatment methods for lactational breast abscesses suggest the latest study published in BMC Surgery.
The optimal treatment of breast abscesses has been controversial. Herein, we report an innovative method for the operative treatment of lactational mammary abscesses.
Most cases of acute mastitis occur in lactating women, and approximately 0.4–11% of patients eventually develop breast abscesses. Surgical incision and drainage (I&D) was once the recommended management for mammary abscesses. However, it has been found to be associated with interruption of breastfeeding, formation of breast fistula, prolonged healing time, and obvious scarring. Recently, clinicians have reported many minimally invasive treatment methods, such as fine-needle aspiration, percutaneous catheter placement and vacuum-assisted breast biopsy (VABB), for breast abscesses. However, these minimally invasive treatments often fail, especially in cases of large (> 3 cm in diameter) or multilocular mammary abscesses. Therefore, a treatment method that can ensure adequate drainage and result in satisfactory cosmetic outcomes needs to be developed.
Nineteen lactating patients diagnosed with breast abscesses were enrolled in the study, and abscess debridement and drainage were performed using an arthroscopic system. The clinical characteristics of the patients were recorded to evaluate the feasibility, efficacy, and cosmetic results of arthroscopic surgery for breast abscesses.
Results:
All 19 patients were cured and did not relapse within the 6-month-follow-up period. One patient stopped breastfeeding due to breast leakage. All patients were satisfied with the postoperative appearance of the breast.
Arthroscopic debridement and drainage are effective treatment methods for lactational breast abscesses, with a high cure rate, few complications, and satisfactory cosmetic outcomes.
Reference:
Lou, L., Ma, W., Liu, X. et al. Application of arthroscopic system in the treatment of lactational breast abscess. BMC Surg 22, 397 (2022). https://doi.org/10.1186/s12893-022-01845-z
Keywords:
Lou, L., Ma, W., Liu, X, Application, arthroscopic, system, treatment, lactational breast, abscess, BMC Surgery.
2 years 8 months ago
Surgery,Surgery News,Top Medical News
Monkeypox virus could also be transmitted by air
For the first time, a group of Spanish scientists discovered high levels of the monkeypox virus in the air and saliva of infected patients, raising the possibility that this virus is also transmitted through the air.
The study, published in The Lancet Microbe, does not rule out the possibility that the virus (monkeypox virus or MPXV, for short) is transmitted through the air, though direct contact, particularly with skin lesions of an infected person, remains the most common mode of infection.
The monkeypox virus, which belongs to the genus Orthopoxvirus, can be transmitted between animals and humans, and while its symptoms are similar to those of smallpox (which was eradicated in 1980), it is less severe, contagious, and lethal. The disease, which is endemic in Central and Western Africa, is primarily spread through close contact.
The World Health Organization (WHO) declared a worldwide outbreak of monkeypox a global health emergency in May 2022. Since then, more than 79,000 cases have been confirmed, which is more than the total number of cases recorded in Africa since the virus was discovered in 1970. According to the European Center for Disease Prevention and Control (ECDC), there were 25,400 confirmed cases in Europe up until November 8, with more than 7,300 cases recorded in Spain.
2 years 8 months ago
Health
NationNews Barbados — nationnews.com
Scientists working on universal flu vaccine
Scientists say they have made a breakthrough designing a vaccine against all 20 known types of flu.
It uses the same messenger-ribonucleic-acid (mRNA) technology as successful Covid vaccines.
Flu mutates and the current annual jab is updated to ensure the best match for the sort circulating but would probably not protect against new pandemic types.
Scientists say they have made a breakthrough designing a vaccine against all 20 known types of flu.
It uses the same messenger-ribonucleic-acid (mRNA) technology as successful Covid vaccines.
Flu mutates and the current annual jab is updated to ensure the best match for the sort circulating but would probably not protect against new pandemic types.
The new vaccine triggered high levels of antibodies, in tests on ferrets and mice, that could fight a broad range.
The antigens it contains – safe copies of recognisable bits of all 20 known subtypes of influenza A and B viruses – can teach the immune system how to fight them and, hopefully, any new strain that could spark a pandemic, the researchers say, in the journal Science.
“The idea here is to have a vaccine that will give people a baseline level of immune memory to diverse flu strains,” Dr Scott Hensley, one of the scientists behind the work, at the University of Pennsylvania, said.
“There will be far less disease and death when the next flu pandemic occurs.”
The 2009 swine flu pandemic – caused by a virus that jumped species to infect humans – was less serious than initially feared.
But the 1918 Spanish flu pandemic is thought to have killed tens of millions of people.
Director of the Institute for Global Health and Emerging Pathogens at Mount Sinai Hospital, in New York, Adolfo García-Sastre, said: “Current influenza vaccines do not protect against influenza viruses with pandemic potential.
“This vaccine, if it works well in people, would achieve this.
“The studies are preclinical, in experimental models.
“They are very promising and, although they suggest a protective capacity against all subtypes of influenza viruses, we cannot be sure until clinical trials in volunteers are done.”
Estanislao Nistal, a virologist at San Pablo University, said: “All of this implies the potential for an easily and rapidly constructed universal vaccine that could be of great use in the event of a pandemic outbreak of a novel influenza virus.” (BBC)
2 years 8 months ago
Editors Pick, World, Barbados Nation, messenger-ribonucleic-acid (mRNA), Nation News, universal flu vaccine
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
Restricting iron diet in patients with sickle cell disease prevents organ damage: Study
Many therapies under development aim to reduce systemic iron concentrations in order to alleviate illness consequences, among these iron-induced changes in microbial load and gut integrity are connected and potential therapeutic targets, says an article published in Blood Journal.
Sickle cell disease is a set of hemoglobinopathies characterized by the inheritance of at least one sickle (S) beta-globin gene with another kind of defective hemoglobin. The most frequent of these disorders are sickle cell anemia (HbSS), hemoglobin SC disease (HbSC), and minor and major hemoglobin S thalassemia (HbSthal).
Sickle cell disease (SCD) is a hereditary ailment caused by a -globin gene mutation that causes erythrocyte sickling, vaso-occlusive episodes (VOE), and progressive organ destruction. Chronic hemolysis, inflammation, and red blood cell transfusions can all impair iron homeostasis in SCD. Iron excess occurs in individuals who get many blood transfusions, whereas iron deficiency occurs in another subset of SCD patients.
Huihui Li and colleagues undertook this work in order to explore links between the microbiota, dietary iron, and SCD pathogenesis, we fed SCD mice an iron-restricted diet (IRD).
The key findings of this study were:
1. In SCD mice, IRD therapy reduced iron availability and hemolysis, lowered acute VOE, and improved chronic organ damage.
2. Previous research has shown that the gut bacteria influence illness in SCD mice.
3. IRD modifies microbial load and enhances gut integrity, limiting cross-talk between the gut microbiome and inflammatory factors such old neutrophils and lowering VOE and organ damage.
4. These data support the therapeutic potential of modulating iron homeostasis and the gut flora to improve SCD pathogenesis.
In conclusion, iron overload is a major cause of illness and premature mortality in SCD patients. Dietary iron restriction can be used in conjunction with iron chelating treatment in individuals who require frequent transfusions. This technique is less obvious for the subset of individuals with iron insufficiency and requires confirmation.
Reference:
Li, H., Kazmi, J. S., Lee, S. K., Zhang, D., Gao, X., Maryanovich, M., Torres, L. S., Verma, D., Kelly, L., Ginzburg, Y. Z., Frenette, P. S., & Manwani, D. (2022). Dietary iron restriction protects against vaso-occlusion and organ damage in sickle cell disease. In Blood. American Society of Hematology. https://doi.org/10.1182/blood.2022016218
2 years 8 months ago
Medicine,Medicine News,Top Medical News
Hospital expenses for the care of Haitian patients amount to RD$10 billion
Daniel Rivera, the Minister of Public Health, confirmed on Wednesday that hospital care for patients of Haitian origin consumes 14% of the portfolio’s total hospital resources. Rivera estimates that the total investment in Haitian patients will be around 10 billion pesos by the end of 2022.
“According to our planning, it is estimated, if there is no variation, that there will be 10 billion this year.” says Dr. Mario Lama of the National Health Service (SNS), “the pressure of the occupation of the general hospitals total 14% of the resources for Haitian patients,” the official said.
Although the maternity sector receives the most funding, approximately six billion pesos, the doctor emphasized that it is not only parturients and children who require neonatal care, but also patients with HIV, cancer, and those injured in fights or traffic accidents, among other circumstances.
Rivera’s 14% figure refers to the sum of the Public Health budget (8,300 million) and the SNS budget (75,000 million), which totals 83,300 million. The health sector’s overall budget is 123 billion pesos.
2 years 8 months ago
Health, Local