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School reopening: Is it the ideal time? Experts discuss

by Medically Speaking Team November 6, 2021

After all the festivities end, it’s about time children go back to school as several states finally open doors from November 1. While the reopening of schools started in graded manner, parents’ worries for their wards’ health spark a debate as pollution, Dengue and Covid pose a threat.

To discuss about the same, Medically Speaking spoke to a panel of experts that included: Dr Neeraj Nischal, Internal Medicine, AIIMS; Dr Krishan Chugh, Pediatric Department, Fortis Hospital; Dr Anil Gulati, Pediatric Department, Max Hospital.

Here are a few snippets:

What would you like to tell the parents who are still holding of sending their children to schools because end of the day this fear of Covid still lurks in the back of our mind even though the cases are at an all-time low.

Dr Neeraj Nischal: We have been dealing with Covid since the last two and now we need to find a way to co-exist with it. The only thing which has not started yet is the schools of the children. Everybody is worried about the safety of the children but what we have realized is that the cases have come down and children are going everywhere whether its mall, picnic, trips, etc. but schools. Risk of Covid in school is almost the same as going outside. Definitely, schools have a better control over the virus as compare to any other place. As far as the Sero-Survey and other things are concerned, even prior to the second wave, we thought we have already controlled this disease, but we were wrong. I feel this is the right time to open the schools with all precautions in place.

Parents’ concern here is that when going out to malls and trips, they can enforce their children to wear masks but cannot keep an eye on them in the school. Children also like to mingle with each other. Do you agree with this line of thought?

Dr Krishan Chugh: When it comes to going to school, they are compared to malls and other places. Children stay with each other for several hours, depending on the various factors and in a comparatively closed space as the classrooms, as they are not huge these days. So spread of covid from one to another is possible probably slightly more than what it would be in other places, where the contact with each other is not close enough. But the fact is most children have not suffered very serious disease in the past, so we can expect that even if they contract the disease, they will not catch any severe disease. But they can become carriers and spread them to elderly back at home who are in comorbid condition.

Did you see children catching Covid in second wave build a strong immunity against the virus and can we still rely on that, keeping in mind that children do not develop severe Covid complication?

Dr Anil Gulati: We didn’t have to face a deluge of pediatricians when the waves were going on and henceforth, we didn’t get them tested when the whole family was suffering. When they come to us for some other reason and they have fever, we get their antibodies done and they’re positive. It is like D-Factor vaccination. I think the bigger worry is that children should not be the victims now, they have been reasonably exposed in the past and they had faced it better than the adults. We were very lucky that not many children were sick enough.

Do you think there is a need to vaccinate children on an urgent basis and can it go simultaneously with vaccination of the population?

Dr Neeraj Nischal: Definitely, vaccination is going to be an important part, but most of the children carry antibodies. What we realized during even second wave, which was deadlier than the first wave, is that the chances of re-infection even in those who have contacted earlier was less. The same thing applies to the children, luckily they have been spared relatively by the particular virus so far. Whatever patients we saw, we saw children who had some comorbidities, whether its related to some childhood leukemia, or some liver related disorder. Apart from that, few more pediatric patients landed up in ICU and because of Covid-19, in 18 months we hardly saw any patient. So, from my point of view definitely they are safe and we should try to start vaccination as soon as possible but we should not keep our schools closed thinking that they will start because everybody is vaccinated, because that is going to take time even if we try at first place.

Speaking of Comorbid children, what should be the precautions they should take at this point of time considering schools have reopened?

Dr Krishan Chugh: Yes, it is the reality that we should be sending our children to school but the question is, is it today or could it be postponed a little more? My belief is that we could have waited for the two to three weeks more, reason being that it’s a festive season which are celebrated with a bash, people come close for longer times. To see an impact of that, probably we need to wait for two weeks after Diwali festival. Around 20-25^th or November would have been a better date to reopen schools. By then we would have seen the effect or by chance another kind of wave or more number of cases is coming, then we would probably take more precautions either open the schools only very partly or may be differ again.

Dr Gulati, would you agree?

Dr Anil Gulati: I agree with him because last year also, when Diwali rush was there in all the markets, we had a lot of cases. Its like being extra cautious. If they have been in the house for two years, another few weeks, two weeks, three weeks probably would not matter. But what I see is that they are opening in phases. They have warned the parents also. There is an abundance of caution. The schools are giving parents an option, if you agree, you can go online classes or offline. I think the message is clear to the parents, we have to live our lives. Live with caution, we cannot stay indoors and children have stayed under house arrest for two years and I have a sympathy with their overall development.

Considering the status of rural areas and how much children absorb sitting online, what do you think reopening of schools at this time good idea or perhaps it should be delayed a little more?

Dr Neeraj Nischal: We have lost that window when cases were much lower. That was the best time to reopen and I think we should start of course gradually, and I am saying because I have two kids one is six-years-old and the other is four-years-old. I have been seeing what behavioral change they had while at home. It’s not right to say we must wait for the ideal time because that is not going to come certainly in the next two years. Precautions must be take, that is, if we see a spurt in cases, schools must be shut down immediately. But at the same time if we say that online classes should continue through laptops, mobile and tablets, think about the 60% to 70% of the population that does not have access to these luxuries. We must take baby steps and not wait for the ideal time.

Let’s say waiting for two to three weeks can be appropriate, but then it will be mid-December and people meet and mingle again and let’s delay a little more and it is next year. What would you tell those who offer this counter to your argument?

Dr Krishan Chugh: As Dr Neeraj said there is no ideal time, but we are looking at what is obvious, which is that Diwali is a festival where we see far much more gatherings than what we see at Christmas and New Year. The two are very different from each other. Therefore, I believe the two to three weeks of delay would have been the best measure. Nothing is predictable about this virus but what we have now and what we are seeing across the world is that we are near the time when schools should open in a graded manner.

USFDA has approved Pfizer and we have Covaxin which has gotten the initial approval of the drug authority and final nod is still awaited. What will you say, at least as comorbid children are concerned, would you agreed that the vaccination should be started at the earliest?

Dr Anil Gulati : It is not me agreeing with this or not. There is a process. Whenever a new vaccine is invented or launched, there is a process we go through in a very scientific and systematic manner.

Children are very precious, I mean all the trials that place, children are excluded initially, unless the disease is children specific. We leave it to the experts who deal with vaccines, but certainly we are quite encouraged by the results of all the vaccines and they are all good.

There is a fear that owing to the festive season, children could become silent carriers. Is that a real fear?

Dr Neeraj Nischal: That will always be a fear because the biggest problem with this particular infection is that majority of them will remain asymptomatic and they may actually transfer this virus without even knowing. Therefore, right from the start, we have been talking about the social vaccination aspect, that is always follow the covid appropriate behavior. That is what we have to keep on reenforcing on our children because if they really want go to school, they have to follow this appropriate behavior. Going by my experience, my children listen better to the teacher rather than listening to me. I am certain, specially the younger children, they are going to listen to the teacher because they are bored staying at home. And of course we have to take care of them because they are the most precious thing we are working for actually.

Would you say rise in number of Dengue cases and Diwali pollution must be the bigger worry right now and not Covid?

Dr Krishan Chugh: Dengue is what is going around and many parts of the country are seeing a deluge of patients. Probably in Delhi and around is coming down little bit, but rest of the country is far worse. As far as pollution is concerned, we know that agricultural burning and fireworks are going add up and the next few weeks are going to be really bad for children’s lungs as well as the rest of the body. We know that pollution effects even the brain and not just the lungs. We are in full for a difficult period here. Let’s hope that parents as well as the government agencies will be take enough precaution to keep our children healthy.

What would be your advice to the anxious parents who are still to take a decision on whether they should send their wards to school or not, considering at least many private school are also playing quite safe and cautious?

Dr Anil Gulati: While we are very sure that the numbers have come down and its safer than what it was a few months ago, and Dr Nischal has said it is very clear there is no ideal time. I think it is the mental state of the parents which needs to be addressed. I think they need to be a counselled that finally you have to send your children to school. Each parent has a different level of fear. It is a hybrid model, either you come to school or you take online classes. It gives anxious parents some time to watch how the things go when the schools open after a week or 2 week or one month, finally everything goes on right all children will happily go to school.

Dr Nischal I am sure you agree with this because at the end of the day, one cannot stop their children from going out or playing outdoors at least for a few minutes if not an hour or a day or so.

Dr Neeraj Nischal: That’s what I have said that its really difficult to keep our children at home for their development as well and that’s why we have to take a call and hybrid mode is the best way forward for the time being. It has to be participation of both sides, parents and teachers. Schools are laying down their own norms so that the chances of the infection minimize. If we keep on following all those rules, i think we can safely open our school but at the same time we have to keep a watch, slightest sign of increase of cases and we should not hesitate shutting down schools again.

Would you advise parents to stay at home after this festive season or would you advise them to go to school and follow Covid appropriate behaviour?

Dr Krishan Chugh: I would again say that waiting for three more weeks is not going to make a very big difference considering that they have been at home for almost two years now. When it comes to other place like cinema halls I would again advice children they should not be going to these places also for next coming weeks .

November 6, 2021 0 comment

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Abdominal Lump

by Medically Speaking November 6, 2021

written by Medically Speaking

What exactly is an abdominal lump?

An abdominal lump is a swelling or bulge that appears in any part of the abdomen. It is usually soft, but it can be firm depending on the underlying cause.

A hernia is the most common cause of a lump. An abdominal hernia occurs when the structures of the abdominal cavity push through a weakness in the abdominal wall muscles. Typically, surgery can easily correct this.

In rarer cases, the lump may be an undescended testicle, a harmless hematoma, or a lipoma. In even rarer circumstances, it may be a cancerous tumor.

If you also have a fever, vomiting, or pain around an abdominal lump, you may need emergency care.

Possible causes of an abdominal lump

A hernia causes the majority of lumps in the abdomen. Hernias often appear after you have strained your abdominal muscles by lifting something heavy, coughing for a long period, or being constipated.

There are several types of hernias. Three kinds of hernias can produce a noticeable lump.

Inguinal hernia

An inguinal hernia occurs when there is a weakness in the abdominal wall and a part of the intestine or other soft tissue protrudes through it. You’ll most likely see or feel a lump in your lower abdomen near your groin and feel pain when coughing, bending, or lifting.

In some cases, there are no symptoms until the condition gets worse. A hernia isn’t typically harmful by itself. However, it needs to be repaired surgically because it can cause complications, such as a loss of blood flow to the intestine and/or obstruction of the intestine.

Umbilical hernia

An umbilical hernia is very similar to an inguinal hernia. However, an umbilical hernia occurs around the navel. This type of hernia is most common in babies and often disappears as their abdominal wall heals on its own.

The classic sign of an umbilical hernia in a baby is outward bulging of tissue by the belly button when they cry.

Surgery is required to fix an umbilical hernia if it doesn’t heal on its own by the time a child is four years old. The possible complications are similar to those of an inguinal hernia.

Incisional hernia

An incisional hernia happens when a prior surgical incision that has weakened the abdominal wall, allows intra-abdominal content to push through. It requires corrective surgery to avoid complications.

Less common causes of an abdominal lump

If a hernia isn’t the cause of an abdominal lump, there are several other possibilities.

Hematoma

A hematoma is a collection of blood under the skin that results from broken blood vessels. Hematomas are typically caused by an injury. If a hematoma occurs by your abdomen, a bulge and discolored skin may appear. Hematomas typically resolve without needing treatment.

Lipoma

A lipoma is a lump of fat that collects under the skin. It feels like a semi-firm, rubbery bulge that moves slightly when pushed. Lipomas typically grow very slowly, can occur anywhere on the body, and are almost always benign.

They can be removed surgically, but in most cases, surgery isn’t necessary.

Undescended testicle

During male fetal development, the testicles form in the abdomen and then descend into the scrotum. In some cases, one or both of them may not fully descend. This may cause a small lump near the groin in newborn boys and can be corrected with hormone therapy and/or surgery to bring the testicle into position.

Tumor

Although rare, a benign (noncancerous) or malignant (cancerous) tumor on an organ in the abdomen or in the skin or muscles can cause a noticeable lump. Whether it requires surgery or another type of treatment depends on the type of tumor and its location.

How is it diagnosed?

If you have a hernia, your doctor will likely be able to diagnose it during the physical exam. Your doctor may want you to undergo an imaging study, such as an ultrasound or CT scan of your abdomen. Once your doctor confirms an abdominal hernia is present, you can then discuss arrangements for a surgical correction.

If your doctor doesn’t believe the lump is a hernia, they may require further testing. For a small or asymptomatic hematoma or lipoma, you probably won’t need further tests.

If a tumor is suspected, you may need imaging tests to determine its location and extent. You’ll likely also need a biopsy, which involves tissue removal, to determine if the tumor is benign or malignant.

When to seek medical help

If you feel or see a lump in your abdomen that you can’t identify, make an appointment to see your doctor. If you also have a fever, vomiting, discoloration, or severe pain around the lump, you may need emergency care.

At your doctor’s appointment, you can expect to receive a physical examination of your abdomen. Your doctor may ask you to cough or strain in some way while they’re examining your abdomen.

Other questions they may ask include:

When did you notice the lump?

Has the lump changed in size or location?

What makes it change, if at all?

Do you have any other symptoms?

November 6, 2021 0 comment

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South Asian descent gene linked to higher Covid risk: study

by Medically Speaking November 6, 2021

written by Medically Speaking

Researchers in the United Kingdom discovered that three out of every five people of South Asian ancestry carry a gene linked to a doubling of the risk of respiratory failure caused by severe Covid-19.

The study by researchers at the University of Oxford said that the high-risk version of the gene, ‘leucine zipper transcription factor like 1’, or LZTFL1, “probably” prevents the cells lining the airways and lungs “from responding to the virus properly”. The researchers also said that the genetic signal doubled the risk of dying from Covid-19 in adults under the age of 65 years.

“But importantly, it doesn’t affect the immune system, so the researchers expect people carrying this version of the gene to respond normally to vaccines,” Oxford said in a release on the findings of the study published on Thursday.

“Although we cannot change our genetics, our results show that the people with the higher risk gene are likely to particularly benefit from vaccination. Since the genetic signal affects the lung rather than the immune system it means that the increased risk should be cancelled out by the vaccine,” the release quoted study co-lead James Davies, associate professor of genomics at Oxford’s Radcliffe Department of Medicine.

The study published in Nature Genetics (‘Identification of LZTFL1 as a candidate effector gene at a COVID-19 risk locus’: Hughes et al) is a genome-wide association study (GWAS) aimed at identifying candidate genes that predispose to severe Covid-19 that can cause multiple organ failure through cytokine release, etc.

The key finding of the GWAS was that 60 per cent with South Asian ancestry carry the high-risk genetic signal, compared to 15 per cent of those with European ancestry. This, the release said, “partly explains the excess deaths seen in some UK communities, and the impact of COVID-19 in the Indian subcontinent”.

The study also found that only 2 per cent of people with Afro-Caribbean ancestry carried the higher risk genetic signal, “meaning that this genetic factor does not completely explain the higher death rates reported for black and minority ethnic communities”.

Davies underlined that “socioeconomic factors are also likely to be important in explaining why some communities have been particularly badly affected by the COVID-19 pandemic”.

“The genetic factor we have found explains why some people get very seriously ill after coronavirus infection. It shows that the way in which the lung responds to the infection is critical. This is important because most treatments have focussed on changing the way in which the immune system reacts to the virus,” he said.

Study co-lead Jim Hughes, a professor of gene regulation, was quoted as saying: “The reason this has proved so difficult to work out is that the previously identified genetic signal affects the “dark matter” of the genome. We found that the increased risk is not because of a difference in gene coding for a protein, but because of a difference in the DNA that makes a switch to turn a gene on. It’s much harder to detect the gene which is affected by this kind of indirect switch effect.”

November 6, 2021 0 comment

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New COVID-19 pill cut hospital, death risk by 90%: Pfizer

by Medically Speaking November 6, 2021

written by Medically Speaking

Pfizer Inc. said on Friday that its experimental antiviral pill for COVID-19 reduced hospitalisation and death rates by nearly 90%, as the drugmaker joins the race to bring the first easy-to-use coronavirus medication to the US market.

Currently all COVID-19 treatments used in the US require an IV or injection. Competitor Merck’s COVID-19 pill is already under review at the Food and Drug Administration after showing strong initial results, and on Thursday the United Kingdom became the first country to OK it.

Pfizer said it will ask the FDA and international regulators to authorize its pill as soon as possible, after independent experts recommended halting the company’s study based on the strength of its results. Once Pfizer applies, the FDA could make a decision within weeks or months.

Researchers worldwide have been racing to find a pill against COVID-19 that can be taken at home to ease symptoms, speed recovery and reduce the crushing burden on hospitals and doctors.

Pfizer released preliminary results Friday of its study of 775 adults. Patients taking the company’s drug along with another antiviral had an 89% reduction in their combined rate of hospitalization or death after a month, compared to patients taking a dummy pill. Fewer than 1% of patients taking the drug needed to be hospitalized and no one died. In the comparison group, 7% were hospitalized and there were seven deaths.

“We were hoping that we had something extraordinary, but it’s rare that you see great drugs come through with almost 90% efficacy and 100% protection for death,” said Dr. Mikael Dolsten, Pfizer’s chief scientific officer, in an interview.

Study participants were unvaccinated, with mild-to-moderate COVID-19, and were considered high risk for hospitalization due to health problems like obesity, diabetes or heart disease. Treatment began within three to five days of initial symptoms, and lasted for five days.

Pfizer reported few details on side effects but said rates of problems were similar between the groups at about 20%.

An independent group of medical experts monitoring the trial recommended stopping it early, standard procedure when interim results show such a clear benefit. The data have not yet been published for outside review, the normal process for vetting new medical research.

Top US health officials continue to stress that vaccination will remain the best way to protect against infection. But with tens of millions of adults still unvaccinated — and many more globally — effective, easy-to-use treatments will be critical to curbing future waves of infections.

The FDA has set a public meeting later this month to review Merck’s pill, known as molnupiravir. The company reported in September that its drug cut rates of hospitalization and death by 50%. Experts warn against comparing preliminary results because of differences in studies.

Although Merck’s pill is further along in the US regulatory process, Pfizer’s drug could benefit from a safety profile that is more familiar to regulators with fewer red flags. While pregnant women were excluded from the Merck trial due to a potential risk of birth defects, Pfizer’s drug did not have any similar restrictions. The Merck drug works by interfering with the coronavirus’ genetic code, a novel approach to disrupting the virus.

Pfizer’s drug is part of a decades-old family of antiviral drugs known as protease inhibitors, which revolutionized the treatment of HIV and hepatitis C. The drugs block a key enzyme which viruses need to multiply in the human body.

The drug, which has not yet been named, was first identified during the SARS outbreak originating in Asia during 2003. Last year, company researchers decided to revive the medication and study it for COVID-19, given the similarities between the two coronaviruses.

The US has approved one other antiviral drug for COVID-19, remdesivir, and authorized three antibody therapies that help the immune system fight the virus. But they have to be given by IV or injection at hospitals or clinics, and limited supplies were strained by the last surge of the delta variant.

November 6, 2021 0 comment

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Is it Possible to Improve Hair Health by Applying Curd to the Scalp?

by Medically Speaking November 5, 2021

written by Medically Speaking

You may remember the nursery song “curds and whey” from your youth, but curd is much more than that. Curd is prepared from curdled milk that has been mixed with plant acids, making it more acidic than other milk products such as yoghurt. Curd is an excellent source of protein and calcium, as well as potassium, magnesium, and vitamin A in terms of nutrition.
While curd may be included in a well-balanced diet to provide the nutrients necessary for healthy hair, some individuals choose to apply it straight to the scalp. This is done to help soften and strengthen the cuticle, as well as cure scalp diseases like dandruff more effectively.

While more studies are needed to back the efficacy of curd for hair health, there are some potential benefits to consider discussing with a dermatologist.

Curd’s potential hair benefits
While certain minerals in curd may aid in general hair health, there are no definite correlations between curd and hair benefits. Nonetheless, some claim that curd provides the following health advantages.

Dandruff control

It’s said that hair health starts at the scalp, and for good reason — this is where your hair forms within the follicles underneath your skin. Dandruff is one scalp issue that can eventually affect your hair health.

Some claim that curd is a natural anti-dandruff product due to its anti-inflammatory properties. You may also see curd touted as being antimicrobial to help treat scalp infections.

Hair growth

Besides a healthy scalp, your hair relies on strength to remain intact so it can grow properly. To that end, some believe curd may help promote hair growth.

It’s thought that B vitamins are partially credited here, as they can promote stronger hair growth at a faster rate. Biotin (vitamin B-7) in particular is credited with the promotion of hair growth, along with other ingredients found in milk products, such as zinc.

Hair softening

Perhaps one of the more credible claims surrounding curd and hair health is the product’s ability to soften and moisturize your hair. You may also notice reduced frizz.

While no studies have linked curd with treating hair damage, another milk product, yogurtTrusted Source, has been used as a traditional Middle Eastern remedy for both damage and to increase growth.

Side effects of curd for hair

While curd could potentially moisturize your hair and increase overall manageability, it’s important to be aware of the potential side effects, including:

allergic reactions, especially if you have a milk allergy
greasy hair and scalp
unpleasant smell

To test your skin, do a patch test of curd on your inner elbow and wait 30 minutes to see if the skin becomes inflamed before applying it to your scalp.

How to apply curd on hair

The key to reaping the purported benefits of curd is to combine it with other known healthy hair ingredients.

Curd hair mask

Perhaps the most reported way to use curd in your hair is in a hair mask. The curd is combined with other natural ingredients, such as honey, olive oil, or aloe vera.

Other plant-based oils have the potential to work with curd to moisturize your hair, including:

Fatty ingredients, such as eggs, mayonnaise, and avocados may also help reduce frizz.

Once you have your mask mixed together, apply it evenly to your hair. Place a shower cap on your head and let the mixture sit for 30 minutes. Rinse out before continuing with your shampoo and conditioner routine.

Curd scalp treatment

If you’re looking to treat dandruff and other scalp issues, you can combine curd with a small amount of plant acids. Possible combinations include curd and lemon, or curd and apple cider vinegar. Apply directly to the scalp and let it sit for a few minutes before rinsing out.

It’s also important to note that traditional curd is prepared with lemon juice or vinegar, making the product acidic already. Check the ingredient label carefully when buying prepared curd.

Where to get curd

When making your own hair mask, consider looking for curd at a local health food store.

Curd shouldn’t be confused with yogurt. Both are made with milk, but yogurt is partially made with the help of healthy bacteria. Also, while plain yogurt may also be used in your hair as a mask, it doesn’t contain the lactic acid that curd has.

Takeaway

Curd contains nutrients that could potentially help scalp conditions and moisturize and strengthen your hair. Still, these benefits are anecdotal at best, as there are no available long-term studies on the use of curds for scalp and hair health.

Talk to a dermatologist if you have any ongoing scalp and hair health concerns.

November 5, 2021 0 comment

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FEMALE CONDOM: ALL YOU NEED TO KNOW!

by Medically Speaking November 5, 2021

written by Medically Speaking

Female condoms (sometimes called internal condoms or Femidons) are used to prevent STIs including HIV and pregnancy during vaginal intercourse. They can also be used to guard against STIs inside the anus. For information on how to use male (external) condoms, see our male (external) condom page.

What is a female condom?

A female condom is worn into the vaginal or anus to form a barrier between the body and bodily fluids and sperm. They are constructed of nitrile, a soft plastic substance.

Despite the fact that they are referred to as female condoms, they may be used by persons of either gender to protect themselves during anal intercourse.

Female condoms are frequently given away for free by sexual health clinics or healthcare experts, and they are also available for purchase in some stores and pharmacies. These condoms are also available online if you can’t locate them locally. Female condoms come in a variety of styles and brands, including Femidom, Dominique, Femy, Myfemy, Protectiv, Elegance, Della, and Care.

Why should I use them?

They work really well.

When used correctly, condoms provide excellent protection against HIV, pregnancy and most STIs. In fact, they are the only type of contraception that also stops you getting or giving STIs (including HIV). If you use a condom, you can relax and enjoy sex knowing that you and your partner are protected.

Top tips for using female condoms

Condoms only offer protection against STIs, HIV and pregnancy if you use them every time you have sex.
Don’t double up! Using an internal condom at the same time as an external (male) one does not make sex safer. Instead it causes friction and the condom may break.
Use a new condom every time you have sex or if you move between vaginal, anal or oral sex.

How to use a female condom

Though they may seem daunting at first, female condoms are easy to use with a bit of practice.

Before you begin

Check the condoms are within the date on the packet and make sure you use ones with a mark (FDA, CE, ISO or Kitemark) that guarantees they meet safety standards.
Keep the condoms somewhere close to hand (like in your bag or next to your bed) but not in a pocket or anywhere they can get hot, crumpled or damaged.
Take the condom out of the packet carefully so you do not rip it – don’t use your teeth or scissors and be careful with sharp fingernails or jewellery.

VAGAINAL SEX

There are instructions in the packet and you can get advice on how to insert a condom from a sexual health professional. These are the steps:

Sit, squat, lie or stand in a comfortable position, similar to how you would insert a tampon. Squeeze the smaller ring at the closed end of the condom and insert it into your vagina as far as it will go, making sure it doesn’t twist. The large ring at the open end of the female condom will cover the area around the vaginal opening – this part will sit outside your body.
When you have sex the penis should enter into the condom, rather than between the condom and the side of your vagina. You can help guide your partner to ensure it goes in the right place.
After sex, twist the large ring to prevent semen from leaking out and gently pull the female condom out.
Always use a new condom each time you have sex.

ANAL SEX

Female condoms can be used by a person of any gender to protect against STIs, including HIV, during anal sex. If you’re using the condom for anal sex you wear it like a male condom. Put lubricant inside the condom and place it on the penis, put plenty more lube on the outside of the condom and around the anus before inserting the penis gradually. You can also place the condom in the anus before sex, as you do for vaginal sex. To do this follow these steps:

Use lube around the anus first, then squeeze the inner ring of the condom to form an oval shape and push it into the rectum.
Put your finger inside the condom and push it as far up as you can. The outer ring should stay outside the anus. Do not try to remove the inner ring, you may break the condom.
After sex, when you are ready, withdraw the penis. Then twist the external ring a few times and gently pull the condom out ensuring no semen is spilt.

Make sure you use plenty of lubricant during sex, because the anus doesn’t create its own. Lube also help to reduce the chance of passing on STIs and HIV.

Female condoms vs male condoms

Both types of condoms are just as effective as long as they are used correctly. It is good to understand both options. You could experiment with both, you may be surprised which you prefer. Here are a few things to think about:

Interruptions

Male condoms need to be put on just before sex, when the penis is erect, but a female condom can be inserted earlier (up to eight hours before sex). So, with female condoms there are no interruptions in the heat of the moment and the penis can be put into or near the vagina or anus before it’s fully erect.

Sensitive types

Most male condoms are made of latex and some people are sensitive to this. Female condoms are made from nitrile. This is hypoallergenic, so it doesn’t irritate sensitive genital skin.

Size matters

If you find a male condom doesn’t feel comfortable during sex, then a female condom might be the answer. Female condoms are larger and don’t fit snugly around the penis. This means they give the penis more breathing room. Some men prefer them as they find them more comfortable and can make it easier to keep an erection.

Maximum pleasure

Using female condoms can make sex more pleasurable for men and women. During vaginal sex, the female condom’s inner ring may stimulate the tip of the penis, and the external ring can rub against the vulva and clitoris – this can feel great for both of you.

… and relax

Unlike a male condom, a female condom does not need an erection to stay in place, so your partner does not have to withdraw straight after ejaculation. You can relax after sex and remove the female condom when it suits you both.

Taking control

You might choose to include the condom in your foreplay letting your partner put it in for you. Or you may prefer being in control yourself and feel more relaxed if you are responsible for inserting the condom. However awkward it may feel at first, you will become more comfortable and will learn what works best for you.

What to do if a condom breaks

It’s very rare for a condom to break when used properly but if it does split or break or something else goes wrong like the outer ring moves up inside the vagina / anus, there are some simple things you can do:

withdraw the penis immediately
remove as much semen (cum) as you can
gently wash the outside of your genitals – avoid washing inside your vagina or anus (douching) as this can spread infection further or cause irritation
if you’ve been having vaginal sex go to the bathroom and pee to flush away any semen
if you haven’t been using any other contraceptive to prevent pregnancy, you may need to access emergency contraception to prevent pregnancy. This should be done within 72 hours of having sex.

Get tested

Visit a health facility. They will probably advise you to have a sexual health test around 10 days after exposure (or earlier if you’re worried about any symptoms) and then again around three months later. This is because different STIs become detectable at different times after infection.

If your partner has HIV

If your partner is on regular treatment and their viral load has been undetectable for at least the last six months, there is no risk of HIV transmission (but this should not stop you both from getting tested for other STIs).

If your partner is not on regular treatment or is unsure how well they are responding to treatment, you need to visit a sexual health professional as soon as possible. You may be offered post-exposure prophylaxis (PEP) treatment. This involves taking antiretroviral drugs (ARVs) for a month to reduce the chance of becoming HIV-positive. PEP has a high success rate, but it is not a replacement for condoms, it is a powerful drug with side effects and is not appropriate for everyone.

If you’re in a relationship with someone who is living with HIV, you might consider using pre-exposure prophylaxis (PrEP) to protect you from HIV transmission, but don’t forget, this will not protect you from other STIs or pregnancy.

Safer sex for trans people

Whether you’ve had lower surgery or not, the best way to protect yourself and your partner against STIs and HIV is to use a condom (either female or male) with water-based lube. Not all trans women can use female condoms, it depends on the depth of your vagina.

If you’ve recently had surgery, you should be extra careful. Your skin may not have healed and can bleed easily, making it easier for you to acquire or pass on HIV.

How do I talk to my partner about condoms?

You may feel embarrassed to talk about using condoms, especially at the beginning of a relationship, but don’t let that stand in the way of protecting yourself against STIs, HIV and pregnancy. Talking to your partner about condoms isn’t a sign that you don’t trust them – it’s a way of showing you care and want to protect you both.

If your partner refuses to use a condom don’t feel pressured into having unprotected sex – remember you always have the right to decide whether or not to have sex.

Try and have the conversation beforehand rather than in the heat of the moment, then you can feel safe to relax and enjoy sex.

November 5, 2021 0 comment

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UTI: all you need to know

by Medically Speaking November 5, 2021

written by Medically Speaking

A urinary tract infection (UTI) affects any component of your urinary system, including the kidneys, ureters, bladder, and urethra. The bladder and urethra are the most often infected parts of the urinary system.

Women are more likely than males to have a urinary tract infection. A bladder infection may be both painful and inconvenient. If a UTI spreads to your kidneys, though, it might have significant implications.

Doctors typically treat urinary tract infections with antibiotics. But you can take steps to reduce your chances of getting a UTI in the first place.

Symptoms

Urinary tract infections don’t always cause signs and symptoms, but when they do they may include:

A strong, persistent urge to urinate
A burning sensation when urinating
Passing frequent, small amounts of urine
Urine that appears cloudy
Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
Strong-smelling urine
Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone

UTIs may be overlooked or mistaken for other conditions in older adults.

Types of urinary tract infection

Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected.

Part of urinary tract affected	Signs and symptoms
Kidneys (acute pyelonephritis)	Back pain or side (flank) pain High fever Shaking and chills Nausea Vomiting
Bladder (cystitis)	Pelvic pressure Lower abdomen discomfort Frequent, painful urination Blood in urine
Urethra (urethritis)	Burning with urination Discharge

When to see a doctor

Contact your doctor if you have signs and symptoms of a UTI.

Causes

Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract.

The most common UTIs occur mainly in women and affect the bladder and urethra.

Infection of the bladder (cystitis). This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible.
Sexual intercourse may lead to cystitis, but you don’t have to be sexually active to develop it. All women are at risk of cystitis because of their anatomy — specifically, the short distance from the urethra to the anus and the urethral opening to the bladder.
Infection of the urethra (urethritis). This type of UTI can occur when GI bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

Risk factors

Urinary tract infections are common in women, and many women experience more than one infection during their lifetimes. Risk factors specific to women for UTIs include:

Female anatomy. A woman has a shorter urethra than a man does, which shortens the distance that bacteria must travel to reach the bladder.
Sexual activity. Sexually active women tend to have more UTIs than do women who aren’t sexually active. Having a new sexual partner also increases your risk.
Certain types of birth control. Women who use diaphragms for birth control may be at higher risk, as well as women who use spermicidal agents.
Menopause. After menopause, a decline in circulating estrogen causes changes in the urinary tract that make you more vulnerable to infection.

Other risk factors for UTIs include:

Urinary tract abnormalities. Babies born with urinary tract abnormalities that don’t allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs.
Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTIs.
A suppressed immune system. Diabetes and other diseases that impair the immune system — the body’s defense against germs — can increase the risk of UTIs.
Catheter use. People who can’t urinate on their own and use a tube (catheter) to urinate have an increased risk of UTIs. This may include people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed.
A recent urinary procedure. Urinary surgery or an exam of your urinary tract that involves medical instruments can both increase your risk of developing a urinary tract infection.

Complications

When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, a urinary tract infection can have serious consequences.

Complications of a UTI may include:

Recurrent infections, especially in women who experience two or more UTIs in a six-month period or four or more within a year.
Permanent kidney damage from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.
Increased risk in pregnant women of delivering low birth weight or premature infants.
Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis.
Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys.

Prevention

You can take these steps to reduce your risk of urinary tract infections:

Drink plenty of liquids, especially water. Drinking water helps dilute your urine and ensures that you’ll urinate more frequently — allowing bacteria to be flushed from your urinary tract before an infection can begin.
Drink cranberry juice. Although studies are not conclusive that cranberry juice prevents UTIs, it is likely not harmful.
Wipe from front to back. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
Empty your bladder soon after intercourse. Also, drink a full glass of water to help flush bacteria.
Avoid potentially irritating feminine products. Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra.
Change your birth control method. Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.

November 5, 2021 0 comment

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ICMR-NIV research finds the most common type-2 dengue strain in Maharashtra

by Medically Speaking November 5, 2021

written by Medically Speaking

PUNE: A “nasty strain” of the mosquito-borne viral disease has been blamed for this year’s severe dengue outbreak, according to scientists.
The Indian Council of Medical Research-National Institute of Virology (ICMR-NIV) revealed that dengue virus 2 (DENV-2) is the main circulating strain or serotype in Maharashtra this year after a molecular investigation of the blood samples of 1,413 dengue infected patients.

Dengue virus has four distinct strains — DENV-1, DENV-2, DENV-3, and DENV-4. Treating doctors said they were also coming across patients showing early onset of severe symptoms and rapid progression — some of the fairly identifiable traits of DENV-2.Another important indication coming forth this year is DENV-2’s ability to “superinfect” the previously infected individuals, causing an enhanced or double-antibody response leading to an increased virus intrusion in cells and triggering a severe inflammatory response, higher organ penetration. All these factors are eventually leading to clinically severe illness. Some of the prominent cities, such as Pune, had three strains — DENV-1, DENV-2, and DENV-3 — cocirculating in 2019-20.However, there were comparatively fewer cases. As a part of the National Vector Borne Disease Control Programme (NVBDCP), ICMR-NIV supports the state of Maharashtra and Goa to understand the circulating serotypes of the dengue virus. Recently, Andhra Pradesh and Telangana have been added to the list. The ICMR-NIV Bengaluru field unit supports the state of Karnataka.

“For the year 2021, ICMR-NIV has tested 1,413 samples from Maharashtra, 209 from Goa, 28 from Andhra Pradesh and 385 samples from Karnataka. DENV-2 is a predominantly circulating serotype in the states of Maharashtra, Goa, Andhra Pradesh and Karnataka. Earlier in 2018, DENV-1 and DENV-3 were the predominantly circulating serotypes in Maharashtra,” an ICMR-NIV official said.In addition to adults, the dengue virus strain is affecting a lot of children too. “This year, we are witnessing more and more children with severe dengue. Hence, it appears to be a more severe dengue season in comparison to the previous years’,” said Deenananth Mangeshkar hospital’s paediatric intensivist, Sumant Patil.

“DENV-2 does not have a very specific manifestation separating it from other strains but can be recognized by early onset of severe symptoms and rapid progression,” he said.

The dengue cases peaked in Maharashtra between August and October this year. “The cases have not come down very much as of now but stabilized and not worsened further,” Patil said.

“Some of the northern states such as Delhi, Uttar Pradesh, Bihar and southern states such as Andhra Pradesh, Karnataka and Tamil Nadu have an ongoing dengue health crisis in adults as well as in children, mostly related to DENV-2,” he added.

Secondary dengue is the biggest risk factor for severe dengue and doctors have been witnessing a rise in such cases over the last four months.

We saw quite a surge in cases of secondary dengue infection this year in the past four months, where dengue is very severe and patients undergo a lot of complications,” said Pune-based physician Abhijit Lodha.

During a primary (first) dengue infection, the patients’ IgM dengue antibody levels are very high, but they test negative for IgG dengue antibody. “But in the secondary (second time) dengue infection, patients test positive for both the antibodies. And their IgM antibody levels are lower than IgG. The levels of IgG actually increase during secondary infection,” Lodha said.

The state registered 6,374 cases of dengue and 1,537 cases of chikungunya till September 14. Eleven persons have so far died due to dengue viral fever. There were 2,029 cases of dengue and four deaths from the disease and 422 cases of chikungunya were registered during the same period last year.

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PMC has begun preparations for launch of Atal Bihari Vajpayee Medical College

by Medically Speaking November 5, 2021

written by Medically Speaking

PUNE: With the Pune Municipal Corporation (PMC) intending to open a medical college in former Prime Minister Atal Bihari Vajpayee’s name this academic year, the municipal body’s standing committee has authorised a total of 1.97 crore for furniture and over 62 lakh for the first purchase of various books.

“The PMC has gotten all the requisite permits for building a new medical institution in the name of former Prime Minister late Atal Bihari Vajpayee,” said standing committee chairman Hemant Rasane. The PMC is putting up the appropriate equipment at Baburao Sanas school as admissions begin this year.” Staff recruitment for the medical college is nearing completion, according to Rasane, and the standing committee has authorised a budget of 62.51 lakh for the purchase of various publications.

Earlier on October 16, the central government gave its clearance for the PMC-run Atal Bihari Vajpayee Medical College to begin from this academic year. The medical college will be located at and attached to the Kamala Nehru hospital and Naidu hospital in the city. This year, a total 100 students will get admission and constitute the first batch.

A central government team had previously visited the PMC and raised objections but the mayor and municipal commissioner Vikram Kumar subsequently met Union health minister Mansukh Mandaviya in the capital to sort out various issues.

Rasane said, “The PMC has established the pathological ward at Kamala Nehru hospital which spans an area of 2,200 square feet. The standing committee has already decided to run this ward with the help of Poona Medical and Relief and Research Centre.” The PMC has also approved the rates for various tests and all tests will have to be conducted at the decided rates only.

After B J Medical college, the Atal Bihari Vajpayee Medical College will be the second government-run medical college in the city. The PMC has formed a trust to run the college and is hoping that trainees from the college will serve in PMC-run hospitals.

November 5, 2021 0 comment

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NEET 2021: MCC and AYUSH Counselling Updates

by Medically Speaking November 5, 2021

written by Medically Speaking

NEET 2021 results have been released in New Delhi. Candidates who are eligible for medical admission are eagerly awaiting information about the NEET 2021 counselling procedure. The Medical Counselling Committee (MCC), the AYUSH Admissions Central Counseling Committee (AACCC), and other state and central counselling bodies will start the undergraduate medical counselling registration process soon.

NEET 2021: MCC Counselling

The MCC is responsible for conducting MBBS and BDS counselling for 15 per cent all India quota seats. The official website, mcc.nic.in has been recently updated. A notification on the official website reads the counselling schedule, seat matrix and the information bulletin will be released soon. Before applying for counselling, candidates should download the information bulletin and check the other eligibility conditions, other than qualifying in NEET, for admission to a particular medical college. They should also check the seat matrix of that medical college.

NEET 2021: MCC Counselling

November 5, 2021 0 comment

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