Hope in a Weekly Pill: A Doctor’s Reflection

The life of a doctor on a 24‑hour shift is like being caught in a storm. My duty starts at 9 a.m. and ends at 9 a.m. the next day. There’s barely a quiet moment. It’s a continuous loop of emergencies, decisions, and caring for people on the edge. By 5:30 p.m., even though the night lies ahead, the tiredness sinks deep into the bones. There’s no real break — not even for 30 minutes. This life, though meaningful, slowly chips away at health, sleep, and sometimes, the spirit.

In the emergency room, we often see patients with longstanding diabetes. Many have struggled for more than a decade. They are tired. Tired of taking pills — morning, noon, and night. They say it out loud: “Pills, pills, and more pills!” This fatigue leads to missed doses, rising sugar levels, and eventual organ damage—a painful cycle we see too often.

But even in this chaos, there's a quiet thread among us—shared knowledge. It’s not formal. It’s just someone sending a message, a link, a photo on WhatsApp, hoping to keep colleagues informed.

Yesterday, in a rare moment of pause, I checked my phone. A senior had sent a picture of a new medicine — Trelaglip. The words jumped out: “Once Weekly Oral DPP‑4i.” My heart skipped a beat. Could this be real?

I read the message: “Same day, every week. Trelaglip tablets.” That was it. A once-weekly oral medicine for type 2 diabetes. No more three-times-a-day routine. One tablet a week. Like Vitamin D. Simple. Manageable. Revolutionary.

If it works as promised, it could change everything. Patients might finally stick to treatment. That means better sugar control, fewer complications, and possibly, a better life. We’ve had weekly injections before. But a pill? That’s far more acceptable.

Of course, cost remains a question. But if the drug is effective, prices may fall. It could reach many, not just a few. For public health, it could be a game‑changer in our fight against diabetes.

It’s strange—how during a hectic shift, a colleague’s simple message can feel like a small light in the dark. These moments remind me why we keep going, even when exhausted. We’re all striving to improve patient lives.

Sometimes, hope arrives not in big discoveries, but in a small tablet taken once a week — and in a brief moment of shared belief.

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Once‑Weekly Oral Antidiabetic Therapy: A Public Health Perspective for India

Introduction

The rise of once‑weekly oral antidiabetic agents, such as Trelagliptin (a DPP‑4 inhibitor), could represent a breakthrough in managing type 2 diabetes mellitus (T2DM). In India, where diabetes prevalence is escalating, this innovation may reduce long‑term complications and improve adherence.

The Public Health Burden

Diabetes is a chronic disease with serious complications affecting both individuals and health systems:

• Microvascular: Retinopathy, nephropathy, neuropathy.
• Macrovascular: Heart attack, stroke, peripheral artery disease.
• Infections: Increased susceptibility due to reduced immunity.
• Quality of Life: Chronic disability and loss of productivity.

These complications heavily burden India’s healthcare resources and economy due to loss of productive life‑years.

The Role of Once‑Weekly Therapy

1. Medication Adherence

• Pill Fatigue: Reducing dose frequency simplifies treatment.
• Compliance: Less frequent dosing supports more consistent use and delayed progression.

2. Complication Reduction

• Microvascular: Better control reduces risks of blindness, dialysis, amputations.
• Cardiovascular: Stable glucose lowers heart attack and stroke incidence.
• Healthcare Demand: Fewer complications reduce hospital and specialist burden.

3. Quality of Life

• Self‑Confidence: Simpler regimens boost patient empowerment.
• Mental Health: Reducing daily reminders of illness eases stress.
• Productivity: Healthier patients support economic activity and relieve caregiver strain.

Challenges for Integration

• Cost‑effectiveness: Sustainable pricing and generics/essential medicine inclusion are needed.
• Rural Accessibility: It must reach primary health centers and NCD programs.
• Provider Training: Community doctors and health workers need education and support.

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Trelagliptin: Pharmacology and Clinical Profile

Introduction

Trelagliptin is a once‑weekly oral DPP‑4 inhibitor approved in Japan (March 2015) and India (December 2024) for T2DM management. It enhances incretin activity to improve glycemia with low hypoglycemia risk.

Mechanism of Action

• Inhibits DPP‑4, preserving GLP‑1 and GIP to enhance glucose‑dependent insulin and suppress glucagon.
• Slows gastric emptying; may support β‑cell health.
• High specificity (IC₅₀ ≈1.3–5.4 nmol/L).

Pharmacokinetics

• Oral bioavailability high; peak levels ~1–1.5 h post‑dose.
• Long elimination half‑life (38–54 h) supports once‑weekly dosing.
• Mainly renally excreted; minimal hepatic metabolism.

Pharmacodynamics

• Sustains ~70–80% DPP‑4 inhibition for a week.
• Phase 2/3 trials show HbA₁c reductions of ~0.5–1.0%.
• Weight‑neutral, low hypoglycemia risk when used alone.

Clinical Efficacy & Safety

• Monotherapy: dose‑dependent HbA₁c reduction similar to daily DPP‑4 inhibitors.
• Phase 3 trials show non‑inferiority versus alogliptin; good tolerability.
• Add‑on to insulin: ~0.63% greater HbA₁c reduction without severe hypoglycemia.
• Pilot studies: increased adiponectin; no endothelial compromise.
• Side effects: mild nasopharyngitis, headache, upper respiratory symptoms.

Clinical Implications

• Once‑weekly dosing boosts adherence, especially in low‑resource areas.
• Safe for diverse populations due to weight neutrality and low hypoglycemia risk.
• Effective as adjunct therapy with insulin.

Precautions & Dosing

• No dose adjustment in mild/moderate hepatic impairment.
• Renal impairment: dose reductions per eGFR recommendations.
• Use caution with insulin or sulfonylureas to avoid hypoglycemia.

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Safety Profile and Complications of Trelagliptin

Introduction

Trelagliptin is generally well tolerated, but distinguishing common side effects from rare serious complications is essential.

1. Hypoglycemia

• Monotherapy: low risk due to glucose‑dependent mechanism.
• Combined therapy: risk increases with sulfonylureas or insulin; adjust doses accordingly.

2. Pancreatitis

• Meta‑analyses show slight increase in acute pancreatitis risk (OR ~1.7).
• Rare cases (~0.3%) in clinical trials.
• Discontinue drug if pancreatitis suspected.

3. Bullous Pemphigoid

• Possible 2–4× increased risk, particularly in people >70 years.
• Discontinue if suspected; refer to dermatology.

4. Arthralgia

• Severe joint pain reported; typically resolves after stopping drug.

5. Hypersensitivity

• Rare angioedema, urticaria, anaphylaxis, especially in first 3 months.
• Discontinue immediately; manage supportively.

6. Heart Failure

• Saxagliptin and alogliptin showed heart failure risk, but no strong signal for Trelagliptin.
• Monitor in heart disease patients.

Other Observations

• Renal impairment: no major issues, but dose adjustments may be needed.
• Gallbladder events: slightly increased in meta‑analyses.

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Summary & Abbreviations

Summary: Trelagliptin is a once‑weekly oral DPP‑4 inhibitor offering simplified therapy, sustained glycemic control, and strong safety. It reduces pill burden, enhances adherence, and lowers complication risk. Rare but serious effects—pancreatitis, arthralgia, bullous pemphigoid, and hypersensitivity—require vigilance. While care is needed when combined with insulin or sulfonylureas or in comorbid conditions, the drug’s convenience and tolerability make it a promising option in diabetes management and public health.

Abbreviations:
DPP‑4 = dipeptidyl peptidase‑4 | GLP‑1 = glucagon‑like peptide‑1 | GIP = glucose‑dependent insulinotropic polypeptide | T2DM = type 2 diabetes mellitus | HbA_1c = glycated hemoglobin | eGFR = estimated glomerular filtration rate.

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References

1. Seino Y, Kuwata H, Yabe D. Incretin-based drugs for type 2 diabetes: Focus on Takeda's trelagliptin and alogliptin. Expert Opin Pharmacother. 2015;16(16):2583–2596.
2. Yabe D, Seino Y. DPP-4 inhibitors – their potential in the treatment of type 2 diabetes. Expert Opin Investig Drugs. 2011;20(3):343–360.
3. Yasuda N, Inoue T, Nagakura T, et al. Trelagliptin, a novel once-weekly oral DPP-4 inhibitor: preclinical and clinical pharmacology. Diabetes Obes Metab. 2016;18(6):627–634.
4. Monami M, Dicembrini I, Mannucci E. Dipeptidyl peptidase-4 inhibitors and pancreatitis risk: a meta-analysis. Diabetes Obes Metab. 2014;16(1):48–56.
5. Singh S, Chang HY, Richards TM, et al. GLP-1 therapies and risk of acute pancreatitis. JAMA Intern Med. 2013;173(7):534–539.
6. Ujiie T, Muramatsu K, Ozeki T, et al. DPP-4 inhibitors and bullous pemphigoid: a disproportionality analysis. Br J Dermatol. 2020;183(6):1121–1123.
7. US FDA. Drug Safety Communication: DPP-4 inhibitors may cause severe joint pain. 2015.
8. Scirica BM, Bhatt DL, Braunwald E, et al. Saxagliptin and cardiovascular outcomes in T2DM. N Engl J Med. 2013;369(14):1317–1326.
9. White WB, Cannon CP, Heller SR, et al. Alogliptin after acute coronary syndrome. N Engl J Med. 2013;369(14):1327–1335.
10. Yamada Y, Nishida T, Yamada Y, et al. Once-weekly trelagliptin in Japanese patients: phase III trial. Diabetes Obes Metab. 2016;18(3):249–257.
11. Zuventus Healthcare Ltd. Efficacy and safety of once-weekly Trelagliptin vs vildagliptin in Indian patients. 2025.
12. American Diabetes Association. Standards of Medical Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S1–S207.

SOP - Hip Circumference

Hip circumference measurements are taken in some sites as an expanded option to measure overweight and obesity.

To take hip circumference measurements we need : 

• constant tension tape (for example, Figure Finder Tape Measure)
• pen/pencil
• chair or coat stand for participant's to place their clothes.

A private area is necessary for this measurement. This could be a separate room, or an area that has been screened off from other people within the household. Hip measurements are taken immediately after waist circumferences.

• This measurement should be taken without clothing, that is, directly over the skin.
• If this is not possible, the measurement may be taken over light clothing (Must not be over thick or bulky clothing. This type of clothing must be removed)

This measurement should be taken:

• with the arms relaxed at the sides
• at the maximum circumference over the buttocks

Steps of measurement:

1. Stand to the side of the participant, and ask them to help wrap the tape around themselves.
2. Position the measuring tape around the maximum circumference of the buttocks.
3. Ask the participant to: 
• stand with their feet together with weight evenly distributed over both feet;
• hold their arms relaxed at the sides.Check that the tape position is horizontal all around the body and snug without constricting.
4. Measure hip circumference and read the measurement at the level of the tape to the nearest 0.1 cm.
5. Record the measurement on the participant’s instrument.

SOP - mid upper arm circumference (MUAC)

• The major determinants of MUAC are muscle and subcutaneous fat, both important determinants of survival in malnutrition and starvation. 
• MUAC is less affected than weight and height based indices (e.g. Body Mass Index) by accumulation of fluid (i.e. nutritional oedema, periorbital oedema and ascites). 
• So MUAC is a good predictor of mortality. 
• It is recommended for identifying young children with, or at risk of, severe acute malnutrition and adults with acute energy deficiency.
• In children between 6-59 months old, MUAC <110 mm indicates severe acute malnutrition and is recommended as a criterion for admission to therapeutic feeding programmes. 
• Values between 110 and 120/125 mm indicate moderate malnutrition. 
• Values below 250 mm in adults indicate severe wasting. 
(Note that MUAC is not sensitive enough to routinely monitor growth at young child clinics)

SOP

It's been quite a while since I posted something on my blog. Today while cleaning up the junk accumulated on my hard drive I came across several useful articles that I had prepared during my PG- ship.

SOP or standard operating procedures.

Sharing here are some of the articles that I found useful for public health purposes.

1. mid upper arm circumference 
2. waist circumference 
3. hip circumference 
4. height
5. weight
6. pallor

ECG monitoring using mobile device - when engineering met medicine

Innovativeness and creativity has always been a part of science. In this ever developing world, Science has made our lives easier. With every passing day a new development strikes the market and leaves it's imprint behind.

Mobile Technology has affected every aspect of the human life all over the world. Not only has mobile technology made connectivity easier, it has also positively impacted Healthcare services. In this regard and new development that caught my attention in recent times was the use of a smart phone to monitor ECG.

I came across such device on a Facebook Post. The interface uses ECG leads connected on the chest wall of the patient and transmitting data via cable directly to the mobile device. Once connected, an app installed in the mobile can recognize the electrical activity and display the graph. it can be used for continuous monitoring and also a graph can be printed. The best part of the system is that it can be used by Healthcare providers in Periphery (like in Sub Center or PHC) and the information can be transmitted to a higher setup.
In this manner even a health worker who has been trained to connect the leads on the patient's chest and run the app on mobile can take out an ECG from a patient who complains of cardiac or similar symptoms within moments. The data thus obtained can be analysed by doctor positioned more centrally and the health worker may be guided to take the best course of action which he may be unable to take himself otherwise.

For example, a patient visiting a sub Center located in a remote village complains of sudden onset chest pain. ECG taken out by the health worker may be immediately sent to the higher center to the consultant whereby a diagnosis of Acute Myocardial Infarction is suspected. Accordingly the health worker can be guided to provide the immediate care(like Morphine, Oxygen, Nitrate, Aspirin) and shift the patient as early as possible to a better equipped center for further management thus improving the chances of survival of the patient and bringing down the cost of therapy as well. This system may also help in avoiding unnecessary referrals.

Lifestyle Diseases and Prevention

From a discussion on Lifestyle Diseases and their prevention

Lifestyle Diseases and Prevention from Pallab Nath

People Who Travel Alone Are More Intelligent

A study by British Psychological Society revealed that people who experience solitude and who like to travel alone are more intelligent than others. They also concluded that, "lower life satisfaction with more frequent socialization with friends”, leads to an intelligent life.

The study was related to "savanna theory of happiness" according to which less socialising is equal to more intelligence and happiness.

They compared more rural living to how ancestors once traveled in close-knit, smaller tribes. Basically the lifestyles of hunter-gatherer tribes have formed the evolutionary foundation for what makes people happy now.

It was thus concluded that, for the average person, living in a smaller town and actively socializing with friends is key to happiness. However, for a highly intelligent person it was quite the opposite.

It was also observed that, smarter people try to spend time alone by taking days off to travel alone.

They contemplate on life and come back with some richer experiences.

Hiv and the truckers

according to UNAIDS sex workers are 10 times more likely than the general population to be HIV positive. Another high risk group consists of the truckers. Truckers spend weeks, even months, on the road ferrying loads across the length and breath of the country. But it's not just cargo that moves along these transportation routes, it's also HIV. Sexual health awareness is low among these truck drivers.

OTC INSIGHT Asia-Pacific reported recently that, in India, around 2 million truck drivers are frequently engaging in unprotected sex with sex workers and only 11.4% of these workers said they had used a condom.
Tata Motors decided to tackle the problem head-on with the target group, the truckers. Tata Motors with the help of creative agency Rediffusion Y&R and launched the “Use Dipper At Night” campaign in April 2016.

Indian truckers have a strong cultural identity and “Use Dipper At Night” (reminding drivers to dip their headlights during nighttime). The idea was to encourage truck drivers to practice safe sex by linking this concept to the phrase that resonates strongly with every member of the community. Thereby a new condom brand called Dipper was created and marketed exclusively for the truck drivers.

HLL Lifecare, a government-owned corporation and India’s largest condom manufacturer, produces the the condoms. Each wallet, which contains three condoms, is decorated with different truck art motifs and slogans, such as “Have a Safe Journey”, to make them more appealing to the target consumer.

Empirical diet chart for a Bengali patient with Diabetes Mellitus Type 2

Dietary guideline for a Bengali  patient with Diabetes Mellitus Type 2
Meal/time	Dietary advice
Breakfast 7:30 – 8 A.M.	1 cup tea (125 ml appx) with skimed milk (double toned milk) with no sugar (add one pellet of sugar free although I don’t recommend that)  2 slices of brown bread Alternately you can take one bowl of muesli with double toned milk
Snack 10 – 10.30 A.M	4 sugar free cream cracker biscuits Or One bowl of puffed rice
Lunch 12:00 – 1pm	1- 2 cup brown rice  1 cup of dhal  1 cup of boiled vegetables,  (if you find the taste difficult to adjust, stir-fry with 5 to 10 ml olive oil)  50 gms of fish (low fat, small fresh water fish) or meat (chicken/ lean meat)- preferably cooked in olive oil end the meal with curd made from skimmed (double toned) milk – half cup
Afternoon 3 - 3.30 P.M.	one bowl of fresh fruit cut into medium sized cubes (avoid high sugar containing ones like jack fruit, mangoes etc) You can also add cucumber, acts as a good filler One cup of tea
Dinner 7 - 8 P.M.	1 cup brown rice or 2 rotis made from multi grain flour or one cup boiled white oats  1 cup stir-fried vegetables (as mentioned above)  50 gm of chicken or fish  1 bowl of salad (cucumber) or Raita made with low-fat milk
Snack 9- 10 P.M	1 cup of skim milk
Whenever you feel hungry in between meals	Have one bowl of puffed rice with cut pieces of cucumber

Metformin against cancer

Evidence from two new studies from the Perelman School of Medicine at the University of Pennsylvania suggest that metformin improves survival for some breast cancer patients. 

Results of the study showed that patients who used metformin before being diagnosed with breast cancer were more than twice as likely to die than patients who never used the drug, while patients who began using metformin after their cancer diagnosis were almost 50 percent more likely to survive than non-users.

Alcoholism in Men affects the health of children they father: study finding

*If the father is alcoholic, a newborn can be diagnosed with foetal alcohol spectrum disorder (FASD), even though the mother has never consumed alcohol.

*Alcohol use in fathers has also being linked to decreased birth weight, marked reduction in overall brain size, and impaired cognitive function.

*Advanced age of a father can elevate the rates of schizophrenia and autism in his children.

Anxiety and Depression in Indians with polycystic ovarian syndrome

Source: univadis

A cross-sectional study was conducted to evaluate prevalence of anxiety and depression in PCOS patients. 200 women with PCOS from obstetrics and gynaecology department of a tertiary care centre in India were assessed on hospital anxiety depression scale and sociodemographic, clinical information about socioeconomic status and clinical symptoms was gathered using semi-structured questionnaire.

Out of 200 participants 56 (28%) demonstrated increased anxiety scores (HADS anxiety subscale ≥11) and 22 (11%) showed increased depression scores (HADS depression subscale ≥11). 34 (17%) scored above the cutoff for both anxiety and depression subscales.

Symptoms of PCOS such as acne, hirsutism, obesity, and infertility are associated with increased psychiatric morbidities (Anxiety and Depression). 

High level of anxiety and depression in PCOS may be due to infertility, loss of sexuality, acne, hirsutism, and obesity.

Reference:

Upadhyaya SK, Sharma A, Agrawal A. Prevalence of anxiety and depression in polycystic ovarian syndrome. Int J Med Sci Public Health 2016;5:681-683.

3 years jail, Rs 20,000 fine if AYUSH practioners practice Allopathy

as seen on: Medical Dialogues 

Trouble seems to be mounting for practitioners of Indian Systems of Medicine (AYUSH), including BUMS, BAMS, BIMS, BHMS practitioners who were earlier practicing allopathy. After the recent high court judgement clearly specifying that such practitioners cannot practice allopathy, the Delhi Medical Council taking cognizance of the order, has issued an advertisement in a newspaper reiterating the same.

Referring the judgement that came out on 8th April, 2016, DMC has noted that only persons who possess any of the recognized medical qualification as per First, Second or Third Schedule to the Indian Medical Council Act, 1956 and registered with the Delhi Medical Council is entitled to practice in modern scientific system of medicine (allopathy) in the NCT of Delhi.Moreover, the advt states that qualification of BAMS, BIMS, BUMS, Ayurvedic/Unani/ Siddha or Homeopathy are not recognized medical qualification as per the Indian Medical Council Act, 1956, hence, holder of such qualifications are not entitled to practice modern scientific system of medicine (allopathy).

Any person practicing modern scientific system of medicine (Allopathy) in contravention of the above will render himself liable to punitive action, inter-alia, under Section 27 of The Delhi Medical Council Act, 1997, which is reproduced as under:-

Section 27. False assumption of Medical Practitioner or Practitioner under this Act to be an offence: Any person who falsely assumes that he is a medical practitioner or practitioner as defined in Clause (7) of Section 2 and practices the modern scientific system of medicine, shall be punishable with rigorous imprisonment which may extend up to three years of with fine which may extend up to Rs. 20,000/-or with both.

Speaking to Medical Dialogues Team, Dr Arun Gupta, President, Delhi Medical Council said, ” Delhi Medical council as a constitutional body, has an obligation to see and check that those who are not qualified in the field of allopathy, should not be allowed to practice the same. I rather urge to all my colleagues from other pathies to restrict to their own pathy and not to demean their own field by indulge in cross pathies. ”

Following is the copy of the advt

link: http://medicaldialogues.in/3-years-jail-rs-20000-fine-if-ayush-practioners-practise-allopathy/

African Sleeping Sickness

An orgasm a day can keep prostate cancer risk at bay

source: Times of India

A recent study indicates that men who ejaculate every day have a lower risk of prostate cancer than men who do not ejaculate regularly.

Statistically, men who ejaculated more than 21 times a month had a 22 % lower risk of getting the disease.

However, no specific reasons for the findings were given.

According to the World Cancer Research Fund International, in 2012, there were more than 1.1 million cases of prostate cancer, making it accountable for 8 percent of all new cancer cases, and 15 percent of cancers in men.

Further reading: Giles, G.G., Severi, G., English, D.R., McCredie, M.R.E., Borland, R., Boyle, P. and Hopper, J.L. (2003), Sexual factors and prostate cancer. BJU International, 92: 211–216. doi: 10.1046/j.1464-410X.2003.04319.x

New Drug of Abuse: Gabapentin

Gabapentin is increasingly being used by patients in methadone maintenance programs to get a high.

Increasing availability, infrequent drug testing, and potentiation of euphoria when combined with opioids have likely all contributed to gabapentin misuse.

• Drug Abuse Warning Network (DAWN) data show that ED visits involving thenonmedical use of gabapentin have increased by 90% in the United States since 2008. 
• DAWN data also suggest that 20% of patients in treatment may misuse or abuse gabapentin.

Meanwhile, there has been a rise in gabapentin prescribing.

Current advice on prescribing Gabapentin: use caution. Don't necessarily avoid prescribing it, but be careful and prescribe it from visit to visit. Don't just give somebody six refills and say you will see them in 6 months. 

source: http://www.medscape.com/viewarticle/855819?nlid=93367_2982, (Medscape Medical News from the American Academy of Addiction Psychiatry (AAAP) 26th Annual Meeting)

keep your heart healthy... many lives depend on you

PC: Idiot Club Community on Facebook

I do believe angels exist

I love to talk when I'm in the mood. And the best thing to get me into mood is to set up a good conversation. Last Monday proved one such day when I was having a conversation with a junior budding physician from Kolkata Medical College. We talked on various topics and soon it turned to society and our perspective of it. I have to admit although of my being bit of a pessimistic person in this matter but the conversation tickled many grey cells and later I received an email from his side detailing one of his many experiences as a trainee. I present it here with his due permission:

"He spake well who said that graveyards are the footprints of angels" - H. W. Longfellow

What’s the relevance of this quote with my status update??? 

Oh yes, there is. In these 6 long years of my life as a 'junior' doctor, I have witnessed the fate of several patients. Some have been cured; some have died while some others have survived only to lead a mere future life of hopelessness. Many of these souls have become too closely attached to me. And one of them is undoubtedly that small boy of our very own Paediatrics Department...the one I have always talked about: the HIV infected youngest friend of mine about whom I had written almost a year back. 

My last day out with this little friend of mine was 8 months back when he came to our hospital with the same old complaint of fever and diarrhea and got admitted. But since then there has been an uncanny silence from his end and I got no trace of him through calls or letters. The ice was finally broken when I enquired about his whereabouts from the nurses of our Medical ward where he was last admitted. And what did I come to know was that he is no more. He left this world 5 months back! He went into a deep slumber from which he will never wake up. 

I went silent for a moment. I looked down at the envelope in my hand in which I had brought the money to give him so that he could have a great time in the festive season. But all was a waste.

What's the use of the money now...

I feel helpless and hopeless at times when I lose someone close to my heart. I ask myself, ‘who are we? Next to God or next to nothing? We take pride in making new drug discoveries or when we heal a patient physically. But can we heal him from within? Can we help him adapt to this filthy society and live the life with dignity?’ 

The answer that creeps up every time is a big ‘No’.

We don’t in most cases. But surely we can. Curing someone isn’t merely restricted to healing of a bed-sore or relieving Acute Kidney Injury through Hemodialysis or prolonging the life of a cancer patient by 5 years. To heal someone means to heal with the power of love. Even if medical therapy fails to resuscitate a dying person but the touch of love can surely let his pain be eased in the last few moments of survival. I don’t know if I will ever emerge as a stalwart in my professional arena, but what I am happy about is the fact that I have given all the love I could to my little friend who would always have a shining smile on his face upon catching a glimpse of me. Now he will rest in peace forever in my sweetest memories. But the war he fought so far should never go in vain. 

The money that I failed to give him before he breathed his last still lies in the locker of my bank account. And someday, I want to use it for building a centre for the welfare of HIV infected children. You can call me a dreamer because ingle headedly it’s surely a difficult task but I hope people from this very society will join me in this venture over time. I do believe angels exist—even today...

Courtesy: Dr. Avik Basu

New HIV infections down by 20 per cent in India: UN

http://timesofindia.indiatimes.com/india/New-HIV-infections-down-by-20-per-cent-in-India-UN/articleshow/48079039.cms via@timesofindia

India has been able to achieve a more than 20 per cent decline in new HIV infections between 2000 and 2014, reversing the spread of the virus, according to a UN report that says the world is on track to end the AIDS epidemic by 2030.

New HIV infections have fallen by 35 per cent and AIDS-related deaths by 41 per cent, while the global response to HIV has averted 30 million new infections and nearly 8 million AIDS-related deaths since 2000 (UNAIDS).

The report noted that India "literally" changed the course of its national HIV epidemic through the use of strategic information that guided its focus to the locations and population approach.

"This placed communities at the centre of the response through the engagement of non-state actors and centrally managed policy and donor coordination," it said.

HIV treatment coverage for people living with HIV and TB has also increased and in terms of numbers of patients, the largest increases in antiretroviral therapy among people living with both HIV and TB have occurred in India, South Africa, Tanzania and Zambia.

India accounts for more than 60 per cent of the Asia Pacific region's people living with HIV-associated TB.

The report noted that currently nearly 85 per cent of the antiretroviral medicines for HIV treatment come from India.

It said the Indian government had also succeeded in preserving the legislative and policy spaces that permit Indian companies that make generic medicines to consolidate their exporting capacities to other developing countries.

Currently, however, India is under pressure from several companies and governments of developed countries to dilute these provisions in free-trade agreements being negotiated with them, it said.

Physical activity Guidelines by WHO

WHO developed the "Global Recommendations on Physical Activity for Health" with the overall aim of providing national and regional level policy makers with guidance on the dose-response relationship between the frequency, duration, intensity, type and total amount of physical activity needed for the prevention of NCDs.

The recommendations address three age groups: 5–17 years old; 18–64 years old; and 65 years old and above.

Physical Activity and Young People (for children aged 5 - 17 years):

In order to improve cardiorespiratory and muscular fitness, bone health, and cardiovascular and metabolic health biomarkers:

1. Children and youth aged 5–17 should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily.
2. Amounts of physical activity greater than 60 minutes provide additional health benefits.
3. Most of the daily physical activity should be aerobic. Vigorous-intensity activities should be incorporated, including those that strengthen muscle and bone*, at least 3 times per week.

*For this age group, bone-loading activities can be performed as part of playing games, running, turning or jumping.

ü  These recommendations are relevant to all healthy children aged 5–17 years unless specific medical conditions indicate to the contrary.

ü  The concept of accumulation refers to meeting the goal of 60 minutes per day by performing activities in multiple shorter bouts spread throughout the day (e.g. 2 bouts of 30 minutes), then adding together the time spent during each of these bouts.

ü  For inactive children and youth, a progressive increase in activity to eventually achieve the target shown above is recommended. It is appropriate to start with smaller amounts of physical activity and gradually increase duration, frequency and intensity over time. It should also be noted that if children are currently doing no physical activity, doing amounts below the recommended levels will bring more benefits than doing none at all.

Physical Activity and Adults (physical activity for adults aged 18 - 64 years):

In order to improve cardiorespiratory and muscular fitness, bone health, reduce the risk of NCDs and depression:

1. Adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
2. Aerobic activity should be performed in bouts of at least 10 minutes duration.
3. For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity.
4. Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.

ü  These recommendations are relevant to all healthy adults aged 18–64 years unless specific medical conditions indicate to the contrary. They are applicable for all adults irrespective of gender, race, ethnicity or income level. They also apply to individuals in this age range with chronic non-communicable conditions not related to mobility such as hypertension or diabetes.

ü  There are multiple ways of accumulating the total of 150 minutes per week. The concept of accumulation refers to meeting the goal of 150 minutes per week by performing activities in multiple shorter bouts, of at least 10 minutes each, spread throughout the week then adding together the time spent during each of these bouts: e.g. 30 minutes of moderate-intensity activity 5 times per week.

ü  Pregnant, postpartum women and persons with cardiac events may need to take extra precautions and seek medical advice before striving to achieve the recommended levels of physical activity for this age group.

ü  Inactive adults or adults with disease limitations will have added health benefits if moving from the category of “no activity” to “some levels” of activity. Adults who currently do not meet the recommendations for physical activity should aim to increase duration, frequency and finally intensity as a target to achieving them.

Physical Activity and Older Adults (physical activity for adults aged 65 and above):

In order to improve cardiorespiratory and muscular fitness, bone and functional health, reduce the risk of NCDs, depression and cognitive decline:

1. Older adults should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
2. Aerobic activity should be performed in bouts of at least 10 minutes duration.
3. For additional health benefits, older adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate-and vigorous-intensity activity.
4. Older adults, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week.
5. Muscle-strengthening activities, involving major muscle groups, should be done on 2 or more days a week.
6. When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

ü  These guidelines are relevant to all healthy adults aged 65 years and above. They are also relevant to individuals in this age range with chronic NCD conditions. Individuals with specific health conditions, such as cardiovascular disease and diabetes, may need to take extra precautions and seek medical advice before striving to achieve the recommended levels of physical activity for older adults.

ü  There are a number of ways older adults can accumulate the total of 150 minutes per week. The concept of accumulation refers to meeting the goal of 150 minutes per week by performing activities in multiple shorter bouts, of at least 10 minutes each, spread throughout the week then adding together the time spent during each of these bouts: e.g. 30 minutes of moderate-intensity activity 5 times per week.

ü  Older adults who are inactive or who have some disease limitations will have added health benefits if moving from the category of “no activity” to “some levels” of activity. Older adults who currently do not meet the recommendations for physical activity should aim to increase duration, frequency and finally intensity as a target to achieving them.

Note: These recommendations can be applied to people with disabilities. However, adjustments for each individual based on their exercise capacity and specific health risks or limitations may be needed.