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This was published In “The Lancet”.May be informative.

The vaccination strategies according to priority has been defined by WHO.
Perhaps the way forward is to make children the highest priority group for receipt of the first batches of vaccine. However, the WHO Strategic Advisory Group of Experts on Immunization (SAGE) have defined the priority groups for receipt of vaccine in the following order: health-care workers, pregnant women, individuals aged more than 6 months with chronic medical conditions, healthy young adults aged 15—49 years, healthy children, healthy adults aged 490—65 years old, and healthy adults aged more than 65 years. With most governments likely to follow this advice, school children are a long way back in the queue.

To-day Id-ul-Fiter is being celebrated by Muslim community after a month long fasting. This fasting indicates sacrifice for the mankind.It ends on the a day of first moon after the new-moon.There was a community prayer and after that very spicy food is served and the day is celebrated among the near and dears.I was invited by one of our Muslim colleague to his residence and enjoyed with them.There was no ill feeling of religion amongst us.What highlighted sometimes in some media may be correct but common people have nothing to do with that.It is created by a group of people having vested interest in it.

Paradip coast is becoming unsafe because of possible oil leak from the sinking Mongolian ship “Black Rose”.Some fish were found dead in the seashore to-day.Port Authority is in consultation with other international agencies for safe evacuation of the furnace oil and diesel that is in the ship.

The 5 days long “Biswakarma Puja” is coming to it’s closure to-day.The deities are being taken in procession to the sea for a submerge.

So, to-day there is Hindu/ muslim festival and a sword in form of oil pollution is hanging over the head of the inhabitants of Paradip.

Great majority of ladies like to be looked good .An important element for attraction is the breasts. Unfortunately it sometimes does not fulfill the requirement and sometimes becomes worrisome cause for ladies. Broadly three types of breasts need attention of a plastic surgeon. They are small sized breasts, large sized breasts and removed breasts for some disease e.g. cancer breast.

Small breasts need augmentation. Larger ones require resizing. Reconstruction is required for a removed breast. Augmentation is done with silicon gel implants. Through a circumferential incision underneath the breast the implant is put below the breast tissue and gradually inflated to the desired size. The risk of infection, pain and rejection remains. Many adopt this procedure to look good. The second group having very large breasts also sometimes becomes a headache for the ladies and they seek plastic surgery. There are a few procedures for breast reduction. Here required amount of breast tissue is removed and breast is reconstructed. The third group actually needs help where a breast is removed for cancer breast especially in young. Now a days many prefer conservative, minimal or breast preserving surgeries (whatever term one may use).In suitably selected cases this surgery is performed and at the same time reconstruction is also done transferring abdominal muscles to the site of surgery. A nipple is also constructed by a skin graft or shared from the other side. The look after the plastic is very good and indistinguishable from the healthy side.

Incidentally, Sushruta the  great ancient Indian surgeon is credited to be the first plastic surgeon to construct the nose using local skin graft technique.

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As they report inhalable vaccine against H1N1 Influenza will be available soon.It will contain live attenuated virus.
CLIPPED FROM: http://edition.cnn.com/2009/HEALTH/09/18/swine.flu.vaccine/index.html?eref=rss_topstories That form of vaccine is marketed in the United States as FluMist and is approved only for healthy individuals between the ages of 2 and 49. Pregnant women are not allowed to get this type of vaccine because it contains a live virus. Butler added that he thinks there some flu shots may be available in early October as well, but he had a hard number only for the inhalable vaccine. Flu shots contain an inactivated, or dead, virus.

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As the researchers claim it may be helpful to people having some other problems preventing them from strainous exercise.- CLIPPED FROM: http://news.bbc.co.uk/2/hi/health/8263307
A cream allowing erectile dysfunction drugs to be applied directly to the skin could one day make them safer to use, say New York scientists.The arrival of erectile dysfunction treatments in tablet form has been one of the success stories of the modern pharmaceutical industry, with some estimates suggesting that tens of millions of men worldwide have used them. However, although they have worked for many men, they also carry the risk of side-effects such as headaches, blurred vision or upset stomachs in addition, men with severe heart problems, or who have just suffered a stroke, are advised to avoid the tablets altogether or use them with extreme caution.

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Bishwakarma means he who constructed the universe.Hindu mythology is great in the sense that it has  a number of Gods and each is responsible for a particular activity.Bishwakarma is the heavenly architect and engineer who is capable of constructing biggest projects within minutes.On this day his birthday is celebrated all most every part of India.All engaged in some or other construction activity observe this day.So,it is being celebrated in the port city of Paradip with much pump and gaiety.There as many as fifteen decorated stages build by different groups.It will continue for about five days.So many people from the locality and far away places will gather.The port trust has declared free first-aid for all those who may need it.

There was a panic call from our hospital, the Paradip Port Trust hospital in the ninth evening of this month stating that a  loaded cargo ship had sunk after leaving the harbour and many were injured.Our hospital has just adequate number of staffs for routine management .In case of exigencies extra staffs are to be called to attend the duty.Since there is no orthopaedic surgeon here and me being the surgeon have to attend all the emergency calls.I reached the hospital which is about 200 miters away fro my residence. I noticed no preparedness though the staffs present have been informed too.So,in the casualty I alerted the pharmacist in-charge,the emergency medical officer and discussed a plan to tackle the probable 27 victims of the disaster if they arrive en mass.I went  up stairs to alert the in-charge nursing staffs and other paramedical staffs.Vacated the beds from one side to keep the new arrivals and called the dressers to remain prepared to tackle the situation.Operation theatre staffs were called and some other doctors were also called.The chief medical officer,deputy chief medical officer and anaesthetist also arrived by then.All of us chalked out plan to tackle tha situation of mass casualty.

The ambulance carrying the victims was not showing up as we remained waiting in preparedness.Finally one ambulance arrived .Our paramedics rushed to the ambulance only to see that all of them are sitting in side.Seventeen crews and other staffs came out and luckily there had been no injury.We felt relaxed and registered their names.Thereafter another ambulance arrived carrying the captain of the ship in a laying down position in the ambulance bed.The patient was carried into the hospital to a bed.From a birds eye view, it was ascertained that he had no serious injuries .Finally he was the only victim worthy of some treatment.He had sprained his right ankle in the process and was an Ukrainian.He was in high morals was inquiring about his other crews assuring us that he did not had a major problem and wanted some analgesic .He was talking in a broken English which was a little difficult to understand. It was revealed that he was having a sprain of ankle and an X-Rays was ordered.And the crisis was over.Finally it is learnt that the the chief officer is missing .And till date no dead body had been found.

We relaxed, winded up our preparedness and returned to our residence as police personnel and coast guard people engaged with each other in the legal processes to be carried out.This episode ended up as sort of rehearsal or a drill for mass casualty.

Now, to-day while I was going through a review in the local daily written about the cause of accident, came to know that the  exported iron ore fines had a high moisture content in this rainy season.So, instead of remaining in level as the ship shakes some times, teh ore had gone to one side resulting in unequal distribution of weight of cargo and tilted the ship to force sinking.It is also learnt that some ports in India engaged in export of iron ore fines have stopped exporting it in this rainy season.I wonder and claim again that accidents are not pure accidents.Many accidents are due to corretible human errors,negligence and a casual attitude.

An inquiry is going up .Hopefully it will reveal some cause.But I am afraid,we seldom learn from our mistakes and rarely punish the errant.Let us wait for it.

A middle aged lady came to me  after 5 days of  a cat bite.She was limping. There was swelling at the site of bite i.e.lower leg .It was a hard feeling there.She was getting treatment from one of my colleague and had been referred to me for pain at the site .The wound was in the process of healing.A blood sugar test was within normal range. So, I continued the same antibiotics and treatment as prescribed earlier. I was sceptical of the hard feeling which suggest a smouldering inflammation. But no pus point was visible from outside. An X-Rays of the part was taken to exclude infection of underlying bone but was normal. So, I thought the inflammation will resolve. The wound healed after a few days only to show two pus points later. Now, I am sure about pus under the skin. That part was explored . A lot of old blood clots removed along with some pus. Now the patient is doing well.

Retrospectively, I assume that the bite was a little bit  severe  and there was a collection of blood underneath the skin. The collected blood revealed only after the infection.

So, apart from vaccination against rabies the wound should be inspected right at the time of first reporting of patient.                                  Appropriate action for collected blood should be taken along with antibacterial treatment. Vaccination against tetanus is mandatory.

Alcoholics have the exclusive right to suffer from a disease called pancreatitis.Gall stone disease also take a sizable share from this. All others have some share.

Pancreas is responsible for digestion of protein and fat.If some injury to it’s integrity done by way of being toxic to it ,there occurs inflammation of it’s tissue.There is pain in the upper abdomen. Patient prefers a prop up position or feels better if leans forward.Symptoms may range from mild attack to severe.There may be features of severe shock in form of sweating ,pulselessness and vomiting.Abdomen may be distended and there may be a firm feeling of abdominal wall.

There are several scoring systems to asses the severity of the disease.Diagnosis is based on several blood tests and ultrasonogram.A CT scanning may be needed sometimes.The disease is usually serious and mortality is high.Treatment is usually medicinal and sometimes surgery may be required.

Steps to prevent it is by far the best solution.And the key to it is to leave drinking alcohol.