Mortality Risk Up Many Fold If Op Done Within 6 Weeks: Study

DurgeshNandan.Jha@timesgroup.com

New Delhi:14.03.2021 

It’s better to delay surgery, except for emergencies, if you have been diagnosed with Covid-19 recently. A new study shows that people who undergo surgery within six weeks of being Covid-positive are more than two-and-a-half times more likely to pass away compared with those who don’t have the infection.

The risk goes up further if the time of surgery is closer to the diagnosis of Covid-19, the study published in medical journal Anaesthesia says. The analysis was based on over 1.4 lakh surgeries conducted in 1,674 hospitals in 116 countries. This included 56 hospitals from India, including All India Institute of Medical Sciences.

Dr Shilpa Sharma, who led the study from AIIMS, told TOI, “While it is a known fact that SARS-CoV-2 infection during surgery increases the mortality risk, this is the first time a study has given evidence about the least amount of time delay in surgeries that would optimise final outcomes.”

“In all, 31 doctors from AIIMS participated in the study. We analysed deaths and pulmonary complications recorded within 30 days in patients who underwent surgery in departments such as paediatric, orthopaedics, cardiothoracic and general surgery and neurosurgery. It showed that patients with current and past history of Covid-19 were at higher risk of postsurgery complications and even death,” added Sharma.

The doctor said that this could be because Covid-19 causes systemic inflammation. “The infection affects the lungs. Administering anaesthesia isn’t easy. Also, most such patients have low immunity and the risk of postoperative infection is high. The decision to delay surgery needs to be balanced by the disease risk to the patient,” she added.

At AIIMS, RT-PCR and CBNAAT tests are carried out routinely to screen all surgical patients. Surgery is delayed for those who test positive, wherever possible, till the patients recover.

The study showed that time of surgery from the diagnosis of Covid-19 was inversely proportional to the risk of death and even pulmonary complications.

Of the 1,40,231 patients who underwent surgery at different hospitals during the study period (October 2020), 3,127 were diagnosed with current or recent history of Covid-19.

The 30-day post-operative mortality in patients who underwent surgery in 0-2 weeks of diagnosis of Covid-19 was 9.1%, 6.9% within 3-4 weeks of the infection, 5.5% within 5-6 weeks of contracting Covid-19, and 2% in those who were operated upon after seven weeks of being infected with the virus.

Lockdown again not the solution: Experts

Nisha Nambiar & Tushar Pawar TNN

District administrations in parts of Maharashtra — faced with a fresh surge in cases — recently enforced new curbs and warned citizens of a complete lockdown. But health experts said a lockdown — often described as the ‘nuclear’ option in disease containment — is not the solution to stopping Covid-19.

State surveillance officer Pradeep Awate said the lockdown was the “pause button” governments hit at the start of the pandemic to shore up health infrastructure. “Now, with that infrastructure ready, a lockdown is not the answer. After a year of the pandemic, focus is on stopping the spread in clusters.”

In fact, many public health experts have said the recent surge in some parts of the state was caused by large crowds that had gathered for the gram panchayat elections and weddings. The experts added that widespread curbs, when rules are being ignored, are of no use at all.

Scientists have said that people dropping masks and distancing rules remain the biggest hurdle to containment. Evidence is growing that facial covers can stop the spread of droplets from the mouth. An experiment using high-speed video found that hundreds of droplets ranging from 20 to 500 micrometers were generated when saying a simple phrase, but that nearly all these droplets were blocked when the mouth was covered by a damp washcloth.

Real-world research too has found that masks come with immense benefits.

The doctors who charge less than what a cup of tea costs

 The doctors who charge less than what a cup of tea costs

In a country where people fear medical bills more than the illness, a bunch of doctors is treating patients for just a token fee

Mumbai’s one-rupee clinics even help passengers deliver babies

Sharmila.Ganesan@timesgroup.com

Low-cost clinics have been set up near railway stations by Dr Rahul Ghule

On Independence Day last year, when Covid-19 was at its peak, Dr Vishal Wani, an “Ayush doctor” attached to one of Mumbai’s 25 railway-station-adjacent ‘one-rupee clinics’, was having lunch when he got an emergency call from the station manager about a “seven or eight month” pregnant woman in a Delhi-bound train with “severe stomach ache”. Suspecting labour pains, Wani had called gynaecologists who shrivelled away from the scene for fear of infection with the result that he found himself sitting on the bloodsoaked floor of the waiting room of Panvel railway station in Navi Mumbai with neither gloves nor mask delivering a baby girl.

To rewind a bit though, even without the compulsions of emergency deliveries, daily city life throws enough drama his way. Diabetes patients have flopped down unconscious right in front of the dispensary, after panting down the stairs of the escalator-free station. Some people have stepped in with dead scorpions in their hand as proof of the ticketless traveller that just bit them in the long-distance train. On various occasions, Wani has even entered crowded trains to check the BP of palpitating heart patients. And there was even the October night of 2019 when a private hospital nearby refused to admit a pregnant woman whose haemoglobin was low and Wani had to help her deliver on a platform bench.

Wani works for a private organisation that runs these one-rupee clinics across the city. Helmed by Dr Rahul Ghule, who dreamed up the affordable healthcare model when he was working as a medical officer at J J Hospital in Mumbai, the organisation has treated over 2 lakh patients so far.

The clinics were born after fate disrupted his life in 2014. “My parents met with a road accident but there was no hospital on the highway. My mother suffered a brain haemorrhage. She was unable to speak or move for nine months,” recalls Ghule, who decided to use his shock as fuel to apply for a loan of Rs 25 lakh to open charitable clinics that charged a token fee of one rupee at Mumbai’s railway stations, where around 10 people die every day in accidents.

Through subsidised diagnostic tests, including 300-rupee lipid profiles, 50-rupee glucose tests and cheaper MRIS, CT scans, and pharmacies, his clinics not only sustain themselves but also attract the ire of neighbourhood physicians who feel compelled by competition to lower their price. “The reality of the medical field is that 40% of the diagnostic fee goes to doctors as referral kickbacks,” says Ghule, not excluding himself. His real commission, though, he says, is “immense satisfaction” even though some patients don’t even pay the token fee, while some return to pay with interest. In fact, often, homeopath Wani’s friends wonder why he puts himself through such grave ordeals as pulling a baby out in the middle of a pandemic while working at a clinic in which the “fee costs less than the prescription sheet”. His reply is simple: “I enjoy it.”

Kolkata’s Ek-Takar doctor stayed open even in the pandemic

Sumati.Yengkhom@timesgroup.com

Sushovan Banerjee says that for his own expenses, he relies on his UK savings

At 82 and battling a kidney ailment, Dr Sushovan Banerjee continues to tend to poor patients in and around Bolpur with the same fervour for the past 58 years, charging only one rupee as his fee since his return from the UK. Popularly known as ‘Ek Takar Doctor’ (one-rupee doctor), the Padma Shri awardee says he will go on serving poor patients as long as he can. “I draw my energy from tending to these poor patients,” he says.

An MBBS graduate from R G Kar Medical College, and a gold medallist in pathology from Calcutta University, Banerjee could have settled in London comfortably, where he worked as a senior registrar in a hospital after completing his diploma in haematology. But he chose to return to his roots in 1963 and opened his one rupee clinic. “My patients should not feel that they are taking an obligation from me. That is why I charge a token amount. I lead a simple life and the sum that I had saved during my stint in the UK, which I have kept as fixed deposit, is enough for my expenses,” says the octogenarian, whose clinic opens at 9am sharp every day even though he undergoes dialysis twice a week. On those two days, he shows up at the clinic after returning from the hospital and attends to around 30 patients as opposed to the daily average of 100.

Even during the lockdown, Banerjee had kept his clinic open on all days. In fact he got numerous patients with Covid-19 symptoms who were advised immediate testing. Many of them tested positive but he was fortunate to stay healthy. “My daughter and son-in-law (both doctors) were concerned because of my age. But I didn’t want to shut the doors on my patients.”

Ranchi doctor saab has been charging a fiver for fifty years

Jaideep.Deogharia@timesgroup.com

The only time Dr S P Mukherjee hiked fees is during the pandemic

In the heart of Ranchi’s busy Lalpur square, a small old-time building distracts because of the large queue standing outside. The interior is also packed with patients waiting for a sharply-dressed octogenarian doctor about whom the prosperous tea seller nearby says in gratitude: “Doctor saab charges less than me.”

Padma Shri Dr S P Mukherjee, who charges patients Rs 5 per consultation, does not remember any single trigger that prompted him to start his charitable service back in 1957. However, the doctor — who never increased his fee in the last 50 years he has been consulting — admits that the pandemic forced him to increase his fee recently to Rs 50 so that he could sanitise his chamber, and offer hand sanitisers and face masks to the patients. “For those who cannot pay, my consultation and medicines are for free,” says the doctor who thanks his stars for being safe from infection “even after seeing 50 patients every day.”

Has he come across patients with the dreaded virus during the last one year? “Dozens. I advised them to get tested. I have also got patients who came with other complaints after being cured of Covid-19 and got treated here. We cannot shy away from any disease when people are suffering,” says Mukherjee.

He was once asked by Amitabh Bachchan on the show Kaun Banega Crorepati whether his friends ever objected to his low fee. Mukherjee deflected the question by asking all doctors to treat at least one patient daily for free.

Farmer in the morning, skin doctor by day

Milton.lawrence@timesgroup.com

S C Shankregowda

of Mandya

When Vinutha, a Mandya health worker, got a skin problem she decided to step into the ever-crowded home of the famous local ‘fiverupee-doctor’ S C Shankregowda, the one whose “magical” hands work the fields in the morning and prescribe skin medicines during the rest of the day. A week later, when her face cleared up, Vinutha realised that it wasn’t just the nominal fee that drives around 300 people towards the fiverupee doctor every day.

Whether he is tilling the farmland in a lungi or walking on the streets with his family, Shankregowda — who even contested the Assembly polls in the ‘sugar district’ of Mandya as an independent candidate — commands instant respect among the people of Bandi Gowda Layout. They join their hands and say ‘namaste doctor’ when they see him and trust him with everything from itching sensations to sexual health issues.

It has been 38 years since Shankregowda, an alumnus of Kasturba Medical college, Manipal, opened his five-rupee clinic in Mandya soon after his diploma in 1982. Unlike others, he hears the problems of patients in groups — men and women separately — and prescribes low-cost medicines. He runs a clinic without assistants and never handles money. Patients simply place the consultation fee of Rs 5 on the table or don’t.

Odisha patients save money, time

Ashok.Pradhan@timesgroup.com

Shankar Ramchandani has a full-time job at the medical college but he takes out time in the mornings and evenings for destitute patients

Even though Odisha’s Sambalpur city has a government-run college called Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR) that offers completely free treatment, 38-year-old Shankar Ramchandani’s newly-born ‘onerupee’ clinic is doing rather well for various reasons. “If I go to VIMSAR, it will almost be a one-day affair because of the queues. I will lose my entire day’s earnings of around Rs 200. But I can just walk into Ramchandani sir’s clinic after work,” says Bishnu Goura, a 68-year-old rickshaw puller who visited the clinic last week for his knee pain.

Ramchandani works in VIMSAR as an assistant professor. He runs the clinic for an hour before and an hour after his duty in the medical college. “It runs well beyond 8pm most of the days since it is difficult to see 30 to 40 patients in an hour,” says Ramchandani, whose late father Brahmanand wanted him to set up a nursing home and serve the poor. “But since setting up a nursing home requires a lot of investment, I decided to open a clinic instead,” he says, adding that even Rs 10 is a big amount for the poor, destitute, elderly, differently-abled and underprivileged patients he attends to.

“The destitute tend to be apprehensive of big hospitals. They easily walk in here,” says Ramchandani, who had earlier drawn media attention when he carried a leprosy patient in his arms and dropped him in his house in 2019. He also shifted a Covid-19 patient to VIMSAR in his own car in October without worrying about the virus.

Ramchandani — whose wife Sikha Ramchandani, a dental surgeon, also helps out — hopes to start a mobile medical unit to take medical care to inaccessible places one day. Till then, he’s happy making treatment accessible to the poor.

Work-life balance is a lot of work too

Work-life balance is a lot of work too

14.03.2021 

When it comes to work-life balance, so much has been said about how to achieve it, the gender dynamics at play and what employers can do to make this goal a reality. What many of these perspectives share is the positioning of work-life balance as a goal to achieve or a finish line we have to cross to be successful adults.

Yet, the way in which we think about work-life balance may be part of the reason it seems so elusive, argues a BBC article. We tell ourselves: “’I’m going to put in eight hours’ worth of work, and then I’m going to put in eight hours’ worth of me time, which will include my family, my hobbies, my workout, my everything,” Anat Lechner, clinical associate professor of management at New York University told BBC. “I don’t think it’s such a simple formula.”

Now, researchers are encouraging us to rethink the concept. Researchers Ioana Lupu of ESSEC Business School in France, and Mayra Ruiz-Castro of the University of Roehampton in the UK argue that it is “a cycle, not an achievement”. This means, instead of thinking about work-life balance as an achievement that we either hit or miss, we should instead think of it as a continuous process that will require tweaks and self-awareness to actively maintain.

The researchers interviewed 80 employees at two London-based firms working in middle or senior management roles. All the participants were between the ages of 30 and 50 and had at least one dependent child.

Of them, 30% of the men and 50% of the women reported resisting working long hours. The others did not resist this, since they believe that’s just what successful professionals do. Those who rejected long hours, the researchers found, had similar ways of maintaining their work-life balance. They were more reflexive — open to examining their own beliefs and judgments — and took regular steps to adjust the factors standing in the way of work-life balance.

“Claiming this mental space to gain clarity of what they want for themselves is the first step toward identifying and implementing alternative ways of working and living,” Ruiz-Castro told BBC.

Ruiz-Castro and Lupu identified the five steps that employees with better work-life balance used. First, they questioned the belief that they have to work long hours to be a “professional” and asked themselves what is causing them stress. Second, they identified the emotions that stress is causing, whether that’s anger or sadness. Third, they would ask themselves if working longer hours is worth cutting back on family time. Then, they considered the alternatives — is there anything that can be changed at their workplace to accommodate their priorities. Finally, they took actionable steps to make that happen, for instance, asking for greater flexibility or not taking on that project.

“Awareness of your emotional state is essential in order to determine the changes you want to make in your work and in your life,” says Lupu.

For more: BBC

TWO BOATS: Jacqueline Fernandez says she tries to juggle the personal and professional

Why some people are still buying VHS tapes

Why some people are still buying VHS tapes

Hannah Selinger

14.03.2021 

The last VCR, according to Dave Rodriguez, 33, a digital-repository librarian at Florida State University was produced in 2016 by Funai Electric in Osaka, Japan. But the VHS tape itself may be immortal. Today, a robust marketplace exists, both virtually and in real life, for this ephemera.

On Instagram, sellers tout videos for sale, like the 2003 Jerry Bruckheimer film ‘Kangaroo Jack,’ a comedy involving a beauty salon owner — played by Jerry O’Connell — and a kangaroo. Asking price, $190 (Rs 13,800).

If $190 feels outrageous for a film about a kangaroo accidentally coming into money, consider the price of a limited-edition copy of the 1989 Disney film ‘The Little Mermaid,’ which is listed on Etsy for $45,000 (Rs 32 lakh). The cover art for this hard-to-find copy is said to contain a male anatomical part drawn into a sea castle.

There is, it turns out, much demand for these old VHS tapes, price tags notwithstanding, and despite post-2006 advancements in technology. Driving the passionate collection of this form of media is the belief that VHS offers something that other types of media cannot.

“The general perception that people can essentially order whatever movie they want from home is flat-out wrong,” said Matthew Booth, 47, the owner of Videodrome in Atlanta, which sells VHS tapes in addition to its Blu-ray and DVD rental business. Streaming, Booth said, was “promised as a giant video store on the internet, where a customer was only one click away from the exact film they were looking for.”

But the reality, he said, is that new releases are prohibitively expensive, content is “fractured” between subscription services, and movies operate in cycles, often disappearing before people have the chance to watch them. In that sense, the VHS tape offers something the current market cannot: a vast library of moving images that are unavailable anywhere else.

“Anything that you can think of is on VHS tape, because, you’ve got to think, it was a revolutionary piece of the media,” said Josh Schafer, 35, of Raleigh, North Carolina, a founder and the editor-in-chief of Lunchmeat Magazine and LunchmeatVHS.com, which are dedicated to the appreciation and preservation of VHS. There is, Schafer said, “just so much culture packed into VHS,” from reels depicting family gatherings to movies that just never made the jump to DVD. Schafer owns a few thousand tapes himself.

Michael Myerz, 29, an experimental hip-hop artist in Atlanta who has a modest collection of VHS tapes, finds the medium inspirational. Some of what Myerz seeks in his work, he said, is to replicate the sounds from “some weird, obscure movie on VHS I would have seen at my friend’s house late at night, after his parents were asleep.” He described his work as “mid-lo-fi.” “The quality feels raw but warm and full of flavour,” he said of VHS.

For collectors like April Bleakney, 35, the owner and artist of Ape Made, a fine art and screen-printing company in Cleveland, nostalgia plays a significant role in collecting. Bleakney, who has between 2,400 to 2,500 VHS tapes, views them as a byway connecting her with the past. She inherited some of them from her grandmother, a children’s librarian with a vast collection.

“I think that people are nostalgic for the aura of the VHS era,” said Thomas Allen Harris, 58, a creator of the television series ‘Family Pictures USA’ and a senior lecturer in African American studies and film and media studies at Yale University.

“So many cultural touch points are rooted there,” Harris said of the 1980s. It was, he believes, “a time when, in some ways, Americans knew who we were.”

Some who are rooted in the world of VHS hope that what is currently an underground culture will become mainstream again. Record players, Schafer pointed out, have enjoyed a surge in popularity.

But whether or not the VCR makes a complete comeback, VHS enthusiasts agree that these tapes occupy an irreplaceable place in culture.“It’s like a time capsule,” Myerz said. “The medium is like no other.” NYT NEWS SERVICE

NOSTALGIA FACTOR: Some people still collect VHS tapes because it reminds them of a simpler time

Is there an age limit for organ donation?

Is there an age limit for organ donation?

14.03.2021` 

No, there isn’t. The decision about whether some or all organs or tissue are suitable for transplant is made by medical specialists at the time of donation, taking into account your medical, travel and social history.

Parents and guardians can register their children, and in some countries, children can register themselves provided they are above a minimum age, or — as is mandatory in India — they have a parent or guardian agreement for the donation to take place.

There is another myth surrounding organ donations too: That you can’t donate if you have a tattoo. Again, not true. Having a tattoo doesn’t prevent one from donating their organs.

— DAILY MIRROR

Maths, physics optional for engg: AICTE sticks to its decision

Maths, physics optional for engg: AICTE sticks to its decision

‘Council Initiative Would Enhance Accessibility Of Technical Edu’

Ragu.Raman@timesgroup.com

Chennai:14.03.2021 

After receiving widespread criticism for its move of making maths, physics optional for engineering admissions, the All India Council for Technical Education (AICTE) stands by its decision of making maths, physics optional for engineering admissions from 2021-22. The council which removed the approval process handbook (APH) on Friday due to “certain typographical errors in the text and table” uploaded it on Saturday after corrections. However, APH for 2021-22 did not change the eligibility criteria for BE, BTech admissions.

As per the new eligibility criteria it is not mandatory for students to study maths and physics to join engineering and technology programmes.

They can pursue engineering by studying any three of the 14 subjects -- physics, mathematics, chemistry, computer science, electronics, information technology, biology, informatics practices, biotechnology, technical vocational subject, agriculture, engineering graphics, business studies and entrepreneurship.

“This initiative of AICTE will enhance accessibility of technical education to students coming from diverse background and also it shall seek to reduce the pressure on students to pursue such portions which are not relevant in pursuance of higher technical education. This is totally in line with the philosophy of National Education Policy 2020 in terms of flexibility and multi-disciplinary courses, innovation etc.,” the council said in its clarification.

It further said it received representations from students and industry to give option to pursue technical courses such as agriculture, biotechnology, information technology, electronics to students who did not have prior electives of maths and physics at Class XII level. The council further said that it is an option given by the council which is not binding on the states or universities and for various entrance exams such as JEE and CET among others.

“They may continue to hold the entrance exams in physics, chemistry and mathematics as is being done now and gradually decide to conduct exam in other subjects after discussing and taking decisions in the university senates and academic councils and state level committees. In future, when NEP shall be implemented in totality then this option can be implemented in its letter and spirit,” AICTE said.

Under the new pattern of 5+3+3+4 in school education, the disciplinary boundaries have been removed to promote overall development of students in different disciplines.

“Hard Boundaries (physics, chemistry, mathematics) imposed for entry into all branches of engineering education (which are 367 in Diploma and 261 in UG) since long time was affecting access to higher technical education for those who had not taken these subjects,” the council said while citing example of making chemistry optional for circuit branches including computer science.

E Balagurusamy, former vicechancellor of Anna University said AICTE should identify the engineering courses which do not need maths or physics and exempt it. “But, they cannot generalise for all courses as students cannot even understand the engineering concepts without understanding maths,” he said.

He further said such a big move has been brought in without any discussions. “There was no deliberation even among the academicians before taking such a decision.” he said adding that it would further deteriorate the quality of engineers in our country. Bridge courses will not be much help as colleges and universities may end of teaching maths for more than two years.

“Maths is a unifying subject in this emerging paradigm of interdisciplinary engineering education and hence important as a subject of study in Class XII. Also, JEE has a maths paper because its considered important for engineering admissions,” said S Vaidhyasubramaniam, vice-chancellor of SASTRA university.

The council said it received representations from students and industry to give option to pursue technical courses such as agriculture, biotechnology, information technology, electronics to students who did not have prior electives of maths and physics at Class XII level

No entry for passengers sans masks at airports, says DGCA

No entry for passengers sans masks at airports, says DGCA

Directs To Deboard Flyers For Not Wearing Mask Properly

TIMES NEWS NETWORK

New Delhi:14.03.2021 

India’s aviation regulator on Saturday directed security agencies not to allow airport entry to passengers without masks. Passengers refusing to wear masks properly before takeoff will now be deboarded before departure, and those not masking properly as per norms on flights despite repeated warnings will now be treated as “unruly passengers”. Once classified as unruly, a person can be barred from flying for anywhere up to a lifetime, depending on the gravity of the violation of safety norms.

“In case, any passenger is not following Covid-19 protocol, they should be handed over to security agencies after proper warnings. If required, they may be dealt as per law,” the Directorate General of Civil Aviation (DGCA) on Saturday said in an order to all airlines, airport operators and security agencies to ensure “strict compliance of Covid-19 protocol during air travel.”

The order came after a high court judge observed blatant violation of Covid-19 norms by passengers on a domestic flight recently, and directed DGCA to issue orders for the strict compliance of pandemic-time rules by all travellers.

The regulator said some flyers aren’t adhering to Covid-19 protocols, which essentially involves masking properly — not below the nose and during all times of the journey from entering the airport for departure to exiting the airport after arrival. “…some passengers after entering the airport do not wear mask properly or maintain social distance within the premises. Similarly, some passengers have been noticed not wearing their masks properly while on-board the aircraft,” the order stated.

The DGCA order directed airlines, airport operators and CISF to ensure that passengers wear masks and maintain social distancing norms at all times during air travel. “The mask shall not be moved below the nose except under exceptional circumstances. CISF or other police personnel deployed at the airport entrance shall ensure that none is allowed to enter the airport without a mask,” the order stated.

COVID-19 PROTOCOL: The DGCA order directed airlines, airport operators and CISF to ensure that passengers wear masks and maintain social distancing norms at all times during air travel