Monday, July 31, 2017
Sunday, July 30, 2017
The Hindu Tiruchi 31.7.2017
‘State has submitted reply on AIIMS site’
TIRUCHI, JULY 31, 2017 00:00 IST
UPDATED: JULY 31, 2017 04:57 IST
Centre responds to RTI query
The Union Ministry of Health and Family Welfare has said that it had recently received a response from the State government on the selection of site for establishing an All India Institute of Medical Sciences (AIIMS), adding that a final decision in this regard will be taken based on the State’s inputs.
The Ministry’s statement came in response to a Right To Information (RTI) query by Tiruchi-based neurologist M.A. Aleem. The response, signed by K. Vinod Kumar, Under Secretary, Union Ministry of Health and Family Welfare, stated that the Tamil Nadu government had submitted a reply on July 12, 2017, in response to the clarification and additional details sought by the Ministry with regard to the selection of site for AIIMS.
Mr. Kumar further noted that proposals to establish six AIIMS, including one in Tamil Nadu, was announced by the Union Finance Minister in his budget speech for the year 2015-16. Following this, the State government was requested to assess and identify three to four locations for hosting AIIMS. A final decision would be taken based on the inputs submitted by the State government in a letter dated July 12, 2017, he said.
Dr. Aleem, former Vice Principal of K.A.P. Viswanatham Government Medical College, said that Sengipatti in Thanjavur district, which was in close proximity to Tiruchi, Ariyalur, Perambalur and Pudukottai districts, was an ideal location for establishing AIIMS in the State. He stressed that the Tamil Nadu government and the Centre should not let the issue drag on any longer, and that a formal decision should be announced immediately, upon considering all parameters.
Thuvarnkurichy Mohideenandaver mosque centenary (1917-2017) celebration held on 30.7.2017. K.Mohamed Ibrahim preside the function. A Jamal Executive secretary of Jamath welcome the gathering on the presence of Dr.S.shahul Hameed EO of ponnampatty Town panchayat. N.Amjed Ibrahim former Thasildsr and M.Jamal former Trusty. Dr.M.A.Aleem delivered a speech on alcohol. Prof.Kamaludeen former MIET Arts college, A.K.Abdulkadir chennai , A.U. Abubacker Usmani Imam Msjid Mohamed pallavakkam chennai , TSAA . Abdul Salam Bakavi Kadib , J Asraf Ali Deputy Kadib of Mohideenandaver Mosque Thuvarnkurichy, Dr.MM.Shahul Hameed correspondence Aiman college Trichy. M.Sadeedudeen principal Alhuda Arabic college chennai given special lectures.m M.Mohamed Ali chairman Maharaja Group of company, A.Jamal Mohamed Gani Sales, M Kaja Mohideen Maharaja and Italia shoes chennai, M.Mohamed Ismail Bharath Metriculation school TVK, A.Abdul Malik Ex. Chairman ponnampatty Town panchayat, VPM.Jamal Mohamed Raja Rani Group, Tirupur Thuvarankurichy Muslim Jamath , Bismilla S.P.Mohamed Ali, VMSI. S.Shrbudeen, Uppu A. Raja Mohamed organised the function. M.U.Liakatali Ammbalam All India congress Trichy south district deputy president sponsored lunch. TSK.Habeeb offered vote of Thanks. More than 2000 men and women of Thuvarankurichy Muslim jamath participated in this centenary function with great enthusiasm.
Thuvarnkurichy Mohideenandaver mosque centenary (1917-2017) celebration held on 30.7.2017. K.Mohamed Ibrahim preside the function. A Jamal Executive secretary of Jamath welcome the gathering on the presence of Dr.S.shahul Hameed EO of ponnampatty Town panchayat. N.Amjed Ibrahim former Thasildsr and M.Jamal former Trusty. Dr.M.A.Aleem delivered a speech on alcohol. Prof.Kamaludeen former MIET Arts college, A.K.Abdulkadir chennai , A.U. Abubacker Usmani Imam Msjid Mohamed pallavakkam chennai , TSAA . Abdul Salam Bakavi Kadib , J Asraf Ali Deputy Kadib of Mohideenandaver Mosque Thuvarnkurichy, Dr.MM.Shahul Hameed correspondence Aiman college Trichy. M.Sadeedudeen principal Alhuda Arabic college chennai given special lectures. M.Mohamed Ali chairman Maharaja Group of company, A.Jamal Mohamed Gani Sales, M Kaja Mohideen Maharaja and Italia shoes chennai, M.Mohamed Ismail Bharath Metriculation school TVK, A.Abdul Malik Ex. Chairman ponnampatty Town panchayat, VPM.Jamal Mohamed Raja Rani Group, Tirupur Thuvarankurichy Muslim Jamath , Bismilla S.P.Mohamed Ali, VMSI. S.Shrbudeen, Uppu A. Raja Mohamed organised the function. M.U.Liakatali Ammbalam All India congress Trichy south district deputy president sponsored lunch. TSK.Habeeb offered vote of Thanks. More than 2000 men and women of Thuvarankurichy Muslim jamath participated in this centenary function with great enthusiasm.
Saturday, July 29, 2017
Friday, July 28, 2017
The antibiotic course has had its day
BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3418 (Published 26 July 2017)
Cite this as: BMJ 2017;358:j3418
Re: The antibiotic course has had its day
Antibiotic Resistance in India
In developing countries like India, the empirical prescription of antibiotics for viral infections is one of the important causes of the development of resistance to antibiotics.
So strict adherence to the guidelines and evidence based prescription are important to prevent antibiotic resistance.
Competing interests: No competing interests
28 July 2017
Annamalainagar Trichy 620018 Tamilnadu India
Wednesday, July 26, 2017
Trichy MLS election was conducted on 23.7.2017 and the new team elected as follows- Dr.M.K. Mohamed usman as president, K.syed Jafar as General Secretary , Umar Iqbal and Dr.M.A. Aleem as Vice President, P.M.Mohamed Iqbal and Dr.A.syeed Jakir Hassan as Joint secretary and A.Mohamad Jalludeen Akbar as Treasure along with 23 Executive Nembers for the year 2017-2020 . All elected members were given with certificate by Election officer Advocate M.S.Vinoth on 26.7.2017 in the presence of Prof. Kader Mohideen president IUML and Mohamed Nizar president Trubu mosque Trichy
Friday, July 21, 2017
Times is India Trichy 22.7.2017
Call for setting up AIIMS centre in Sengipatti gains momentum
TNN | Updated: Jul 22, 2017, 12:32AM IST
Trichy: Once again AIIMS has become a hot topic among the people in the central region with a group of people including doctors, social activists joining together to press the Union government in picking Sengipatti in Thanjavur as the location for AIIMS in Tamil Nadu. The protesters alleged that Union minister Pon Radhakrishnan tried to shift the project to Madurai though the site in Sengipatti had an edge over Madurai in several parameters
The Federation of Consumer and Service Organisations (FCSO) led the attention seeking protest in which the call for selecting Sengipatti as the location for AIIMS.
"Out of the five locations identified by the state government for the project, Sengipatti and Madurai were taken into consideration. Sengipatti remains on top based on many parameters prescribed by the Union health ministry under the challenge method. Now, we demand the government to take a call on the issue based on the merits and not budge to pressure from politicians," said M Sekaran, president of the organisation, pointing out that the role of Pon Radhakrishnan to establish AIIMS in Madurai was said to be prominent.
Sengipatti in Thanjavur district was one of the five locations identified by the Tamil Nadu government in 2014. The state government finalised the site after the Central and state teams of officials visited Sengipatti, Chengalpattu in Kancheepuram, Pudukkottai town, Perundurai in Erode and Thoppur in Madurai in 2015.
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Citing an RTI reply given to him by the Union health ministry, Sekaran said that Sengipatti scored well than Madurai under the challenge method - early availability of suitable land, provision of utilities (power, water supply etc), health indicators and gap in tertiary health care facilities, connectivity (road, rail, airport), primary and secondary healthcare facilities nearby, accessibility of school and college facilities, employment opportunities for family, fast track single window for clearances, financial incentives.
Former vice-principal of KAP Viswanatham government medical college, Trichy, Dr M A Aleem suggested bringing AIIMS in both the locations. "Like some other states where two AIIMS have been allocated, the Central government can consider Tamil Nadu for AIIMS in two locations to make the speciality treatment available to everyone easily," he said.
Thursday, July 20, 2017
New diagnostic tests: more harm than good
BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3314 (Published 18 July 2017)
Cite this as: BMJ 2017;358:j3314
Re: New diagnostic tests: more harm than good
In neurological diseases it may be act as a double edged weapon. Sometimes knowing or unknowing the facts about neurological diseases may be stressful or harmful to the patients.
Competing interests: No competing interests
20 July 2017
Trichy 620018 Tamilnadu India
World Brain Day 22.7.2017 devoted to stroke
KAPV Govt. Medical College and MGM Govt. Hospital.
To mark World Brain Day, held annually on 22 July, the World Federation of Neurology is working, together with the World Stroke Organisation, to increase awareness of stroke this year. Despite revolutionary advances in therapy, stroke is now the second most common cause of death in the over 60s and the second most common cause of disability. Experts are calling for improved prevention measures and better neurological care in all parts of the world.
“Stroke is the epidemic of the 21st century,” says Prof Raad Shakir, President of the World Federation of Neurology (WFN), explaining the organisation’s decision to adopt “Stroke is a brain attack: Prevent it – treat it” as its motto for this year’s World Brain Day which is celebrated in partnership with the World Stroke Organisation (WSO). World Brain Day was launched by the WFN in 2014 and is dedicated to a different topic every year. The date for this awareness day was not chosen at random: The WFN was founded on 22 July 1957. “We want to use this initiative to help reduce the number of deaths and disabilities caused by stroke,” Prof Shakir says.
Stroke incident somewhere in the world every two seconds
16 to 17 million people worldwide suffer strokes each year, six million of whom do not survive. There are a greater number of stroke-related deaths each year than deaths linked to AIDS, tuberculosis and malaria put together. More than one in ten deaths are attributable to stroke, making this cerebrovascular condition the second-largest cause of death in the world among people over 60. It is also a leading cause of disability.
80 percent of sufferers live in developing countries
Worldwide, around a fifth of all women and a sixth of all men have a stroke at some point in their lives. While risk increases with age, young people are also affected: according to the WHO, stroke is the fifth most common cause of death for people in the 15 to 59 age bracket. However, the prevalence and effects of the disease vary greatly throughout the world. Currently around 80 percent of those affected come from low and middle income countries. “Between 2000 and 2008 the incidence of stroke in countries with low to middle incomes was around 20 percent higher than in high income nations. This shows that having a stroke is not inevitable, but very much depends on a person’s environment.
Stroke classified as a neurological disease by the WHO
In light of the growing significance of stroke for the global disease burden, the World Health Organisation has also changed its stance and redefined stroke in the International Classification of Diseases (ICD). The categorization of strokes in the ICD-10 was inconsistent and outdated. While stroke was listed under the cardiovascular disease category, transient ischemic attacks were attributed to diseases of the nervous system and silent cerebrovascular diseases were included in the section of incidental imaging findings. The newest version, ICD-11, expected to be approved by the World Health Assembly next year, will reflect the recommendations of an expert advisory committee and create a single block of “cerebrovascular diseases” within the category of diseases of the nervous system which includes all relevant conditions.
This latest development in the ICD-11 process correctly signals that stroke is a brain disease and contributes to improved clarity and clinical usefulness. Stroke is no longer in the shadow of other cardiovascular diseases and the position of stroke as one of the most important non-communicable disease, possible to prevent and treat, is strengthened.
Stroke increasingly treatable thanks to breakthroughs
“There are few other diseases for which treatment options have improved so radically over the past decade and a half. Until recently we were largely powerless in the face of stroke and couldn’t do much more than alleviate some of the consequences – but today we can finally say that strokes are treatable.
The first major breakthrough came 15 years ago when intravenous thrombolysis was first introduced. Under this procedure, stroke-causing blood clots in vessels of the brain are dissolved using medication. Widespread use of this method has not only saved many lives, but also led to a huge expansion of neurological infrastructure and the introduction of stroke units in many countries. This alone can reduce mortality by about 20 percent in a single .
In around 10 percent of cases, the occlusions are so large that thrombolysis does not work. However, endovascular thrombectomy was introduced a few years ago to provide an option in precisely these kinds of cases. The procedure involves removing a clot from a blood vessel in the brain using a catheter inserted via the groin. Data have recently been made available which show that even blockages that are more than six hours old can be treated successfully. Numerous international studies have shown that endovascular treatment represents a major advance compared with medication-only treatment.
Major variances in quality of care provision worldwide
There is still a long way to go before these breakthroughs benefit all patients worldwide. Unfortunately there are still a lot of countries that simply do not have the infrastructure and specialists in neurology. While wealthy countries have three neurologists per 100,000 inhabitants, the total for low income nations drops to just 0.03. The fact that the chances of surviving a stroke depend greatly on where someone lives is unacceptable and something that the WFN and its partners must tackle with all of the resources available to them.
“Stroke, its treatment and prevention must be given the highest priority in healthcare policy in every country. As advocates for stroke patients, we will not tire of calling for and promoting fair distribution of treatment opportunities for stroke patients. But for this to happen, all hospitals need to be equipped with specialist stroke units, and medicine for basic thrombolysis treatment needs to be made available – but that’s not all. It is of great importance to raise awareness in the general population for the most common risk factors, in particular hypertension, for early detection and for the need for adequate care, not only in the acute stage, but also on the long term. As the prevalence of stroke sufferers left with permanent disability is still high, efforts towards permanent care facilities need to be a task of national neurological and stroke societies.
Ten risk factors responsible for 90 percent of all strokes
A large proportion of all strokes are avoidable, according to data from the INTERSTROKE study. Ten influenceable risk factors are responsible for 91 percent of all strokes worldwide. These are high blood pressure, physical inactivity, an unfavourable situation of blood lipids, poor diet, a high waist-to-hip ratio, psychosocial factors, smoking, a high alcohol intake, cardiac disease and diabetes. An analysis of the results of stroke-related data generated by the 188-country Global Burden of Disease Study came to a similar conclusion, but like other current studies also highlighted air pollution as an additional risk factor.
High blood pressure is the single largest risk factor for stroke. Hypertension is behind almost 50 percent of all strokes and also increases the risk of intracerebral haemorrhage, which often leads to particularly severe disabilities. There is potential to add 100 million healthy years worldwide solely from effective strategies designed to reduce strokes. In addition to focusing on the effective treatment of diabetes, increased blood lipids and atrial fibrillation, as well as preventing obesity and promoting physical activity, experts are also pushing for the speedy introduction of a global smoking ban.
Early detection saves lives
Alongside prevention, we also have to promote awareness of how to detect and respond correctly in an emergency confirms is one of the aims of this year’s World Brain Day. Experts believe that almost 70 percent of patients fail to identify transitory ischemic attacks – a temporary interruption to the brain’s blood supply – and even mild strokes. Even when symptoms are identifiable, almost one in three people do not seek immediate help. Reducing the amount of time that elapses between the emergence of the initial symptoms and the patient receiving care is a central factor in improving treatment outcomes, and can save many sufferers from a lifetime of severe disability.
To help people with a non-medical background identify the wide range of different – and often unclear – symptoms, the WFN and WSO draw attention to some simple guidelines to provide clarity in the event of a suspected stroke incident. The only thing that non-experts have to remember is the “FAST” mnemonic:
• F for face drooping: Ask the person to smile. Does one side of their face droop?
• A for arm weakness: Ask the person to raise both arms. Is one arm numb and does it drift downward?
• S for speech difficulty: Ask the person to repeat a simple sentence. Is their speech slurred? Are they able to correctly repeat the words, or are they hard to understand?
• T for time to call an ambulance: If someone shows any of these symptoms, time is crucial. Call an ambulance or help get the person to hospital immediately.
“World Brain Day is also intended to give sufferers grounds for positivity.
In stroke rehabilitation is a long – sometimes lifelong – process, but it can be successful. No one can manage it alone, and the support of loved ones and other helpers is very important.
Wednesday, July 19, 2017
The Hindu Trichy 17.7.2017
Roadside eateries pay no attention to hygiene
TIRUCHI, JULY 17, 2017 00:00 IST
UPDATED: JULY 17, 2017 03:50 IST
GST forces many poor people to opt for them
K. Ravichandran (47) of Aruppukottai just needs Rs. 40 to have a non-vegetarian unlimited meal on a roadside eatery on V. O. Chidambaram road near the Central Bus Stand in Tiruchi. On Sunday, while he was being served a curry, a layer of dust kicked up by a swirling wind fell on his plate. A layer of dust also covered the omelettes and parottas being made by the food stall owner. But neither he nor Ravichandran bothered much about the dust and Ravichandran continued to enjoy his lunch, as the owner went on cooking.
Ravichandran was not a lone customer having lunch at the roadside eatery. Similar was the scene at most of the roadside push cart eateries at Central Bus Stand. At least 50 customers were seen eating at different stalls on VOC road. Most of them were having lunch as they waited for buses to various destinations.
Some of them were drivers and conductors of State owned transport corporation buses and private buses.
They get one parotta at Rs. 10 and kuska and varieties of rice at just Rs. 20 per plate. One plate of mutton biriyani was being sold at Rs. 70.
“Most of the restaurants charge Rs. 100 for a vegetarian meal. In addition, I have to pay Rs. 10 to Rs. 18 to the government on Goods and Service Tax. I cannot afford it. Hence I prefer to eat at a roadside eatery,” says Ravichandran.
Surprisingly many are aware that most of the food stall owners pay little attention to ensure hygienic environment and hygienic methods of food preparation.
“We know well that we eat food items prepared in a poor hygienic condition. But, we can afford only to eat at roadside eateries,” says a woman, a Thiruverumbur bound passenger from Erode, who was having lunch at a roadside eatery.
A owner of a roadside eatery said that he was giving top priority for hygienic preparation of foods but the windy season was making the job difficult.
Sounding an alert on possible outbreak of diarrhoea and cholera, M. A. Aleem, former Vice Principal, K. A. P. Viswanatham Medical College, said that most of the roadside eateries were transacting business in an unhealthy and unhygienic environment. The windy season would make the food quality worse. It was important for the health officials to ensure good environment surrounding eateries.
While acknowledging that roadside eateries have come to stay in the city, Dr. Aleem further said that the Tiruchi Corporation, Public Health and Food Safety officials should conduct an awareness programme for all owners, cooks and other employees of these eateries.
Monday, July 17, 2017
Sunday, July 16, 2017
The Hindu Trichy 17.7.2017
AIIMS site to be chosen by ‘Challenge Method’
JULY 17, 2017 00:00 IST
UPDATED: JULY 17, 2017 04:53 IST
Union Ministry of Health and Family Welfare confirms this in response to RTI queries
The Union Ministry of Health and Family Welfare has confirmed that the choice of site for AIIMS in Tamil Nadu will be made based on the ‘Challenge Method’, under Pradhan Mantri Swasthya Suraksha Yojana.
A letter sent recently by the Ministry in response to queries made under RTI Act by the president of Federation of Consumer and Service Organisations, Tiruchi, M. Sekaran, states that the suitability of one of the five sites proposed by the State Government would be determined based on 10 parameters.
Out of 100 marks, weightage is split for the undermentioned parameters as per Challenge Method: Early availability of suitable land – 15 marks, provision of utilities (power, water supply etc) – 5, health indicators and gap in tertiary health care facilities – 20, connectivity (rail/airport/road) – 15, primary and secondary healthcare facilities nearby – 10, accessibility of school / college facilities – 10, employment opportunities for family – 5, fast track single window for clearances – 5, and unallocated (to be suitably considered by the selection committee) – 10.
The Health Ministry has clarified that it had sought information on the sixth and seventh parameters through a communication sent during May.
The sixth is regarding accessibility of school and college facilities, along with specific details of schools, colleges, universities, and professional courses, and the seventh parameter pertains to availability of employment opportunities for family of faculty members.
Industrial commercial activities in the city would be relevant aspect for determining availability of jobs, the letter sent by the Ministry to the Government states.
To a query from Mr. Sekaran on whether Union Ministers or MPs had given their recommendations on the site for AIIMS, the RTI reply states thus:
“No such information is available in compiled form. If you so desire, you can inspect the records available in this office.”
Saturday, July 15, 2017
Thursday, July 13, 2017
WHO downgrades status of oseltamivir
BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3266 (Published 12 July 2017)
Cite this as: BMJ 2017;358:j3266
Re: WHO downgrades status of oseltamivir
Antiviral Agents For Influenza
At present vaccinations are the only preventive measures useful to prevent influenza . Influenza antiviral agents are an important adjunct to vaccinations.
The recommendations for using influenza antiviral medications are based on data from the randomized clinical trials as well as from observational studies of patients receiving treatment in practice. Early antiviral treatment in people with influenza can lessen the illness severity, shorten time of illness, and reduce the serious Influenza related complications such as pneumonia in outpatients and death in hospitalized patients.
There are three antiviral agents recommended for the treatment of influenza, they are oral oseltamivir, inhaled zanamivir, and intravenous peramivir. These neuraminidase inhibitors are chemically related and have activity against both influenza A and B viruses. Generic oseltamivir was approved by the US Food and Drug Administration (FDA) in August 2016 .
To treat influenza, oral oseltamivir and inhaled zanamivir are usually prescribed for 5 days, although hospitalized patients may receive treatment for longer. Intravenous peramivir is administered in a single infusion over 15-30 minutes. Peramivir is approved for treatment in adults, zanamivir for treatment of children 7 years or older, and oseltamivir for treatment even in infants.
Resistance to the circulating influenza viruses to any of the neuraminidase inhibitor antiviral agent is low at present.
Still more randomised control studies are required to confirm the effectiveness of antivirals in influenza viral infections
Competing interests: No competing interests
14 July 2017
Annamalainagar Trichy 620018 Tamilnadu India
Wednesday, July 12, 2017
Tuesday, July 11, 2017
Tamil Nadu becomes second Indian state to report Zika infection
Updated: Jul 11, 2017 11:22 IST
By Sadaguru Pandit
Mosquito-borne Zika Virus Disease continues to remain a global public health concern . (Shutterstock)
Tamil Nadu became the second state of the country to report the Zika infection on Monday. India’s fourth Zika case and the first one from Tamil Nadu is a 27-year-old tailor with no history of travel to the affected regions, officials confirmed.
Zika virus is transmitted to people through the bite of an infected mosquito from the Aedes genus, mainly Aedes aegypti in tropical regions. This is the same mosquito that transmits dengue, chikungunya and yellow fever.
“The transmission has not taken place from any Zika-affected country. We suspect that the man is locally infected,” said J Radhakrishnan Tamil Nadu’s health secretary. While the man has recovered completely as per health officials, the local spread of the virus is a major concern.
Health officials however said that there is no need to worry since not a single individual from the man’s family or locality have tested positive for the deadly virus. The infection was detected during a routine visit.
On May 15, the Ministry of Health and Family Welfare (MoHFW) reported three laboratory-confirmed cases of Zika virus disease in Bapunagar area in Ahmedabad, Gujarat, for the first time. The victims, including a pregnant woman were detected in February last year, the second in November and the latest one this January. However, the government only released the information this May, attracting criticism.
WHO termed the findings “low-level transmission” but warned that new cases of the disease linked to babies born with underdeveloped brains could occur in the future.
Only last year, the union government had put planned a mammoth exercise to measure the head circumference of every child born in the country to find out if there is any sudden rise of microcephaly cases — a birth defect that causes abnormally small heads in newborns which is a symptom of the Zika infection.
Key facts about Zika
Zika virus disease is caused by a virus transmitted primarily by Aedes mosquitoes.
People with Zika can have symptoms including mild fever, skin rash, conjunctivitis, muscle and joint pain, malaise or headache.
The symptoms normally last for 2-7 days.
There is scientific consensus that Zika virus is a cause of microcephaly and Guillain-Barré syndrome.
Dr.M.A.Aleem member Attended his first Trichy district welfare Fund committee meeting under the chairmanship of district collector k.Rajamani IAS with vice chairman DRO A.Basheer ,Treasure k. Govindaraju, members JJL.Ganaraj , Dr.V.Jayapal, and P.Selvaraj on 11.7.2017 at collectorate Trichy
Friday, July 7, 2017
When “patient centred” is no longer enough: the challenge of collaborative health: an essay by Michael L Millenson
BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3048 (Published 05 July 2017)
Cite this as: BMJ 2017;358:j3048
Re: When “patient centred” is no longer enough: the challenge of collaborative health: an essay by Michael L Millenson
A change of name will not change the patient's care.
The end result of collaborative health is centered on patient's health care issues by the team of heath care professionals.
Competing interests: No competing interests
07 July 2017
Annamalainagar Trichy 620018 Tamilnadu India