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Medically Speaking


Shalini Bhardwaj



Q. What would be the first step basic to start mass vaccination?

A. A mass vaccination exercise will require diligent planning and like all successful supply chain strategies, the basic step must be to first identify the destination points. After terminal inoculation centres are known, the strategy will be to work backwards to distribution depots, a regional store or the source manufacturer. The long haul from source to distribution depots will be planned as a bulk movement and from depot to inoculation centres in smaller tertiary shipper boxes. Each shipper box can carry 5,000 to 10,000 doses so that can be replenished every few days or weekly. The identifying of first recipients is just a diversion and efforts should be applied to identify vaccine givers and inoculation centres. The vaccine givers should be the first recipients, and they should receive their dose at least two weeks before they start inoculating the others in their zone.

Q. How the distribution of vaccines will be done to make the process smooth?

A. The first concern will be to administer the vaccine in a socially distanced environment. A vaccine taker should not run the risk of picking up Covid-19 even while waiting to receive the vaccine. Therefore, existing movie halls, restaurants, schools and convention halls should be designated as vaccination centres. Luckily, they are all under-occupied or empty, most already have cold rooms which can hold the vaccine at 2°C to 8 °C for a couple of days.

Railway coaches can be compartmented and quickly converted into inoculation centres, and a vaccine train can be deployed in each region to service rural areas as it moves from village to village. Similarly, a group of vaccine buses can be used as mobile inoculation centres. The same infrastructure can be used at multiple locations. A one-way flow of people must be maintained and crowding must be avoided. Further, to ensure that a schedule is maintained, a ‘vaccine deposit’ can be refunded if the recipient will abide by the programme. Another option is to offer coronavirus insurance for a year if the discipline of schedule is kept. Lastly, the actual distribution of the vaccine should be matched against return logistics of used syringes and vials from each location, to safely manage the medical waste that will be generated and as a double check avoid incorrect reporting.

Each vaccine taker should be marked with indelible ink like it is done after voting and as a sign of social responsibility. Aadhaar linked digital records should also be kept.

Q. What procedure should be followed for storing vaccines?

A. Storage should only be to buffer the supply, with the agenda being to maintain a high throughput of vaccines. After all, the vaccines are not being made to be stored but to be distributed. Any storage, in-situ or in transport, should be monitored for three parameters: for time and location through GPS, for temperature through data loggers and for excursions through thermos-chromic labels. The first would apply to the basic article of carriage, the second to tertiary packaging or individual boxes, and the third to individual vials. This will ensure a very high level of safety in the distribution network and mitigate risks. Usually, any vaccine movement is monitored similarly, and in this case, will probably require more close monitoring.

It will be imperative that the temperatures are maintained within the set parameters. Either within the range of 2°C to 8 °C, or below -20°C and/or below –70 °C depending on the vaccine. We must also keep in mind that in cold climates such as Jammu and Kashmir space may need to be heated to maintain the desired temperature. So, it is not always refrigeration for cooling but could also require heating. Data loggers will be important so that out-of-range parameters are flagged off and that batch can be discarded.

Another option is to store the vaccine in thermal shippers with passive cooling, and inside actively refrigerated space (like cold rooms and reefer trucks). A far higher level of redundancy will be in-built in case of a cooling failure. This is not too dissimilar to ice-lined refrigerators where the refrigeration system is buffered with the passive cooling system.

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Medically Speaking

Ask a Birth Injury Lawyer: 8 Frequently Asked Questions



Medical malpractice can devastatingly affect a patient’s health, especially for pregnant women. If you were a victim of birth injuries, a lawyer must review your case and help you understand a strategy to move forward. A birth injury lawyer understands the nuances of the law regarding medical malpractice and is the most qualified to help you get fair compensation.

Ask a Birth Injury Lawyer: 8 Frequently Asked Questions1. How Long Can I Wait Before Filing a Lawsuit?The statute of limitations for medical malpractice resulting in birth injuries in Maryland is five years from the moment of the injury or five years from when the injury is discovered. If a child who suffered injuries at birth wants to file a claim, they have three years after reaching 18 years of age. Parents can file a lawsuit on behalf of their infant son. It’s important to understand that the longer you wait before filing a claim, the more challenging it becomes to prove. 2. Who Can Be Held Liable for Birth Injuries?All medical staff related to birth can be liable for birth injuries. This includes nurses, obstetricians,anesthesiologists, and other healthcare professionals present at birth. Sometimes, you can also sue the hospital where the baby was delivered. Consult a birth injury lawyer in Baltimore who can help you determine who you need to sue. 3. What Evidence Will I Need to Provide?To prove a medical malpractice case (including birth injuries), you will need all medical records concerning the case, from the first appointment during your pregnancy. Other valuable evidence may include:

  • Testimonies from a witness present during the delivery (for example, your partner or doula)
  • Testimonies from other healthcare professionals who review your case

Your attorney will conduct a “discovery” phase, in which they will help you gather all the evidence required to prove your case in court. 4. Do I Need Expert Certification for a Birth Injury Claim?Before you file a lawsuit for any medical negligence (including birth injury) in Maryland, you need a “Certificate of a Qualified Expert.” The law defines qualified experts as board-certified medical professionals in the field of the claim (in this case, obstetricians or gynecologists) or a medical professional who teaches the relevant medical specialty and has done it for at least five years. This certificate must certify that:

  1. You received substandard medical attention
  2. Your injuries (or your child’s injuries) directly result from the inappropriate standard of care

You must file this certificate within 90 days of filing your initial claim. 5. What Are Some Examples of Medical Negligence Resulting in Birth Injuries?

  • Failure to perform a necessary cesarean section
  • Failure to properly monitor a newborn
  • Failure to prevent tearing or hemorrhaging in the mother
  • Failure to properly use birthing tools
  • Failure to diagnose conditions such as preeclampsia or high blood pressure

Other instances of medical malpractice regarding pregnancy and birth include “wrongful birth,” when a healthcare professional fails to inform about any condition that may have resulted in pregnancy termination. It also includes “wrongful pregnancy,” when a woman’s choice to avoid pregnancy fails because of misinformation, defective medication, or defective birth control devices. 6. What Are The Caps For Damages in a Birth Injury Case?To determine a compensation amount for economic damages, the court must consider the severity of the injuries, especially when they have lifelong consequences. Economic damages are not capped in Maryland and include past and future medical expenses and future loss of income. Non-economic damages, such as pain and suffering, are capped at $895,000, and this amount increases by 15% every year. 7. Are There Special Requirements for a Birth Injury Case?In Maryland, all medical negligence cases must begin by filing with the Maryland Healthcare Alternative Resolution Office, and your case will go through an arbitration process. During this process, a panel composed of a lawyer, a healthcare professional, and a general public member will review your evidence and give a verdict, including a compensation amount. However, you have the right to waive arbitration and or reject the arbitration panel’s decision in court. 8. Will I Need to Pay My Attorney’s Fees Out of Pocket?Most birth injury attorneys will accept to be paid a percentage of your winnings. If you lose the case, they won’t make any money. However, you will have to pay for all associated fees. Once you hire a lawyer, ask for a written contract specifying payment conditions and the attorney’s obligations. The law protects you if you or your child are victims of medical negligence resulting in birth injuries. While no amount of money can repair your losses when it comes to a birth injury, fair compensation may help you cope with the challenges ahead of you. Getting professional legal help increases your chances of a good outcome in court.

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Medically Speaking


Brain tumour is an abnormal growth of the brain cells. The extra growth inside the brain can exert pressure on the skull, causing life-threatening complications.

Dr Ravi Gopal Varma



Brain tumour is an abnormal growth of the brain cells. The extra growth inside the brain can exert pressure on the skull, causing life-threatening complications. However, not all brain tumours are malignant. Some can be non-cancerous, benign or harmless masses of cancerous cells that mainly target the structural tissue of the brain. It can start either in the brain, or cancer elsewhere in the body can spread to the brain.

According to WHO guidelines brain tumours are categorized into four grades based on the intensity and abnormality of the cells.

·         GRADE 1: Cells look benign and grow slowly; survival of the patient is likely.

· GRADE 2: Cells look slightly abnormal. The tumor grows slowly and may spread to other tissues.

· GRADE 3: Cells look abnormal. The tumor grows aggressively and tends to recur.

· GRADE 4: The cells look abnormal and spread quickly. Tumour could be life-threatening.


Depending on the type, location, and stage of the tumor, it can cause both physical and mental symptoms. Some of the commonly observed signs and symptoms of brain tumors are

Unusual headache: Headache can be a common symptom. If someone is experiencing an unusual headache, especially a new one that feels localized to a specific part of the head it could be an early indication of a brain tumor. The headache tends to be more severe in the morning. A brain tumor increases the pressure inside the skull, which can lead to inflammation and tissue damage. Hence, severe, persistent headaches can occur. If there are changes in the frequency or intensity of the headaches, one must consult a doctor.

Seizures: They are one of the most common symptoms of brain tumors. The seizures occur when the brain’s normal patterns of electrical impulses are disrupted. It is reported that brain tumor-related epilepsy (BTE) is common in low- and high-grade gliomas. The risk of seizures varies between 60% and 100% among low-grade gliomas and between 40% and 60% in glioblastomas.

Memory loss, Speech difficulties and hearing loss: Brain tumors can affect the stages of creating, storing and recalling of memory. Retrograde amnesia, a state where one can’t recall memories that were formed before the event that caused the amnesia and anterograde amnesia, where one can’t form new memories after the event that caused the amnesia can occur in people with brain tumor. A brain tumor can affect the communication capabilities of a person and can cause difficulties in uttering or producing sounds, finding the correct word, and understanding what others are saying. It can also have an impact on reading and writing. Also, the pressure exerted by a tumor on surrounding nerves may cause hearing loss and imbalance.

Weakness in the hands and legs: Weakness or numbness in the face, arms or legs is a common occurrence in brain tumors. It is caused by brain tumors located in the frontal lobes or the brainstem. Weakness in one foot/leg or both feet/legs can cause difficulty in walking. Hence, one may experience loss of balance while walking.

Sudden shifts in mood or personality: Mood changes are commonly associated with brain tumors located in the frontal lobe. This part of the brain is highly involved in regulating personality and behaviour and it also helps controls a person’s behavior and emotions. Sudden mood change can be seen in persons whose pituitary gland has been affected by tumors. It can cause the gland to under-or overproduce hormones, leading to a hormonal imbalance. Getting to know about one’s diagnosis of brain tumor can greatly affect the mental and emotional state.


The above symptoms are a clear indication that one must immediately seek medical help. Upon diagnosis and conducting a range of neurological tests, your doctor will be able to identify and tell you what’s causing the symptoms.

If diagnosed with a tumor, one can identify the types and follow the doctor’s advice. Always remember that early diagnosis and treatment are important to help prevent the tumour from growing.

The writer is the Lead Consultant Neurosurgery & Program Director – Global Centre of Excellence in Neurosciences, Aster Hospitals Bengaluru.

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Medically Speaking


If practising yoga on an empty stomach works for you, do that. On the other hand, if you feel like eating something to get a better start to your day, consider something light.



In this fast-paced world, where we are all trying to cope with the hectic lifestyle, Yoga has become a preferred choice of exercise for many, not only to stay fit, active and agile but also to reduce stress and promote relaxation of the body and mind. With physical exercise, it becomes important to focus on the right nutrition and right diet as well.

So can you or should you practice Yoga on an empty stomach?

Well, there are many claims doing the rounds, with some saying it’s necessary to do yoga on an empty stomach and other’s saying it’s not. Some also consider eating the right breakfast is necessary. However, remember you and only you will know and understand your body, so make sure you listen to it, protect it and celebrate it.

While it is believed, working out in the morning on an empty stomach is the best approach, as you can get the best of your breath work and your yoga practice, nourishing your body allows a deeper yoga practice. It is necessary to have something light before you exercise in the morning to help jumpstart your metabolism. However, remember to avoid eating anything heavy for at least 4 hours before performing any asanas.

If you are looking for a great way to lose more weight, try practising Yoga while on intermittent fasting. It is one of the best morning workouts as it allows the body to use the stored fat as energy and is easy on the body. If you first eat something and then workout, your body will focus more on burning the food you just put into your body instead of your stored fat. Also doing high impact or cardio workouts while on fasts, requires you to burn a lot of energy because of the high intensity workouts. 

In the end, remember everyone’s body is different and reacts differently. What may work for us, will not work for others. It really comes down to observing and understanding your body, listening to what it likes and what it dislikes and what deems fit for you. If practising yoga on an empty stomach works for you, do that. On the other hand, if you feel like eating something to get a better start to your day, consider something light.

The writer is a fitness expert.

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Medically Speaking




A new study led by researchers at Harvard T.H. Chan School of Public Health has found that higher levels of optimism were associated with longer lifespan and living beyond age 90 in women across racial and ethnic groups.

The study was published in the Journal, ‘American Geriatrics Society’. “Although optimism itself may be affected by social structural factors, such as race and ethnicity, our research suggests that the benefits of optimism may hold across diverse groups,” said Hayami Koga, a PhD candidate in the Department of Social and Behavioral Sciences at Harvard Chan School and lead author of the study. “A lot of previous work has focused on deficits or risk factors that increase the risks for diseases and premature death. Our findings suggest that there’s value to focusing on positive psychological factors, like optimism, as possible new ways of promoting longevity and healthy ageing across diverse groups.”

In a previous study, the research group determined that optimism was linked to a longer lifespan and exceptional longevity, which was defined as living beyond 85 years of age. Because they had looked at mostly white populations in that previous study, Koga and her colleagues broadened the participant pool in the current study to include women from across racial and ethnic groups. According to Koga, including diverse populations in research is important to public health because these groups have higher mortality rates than white populations, and there is limited research about them to help inform health policy decisions.

For this study, the researchers analyzed data and survey responses from 159,255 participants in the Women’s Health Initiative, which included postmenopausal women in the U.S. The women enrolled at ages 50-79 from 1993 to 1998 and were followed for up to 26 years.

Of the participants, the 25 per cent who were the most optimistic were likely to have a 5.4 per cent longer lifespan and a 10 per cent greater likelihood of living beyond 90 years than the 25 per cent who were the least optimistic. The researchers also found no interaction between optimism and any categories of race and ethnicity, and these trends held true after taking into account demographics, chronic conditions, and depression. Lifestyle factors, such as regular exercise and healthy eating, accounted for less than a quarter of the optimism-lifespan association, indicating that other factors may be at play.

Koga said that the study’s results could reframe how people view the decisions that affect their health.

“We tend to focus on the negative risk factors that affect our health,” said Koga. “It is also important to think about the positive resources such as optimism that may be beneficial to our health, especially if we see that these benefits are seen across racial and ethnic groups.”

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Medically Speaking

Social isolation is a key reason for dementia



Scientists have found that a major reason for dementia is social isolation, which causes changes in the brain structures associated with memory, according to a study by the University of Warwick.

Setting out to investigate how social isolation and loneliness were related to later dementia, researchers at the University of Warwick, University of Cambridge and Fudan University used neuroimaging data from more than 30,000 participants in the UK Biobank data set. Socially isolated individuals were found to have lower gray matter volumes of brain regions involved in memory and learning.

The results of the study are published online today (June 8, 2022) in Neurology, the medical journal of the American Academy of Neurology, in a paper entitled “Associations of social isolation and loneliness with later dementia” by Shen, Rolls, Cheng, Kang, Dong, Xie, Zhao, Sahakian and Feng.

Based on data from the UK Biobank, an extremely large longitudinal cohort, the researchers used modelling techniques to investigate the relative associations of social isolation and loneliness with incident all-cause dementia. After adjusting for various risk factors (including socio-economic factors, chronic illness, lifestyle, depression and APOE genotype), socially isolated individuals were shown to have a 26% increased likelihood of developing dementia.

Loneliness was also associated with later dementia, but that association was not significant after adjusting for depression, which explained 75% of the relationship between loneliness and dementia. Therefore, relative to the subjective feeling of loneliness, objective social isolation is an independent risk factor for later dementia. Further subgroup analysis showed that the effect was prominent in those over 60 years old.

Professor Edmund Rolls, the neuroscientist from the University of Warwick Department of Computer Science, said: “There is a difference between social isolation, which is an objective state of low social connections, and loneliness, which is subjectively perceived social isolation.

“Both have risks to health but, using the extensive multi-modal data set from the UK Biocomputational scbank, and working in a multidisciplinary way linking sciences and neuroscience, we have been able to show that it is social isolation, rather than the feeling of loneliness, which is an independent risk factor for later dementia. This means it can be used as a predictor or biomarker for dementia in the UK.

“With the growing prevalence of social isolation and loneliness over the past decades, this has been a serious yet underappreciated public health problem. Now, in the shadow of the COVID-19 pandemic, there are implications for social relationship interventions and care — particularly in the older population.”

Professor Jianfeng Feng, from the University of Warwick Department of Computer Science, said: “We highlight the importance of an environmental method of reducing the risk of dementia in older adults through ensuring that they are not socially isolated. During any future pandemic lockdowns, it is important that individuals, especially older adults, do not experience social isolation.”

Professor Barbara J. Sahakian, of the University of Cambridge Department of Psychiatry, said: “Now that we know the risk to brain health and dementia of social isolation, it is important that the government and communities take action to ensure that older individuals have communication and interactions with others on a regular basis.”

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Medically Speaking

Controlling body weight in early life can prevent male infertility later



Controlling body weight more carefully during childhood and adolescence can be helpful in preventing male infertility later in life, suggests the findings of a recent study.

The researchers will be presented at the Endocrine Society’s annual meeting in Atlanta, Ga. The study finds that children and adolescents with overweight or obesity, or those who have high levels of insulin or insulin resistance tend to have smaller testicles compared with their peers with normal weight and insulin levels.

“More careful control of body weight in childhood and adolescence may help to maintain testicular function later in life,” said lead researcher Rossella Cannarella, M.D., of the University of Catania in Italy.

The prevalence of male infertility is increasing, and the average sperm count has been reduced by half in the past 40 years worldwide for no apparent reason, she said.

Testicular volume (a measure of testicle size) is directly related to sperm count. This means smaller testicles tend to produce less sperm. Up to one-quarter of young men aged 18-19 have low testicular volume or smaller-than-normal testicles. This puts their future fertility at risk, Cannarella said. At the same time, the prevalence of childhood obesity has increased.

“This evidence suggests a possible link between childhood obesity and the high prevalence of low testicular volume in youngsters,” she said.

To look for a possible link between low testicular volume and obesity, the researchers assessed testicular volume in 53 children and teens with overweight and 150 with obesity. Their results were compared to 61 age-matched healthy peers. The boys and teens with normal weight had a significantly higher testicular volume compared to their peers with obesity or overweight.

The study also looked at the relationship between obesity-related metabolic abnormalities, such as insulin resistance and hyperinsulinemia, on testicular volume. Insulin resistance is an impaired response of the body to insulin, resulting in elevated levels of glucose in the blood.

Hyperinsulinemia is abnormally high levels of insulin in the body. Children and teens with normal insulin levels had significantly higher testicular volume compared to those with hyperinsulinemia. Post-puberty teens with insulin resistance had lower testicular volume compared to those without insulin resistance.

“These findings help to explain the reason for the high prevalence of decreased testicular size in young men,” Cannarella said. 

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