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Cristina Mitchell

10 Jan 2023

DrNB Neurology
or Doctorate of National Board in Neurology also known as DrNB in Neurology is
a super specialty level course for doctors in India that is done by them after
completion of their postgraduate medical degree course. The duration of this super specialty course is 3
years, and it focuses on the diagnosis
and treatment of the central and peripheral nervous systems including their blood vessels, nerves, and muscles.

The course
is a full-time course pursued at various accredited institutes/hospitals across
the country. Some of the top accredited institutes/hospitals offering this
course include Amala Institute of Medical Sciences, Kerala, Apollo BGS Hospital,
Mysore, Karnataka, Apollo Hospital, Bangalore, Karnataka, and
more.

Admission to this course is done through the NEET-SS Entrance exam
conducted by the National Board of Examinations, followed by counseling based
on the scores of the exam that is conducted by DGHS/MCC/State Authorities.

The fee
for pursuing DrNB (Neurology) varies from accredited institutes/hospital to
hospital and may range from Rs.1,05,000 to
Rs.1,25,000 per annum.

After completion of their respective course, doctors can either join the
job market or can pursue certificate courses and Fellowship programs recognized by
NMC and NBE. Candidates can take reputed jobs at positions as Senior residents,
Consultants, etc. with an approximate salary range of
Rs.6,00,000 to Rs.60,00,000 per
annum.

DNB is equivalent to
MD/MS/DM/MCH degrees awarded respectively in medical and surgical super
specialties. The list of recognized qualifications awarded
by the Board in various broad and super specialties as approved by the
Government of India are included in the first schedule of the Indian Medical
Council Act, 1956.

The Diplomate of National Board in
broad-specialty qualifications and super specialty qualifications when
granted in a medical institution with the attached hospital or a hospital with
the strength of five hundred or more beds, by the National Board of
Examinations, shall be equivalent in all respects to the corresponding
postgraduate qualification and the super-specialty qualification granted under
the Act, but in all other cases, senior residency in a medical college for an
additional period of one year shall be required for such qualification to be
equivalent for teaching also.

What is DrNB in Neurology?

Doctorate of National Board in Neurology, also
known as DrNB (Neurology) or DrNB in (Neurology) is a three-year super
specialty program that candidates can pursue after completing a postgraduate
degree.

Neurology is the branch of medical science
dealing with the diagnosis and treatment of the central and peripheral nervous systems including their blood vessels, nerves, and muscles.

The National
Board of Examinations (NBE) has released a curriculum for DrNB in Neurology.

The curriculum
governs the education and
training of DrNB in Neurology.

The postgraduate students must gain ample knowledge and
experience in the diagnosis, and treatment of patients with acute, serious, and
life-threatening medical and surgical diseases.

PG education intends to create specialists who can
contribute to high-quality health care and advances in science through research
and training.

The required training done by a postgraduate specialist in
the field of Neurology would help
the specialist to recognize the health needs of the community. The student
should be competent to handle medical problems effectively and should be aware
of the recent advances in their specialty.

The candidate is also expected to know the principles of
research methodology and modes of the consulting library. The candidate should
regularly attend conferences, workshops, and CMEs to upgrade her/ his knowledge.

Course
Highlights

Here are some of the course highlights of DrNB in Neurology

Name of Course

DrNB in Neurology

Level

Doctorate

Duration of Course

Three years

Course Mode

Full Time

Minimum Academic Requirement

Candidates must have a postgraduate medical Degree in MD/DNB (General Medicine) or  MD/DNB (Paediatrics), this feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.

Admission Process /
Entrance Process / Entrance Modalities

Entrance Exam
(NEET-SS)

INI CET for various AIIMS, PGIMER Chandigarh, JIPMER Puducherry, NIMHANS Bengaluru

Counseling by DGHS/MCC/State Authorities

Course Fees

Rs.1,05,000 to Rs.1,25,000 per annum

Average Salary

Rs.6,00,000 to Rs.60,00,000 per annum

Eligibility Criteria

The eligibility criteria for DrNB in Neurology are defined as the
set of rules or minimum prerequisites that aspirants must meet to be
eligible for admission, which includes: 

Name of the super specialty course

Course Type

Prior Eligibility Requirement

Neurology

DrNB

MD/DNB (General Medicine)

MD/DNB (Paediatrics)

Note:

·
The feeder qualification for DrNB (Neurology) is defined by the NBE
and is subject to changes by the NBE.

·
The feeder qualification mentioned here
is as of 2022.

·
For any changes, please refer to the
NBE website.

• The prior entry qualifications shall be strictly
  by Post Graduate Medical Education Regulations, 2000, and its
  amendments notified by the NMC and any clarification issued from NMC in this
  regard.
• The candidate must have obtained permanent
  registration with any State Medical Council to be eligible for admission.
• The medical college's recognition cut-off dates
  for the Postgraduate Degree courses shall be as prescribed by the Medical
  Council of India (now NMC).

Admission Process

The admission process contains a few steps to
be followed in order by the candidates for admission to DrNB in Neurology. Candidates can view the complete admission
process for DrNB in Neurology
mentioned below:

• The NEET-SS or
  National Eligibility Entrance Test for Super specialty courses is a
  national-level master's level examination conducted by the NBE for admission to
  DM/MCh/DrNB Courses.
• Qualifying Criteria-Candidates placed at the
  50th percentile or above shall be declared as qualified in the NEET-SS in their
  respective specialty.
• The following medical institutions are not
  covered under centralized admissions for DM/MCh courses through NEET-SS:

1.
AIIMS, New Delhi, and other AIIMS

2.
PGIMER, Chandigarh

3.
JIPMER, Puducherry

4.
NIMHANS, Bengaluru

• Candidates from all eligible feeder specialty
  subjects shall be required to appear in the question paper of the respective group if they are willing to opt for a super specialty course in any of the super
  specialty courses covered in that group.
• A candidate can opt for appearing in the
  question papers of as many groups for which his/her Postgraduate specialty
  qualification is an eligible feeder qualification.
• By appearing in the question paper of a group
  and on qualifying for the examination, a candidate shall be eligible to exercise
  his/her choices in the counseling only for those super specialty subjects
  covered in the said group for which his/ her broad specialty is an eligible feeder
  qualification.

Fees Structure

The fee structure for DrNB in Neurology varies from accredited institute/hospital to hospital. The fee is
generally less for Government Institutes and more for private institutes. The average fee structure for DrNB in Neurology ranges from Rs.1,05,000 to Rs.1,25,000 per annum.

Colleges offering DrNB in Neurology

Various accredited institutes/hospitals across India offer courses for pursuing DrNB in Neurology.

As per the National Board of Examinations website, the following accredited
institutes/hospitals are offering DrNB (Neurology)
courses for the academic year 2022-23.

Hospital/Institute

Specialty

No. of Accredited Seat(s)
(Broad/Super/Fellowship)

Amala Institute of Medical Sciences
Amala Nagar, THRISSUR
Kerala-680553

Neurology

2

Apollo BGS Hospital
Adichunchanagiri Road, Kuvempunagar, Mysore
Karnataka-570023

Neurology

1

Apollo Hospital
154/11, Opp. I.I.M., Bannerghatta Road, Bangalore
Karnataka-560076

Neurology

2

Apollo Hospital
21, Greams lane, Off Greams Rd, Thousand Lights, Chennai.
Tamil Nadu-600006

Neurology

2

Apollo Hospital
A Unit of Apollo Hospital Enterprises Limited New No. 1, Old No. 28, Platform
Road, Near Mantri Mall, Sheshadripuram, Bengaluru
Karnataka-560020

Neurology

2

Apollo Hospital
Plot No. 251 Sainik School Road Unit-15, Bhubaneshwar
Orissa-751005

Neurology

2

Apollo Hospital
Room No. 306, Office of the Director of Medical Education Jubilee Hills,
Hyderabad
Telangana-500033

Neurology

2

Apollo Hospital International
Plot No. 1A, GIDC Estate Bhat, District - Gandhi Nagar
Gujarat-382428

Neurology

1

Apollo Multispecialty Hospitals Limited
58, Canal Circular Road, Kolkata
West Bengal-700054

Neurology

2

Army Hospital (R and R)
Delhi Cantt, New Delhi
Delhi-110010

Neurology

2

Artemis Health Institute
Sector 51, Gurgaon
Haryana-122001

Neurology

1

Aster Medcity
Kuttisahib Road, Near Kothad Bridge, South Chittoor P. O., Cheranalloor,
Kochi
Kerala-682027

Neurology

1

Baby Memorial Hospital
Indira Gandhi Road, Kozhikode
Kerala-673004

Neurology

2

Batra Hospital and Medical Research Centre
1, Tuglakabad Institutional Area, M.B. Road,
Delhi-110062

Neurology

1

Believers Church Medical College Hospital
St. Thomas Nagar, Kuttapuzha P O, Thiruvalla
Kerala-689103

Neurology

3

Bombay Hospital
IDA Scheme no 94/95, Ring Road, Indore
Madhya Pradesh-452010

Neurology

2

Care Hospital
Exhibition Road, Nampally, Hyderabad
Telangana-500001

Neurology

2

Care Hospital
Road No. 1, Banjara Hills, Hyderabad
Telangana-500034

Neurology

4

Caritas Hospital
Thellakom P. O Kottayam
Kerala-686630

Neurology

2

CHL Hospital
A.B Road, LIG Square, Indore
Madhya Pradesh-452008

Neurology

1

Choithram Hospital and Research Centre
Manik Bagh Road, INDORE
Madhya Pradesh-452014

Neurology

1

Cosmopolitan Hospital
Murinjapalam, Pattom P O, TRIVANDRUM
Kerala-695004

Neurology

1

Deenanath Mangeshkar Hospital and Research Centre.
8+13/2, Erandwane, Near Mhatre Bridge, Pune
Maharashtra-411004

Neurology

1

Dr. B L Kapur Memorial Hospital
Pusa Road, New Delhi
Delhi-110005

Neurology

2

Dr. Rajendra Prasad Govt. Medical College
Dist. Kangra At Tanda,
Himachal Pradesh-176002

Neurology

2

Dr. Ramesh Cardiac and Multispeciality Hospital
(Formerly Citi Cardiac Research Centre Ltd.) Ring Road, Near ITI College, Vijayawada
Andhra Pradesh-52008

Neurology

3

First Neuro, Brain and Spine Super Speciality Hospital
D.No.3-89/8, Kannur Village, Padil, Mangalore,
Karnataka-575007

Neurology

2

Fortis Escorts Hospital
Jawahar Lal Nehru Marg, Malviya Nagar, Jaipur
Rajasthan-302017

Neurology

2

Fortis Hospital
B-22, Sector-62, Noida
Uttar Pradesh-201301

Neurology

2

Fortis Hospital
Mulund Goregaon Link Road, Mumbai
Maharashtra-400078

Neurology

1

Fortis Hospital
Sector-62, Phase-VIII, Mohali
Punjab-160062

Neurology

2

Fortis Memorial Research Institute
Sector-44, Opposite HUDA CITY center Metro Station, Gurgaon,
Haryana-122002

Neurology

1

G Kuppuswamy Naidu Memorial Hospital
Post Box No. 6327, Nethaji Road, Pappanaickenpalayam, Coimbatore
Tamil Nadu-641037

Neurology

1

Global Hospital and Health City
(A unit of Ravindernath GE Medical Associate Pvt Ltd) No-439, Cheran Nagar,
Perumbakkam, Chennai
Tamil Nadu-600100

Neurology

1

Government Medical College
Karan- Nagar, Srinagar
Jammu and Kashmir-190010

Neurology

2

Govt. Medical College
B-5, Medical Enclave, Jammu
Jammu and Kashmir-180001

Neurology

2

Indira Gandhi Govt. General Hospital and PG Institute
No. 1, Rue Victor Simonal Street, PONDICHERRY
Pondicherry-605001

Neurology

2

Indo-American Hospital
Brain and Spine Centre, Chemmanakary, Near Vaikom
Kerala-686143

Neurology

1

Indraprastha Apollo Hospital
Delhi-Mathura Road, Sarita Vihar, New Delhi
Delhi-110076

Neurology

2

Institute of Neurosciences
185/1, A J C Bose Road, Kolkata
West Bengal-700017

Neurology

3

Institute of Neurosciences
Nr. Valentino Business Hub, Opp.Khatodra BRTS Bus Stand, Surat
Gujarat-395001

Neurology

2

Jaslok Hospital and Research Centre
15, Dr. Gopalrao Deshmukh Marg, Mumbai
Maharashtra-400026

Neurology

2

Kalinga Hospital
Bhubaneswar
Orissa-751023

Neurology

2

Kasturba Medical College Hospital (KMC Hospital)
Dr. B R Ambedkar Circle, Jyothi Balmatta Road, Mangalore
Karnataka-575001

Neurology

3

Kerala Institute of Medical Sciences
P B No.1, Anayara P O, Trivandrum
Kerala-695029

Neurology

3

Kokilaben Dhirubhai Ambani Hospital and Medical Research
Institute
Achyutrao Patwardhan Marg, 4 Bungalows, Andheri (W), Mumbai
Maharashtra-400053

Neurology

2

Kovai Medical Centre
Post Box No. 3209, Avinashi Road, Civil Arodrom Post, COIMBATORE
Tamil Nadu-641014

Neurology

1

Krishna Institute of Medical Sciences
1-8-31/1, Minister Road, Secunderabad
Telangana-500003

Neurology

3

Kunhitharuvai Memorial Charitable Trust (KMCT) Medical College
Hospital
Manassery P O, Mukkam Calicut
Kerala-673602

Neurology

2

Lalitha Super Specialty Hospital
Kothapet, Guntur
Andhra Pradesh-522001

Neurology

2

Latha Super Specialty Hospital
# 29-14-58, PRAKASAM ROAD, SURYARAOPET, VIJAYAWADA
Andhra Pradesh-520002

Neurology

2

Lokmanya Tilak Municipal Medical College and General Hospital,
Mumbai Maharashtra
Maharashtra-400022

Neurology

2

Malabar Institute of Medical Sciences
Mini Bye Pass, Govindapuram, Calicut
Kerala-673016

Neurology

2

Manipal Hospital
No. 98, Rustum Bagh, Old Airport Road, Bangalore
Karnataka-560017

Neurology

4

Max Super Specialty Hospital
(A unit of Balaji Medical and Diagnostic Research Centre) 108A, Opp Sanchar
Apartments, IP Extension, Patparganj, New Delhi
Delhi-110092

Neurology

2

Max Super Specialty Hospital
1,2, Press Enclave Road, Saket,
Delhi-110017

Neurology

3

Medanta The Medicity
Sector-38, Gurgaon
Haryana-122001

Neurology

4

Meitra Hospital
KARAPARAMBA-KUNDUPARAMBA MINI BYPASS ROAD, EDAKKAD POST, CALICUT
Kerala-673005

Neurology

2

MIMHANS NEUROSCIENCES HOSPITAL
281,283 SECTOR-1, MANGAL PANDEY NAGAR MEERUT
Uttar Pradesh-250004

Neurology

2

MMI Narayana Multispecialty Hospital
(Unit of Narayana Hrudayalaya Ltd.) Dhamtari Road, Lalpur
Chhattisgarh-492001

Neurology

2

Narayana Hrudayalaya Hospital
(NH-Narayana Health City, Bangalore) #258/A, Bommasandra Industrial Area,
Anekal Taluk, Bangalore
Karnataka-560099

Neurology

4

National Neuro Sciences Centre
Peerless Hospital Campus, 2nd Flr, 360 Panchasayar, Kolkata
West Bengal-94

Neurology

1

NEO Hospital
D-170A, Sector-50, NOIDA
Uttar Pradesh-201301

Neurology

2

P.D. Hinduja National Hospital and Medical Research Centre
Veer Savarkar Marg, Mahim, Mumbai
Maharashtra-400016

Neurology

2

Pacific Medical College and Hospital
Bhillo Ka Bedla, Amberi NH 76, Udaipur
Rajasthan-313001

Neurology

2

Paras HMRI Hospital
NH - 30, Raja Bazar, Bailey Road, Patna
Bihar-800014

Neurology

1

Paras Hospital
C-1, Shushant Lok Phase-I, Gurgaon
Haryana-122002

Neurology

1

Poona Hospital and Research Centre
27 Sadashivpeth, Pune
Maharashtra-411030

Neurology

1

Pt. B D Sharma, PGIMS,
Rohtak
Haryana-124001

Neurology

2

Rabindranath Tagore International Institute of Cardiac Sciences
Premises No.1489, 124, Mukundapur, E M Bypass, Near Santhoshpur Connector,
KOLKATA
West Bengal-700099

Neurology

2

Ramkrishna Care Hospital
Aurobindo Enclave, Pachpedhi Naka, Dhamtari Road, N. H. 43, Raipur
Chhattisgarh-492001

Neurology

2

Ruby Hall Clinic
40 Sassoon Road Pune
Maharashtra-411001

Neurology

1

Sahyadri Super Specialty Hospital
Plot No. 30C, Erandawane, Karve Road, Pune.
Maharashtra-411004

Neurology

1

Santokbha Durlabhji Memorial Hospital Cum Medical Research
Institute
Bhawani Singh Marg, JAIPUR
Rajasthan-302015

Neurology

3

Sarvodaya Hospital and Research Centre
YMCA Road, Sector-08, Faridabad
Haryana-121006

Neurology

2

Satguru Partap Singh Hospital
Sherpur Chowk, G T Road, Ludhiana
Punjab-141003

Neurology

1

Seven Hills Hospital
D.No-11-4-4/A, Rockdale Layout, Visakhapatnam
Andhra Pradesh-530002

Neurology

1

Shree Krishna Hospital associated with Paramukhswami Medical
College
Gokal Nagar, Karamsad, Anand
Gujarat-388325

Neurology

2

Shri Balaji Action Medical Institute
FC-34, A-4, Paschim Vihar, New Delhi
Delhi-110063

Neurology

1

Sir Ganga Ram Hospital
Rajinder Nagar, New Delhi
Delhi-110060

Neurology

4

Sir Hurkisondas Nurrotumdas Hospital and Research Centre
Raja Ram Mohan Roy Road, Gordhan Bapa Chowk, Prathana Samaj, Mumbai
Maharashtra-40004

Neurology

2

Sree Gokulam Medical College Research Foundation
Venjaramoodu P.O., Thiruvananthapuram
Kerala-695607

Neurology

1

SRM Institutes for Medical Sciences
No. 1, Jawaharlal Nehru Salai, 100 ft Road, Vadapalani, Chennai
Tamil Nadu-600026

Neurology

2

St. Stephen`s Hospital
Tees Hazari, New Delhi
Delhi-110054

Neurology

1

Star Hospital
8-2-596/5, RD. NO-10, Banjara Hills, Hyderabad
Telangana-500034

Neurology

1

Tamil Nadu Government Multi Superspeciality Hospital
Anna Salai, Chennai
Tamil Nadu-600007

Neurology

2

Uppal Neuro Hospital and Super Speciality Centre
4, Rani Ka Bagh, Amritsar
Punjab-143001

Neurology

2

Venkateshwar Hospital
Sector 18a, Dwarka,
Delhi-110075

Neurology

2

Yashoda Hospital
Behind Hari Hara Kala Bhawan, S.P. Road, Secunderabad
Telangana-500003

Neurology

2

Yashoda Super Speciality Hospital
Nalgonda X Road, Malakpet, Hyderabad
Telangana-500036

Neurology

2

Yashoda Super Speciality Hospital
Raj Bhavan Road, Somajiguda, Hyderabad
Telangana-500082

Neurology

2

Yenepoya Medical College Hospital
University Road, Deralakatte, Mangalore
Karnataka-575018

Neurology

2

Zydus Hospital
Near Sola Bridge, S G Highway, Ahmedabad
Gujarat-380054

Neurology

2

Syllabus

A DrNB
in Neurology is a three years specialization course that provides training
in the stream of Neurology.

The course
content for DrNB in Neurology is given in the NBE Curriculum released by the National Board of
Examinations, which can be assessed through the link mentioned below: 

DrNB Neurology In India: Check Out NBE Released Curriculum

1. The Clinical Method of Neurology

2. Cardinal Manifestations of Neurologic Disease

3. Growth and Development of the Nervous System

4. The Neurology of Aging

a. BASIC SCIENCES RELATED TO NEUROLOGY

i. NEUROANATOMY

The Neuroanatomy with special emphasis on the development of Neuraxis (brain, spinal cord and neurons, and glia), autonomic nervous system and their maturation process in the post-natal, childhood, and adolescent states; the location and significance of stem cells, CSF pathways, Blood supply and sinovenous drainage of the brain and spinal cord, the meninges, skull and vertebral column, the cranial nerves, spinal roots, plexuses, and their relation to neighboring structures; anatomy of peripheral nerves, neuromuscular junction and muscles; histology of cerebrum, cerebellum, pituitary gland, brain stem, and spinal cord, nerves and neuromuscular junction and muscle. Functional anatomy of lobes of the cerebrum and white matter tracts of the brain and spinal cord, craniovertebral junction, CONUS, and epic bonus and cauda equina, brachial and lumbosacral plexuses, cavernous and other venous sinuses; New developments in the understanding of ultrastructural anatomy of neurons, axonal transport, neural networks and synapses and nerve cell function at the molecular level.

ii. NEUROPHYSIOLOGY

Neurophysiology will cover all the physiological changes in the nervous system during its normal function with special reference to nerve impulse transmission along myelinated fibers, neuromuscular junction, and synaptic transmission, muscle contraction; visual, auditory, and somatosensory and cognitive evoked potentials; regulation of secretions by glands, neural control of viscera such as heart, respiration, GI tract, bladder, and sexual function; sleep-wake cycles; maintenance of consciousness, special senses, control of pituitary functions, control of autonomic functions, cerebellar functions, extrapyramidal functions, reflexes, upper and lower motor neuron concepts, and sensory system.

iii. MOLECULAR BIOLOGY

The brain is the one structure where maximum genes are expressed in the human body. Principles of molecular biology including Gene Structure, Expression, and regulation; Recombinant DNA Technology; PCR Techniques, Molecular basis for neuronal and glial function, Molecular and cellular biology of the membranes and ion-channels, mitochondrial genome, the role of RNA in normal neuronal growth and functional expression, receptors of neurotransmitters, molecular and cellular biology of muscles and neuromuscular junction, etc, The Human Genome and its future implications for Neurology including developmental and neurogenetic disorders, bioethical implications and genetic counseling, Nerve growth and other trophic factors and neuroprotectors, Neural Tissue modification by genetic approaches including Gene Transfer, stem cell therapy, etc, Molecular Development of neural tissue in peripheral nerve repair are exciting areas where stunned to have basic exposure.

iv. NEUROCHEMISTRY

All aspects of normal and abnormal patterns of neurochemistry including neurotransmitters associated with different anatomical and functional areas of the brain and spinal cord, especially concerning dopaminergic, serotoninergic, adrenergic, and cholinergic systems, opioids, excitatory and inhibitory amino acids; their role in the pathogenesis of parkinsonism, depression, migraine, dementia, 8 epilepsy; neuromuscular junction and muscle contractions; carbohydrate, amino acid, and lipid metabolism and the neural expression of disorders of their metabolism, electrolytes and their effect on encephalopathies and muscle membrane function, storage disorders, porphyrias

v. NEUROPHARMACOLOGY

The application of neuropharmacology is the mainstay of all medical therapy for epilepsy, Parkinsonism, movement disorders, neuropsychiatric syndromes, spasticity, pain syndromes, and disorders of sleep and dysautonomic syndromes. Their drug interactions with commonly used other drugs, usage during disorders of renal, and hepatic function and in the demented, their adverse reactions, etc.

vi. NEUROPATHOLOGY

All pathological changes in various neurological diseases with special reference vascular, immune-mediated, de/dysmyelinating, metabolic and nutritional, genetic and developmental, infectious and iatrogenic, and neoplastic aetiologies to clinical correlation included. Special emphasis on pathological changes in nerve and muscle in neuropathies and myopathies. Ultrastructural pathologies such as apoptosis, ubiquitinopathies, mitochondrion, channelopathies, peroxisomal disorders, inclusion bodies, prion diseases, disorders mediated by antibodies against various cell and nuclear components, paraneoplastic disorders, etc.

vii. NEUROMICROBIOLOGY

The various microbiological aspects of infectious neurologic diseases including encephalitis, meningitis, brain abscess, granulomas, myelitis, cold abscess, cerebral malaria, parasitic cysts of the nervous system, rhinocerebral mycoses, leprous neuritis, neuroleptospirosis, Primary and secondary Neuro HIV infections, congenital TORCH infections of the brain, slow virus infections such as JCD and SSPE, neurological complications of viral infections such as Polio, EBV, Chickenpox, Rabies, Herpes, Japanese encephalitis, and other epidemic viral infections

viii. NEUROTOXICOLOGY

Organophosphorus poisoning, hydrocarbon poisoning, lead, arsenic, botulinum toxin, and tetanus toxicity, snake, scorpion, spider, wasp, and bee stings are important tropical neurotoxic syndromes whose prompt diagnosis and effective therapy are crucial in life-saving

ix. NEUROGENETICS AND PROTEOMICS:

Autosomal dominant and recessive and X-linked inheritance patterns, disorders of chromosomal anomalies, Gene mutations, trinucleotide repeats, dysregulation of gene expressions, enzyme deficiency syndromes, storage disorders, disorders of polygenic inheritance, and proteomics in health and disease

x. NEUROEPIDEMIOLOGY:

Basic methodologies in community and hospital-based neuroepidemiological studies such as systematic data collection, analysis, derivation of logical conclusions, concepts of case-control and cohort studies, correlations, regressions, and survival analysis; basic principles of clinical trials. 9 snake envenomation

b. CLINICAL NEUROLOGY INCLUDING PEDIATRIC NEUROLOGY AND NEURO PSYCHIATRY.

i. GENERAL EVALUATION OF THE PATIENT

The science and art of history taking, Physical Examination including elements of accurate history taking, symptoms associated with neurological disease, The physical examination of adults, children, infants, and neonates, syndromes associated with congenital and acquired neurological disease, cutaneous markers, examination of unconscious patients, examination of higher mental functions, cranial nerves, the ocular fundus, examination of tone, power of muscles, proper elicitation of superficial and deep reflexes including the alternate techniques and neonatal and released reflexes, neurodevelopmental assessment of children, sensory system, peripheral nerves, signs of Meningeal irritation, skull and spine examination including measurement of head circumference, shortness of neck and carotid pulsations .and vertebral bruits.

o COMA

Pathophysiology and diagnosis of COMA, Diagnosis, and management of coma, delirium and acute confusional states, reversible and irreversible causes, persistent vegetative states and brain death, neurophysiological evaluation and confirmation of these states and mechanical ventilation and other supportive measures of comatose patient and prevention of complications of prolonged coma. The significance of timely brain death in organ donation and ICU resource utilization

o SEIZURES AND EPILEPSY and SYNCOPES

Diagnosis of seizures, epilepsy, and epileptic syndromes, Recognition, clinical assessment, and management of seizures especially their electrodiagnosis, video monitoring with emphasis on phenomenology and their correlation with EEG and structural and functional brain imaging such as CT and MRI, and fMRI, and SPECT scan, Special situations such as epilepsy in pregnant and nursing mothers, driving, risky occupations, its social stigmas differentiation from pseudoseizures, use of conventional and newer antiepileptic drugs, their drug interactions and adverse effects, etc., modern lines of management of intractable epilepsies, such as ketogenic diet, vagal nerve stimulation, epilepsy surgery and about the presurgical evaluation of patients. Management of status epilepticus and refractory status epilepticus; Differentiation of seizures from syncopes, drop attacks, cataplexy, startles, etc.

o HEADACHES AND OTHER CRANIAL NEURALGIAS

Acquisition of skills in the analysis of headaches of various causes such as those from raised intracranial pressures, migraines, cranial neuralgias, vascular malformations, Meningeal irritation, psychogenic, etc., and their proper pharmacologic management.

ii. CEREBROVASCULAR DISEASES

Vascular anatomy of the brain and spinal cord, various causes and types of cerebrovascular syndromes, ischemic and hemorrhagic types, arterial and venous types, anterior and posterior circulation strokes, OCSP and TOAST classifications, investigations of strokes including neuroimaging using dopplers, CT and MR imaging and angiography, acute stroke therapy including thrombolytic therapy, interventional therapy of cerebrovascular diseases, principles of management of subarachnoid hemorrhage, etc. Special situations Pathophysiology and diagnosis of COMA, Diagnosis, and management of coma, delirium and acute confusional states, reversible and irreversible causes, persistent vegetative states and brain death, neurophysiological evaluation and confirmation of these states and mechanical ventilation and other supportive measures of comatose patient and prevention of complications of prolonged coma. The significance of timely brain death in organ donation and ICU resource utilization

o SEI ZURES AND EPILEPSY and SYNCOPES

Diagnosis of seizures, epilepsy, and epileptic syndromes, Recognition, clinical assessment, and management of seizures especially their electrodiagnosis, video monitoring with emphasis on phenomenology and their correlation with EEG and structural and functional brain imaging such as CT and MRI, and fMRI, and SPECT scan, Special situations such as epilepsy in pregnant and nursing mothers, driving, risky occupations, its social stigmas differentiation from pseudoseizures, use of conventional and newer antiepileptic drugs, their drug interactions and adverse effects, etc., modern lines of management of intractable epilepsies, such as ketogenic diet, vagal nerve stimulation, epilepsy surgery and about the presurgical evaluation of patients. Management of status epilepticus and refractory status epilepticus; Differentiation of seizures from syncopes, drop attacks, cataplexy, startles, etc.

o HEADACHES AND OTHER CRANIAL NEURALGIAS

Acquisition of skills in the analysis of headaches of various causes such as those from raised intracranial pressures, migraines, cranial neuralgias, vascular malformations, Meningeal irritation, psychogenic, etc., and their proper pharmacologic management.

ii. CEREBROVASCULAR DISEASES

Vascular anatomy of the brain and spinal cord, various causes and types of cerebrovascular syndromes, ischemic and hemorrhagic types, arterial and venous types, anterior and posterior circulation strokes, OCSP and TOAST classifications, investigations of strokes including neuroimaging using dopplers, CT and MR imaging and angiography, acute stroke therapy including thrombolytic therapy, interventional therapy of cerebrovascular diseases, principles of management of subarachnoid hemorrhage, etc. Special situations like strokes in the young, Strategies for primary and secondary prevention of stroke

iii. DEMENTIAS

Concept of minimal cognitive impairment, Reversible and irreversible dementias, causes such as Alzheimer's and other neurodegenerative diseases and vascular and nutritional and infectious dementias, their impact on individual, family and in society, Genetic and familial syndromes. Pharmacotherapy of dementias, Potential roles of cognitive rehabilitation and special care of the disabled

iv. PARKINSONISM AND MOVEMENT DISORDERS

Disorders of the extrapyramidal system such as parkinsonism, chorea, dystonias, athetosis, tics, their diagnosis and management, pharmacotherapy of parkinsonism and its complications, management of complications of parkinsonism therapy, including principles of deep brain stimulation and lesionalsurgeries. Use of EMG-guided botulinum toxin therapy, management of spasticity using intrathecal baclofen and TENS.

v. ATAXIC SYNDROMES:

Para infectious demyelinations, cerebellar tumors, hereditary ataxias, vestibular disorders; Diagnosis and management of brainstem disorders, axial and extra-axial differentiation. `

vi. CRANIAL NEUROPATHIES:

Disorders of smell, vision, visual pathways, pupllarypatheays and reflexes, internuclear and supranuclear ophthalmoplegia; other oculomotor disorders, trigeminal nerve testing, Bell's palsy, differentiation from UMN facial lesions, brainstem reflexes, Investigations of vertigo and dizziness, differentiation between central and peripheral vertigo, Differential diagnosis of nystagmus, investigations of deafness, bulbar and pseudobulbar syndromes,

vii. CNS INFECTIONS:

Diagnosis and management of viral encephalitis, meningitis: bacterial, tuberculous, fungal, parasitic infections such as cysticercosis, cerebral malaria, SSPE, Neuro HIV primary and secondary infections with exposure to gram stain and cultures, bac tec, QBC, ELISA, and PCR technologies

viii. NEUROIMMUNOLOGIC DISEASES

Diagnosis and management of CNS conditions such as Multiple sclerosis, PNS conditions such as GBS, CIDP, Myasthenia gravis, polymyositis

ix. NEUROGENETIC DISORDERS

Various chromosomal diseases, single gene mutations such as enzyme deficiencies, autosomal dominant and recessive conditions, X-linked disorders, trinucleotide repeats, and disorders of DNA repair. Genetics of Huntington's disease, familial dementias, other storage disorders, hereditary ataxias, hereditary spastic paraplegias, HMSN, muscular dystrophies, mitochondrial inheritance disorders

x. DEVELOPMENTAL DISORDERS OF NERVOUS SYSTEM

Neuronal migration disorders, craniovertebral junction diseases, spinal dysraphisms, phacomatoses, and other neurocutaneous syndromes- their recognition and management.

xi. MYELOPATHIES

Clinical diagnosis of distinction between compressive and non-compressive myelopathies, spinal syndromes such as anterior cord, subacute combined degeneration, central cord syndrome, Brown-secured syndrome, tabetic syndrome, Ellsberg phenomenon. Diagnosis of the spinal cord and root compression syndromes, CV junction lesions, syringomyelia, conuscauda lesions, spinal AVMs, tropical and hereditary spastic paraplegias, and Fluorosis.

xii. PERIPHERAL NEUROPATHIES

Immune-mediated, hereditary, toxic, nutritional, and infectious type peripheral neuropathies; their clinical and electrophysiological diagnosis

xiii. MYOPATHIES AND NEUROMUSCULAR JUNCTION DISORDERS

Clinical evaluation of patients with known or suspected muscle diseases aided by EMG, muscle pathology, histochemistry, immunopathology, and genetic studies. Dystrophies, polymyositis, channelopathies, congenital and mitochondrial myopathies. Neuromuscular junction disorders such as myasthenia, botulism, Eaton-lambert syndrome, and snake eandorgganphosphorus poisoning, their electrophysiological diagnosis, and management. Myotonia, stiff person syndrome.

xiv. PEDIATRIC NEUROLOGY:

Normal development of motor and mental milestones in a child, Cerebral palsy, Attention deficit disorder, Autism, developmental dyslexias, Intrauterine TORCH infections, Storage disorders, Inborn errors of metabolism affecting the nervous system, developmental malformations, Child hood seizures and epilepsies, neurodegenerative diseases.

xv. COGNITIVE NEUROLOGY AND NEUROPSYCHIATRY:

Detailed techniques of higher mental functions evaluation, basics of primary and secondary neuropsychiatric conditions such as anxiety, depression, schizophrenia, acute psychosis, acute confusional reactions (delirium), organic brain syndrome, primary and secondary dementias, differentiation from pseudodementia, Anxiety disorders, Hysteria and personality disorders, depression and Bipolar disease, Schizophrenia Delusional, and paranoid state

xvi. TROPICAL NEUROLOGY

Conditions that are specifically found in the tropics like neuro cysticercosis, cerebral malaria, tropical spastic paraplegia, Snake/scorpion/ Chandipura encephalitis, Madras Motor Neuron disease, etc. will be dealt with in special detail in the curriculum

c. DIAGNOSTIC AND INTERVENTIONAL NEUROLOGY INCLUDING NEUROLOGICAL INSTRUMENTATION

i. DIAGNOSTIC NEUROLOG

Performing and interpreting Digital Electroneurogram, Electromyogram, Evoked potentials, Electroencephalography, Interpretation of skull and spine X-rays, computerized tomography of brain and spine, Magnetic resonance images of the brain including correct identification of various sequences, angiograms, MR spectroscopy, basics of functional MRI, Interpretation of digital subtraction imaging, SPECT scans of the brain, subdural EEG recording, transsphenoidal electrode EEG Techniques for temporal lobe seizures, video EEG interpretation of phenomenology and EEG-phenomenology correlations, EEG telemetry, Transcranial Doppler diagnosis and monitoring of acute ischemic stroke, subarachnoid hemorrhage, detection of right-to-left shunts, etc; Colour duplex scanning in Carotid and vertebral extracranial segment screening

ii. NEUROINSTRUMENTATIONS

To acquire skills in Procedures like a)intrathecal administration of antispasticity drugs, beta interferons in demyelination, opiates in intractable pain, etc., b) EMG-guided Botox therapy for dystonias, c) subcutaneous administration of antimigraine and antiparkinsonian drugs d) Intraarterial thrombolysis in extended windows of thrombolysis in ischemic strokes, e) Transcranial Ultrasound clot-bust intervention in a registry in acute stroke care unit e) Planing in deep brain stimulation therapy in uncontrolled dyskinesias and onoff phenomena in long-standing parkinsonism f) Planning in vagal nerve stimulation in intractable epilepsy

d. RECENT ADVANCES IN NEUROLOGY: ADVANCES IN NEUROIMAGING TECHNIQUES, BIONICS IN NEURAL PROSTHESIS AND REHABILITATION, NEUROPROTEOMICS AND NEUROGENETICS, STEM CELL AND GENE Y, GENE THERAPY

i. ADVANCES IN NEUROIMAGING TECHNIQUES:

Integration of CT, MR, and SPECT images with each other and with EEG, EVOKED potentials based brain maps in structural and functional localization in neurological phenomena and diseases, Fluorescent ye tagged study of neurons in diseases in animal models in vivo and tissue cultures in-vitro.

ii. BIONICS IN NEURAL PROSTHESIS AND REHABILITATION:

Advanced techniques in neurorehabilitation such as TENS, principles of man-machine interphase devices in the cord, nerve and plexus injuries, cochlear implants, and artificial vision.

iii. NEUROPROTEOMICS AND NEUROGENETICS:

Brain functions are regulated by proteomics and genomics linked to various proteins and genes relevant to the brain, the body's maximum number of proteins and genes are expressed in the brain as neurotransmitters or channel proteins and predisposing the brain to several disorders of abnormal functioning of these proteins.

iv. STEM CELL AND GENE THERAPY:

Principles of ongoing experiments on stem cell therapy for nervous system disorders such as fetal brain tissue transplants in parkinsonism; intrathecal marrow transplants in MND, MS, and Spinal trauma; myoblasts infusion therapy in dystrophies

Career Options

After completing a DrNB in Neurology, candidates will get
employment opportunities in Government and the Private sector.

In the Government sector,
candidates have various options to choose from which include Registrar, Senior
Resident, Demonstrator, Tutor, etc.

While in the Private sector, the
options include Resident Doctor, Consultant, Visiting Consultant (Neurology),
Junior Consultant, Senior Consultant (Neurology),
etc.

Courses After DrNB
in Neurology Course

DrNB in Neurology is a specialization course that
can be pursued after finishing a Postgraduate medical course. After pursuing a specialization in DrNB in Neurology,
a candidate could also pursue certificate courses and Fellowship programs
recognized by NMC and NBE, where DrNB in
Neurology is a feeder qualification.

These include:

• Fellowship in Neurology
• Ph.D. (Neurophysiology)
• Ph.D. (Clinical Neuroscience)

Frequently Asked Questions (FAQs) – DrNB
in Neurology Course

Question: What is the complete form of DrNB?

Answer: The full form of DrNB is a Doctorate of
National Board.

Question: What is a DrNB in Neurology?

Answer: DrNB Neurology or Doctorate of National Board
in Neurology also known as DrNB in Neurology is a super specialty level course for doctors in India that is done by
them after completion of their postgraduate medical degree course.

Question: What is the duration of a DrNB in Neurology?

Answer: DrNB in Neurology is a
super specialty program of three years.

Question: What is the eligibility of a DrNB in Neurology?

Answer: Candidates must have a postgraduate medical Degree in MD/DNB (General Medicine) or MD/DNB (Paediatrics), this feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.

Question:
What is the scope of a DrNB in Neurology?

Answer:
DrNB in Neurology offers candidates
various employment opportunities and career prospects.

Question:
What is the average salary for a DrNB in
Neurology candidate?

Answer:
The DrNB in Neurology candidate's
average salary is Rs.6,00,000 – Rs.60,00,000 per annum depending on the
experience.

Question: Can you teach after completing DrNB Course?

Answer: Yes, the candidate can teach in a medical
college/hospital after completing the DrNB course.

One of them is Magna Elena Ramos, who lives in San Carlos, where the Ministry of Public Health (MSP) identified two positive individuals of Haitian origin with the disease last Friday. She is concerned about the disease’s potential for harm. “It’s dangerous if you don’t attend to yourself on time, which is why you have to eat healthy and nothing from the street,” she explained.

Another resident of the sector who only eats food prepared at home José de la Rosa said that street food is the most likely to spread the disease. “You can’t get it at home, but if you eat nonsense on the streets, you’ll get it because they’re not made with the same hygiene,” he said emphatically. Santiago Nuñez, who also lives in San Carlos, has urged authorities to stop the spread of cholera to prevent more cases, particularly among children, the elderly, and people with pre-existing diseases, who are the most vulnerable to death. Similarly, the gentleman urged citizens to follow the recommendations of the health portfolio and specialists to combat the condition.

Because suspicious cases have emerged, some Villas Agricolas residents are also tightening hygiene standards to avoid being included in the bacterial condition’s statistical reports. This is what Ramón Fernández is doing, who has made washing his hands before eating and after using the restroom a daily priority to avoid contracting the disease. Similarly, Julio de Los Santos, who has lived in the neighborhood for years, stated that the population must help the government contain the contagion by taking the necessary precautions.

 

According to the 1,024 reports of the General Directorate of Epidemiology of the Ministry of Public Health, in the last 24 hours, 1,310 tests were performed, of which 1,292 were antigenic and another 18 were Polymerase Chain Reaction (PCR), of which 817 were performed for the first time, and 493 were subsequent.

216 new cases of COVID in the past 24 hours

COVID Statistics
Daily positivity levels remain at 7.47%, while that of the last four weeks stands at 10.26%, and the lethality of the virus is 0.66%, with 4,384 deaths in total, with the last death recorded over half a year ago in the month of June 2022.

Hospital occupancy also shows a decrease in statistics, as only 17 occupied beds in the COVID network and four intensive care units, while no mechanical ventilators are in use.

It inflicts collective trauma on the society, and this is readily apparent in the immediate aftermath of sudden death episodes, especially in places like Jamaica with poorly coordinated emergency response networks and weak cardiovascular care infrastructure where happy endings are not usually the case as opposed to the illustrative cases in the USA and Denmark. It exposes our collective vulnerability and impotence in responding to such a public health concern.

Take for instance 24-year-old NFL player Damar Hamlin who, after suffering a sudden cardiac arrest during a Buffalo Bills game earlier in the week, remains in critical condition in the intensive care unit but is showing signs of improvement. Hamlin benefited from prompt cardiopulmonary resuscitation and his heartbeat was restored on the field before he was transported to the University of Cincinnati Medical Centre where he remains sedated and on a ventilator. The cause of his cardiac arrest remains unclear.

Here in Jamaica, the sudden death of Richard Bernal, Jamaica's former ambassador to the United States, was reported just a short while ago, apparently from cardiac arrest. Bernal reportedly collapsed while walking in Norbrook, St Andrew, with his wife. It is unclear if cardiopulmonary resuscitation was initiated and to what extent resuscitative efforts were administered.

In April 2021 we published an article in our column here highlighting sudden death and proffered recommendations for a systematic approach to reducing the risk of sudden death within the population. In June 2021 we followed up with another article on cardiac arrest in the young following the cardiac arrest episode of young Christian Erickson, a Danish footballer who suffered a sudden death episode on the pitch at Parken in Copenhagen during his side's Euro 2020 Group B match with Finland. This tragic event was telecast to a live audience of thousands of viewers around the world. Fortunately, as with the 24-year-old Damar Hamlin, the 29-year-old midfielder was successfully resuscitated and was fitted with a heart starter, implantable cardioverter defibrillator (ICD) to protect him from further sudden death episodes. In a testament to modern science and good quality health care, in January 2022 Erickson returned to the Premier League as he signed a six-month contract with newly promoted Brentford. This is validation of the need to develop a functional cardiovascular care infrastructure even here on our own island.

It is imperative therefore that we must continue to work towards resolving the friction points that impede rapid access to appropriate care while concomitantly working to encourage the development of high-quality health-care systems anchored on international standards and best practices. Even though many causes of sudden death are not fully characterised, most sudden death episodes have an underlying cardiovascular cause, so improving overall cardiovascular prevention and treatment strategies within the population will have a major impact in identifying individuals at risk for sudden death and will help in proactively acting to reduce or mitigate those risks.

Understanding sudden death syndrome (SDS)

Sudden death syndrome (SDS) is a generic phrase used to define a complex group of cardiac-related conditions that predispose individuals to cardiac arrest, and ultimately death, in the absence of prompt cardiopulmonary resuscitation followed by definitive care in a cardiac intensive care unit — which most likely would include prompt placement of an implantable cardioverter defibrillator. While cardiac arrest is not the same thing as a heart attack it must be noted that a heart attack may lead to sudden death, and so in both situations timely intervention is critical to prevent death.

Cardiac arrest remains a public health crisis. According to a recent report from the American Heart Association (AHA) titled Heart and Stroke Statistics-2022 Update, more than 356,000 out-of-hospital cardiac arrests (OHCA) occur annually in the US, nearly 90 per cent of them fatal. The incidence of non-traumatic OHCA in people of any age attended by emergency medical personnel in the USA is estimated to be 356,461, or nearly 1,000 people each day. Survival to hospital discharge after EMS-treated cardiac arrest is only about 10 per cent. Figures for Jamaica are unknown but most likely not comforting.

It is estimated that sudden cardiac death occurs every three days in the United States among competitive athletes. We do not have reliable information on the prevalence of sudden cardiac death among athletes in Jamaica but, based on media reports, we believe that the incidence is rising both for young athletes and the general population.

The frequency at which sudden death episodes occur by sex, age, race, nationality, and sport is also not fully clarified. However, an estimated 3-15 per cent of athletes at risk for sudden death may be identified through structured and standardised screening. Such young athletes may benefit from structured evaluation using the HIC Play Smart Cardiovascular Screening programme which provides systematic evaluation with a structured medical history and examination, complemented with other cardiovascular diagnostic testing modalities including echocardiograms, stress testing and ambulatory electrocardiogram monitoring as directed by the risk profile. This template can serve as a foundation for an organised national screening programme for Jamaica.

There are several challenges to understanding the epidemiology of cardiac arrest. Despite being a leading cause of death in many countries, there are currently no global standards for surveillance to monitor the incidence and outcomes of cardiac arrest. Currently, registries and clinical trials are the only tools used to provide best estimates.

Structural abnormalities in the heart or problems with the electrical channels and conduction systems in the heart account for many cases of sudden death. Heart function depends on proper function and synchronic coordination of the electrical and mechanical systems of the heart. Any disturbance in the origination or transmission of electrical signals will ultimately impair the mechanical function and may predispose individuals to sudden death episodes. Some of these disorders may have genetic or familial predispositions and, in such cases, clusters of sudden death episodes may be seen within families. Because many individuals at risk may appear healthy and are asymptomatic or have infrequent symptoms, many people at risk may not be recognised until a sudden death episode occurs.

Next week we will look at who is at risk for sudden death and recognising early symptoms of sudden death.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@caribbeanheart.com or call 876-906-2107

Happy new year! As we embark on a new year many will be making resolutions for a fresh start going forward. However, somewhere between the new year and March those vows get broken. Family and work obligations take over and it's goodbye resolutions until next year. This year, try a trick that may seem strange — downsize your expectations. That's right! Go for less and get more.

1. Slowly start working out more

2. Get enough sleep

3. Drink lots of water

4. Visit your primary care doctor to discuss your weight, diet and any problems you are having. Also, ask about what screenings including blood pressure, blood sugar, cholesterol, and vaccines you'll need throughout the year.

Remember, you can't rebuild your body and redesign your health in a single leap but if you take enough baby steps you can make big strides towards a healthier and happier new you.

Dr David Kerr is a general practitioner who cares for the holistic health and wellness of his patients. Contact information – Doctor's office: Shop #2 , 50 Clock Tower Plaza, Kingston 10. Cell: (876) 502-1437; Landline: (876) 678-5215; E-mail: drdavidskerr@gmail.com; Social media: IG: @drdavidkerr Youtube: Dr David Kerr; Facebook : @drdavidskerr; Tiktok: @ drdavidkerr

Posted: Saturday, January 7, 2023. 8:03 am CST.

Photo Credit: Rubén Morales Iglesias

By Rubén Morales Iglesias: Belize Agricultural Health Authority (BAHA) has increased its surveillance measures to contain the Highly Pathogenic Avian Influenza (HPAI) H5N1, or bird flu, from entering Belize as the disease had already made its presence in pelicans on the coast of Puerto Cortes and La Ceiba, Honduras.

“Categorically, we are still free of avian influenza, and we plan to remain so,” Interim Chief Veterinary Officer at BAHA Dr Joe Myers told Breaking Belize News.

Dr Myers said BAHA has received reports of sick pelicans in Belize City and Placencia, but it verified that none were sick with avian influenza.

“We’ve been meeting since the 27th of April, so we’ve been well ahead of the game, so to speak, but the way the disease has been travelling, via wild birds, it’s imminent that it will eventually reach here, so we have to buckle up,” Dr Myers said.

“Initially it was diagnosed in Panama about a month ago. And then the day before yesterday, it was diagnosed in Puerto Cortes, Honduras, which is right across the bay,”

Myers said that BAHA established communication with the Forest Department which has its Wildlife Partners like the Belize Zoo and the Belize Wildlife Referral Clinic, and to avoid information being channeled improperly it was decided that these organizations should inform the Forest Department which in turn will inform BAHA.

Dr Myers said the bird flu can affect humans, so if a bird is found sick or dead, BAHA should be informed within 24 hours, but the bird or birds should only be handled by BAHA trained personnel. In cases when a bird is almost decomposed, it should be burned, but an investigation will still be carried out.

“Ideally, we would want to test the bird, but we also want to preserve life. We don’t want to risk human life just to take a sample,” Dr Myers said.

“It’s a flu, and like every other disease, the old, the young, the immune compromised, almost like COVID, are at risk,” Dr Myers said adding that the people that could be severely affected are almost the same as Covid-19, people who suffer from high blood pressure and diabetes, and the control measures are pretty much the same involving masking and washing hands properly.

So, it’s best not to touch a sick or dead bird.

What a person has to do is inform BAHA immediately. That can be done directly or through the Ministry of Agriculture, the Forest Department, the Ministry of Health and Wellness, the Belize Poultry Association, or any registered veterinarian.

 

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Scar tissue in the skin lacks hair, sweat
glands, blood vessels and nerves, which are vital for regulating body
temperature and detecting pain and other sensations. Scarring can also impair
movement as well as potentially causing discomfort and emotional distress.

In a new study involving three volunteers,
skin scars began to behave more like uninjured skin after they were treated
with hair follicle transplants. The scarred skin harboured new cells and blood
vessels, remodelled collagen to restore healthy patterns, and even expressed
genes found in healthy unscarred skin.

The findings could lead to better treatments
for scarring both on the skin and inside the body, leading to hope for patients
with extensive scarring, which can impair organ function and cause
disability.

Lead author Dr Claire Higgins, of Imperial’s
Department of Bioengineering, said: “After scarring, the skin never truly
regains its pre-wound functions, and until now all efforts to remodel scars
have yielded poor results. Our findings lay the foundation for exciting new
therapies that can rejuvenate even mature scars and restore the function of
healthy skin.”

The research is published in Nature
Regenerative Medicine.

Hope in hair

Compared to scar tissue, healthy skin undergoes
constant remodelling by the hair follicle. Hairy skin heals faster and scars
less than non-hairy skin– and hair transplants had previously been shown to aid
wound healing. Inspired by this, the researchers hypothesised that
transplanting growing hair follicles into scar tissue might induce scars to
remodel themselves.

To test their hypothesis, Imperial researchers
worked with Dr Francisco Jiménez, lead hair transplant surgeon at the
Mediteknia Clinic and Associate Research Professor at University Fernando
Pessoa Canarias, in Gran Canaria, Spain. They transplanted hair follicles into
the mature scars on the scalp of three participants in 2017. The researchers
selected the most common type of scar, called normotrophic scars, which usually
form after surgery.

They took and microscope imaged 3mm-thick
biopsies of the scars just before transplantation, and then again at two, four,
and six months afterwards.

The researchers found that the follicles
inspired profound architectural and genetic shifts in the scars towards a
profile of healthy, uninjured skin.

Dr Jiménez said: “Around 100 million people
per year acquire scars in high-income countries alone, primarily as a result of
surgeries. The global incidence of scars is much higher and includes extensive
scarring formed after burn and traumatic injuries. Our work opens new avenues
for treating scars and could even change our approach to preventing them.”

Architects of skin

After transplantation, the follicles continued
to produce hair and induced restoration across skin layers.

Scarring causes the outermost layer of skin –
the epidermis – to thin out, leaving it vulnerable to tears. At six months
post-transplant, the epidermis had doubled in thickness alongside increased
cell growth, bringing it to around the same thickness as uninjured skin.

The next skin layer down, the dermis, is
populated with connective tissue, blood vessels, sweat glands, nerves, and hair
follicles. Scar maturation leaves the dermis with fewer cells and blood
vessels, but after transplantation the number of cells had doubled at six
months, and the number of vessels had reached nearly healthy-skin levels by
four months. This demonstrated that the follicles inspired the growth of new
cells and blood vessels in the scars, which are unable to do this unaided.

Scarring also increases the density of
collagen fibres - a major structural protein in skin – which causes them to
align such that scar tissue is stiffer than healthy tissue. The hair
transplants reduced the density of the fibres, which allowed them to form a
healthier, ‘basket weave’ pattern, which reduced stiffness – a key factor in
tears and discomfort.

The authors also found that after
transplantation, the scars expressed 719 genes differently to before. Genes
that promote cell and blood vessel growth were expressed more, while genes that
promote scar-forming processes were expressed less.

Multi-pronged approach

The researchers are unsure precisely how the
transplants facilitated such a change. In their study, the presence of a hair
follicle in the scar was cosmetically acceptable as the scars were on the
scalp. They are now working to uncover the underlying mechanisms so they can
develop therapies that remodel scar tissue towards healthy skin, without
requiring transplantation of a hair follicle and growth of a hair fibre. They
can then test their findings on non-hairy skin, or on organs like the heart,
which can suffer scarring after heart attacks, and the liver, which can suffer
scarring through fatty liver disease and cirrhosis.

Dr Higgins said: "This work has obvious
applications in restoring people’s confidence, but our approach goes beyond the
cosmetic as scar tissue can cause problems in all our organs.

“While current treatments for scars like
growth factors focus on single contributors to scarring, our new approach
tackles multiple aspects, as the hair follicle likely delivers multiple growth
factors all at once that remodel scar tissue. This lends further support to the
use of treatments like hair transplantation that alter the very architecture
and genetic expression of scars to restore function.”

Reference:

Dr Claire Higgins et al,npj Regenerative
Medicine,doi 10.1038/s41536-022-00270-3

"We are hoping that by the end of this year, 2023, we can see partial occupation — not full occupation, because it's going to take some time. The biggest challenge, having secured integrity of the structure, is now to ensure that the finer details of the internals are dealt with… But, it will look and feel like a new building," he assured.

Tufton was giving the media an update on rehabilitation work being done on the building during a tour of the facility on Friday.

He pointed out that a lot of work had been done on the second phase of the project over the Christmas holidays. He said the hope is to begin the final phase in the third quarter of this year.

"We're hoping to move into the final phase, which is phase three where the internals are going to be put in. So, that is the ward space, the office space, the lighting and so on. What this phase is, is to make sure that the building is strong and is pretty much a new building — and that's what we're hoping for," stated Tufton.

The minister noted that while work on the current phase is still within budget, costing for the final phase is still being worked out as it will be influenced by the design of the facility and materials used. According to Tufton, those were factors assessed by a team of clinicians and technicians who recently returned from a trip to China.

There is keen interest in when the facility will finally be able to open its doors to the public, as well as the final price tag.

In November 2021 the Jamaica Observer reported that $1.4 billion was spent over the five years of delays experienced on the project. At that time it was also disclosed that taxpayers will have to find an additional $1.6 billion for the penultimate phase of work being done and that the completion date had been pushed back to 2022. The original completion date of 2020 was missed, partly as a result of fallout from the COVID-19 pandemic.

"You are not going to see any signs of a reminder of what Cornwall used to be. You are going to see a brand new Cornwall Regional Hospital, that's the intention, and I am a lot more confident now, having had a lot of starts and stops. And, we have learned many lessons," Tufton said Friday during a ceremony to hand over four ambulances valued at $48 million

"We are still in a delicate stage but we have to manage that. Cornwall Regional is going to become one of the most significant institutions in Jamaica and the Caribbean, serving the people of western Jamaica. And I say, 'Just hold the faith. It is happening;" he promised.