In 2017, just over 200 children aged five or younger consumed a food product infused with cannabis, according to a tally kept by health officials, compared to over 3,050 cases in 2021, said the study in the medical journal Pediatrics.

Often sold in the form of candy, chocolate or cookies, edibles look appealing to children, but can cause serious harm because of the patients' low weight.

While no deaths were reported in some 7,000 cases of such ingestions by children over the five-year period of the study, some eight percent of children required admission to intensive care, while nearly 15 per cent were hospitalised.

The median age of the affected children was three years.

The children's symptoms included depression of the central nervous system, including falling into a coma, tachycardia and vomiting. The patients were treated with intravenous fluids.

When the study began in 2017, recreational marijuana was legal only in eight US states plus Washington, compared to 18 states at the end of May 2022.

"These increases are believed to be associated with more states allowing adult, recreational use of cannabis," wrote the authors of the study.

With over 90 per cent of ingestions occurring at home, researchers called on educating caregivers on the need to store cannabis products in locked containers in a location unknown to children.

"Not only should cannabis products be placed in child-resistant packaging, but they should be in opaque packages with simple labels," the authors wrote. "In addition, there should be clear warning labels on the product cautioning against excessive use."

Some US states, including California, have already implemented such measures, but there are no nationwide laws regarding how cannabis products are packaged.

View the full post Still Smiling, a memoir on surviving depression and suicide ideations on NOW Grenada.

DrNB Paediatric
Critical Care or Doctorate of National Board in Paediatric Critical Care also
known as DrNB in Paediatric Critical Care is a super speciality level course for
doctors in India that they do after completion of their postgraduate
medical degree course. The
duration of this super speciality course is 3 years, and it focuses on saving and improving the lives of
children affected by acute and chronic illnesses, injuries, and toxicities.

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 Apollo Hospital, Chennai, Tamil Nadu, Artemis Health Institute, Gurgaon,
Haryana, Bai Jerbai Wadia Hospital for Children Institute of Child Health and
Research Centre, Mumbai, Maharashtra and more.

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

The fee
for pursuing DrNB (Paediatric Critical Care) varies from accredited
institutes/hospital to hospital and may range from Rs. 1,25,000 to
Rs. 3,15,000 per annum.

After completion of their respective course, doctors can either join the
job market or can pursue certificate courses and Fellowship programmes 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 – Rs.20,00,000 per annum.

DNB is equivalent to
MD/MS/DM/MCH degrees awarded respectively in medical and surgical super
specialities. The list of recognized qualifications awarded
by the Board in various broad and super specialities 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-speciality qualifications and super speciality qualifications when
granted in a medical institution with the attached hospital or in 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-speciality 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 the purposes of teaching also.

What is DrNB in Paediatric Critical Care?

Doctorate of National Board in Paediatric
Critical Care, also known as DrNB (Paediatric Critical Care) or DrNB in (Paediatric
Critical Care) is a three-year super speciality programme that candidates can
pursue after completing a postgraduate degree.

Paediatric Critical Care is the branch of
medical science dealing with saving
and improving the lives of children affected by acute and chronic illnesses,
injuries, and toxicities.

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

The curriculum
governs the education and
training of DrNB in Paediatric Critical Care.

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 Paediatric Critical Care
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 speciality.

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 Paediatric Critical Care

Name of Course

DrNB in Paediatric Critical Care

Level

Doctorate

Duration of Course

Three years

Course Mode

Full Time

Minimum Academic Requirement

Candidates must have a postgraduate medical Degree in MD/DNB in Paediatrics from any college/university recognized by the Medical Council of India (Now NMC)/NBE., 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

Counselling by DGHS/MCC/State Authorities

Course Fees

Rs. 1,25,000 to Rs. 3,15,000 per annum

Average Salary

Rs.6,00,000 – Rs.20,00,000 per annum

Eligibility Criteria

The eligibility criteria for DrNB in Paediatric Critical Care are
defined as the set of rules or minimum prerequisites that aspirants must meet
in order to be eligible for admission, which include:

Name of Super Specialty course

Course Type

Prior Eligibility Requirement

Paediatric Critical Care

DrNB

MD/DNB (Paediatrics)

Note:

·
The feeder qualification
for DrNB Pediatric Critical Care 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 in accordance with 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 of 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 Paediatric Critical Care. Candidates can view the complete
admission process for DrNB in Paediatric
Critical Care mentioned below:

• The NEET-SS or
  National Eligibility Entrance Test for Super speciality 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 speciality.
• 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 speciality
  subjects shall be required to appear in the question paper of the respective group if they are willing to opt for a super speciality course in any of the super
  speciality courses covered in that group.
• A candidate can opt for appearing in the
  question papers of as many groups for which his/her Postgraduate speciality
  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 counselling only for those super speciality subjects
  covered in the said group for which his/ her broad speciality is an eligible feeder
  qualification.

Fees Structure

The fee structure for DrNB in Paediatric Critical Care 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 Paediatric Critical Care ranges from Rs. 1,25,000 to Rs.
3,15,000 per year.

Colleges offering DrNB in Paediatric Critical Care

There are various accredited institutes/hospitals across India that
offer courses for pursuing DrNB in Paediatric Critical Care.

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

Hospital/Institute

Speciality

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

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

Paediatric Critical Care

2

Artemis Health Institute
Sector 51, Gurgaon
Haryana-122001

Paediatric Critical Care

1

Bai Jerbai Wadia Hospital for Children
Institute of Child Health and Research Centre, Acharya Donde Marg, Parel,
Mumbai
Maharashtra-400012

Paediatric Critical Care

2

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

Paediatric Critical Care

1

Kanchi Kamakoti Childs Trust Hospital
12A, Nageswara Road, Nungambakkam, CHENNAI
Tamil Nadu-34

Paediatric Critical Care

3

Mehta Multispecialty Hospital
(Formerly Known as Dr. Mehta`s Hospital) 2, McNichols Road, 3rd Lane,
Chetpet, Chennai
Tamil Nadu-600031

Paediatric Critical Care

1

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

Paediatric Critical Care

2

Rainbow Children's Hospital
Sy. No. 8/5, Marathahalli K R Puram Outer ring road, Doddanekundi,
Marathahalli, Bengaluru
Karnataka-560037

Paediatric Critical Care

1

Rainbow Children`s Hospital
22, Rd#10, Banjara Hills, Hyderabad-500034
Telangana-500034

Paediatric Critical Care

3

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

Paediatric Critical Care

3

St. Johns Medical College Hospital
Sarjapur Road, Koramanagala Bangalore
Karnataka-560034

Paediatric Critical Care

2

Surya Children`s Medicare
(Formerly Surya Children`s Hospital) Junction Of S. V. Road and Dattatray
Road Santacruz (West), Mumbai
Maharashtra-400054

Paediatric Critical Care

2

Syllabus

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

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

DrNB Paediatric Critical Care In India: Check Out NBE Released Curriculum

COURSE CONTENT

1. Training Courses

Each student would have to undergo the following courses:

 Pediatric Basic life support (BLS)

 Advanced Trauma Life Support (ATLS)

 Pediatric Advanced Life Support (ALS)

The suggested areas and topics which should form the core subject content are:

a. Cardiovascular Physiology, Pathology, Pathophysiology, and Therapy

 Shock (hypovolemic, neurogenic, septic, cardiogenic) and its complications

 Cardiac rhythm and conduction Disturbances

 Pulmonary oedema—cardiogenic, non-cardiogenic

 Cardiac Tamponade and other acute pericardial diseases

 Acute and chronic life-threatening valvular disorders

 Acute complications of cardiomyopathies and myocarditis

 Vasoactive and inotropic therapy

 Pulmonary hypertension and cor-pulmonale

 Principles of oxygen transport and utilization

 Perioperative management of patients undergoing cardiovascular surgery

 Recognition, evaluation, and management of hypertensive emergencies and urgencies

 Congenital heart disease and the physiologic alterations with surgical repair

 Noninvasive methods of cardiac output assessment (i.e., aortic Doppler, etc.)

b. Respiratory Physiology, Pathology, Pathophysiology, and Therapy

 Acute respiratory failure

 Hypoxemic respiratory failure including acute respiratory distress syndrome

 Hypercapnic respiratory failure

 Acute on chronic respiratory failure

 Status asthmaticus

 Aspiration pneumonia

 Chest trauma (e.g., flail chest, pulmonary contusion, rib fractures)

 Broncho-pulmonary infections including bronchiolitis/pneumonia etc

 Upper airway obstruction

 Near drowning

 Pulmonary mechanics and gas exchange

 Oxygen therapy

 Mechanical ventilation

 Pressure and volume modes of mechanical ventilators

 Positive end-expiratory pressure, intermittent mandatory ventilation, continuous positive airway pressure, high-frequency ventilation, inverse ratio ventilation, pressure support ventilation, volume support (airway pressure release

 Ventilation, pressure-regulated volume control ventilation), negative pressure ventilation, differential lung ventilation, pressure control and noninvasive ventilation, spilt lung ventilation, one-lung ventilation

 Indications for and hazards of mechanical ventilation (VILI)

 Criteria for exudation and weaning techniques

 Permissive hypercapnia

 High-frequency oscillatory ventilation

 Airway Maintenance

 Airway Emergency airway management

 Endotracheal intubation/rapid sequence intubation

 Tracheostomy, open and percutaneous

 Long-term intubation vs. tracheostomy

 Ventilatory muscle physiology, pathophysiology, and therapy, including polyneuropathy of the critically ill and prolonged effect of neuromuscular blockers

 Pleural diseases: empyema, various effusions, and pneumothorax

 Pulmonary chylothorax, haemorrhage, and hemoptysis

 Noninvasive ventilation

 Chest Physiotherapy /Postural drainage

c. Renal Physiology, Pathology, Pathophysiology, and Therapy

 Renal regulation of fluid balance and electrolytes

 Renal failure: Prerenal, renal, and postrenal

 Hyperosmolar states

 Electrolyte disturbances

 Acid-base disorders and their management

 Principles of renal replacement therapy and associated methodologies (peritoneal dialysis, hemodialysis, peritoneal dialysis, CRRT, SLED) etc

 Ultrafiltration, continuous arteriovenous hemofiltration, and continuous veno- venous hemofiltration) Drug modification in renal failure, calculating eGFR

 Rhabdomyolysis

 Systemic diseases that involve the kidney (hemolytic uremic syndrome)

d. Central Nervous System Physiology, Pathology, Pathophysiology, and Therapy

 Approach to a child presenting with Coma

 Hydrocephalus and shunt function and dysfunction

 Perioperative management of patients undergoing neurologic surgery

 Brain death evaluation and certification

 Diagnosis and management of persistent vegetative states

 Management of increased intracranial pressure, including intracranial pressure monitors Status epilepticus

 Neuromuscular disease causing respiratory failure e.g.

 Guillain-Barré syndrome

 Myasthenia gravis

 Myopathies (Duchenne's, etc.)

 Neuropathy of critical illness

 Traumatic and non-traumatic intracranial bleed

 Traumatic brain injury – mild, moderate and severe

 Sedation & analgesia: principles and titration

 Neuromuscular blockade: Use, monitoring, and complications

 Invasive ICP monitoring procedure & Ventricular tap / Extra ventricular drain placement

e. Metabolic and Endocrine Effects of Critical Illness

 Nutritional support

 Enteral and parenteral

 Evaluation of nutritional needs including indirect calorimetry

 Immunonutrition and speciality formulas

 Endocrine

 Adrenal crisis and insufficiency (primary and secondary)

 Disorders of antidiuretic hormone metabolism

 Diabetes mellitus

 Ketotic and nonketotic hyperosmolar coma

 Hypoglycemia

 Pheochromocytoma

 Insulinoma

 Disorders of calcium, magnesium, and phosphate balance

 Inborn errors of metabolism

 Electrolyte disorders including Na, K, Mg, Ca, PO4 etc.

f. Infectious Disease Physiology, Pathology, Pathophysiology, and Therapy

 Antibiotics: Pharmacodynamics and pharmacokinetics

 Various antibacterial agents and newer emerging classes of antibiotics

 Antifungal agents

 Ant tuberculosis agents

 Antiviral agents

 Agents for parasitic infections

 Infection control for special care units

 AMR

 Universal precautions

 Isolation and reverse isolation

 Sepsis definitions (sepsis, severe sepsis, septic shock)

 Systemic inflammatory response syndrome

 Tropical Infections, Emerging viral diseases (COVID-19 and its complications)

 Health care-associated and opportunistic infections in the critically ill

 Adverse reactions to antimicrobial agents

 ICU support of the immune-suppressed patient

 Acquired immunodeficiency syndrome

 Transplant

 Pediatric malignancies

 Occupational hazards to healthcare workers

 Evaluation of fever in the ICU patient

g. Physiology, Pathology, Pathophysiology, and Therapy of Acute Hematologic and Oncologic Disorders

 Acute defects in hemostasis: Thrombocytopenia/ DIC

 Anticoagulation; fibrinolytic therapy

 Principles of blood component therapy

 Packed red blood cell transfusions

 Fresh frozen plasma transfusions

 Platelet transfusions

 Specific coagulation factor concentrates

 Albumin

 Pharmacologic agents that modify the need for transfusion (i.e., aminocaproic acid, aprotinin)

 Erythropoietin

 Acute hemolytic disorders including thrombotic microangiopathies

 Acute syndromes associated with neoplastic disease and antineoplastic therapy

 Sickle cell crisis and acute chest syndrome

 Plasmapheresis

 ICU-acquired anaemia

 Oncologic emergencies

h. Physiology, Pathology, Pathophysiology, and Therapy of Acute Gastrointestinal, Genitourinary Disorders

 Upper gastrointestinal bleeding, including variceal bleeding

 Lower gastrointestinal bleeding

 Acute and fulminant hepatic failure

 Acute perforations of the gastrointestinal tract

 Perioperative management of surgical patients

 Stress ulcer prophylaxis

 Obstructive uropathy and its complications

i. Environmental Hazards

 Poisoning: Organophosphate poisoning, Hydrocarbon, etc.

 Envenomation: Snake envenomation, Scorpion sting etc.

 Drug overdose and withdrawal: Paracetamol, iron, TCA etc.

 Temperature-Related Injuries: Hyperthermia, heat shock, Hypothermia, frostbite

 Altitude sickness

 Decompression sickness

 Biological and chemical terrorism

 Radiation exposure

j. Immunology and Transplantation

 Principles of transplantation (organ donation, procurement, preservation, transportation, allocation, implantation, maintenance of organ donors, national organization of transplantation activities)

 Immunosuppression

 Organ transplantation: Indications of preoperative and postoperative care

 Transplant-related infectious disease

k. Monitoring, Bioengineering, Biostatistics

 Prognostic indexes, severity, and therapeutic intervention scores

 Principles of electrocardiographic monitoring, and transcutaneous measurements

 Invasive hemodynamic monitoring

 Principles of strain gauge transducers

 Principles of arterial, and central venous catheterization and monitoring

 Echo-based evaluation of cardiac function and derived hemodynamic variables

 Noninvasive hemodynamic monitoring

 Thermoregulation

 Central nervous system brain monitoring (intracranial pressure, NIRS,

cerebral metabolic rate, electroencephalogram, transcranial Doppler)

 Respiratory monitoring (airway pressure, intrathoracic pressure, tidal volume, pulse oximetry, dead space / tidal volume ratio, compliance, resistance, capnography, pneumotachograph)

 Metabolic monitoring (oxygen consumption, carbon dioxide production, respiratory quotient, indirect calorimetry)

 Use of Biostatistics and various tests of significance (SPSS or other soft wares)

l. Ethics

 Consent

 Study enrollment

 End-of-life decision-making and care

 Organ procurement

 Outcome and futility

 Quality of end of life

m. Administration

 Team building, Patient safety

 Organization of patient care

 Physician, nurse, and ancillary staff staffing models

 Documentation and compliance

 Mass casualty or disaster

n. Genetic

 Congenital disease (polysomy, monosomy, trisomy, etc.)

 Storage diseases

 Polymorphisms

 Fundamentals of Genetic testing

 Genetic counselling

o. Pharmacology

 Pharmacokinetics

 Pharmacodynamics

 Safe medication practice

 Drug dosing adjustments in hepatic disease

 Drug dosing adjustments in renal disease

Career Options

After completing a DrNB in Paediatric Critical Care,
candidates will get employment opportunities in Government as well as in 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 (Paediatric
Critical Care), Junior Consultant, Senior Consultant (Paediatric Critical Care), etc.

Courses After DrNB
in Paediatric Critical Care Course

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

Frequently Asked Questions (FAQs) – DrNB
in Paediatric Critical Care
Course

Question: What is the full form of DrNB?

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

Question: What is a DrNB in Paediatric Critical Care?

Answer: DrNB Paediatric
Critical Care or Doctorate
of National Board in Paediatric Critical Care also known as
DrNB in Paediatric Critical Care is
a super speciality level course for doctors in India that they do after
completion of their postgraduate medical degree course.

Question: What is the duration of a DrNB in Paediatric
Critical Care?

Answer: DrNB in Paediatric Critical Care is a super speciality programme of three years.

Question: What is the eligibility of a DrNB in Paediatric Critical Care?

Answer: Candidates must have a postgraduate medical degree MD/DNB in Paediatrics from any college/university recognized by the Medical Council of India (now NMC)/NBE. This feeder qualification is for the year 2022. For further updates, please refer to the NBE website.

Question:
What is the scope of a DrNB in Paediatric
Critical Care?

Answer:
DrNB in Paediatric Critical Care
offers candidates various employment opportunities and career prospects.

Question:
What is the average salary for a DrNB in
Paediatric Critical Care candidate?

Answer:
The DrNB in Paediatric Critical Care
candidate's average salary is Rs.6,00,000 – Rs.20,00,000 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.

Don't let your issue disturb or put your life in jeopardy. If any of the following apply to you, see a urologist in this year:

Blood in urine

Contact your primary care physician right away to ask for assistance setting up an appointment with a urologist if you notice blood in your urine. Your urine may contain blood if it does not have the typical pale-yellow tint and instead appears brown, pink, or tea-coloured. This condition could be transient and brought on by an accident or overly strenuous exercise. However, it may also be a sign of much more significant issues, like:

An infected bladder

Renal infection

Renal stones

Prostate, kidney, or bladder cancer.

Poor bladder control

Urinary incontinence, or losing control of the bladder, is a widespread and frequently unpleasant issue. The intensity can range from occasionally dribbling pee when you cough or sneeze to having a sudden, intense urge to urinate that prevents you from reaching a restroom in time. Do not put off seeing a urologist if your urine incontinence interferes with your everyday activities.

Painful urination

This may occur in females due to a urinary tract infection. Urethritis and a few prostate disorders are the main contributing factors in males. Additional factors for both sexes include:

Urinary stones

Chlamydia

Cystitis

Sexually transmissible diseases

Renal stones

Prostate swelling

Infection of the womb

Candida infection.

Pain in lower stomach, side of back or groin

Kidney stones can cause this pain, and further symptoms may include:

Excruciating agony when standing, sitting, or resting down

Urine with blood in it

Trouble urinating

Flu-related nausea, vomiting, and fever.

It's critical to see a urologist as soon as possible as these symptoms may also point to other urologic issues. Why? Lifetime recurrence rates range from 60 to 80 per cent and can result in irreversible kidney damage if ignored. If you have kidney stones when pregnant they could result in an early labour, unbearable agony that could be fatal if left untreated, or urosepsis (potentially fatal if not immediately treated).

Fallen bladder protrusion

This illness affects women and can have an impact on the cervix, urethra, vagina, and uterus. Nearly 50 per cent of mothers struggle with this issue. It can develop due to a number of circumstances such as:

Age

Obesity

Vaginal delivery

Compromised muscles.

Some symptoms include:

Tissue in or sticking out of the vagina

Pelvic discomfort

Trouble urinating

Feeling shortly after urinating that your bladder is not emptied

Urine leaking when you cough, sneeze, or exert yourself

Frequent bladder infections

Painful sex exchange

A low backache.

Although there are successful, non-surgical and surgical treatment options available, many women are too ashamed to talk about their illness.

Male sexual problems

Over 90 per cent of the 20 to 30 million American males who experience erection difficulties are too ashamed to seek therapy. In addition to being annoying, erectile dysfunction can be dangerous because it could be a sign of a more serious medical condition. Age matters, particularly for males over 40. Additional factors include:

A cardiovascular condition

Diabetes

Depression

Urinary stones

Chlamydia

Cystitis

Sexually transmissible diseases

Renal stones

Prostate swelling

Candida infection.

Overactive bladder (OAB)

An overactive bladder (OAB) can adversely affect your day-to-day activities, employment, quality of sleep, and connections with friends and family. Symptoms of an overactive bladder may include:

Frequency: Passing urine often during the day

Urgency: This is the overwhelming desire to pass urine

Urge incontinence: This is characterised by a bit of unintentional leaking when that strong desire to urinate is felt.

Nocturia: Getting up often at nights to pass urine. the volume of urine may be small when you go to the bathroom and not usually large volumes.

Urinary tract infections (UTIs)

UTIs may be characterised by a change in urinary patterns secondary to infections , the more common symptoms being:

Urgency

Dysuria (burning or discomfort on peeing)

Frequency

Lower abdominal discomfort

Prostate issues

As men get older the prostate (a male organ that forms the first part of the urinary tract below the bladder ) may become enlarged (benign prostatic hyperplasia) and may also present with gradual deteriorating urinary symptoms which may crescendo with inability to pass urine associated with pain amongst other urinary symptoms which may initially go unnoticed. There are increased risks for urinary tract infections, bladder stone formation and renal impairment amongst other debilitating conditions .

The risk of prostate cancer also increases and although in its early stages it has no symptoms , in its advanced stage it can present with symptoms similar to an enlarged non cancerous prostate (BPH) as well as other symptoms including back pain, sudden rapid loss of lower limb function and symptoms of significant renal impairment (leg swelling, shortness of breath etc.)

Furthermore, health is wealth. There is no sense in chasing financial goals and neglecting your health to only then spend your earnings on attempting to recapture your health, which isn't guaranteed. See your general practitioner or your health centre at least once for the year for a general check-up. If any of the above symptoms exist or persist then certainly see your urologist or your medical practitioner who may refer you to a specialist (urologist) .

As per the World Health Organization, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. So take time out to do what makes you happy once it's not self-harming or harmful to others; laugh a lot; exercise regularly; pay attention to your diet; and eat healthy meals more often than not. If you're reading this it means you have much to be thankful for, because you've made it to 2023. A happy, healthy and prosperous new year to you all.

Dr Jeremy Thomas is a consultant urologist. He works privately in Montego Bay, Savanna-la-Mar and Kingston, and publicly at Cornwall Regional Hospital. He may be contacted on Facebook and Instagram: @jthomasurology or by e-mail: jthomasurology@gmail.com

This inequity is compounded by patients' risk factor level, education and health policies.

In a recent report evaluating data from 204 countries and territories in the Global Burden of Cardiovascular Disease Collaboration, the investigators identified Central Asia and Eastern Europe as epicentres of the CVD epidemic with the highest rates of CVD mortality. Furthermore, the report identified hypertension, dietary indiscretion, high cholesterol, and air pollution as the leading causes of CVD globally. The recognition of air pollution as a leading cause of CVD globally is an area that has received scant attention. Starting from the new year, we intend to do a series of articles on air pollution and CVD to highlight this important but neglected cause of CVD.

In high-income regions of North America the researchers found that age-standardised CVD mortality rates ranged from 102.1 to 224.8 per 100,000 in 2021, reflecting a 2.6-fold difference. Hypertensive heart disease had the largest per cent increase in CVD cause-specific, age-standardised mortality rates since 1990 (53.3 per cent), whereas rheumatic heart disease had the largest per cent decrease (61.2 per cent).

Ranking of modifiable risk factors

The analysis of the Global Burden of Diseases, Injuries and Risk Factors study provide a useful ranking of modifiable risk factors associated with these trends in CVD and mortality:

• High systolic BP

•Dietary risks

• High LDL-Cholesterol

• Air pollution

• High body mass index (BMI)

• Tobacco smoking

• High blood glucose

• Kidney dysfunction.

According to the analysis, rheumatic heart disease, fuelled by poverty and crowded housing conditions, as well as alcoholic cardiomyopathy fuelled by excessive alcohol consumption, are also potential targets for CV risk reduction.

Global prevalence of CVD and mortality

Globally, the total number for CVD nearly doubled over the past 30 years from 271 million in 1990 to 523 million in 2019, and CVD deaths increased from 12.1 million in 1990 to 18.5 million in 2019, affecting men and women almost equally (9.6 million men: 8.9 million women), according to the analysis. Approximately 6.1 million premature deaths from CVD were noted in individuals aged 30 to 70 years, representing 33 per cent of CVD deaths worldwide. Additionally, CVD was the underlying cause of death among approximately one-third of all deaths globally. CVD prevalence is likely to increase substantially as a result of population growth and ageing, especially in low-resource communities including much of Africa, Asia, Latin America, and the Caribbean where the share of older persons is projected to double between 2019 and 2050. Increased attention to promoting ideal cardiovascular health and healthy ageing across the lifespan and population segments must therefore form part of the national policy thrust for managing the expected increase in CVD in the coming years. We look forward to working with the Government and other responsible parties in proactively designing mechanisms to address this problem in a way that ensures health equity consistent with the One Health initiative being promoted by the Minister of Health Dr Christopher Tufton.

Disability-Adjusted Life Years (DALY)

The report also looked at disability-adjusted life years, the years of life lost due to premature mortality, and years lived with disability. By summing the DALYs in a population, we can discover which populations are living with the greatest health burden and prioritise those areas for future health interventions. The main advantage is that DALYs provide a composite, internally consistent measure of population health which can be used to evaluate the relative burden of different diseases and injuries, and provide comparison of population health by geographic region and over time. The overall burden of disease is assessed using the disability-adjusted life year (DALY), a time-based measure that combines years of life lost due to premature mortality (YLLs) and years of life lost due to time lived in states of less than full health, or years of healthy life lost due to disability (YLDs). DALY is a very useful assessment of quality of life rather than simply measuring the length of life. Next to ischemic heart disease and stroke, the collaborative investigators found that hypertensive heart disease had the highest age-standardised DALY rate of 226.4. Among all CVD risks, hypertension accounted for the largest proportion of DALYs at 40.5 per cent. Globally, the report noted that ischemic heart disease is the leading cause of CV death, accounting for 9.44 million deaths in 2021 and 185 million DALYs.

Hypertension is a leading modifiable risk for CVD

Hypertension is the leading modifiable risk factor for CV death. High blood pressure remains the key risk factor driving the global rise in CVD mainly through the causation of hypertensive heart disease, coronary artery disease and stroke. According to the Jamaica Health and Lifestyle Survey for 2016/2017, one in three Jamaicans are hypertensives, including nearly 40 per cent of women. More worrisome is that four out of every 10 hypertensives are unaware of their status, 60 per cent of whom are men. Another study from the Imperial College of London notes that more than 80 per cent of hypertensives globally account for about one billion people live in low- and middle-income countries.

In individuals at risk, treatment to lower blood pressure is a remarkably effective strategy to delay progression to cardiovascular complications including heart attacks, strokes, kidney failure and heart failure. When initiated in middle age, intensive blood pressure control is predicted to prolong life expectancy by up to three years. In light of the evidence, there is a great urgency in driving public health strategies to promote early screening, detection, and treatment of hypertension. Affordable and cost-effective approaches must be explored to expand access to include individuals in remote, rural, and low-income communities. Effective strategies currently exist leveraging mobile technology and remote patient monitoring to expand access, and these approaches must be embraced in low-resource nations and communities to address a clear and present danger. Individuals at risk can be evaluated in real time, and early signs of cardiovascular damage can be identified with simple techniques like electrocardiograms (ECGs). Affordable technology currently exists to provide electrocardiograms daily — with cardiologist interpretation in real time in all public health centres in all 14 parishes — and we would be happy to assist the Ministry of Health and Wellness in getting this done. Once identified, treatment approaches must consider the use of polypills for hypertension and other CVD promoters as these have been demonstrated to be highly cost-effective and efficacious, especially in individuals and communities with financial constraints.

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

The study's results, published in the Iranian Journal of Psychiatry, showed high prevalence and increasing sleep disorder trends in the past five years. If not addressed, the community's cardiovascular disease (CVD) burden will significantly increase in the future due to sleep disorders and the associated risk factors.

Sleep disorders are conditions that lead to changes in the way of sleeping. A sleep disorder can affect safety, quality of life, and overall health. Not getting desired sleep can impact the ability to drive safely and raises the risk of other health problems. Some common sleep disorders are sleep apnea, insomnia, narcolepsy, and restless legs syndrome.

The study was a single-stage, cross-sectional, cluster sampling ((KERCADR study phase two) study that examined nine CAD risk factors, including sleep disorders. The study comprising 9997 participants, 15 to 80 years old, was carried out in Kerman. Abdolreza Sabahi, Kerman Universit of Medical Sciences, Kerman, Iran, and colleagues assessed medical examination along with demographic, sleep status, anxiety, depression status (Beck Inventories), and Physical activity level (GPAQ). A fasting blood sample was taken for lipid and blood glucose analysis. Out of 9997 included participants, 59.4% were females.

The authors reported the following findings:

• 45.3% of the participants suffered from hypersomnia and insomnia, which was 15% more than the phase 1 prevalence.
• Participants with insomnia had a higher chance of being anxious. Still, participants with hypersomnia had a higher chance of being depressed, being a cigarette smoker, an opium user, and being sedentary.
• Regarding marital status, the hypersomnia prevalence was as follows in increasing order of prevalence: singles > married > widowed > divorced.
• The incidence rate (IR) of insomnia was higher in females, and a higher IR of hypersomnia were seen in males.
• The incidence rate of both sleep disorders was more significant in people with Low Physical Activity (LPA).

"The findings showed a high current prevalence and increasing sleep disorders trend in the past five years," the authors wrote. "If not addressed properly, the CVDs burden in the community will show a significant increase in the future due to sleep disorders and other associated risk factors."

Reference:

Najafipour H, Sabahi A, khoramipour kayvan, Shojaei Shahrokhabad M, Banivaheb G, Shadkam M, Mirzazadeh A. Prevalence, Incidence and Health Impacts of Sleep Disorders on Coronary Artery Disease Risk Factors: Results of a Community-Based Cohort Study (KERCADRS). Iran J Psychiatry. 2022;17(3):247-256.

At a press conference, the interim representative of the international organization in the country, Bernardino Vitoy, pointed out that they still do not have the arrival date of the vaccine, but that they are in the middle of the negotiations so that in the future the serum can be placed the vulnerable population.

“World production is not very high, there are few suppliers and an estimate is currently being made of how much it will be possible to allocate to the Dominican Republic,” he said. The doctor also stated that they are working to expand the diagnostic capacity of the pathology, with the delivery of more rapid tests so that infections can be confirmed and ruled out.

According to experts, the cholera vaccine is administered orally and two doses are placed so that it can have the necessary effects.

 

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