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The science behind platelet-rich plasma therapy

Platelet-rich plasma therapy or PRP has become a boon. It is a form of regenerative medicine that makes use of those abilities that amplify natural growth factors that are used by the body to heal tissue. The use of blood products has been for a long time in history. PRP definition is a rich concentration of platelets in a small volume of plasma from the patient's own blood-Autologous. It is not a concoction like mesotherapy and hair laser which have no science. The extensive use of PRP in dermatology, dentistry , orthopedics, ophthalmology and even cardiology shows there is a certain science. Platelets have 20 growth factors that cause angiogenesis - New skin vessel formation, Collagenogenesis - new collagen deposit and increased fibroblasts which all lead to skin rejuvenation and scar attenuation. The effect of PRP in reducing wrinkles was assessed using wrinkle severity rating study in 20 patients. A significant reduction in wrinkles was seen along with improvement in skin tightening and clearer skin with increased volume of skin. Response was reduced in patients over 40. PRP is also combined with PDO( Polydioxanone) threads to treat Androgenic alopecia or male or female patterned hair loss. Intra Follicular PRP injections when combined with PDO threads form a bio scaffolding or an envelope that keeps the growth factors activated and released for at least nine months by mechanotransduction. This increases the interval time between two PRP sessions by at least nine months and increased patient acceptability to PRP treatments for hair loss.

20th September, 2021

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48 of 78 adverse events following immunization studied linked to vaccination, mostly anxiety: Report

PUNE: The Union health ministry’s latest analysis of adverse events following immunization (AEFI) for Covid-19 showed that 48 out of 78 cases had a “consistent causal association to vaccination”. Of these 48, as many as 20 reactions were due to anxiety during vaccination. The national-level causality assessment report stated that as many as 22 cases, including seven deaths, were coincidental. It meant they were not linked to vaccination. Seven adverse events, including two deaths, were in the indeterminate category and one event was in the unclassifiable category. The causality assessment for the 78 cases — six related to Covaxin administration and the rest Covishield — was completed on August 3 after thorough review, deliberation and approval by the national AEFI committee. The latest report stated that of the 48 cases of “consistent causal association to vaccination”, a total of 28 were vaccine product-related reactions such as anaphylaxis, allergic reactions and dizziness. The rest 20 were of immunization anxiety-related reactions. The “consistent causal association” to vaccination is a cause-and-effect relationship between the vaccine and the adverse event that follows. Vaccine product-related reaction refers to an adverse event following immunization (AEFI) caused by a vaccine because of one or more of the inherent properties of its product, such as the adjuvant, preservative or stabilizer. Immunization anxiety-related reaction refers to an AEFI arising from anxiety about the immunization. Dr Narendra Arora, advisor, National AEFI Committee, said a chunk of reactions were driven by only panic or fear of vaccination, such as nausea, increase in heart rate and increased sweating, among others. “There has been a higher incidence of anxiety among women than men, after which they had to be admitted to healthcare facilities to alleviate their condition,” he said. Dr Arora said coincidental events were the AEFIs caused by something other than the vaccine product, immunization error or vaccination anxiety. “So far, among all the AEFIs assessed after the vaccination drive against Covid began, all the deaths except one were coincidental. Only one death was due to anaphylaxis,” he said. Among the seven deaths not linked to vaccination, one was a sudden cardiac death, one was related to atypical pneumonia with pulmonary embolism and another was due to chronic diarrhoea and severe malnutrition. According to the report, seven AEFI cases, including two sudden cardiac deaths, were in the indeterminate category. “Indeterminate category includes reactions which have occurred soon after vaccination but there is no definitive evidence in current literature or clinical trial data that these events could have been caused due to the vaccine. Such cases are later re-assessed after all the post-death documentation is available,” Dr Arora said. The report stated that there was another sudden unexplained death of a 70-year-old man under the unclassifiable category. Unclassifiable events are those which were investigated but there was not enough evidence for assigning a diagnosis due to missing crucial information, according to an official of the Union ministry of health and family welfare. The official said in unclassifiable cases, there might be unavailability of complete documents. “The incidence of AEFI events is very small in comparison to the total doses administered in India so far. Up till recently, only 0.02% AEFIs have been reported among the total vaccinations. This is even less than adverse reactions reported in clinical trials. Covishield is a vaccine widely being used across the world and is considered safe,” the official said.

20th September, 2021

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Early diagnosis key to frozen shoulder treatment: Experts

Lucknow: Don’t ignore shoulder pain, stiffness or difficulty in movement of arm if any of this persists for 15-20 days as it could be an early sign of periarthritis, commonly known as frozen shoulder, according to experts. Speaking at a symposium on ‘Problems of shoulder joint and its management,’ organised by UP Orthopaedic Association (UPOA) on Sunday, the association’s secretary and head, sports medicine at KGMU, Prof Ashish Kumar, said: “People start experiencing mild symptoms including pain and stiffness when the periarthritis (frozen shoulder) begins.” “However, since as the pain does not pose much of a problem in the early stage, people tend to ignore it. They usually come to us when hand mobility is reduced to 12-15 degrees. If a patient comes to us in the early stage, the problem can be treated with physiotherapy, supportive treatment along with some medicines, otherwise surgical intervention is a must,” he added. Dr Vinay Pandey, orthopaedic surgeon from Varanasi, said the problem was common in people above 40 years of age, those with shoulder injury or diabetes. “It is caused due to tightening of tissues around the bone of the shoulder. Often patients report with severe frozen shoulders. We have to then perform arthroplasty, which is a minimally invasive technique to detect tightening tissue and remove it,” he added. Dr Uttam Garg, the co-organising secretary of the symposium, said: “Advance treatments for this problem are available but it is significant that everyone should know about the early signs.” Highlighting the importance of public awareness, KGMU vice-chancellor Lt Gen Prof Bipin Puri, who was the chief guest on the occasion, said such programmes helped the medical fraternity and people aware and updated, which ultimately resulted in better patient care.

20th September, 2021

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Research reveals drug targets for memory enhancement

Bristol [UK]: Bristol-led research has identified specific drug targets within the neural circuits that encode memories, paving the way for significant advances in the treatment of a broad spectrum of brain disorders. Loss of memory is a core feature of many neurological and psychiatric disorders including Alzheimer's disease and schizophrenia. Current treatment options for memory loss are very limited and the search for safe and effective drug therapies has, until now, had limited success. The study was published in Nature Communications. The research was done in collaboration with colleagues at the international biopharmaceutical company Sosei Heptares. The findings identify specific receptors for the neurotransmitter acetylcholine that re-route information flowing through memory circuits in the hippocampus. Acetylcholine is released in the brain during learning and is critical for the acquisition of new memories. Until now, the only effective treatment for the symptoms of cognitive or memory impairment seen in diseases such as Alzheimer's is using drugs that broadly boost acetylcholine. However, this leads to multiple adverse side effects. The discovery of specific receptor targets that have the potential to provide positive effects whilst avoiding negative ones is promising. Lead author, Professor Jack Mellor, from the University of Bristol's Centre for Synaptic Plasticity, said: "These findings are about the fundamental processes that occur in the brain during the encoding of memory and how they may be regulated by brain state or drugs targeting specific receptor proteins. In the long term, the discovery of these specific targets opens up avenues and opportunities for the development of new treatments for the symptoms of Alzheimer's disease and other conditions with prominent cognitive impairments. The academic-industry partnership is important for these discoveries and we hope to continue working together on these projects." Dr Miles Congreve, Chief Scientific Officer at Sosei Heptares, added: "These important studies have helped us to design and select new, exquisitely targeted therapeutic agents that mimic the effects of acetylcholine at specific muscarinic receptors, without triggering the unwanted side effects of earlier and less-well targeted treatments. This approach has the exciting potential to improve memory and cognitive function in patients with Alzheimer's and other neurological diseases." "It is fascinating how the brain prioritises different bits of information, working out what is important to encode in memory and what can be discarded. We know there must be mechanisms to pull out the things that are important to us but we know very little about how these processes work. Our future programme of work aims to reveal how the brain does this using acetylcholine in tandem with other neurotransmitters such as dopamine, serotonin and noradrenaline," said Professor Mellor.

20th September, 2021

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Study provides new insights into how immune system responds to skin cancer therapy

London [UK]: Skin cancer patients could have a better prognosis if their T cells send messages from five specific genes in their immune response to drugs given to treat the disease suggests the findings of a new research led by the University of Birmingham. The research, carried out in mice, cells in the laboratory, and using publicly available data from patients with advanced melanoma before and after treatment with Nivolumab therapy, was published in the journal Immunity. T cells are white blood cells that protect the body from harm from viruses, bacteria, and cancer cells and explore their environments by using their T cell receptor (TCR) to recognise fragments - called antigens - of microbes or damaged cancer cells. The TCR controls the behaviour of the T cell and can send messages to the T cells' command centre to kick-start an immune response. This process is important for vaccine research and treatment of autoimmune conditions but is particularly of interest for cancer treatments to improve the anti-tumour function of T cells. The researchers carried out the study to better understand how the amount of antigen controls how the TCR sends messages to the T cells' command centre, and how this affects the type of immune response. They wanted to explore how antigen amounts control the expression of so-called 'immune checkpoints' that act as brakes on immune responses. It is these immune brakes, such as one called PD1, that are the target of drugs that seek to increase the immune response in cancer immunotherapy. Lead author Dr David Bending, of the University of Birmingham's Institute of Immunology and Immunotherapy, explained: "Through our research, we discovered that the amount of antigen determined how many immune checkpoints or immune brakes a T cell had on its cell surface. "When we exposed T cells to the highest amounts of antigen, they stopped sending signals to their command centre, and this was because they had increased the number of immune brakes, which shut down the messengers. This made these T cells unable to respond to antigens for a period." By blocking one of the immune brakes, called PD1, the researchers were able to re-awaken some of these 'unresponsive' T cells. They found that these re-awakened T cells not only started sending messages to their command centres, but the messages they sent were louder and clearer. "The response from the command centre was that the T cells started to increase the number of messages from five specific genes," added Dr Bending. "By looking for the messages from these five genes, we were able to show that these stronger and louder messages were increased in melanoma patients who survived for longer on drugs that block the immune brake PD1. We think that this means that those cancer patients whose immune cells can send messages from these five genes in response to drugs that target PD1, a good outcome is far more likely." The researchers said their finding shows that the immune system likely requires an optimal level of stimulation to mount the most effective immune response in skin cancer patients. Dr Bending added: "Our research gives us an interesting insight into fundamental workings of the immune system. It suggests that both the amount of antigen around a T cell and also the number of immune brakes the T cells have at their surface are very important in controlling immune responses. Furthermore, we have shown that we can alter the balance of the immune response through stopping some of these immune brakes, which results in a stronger T cell response." The study has generated a new potential readout to monitor patients on drugs targeting PD1 in cancer. It also may be useful for exploring the potential of combinations of drugs that target multiple immune checkpoints to try to further re-awaken T cells in cancer patients.

20th September, 2021

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Amid a global health crisis, it’s vital to bolster your health insurance with super top-up plans

In late 2019 when the Coronavirus crisis gained its foothold across the world, little did we know that it would realign our healthcare priorities. The dramatic surge in cases unleashed a catastrophe on the healthcare sector that was ill-equipped to tackle a public emergency like this one. The access and delivery of medical services got severely affected, leading to an increase in costs for quality treatment. This growing uncertainty accelerated the need to bolster one’s physical and financial health and put the spotlight on health insurance. Many health insurance owners hence started looking for policies that came with higher sum insured and better benefits so that they don’t have to dig into their personal savings to meet the sky-rocketing healthcare costs in case their existing policy falls short. To safeguard oneself from such uncertainties, upgrading one’s existing health insurance might seem like a way ahead, but it could lead to a high premium cost. This is where super-top up health insurance plans come in as one of the most affordable and reliable ways to obtain optimum health coverage and financial security, especially during the current crisis. Understanding super top-up health insurance plans: Why do you need it? A health insurance super top-up is a policy that provides coverage for cumulative medical expenses incurred when the sum insured on your standard health policy gets exhausted or you have paid the costs up to the deductible on your own. Super top-up plans, as the word suggests, attaches benefits on top of your existing base policy. However, it is not mandatory to have a base policy to buy a super top-up cover. In order to claim the benefits of your super top-up policy, the deductible on your base policy has to be crossed, after which you are eligible to claim. For example, let’s assume that you have a sum insured of Rs 10 lakhs with Rs 3 lakhs deductible. In case of any hospitalization, if your bill/expense crosses Rs 3 lakhs, the super top-up policy will start to cover expenses incurred up to a sum of 10 lakhs. It is one of the most affordable ways to increase your health coverage, especially during this uncertain phase when hospitalization bills are running amok amid unexpected medical emergencies. Thus, a super top-up plan transforms into a backup plan designed to provide financial cushioning and can be particularly helpful when it is difficult to determine how much health insurance is adequate. A super top-up health cover is, in fact, an upgraded version of top-up health plans that rose to popularity a few years back. Top-up plans increase the base cover of the existing health insurance plans and provide coverage up to a deductible limit for every singular event that requires hospitalization. This means that your super top-up plan is better as it gets activated when your deductible is overshot during a single or multiple episodes of hospitalization, which usually happens during catastrophic events. Super top-ups go a step ahead by providing cover not only for standalone events but also for long-standing illnesses or situations where there are higher chances of the base policy getting exhausted due to multiple hospital treatments. They provide insurance buyers with future-proof solutions and this is why it is extremely important for people to consider various factors before choosing the premium that suits them the best. Let’s take a look at some of the factors why it is vital to strengthen your existing health insurance with super top-up plans, during the pandemic and beyond. Health insurance that is at par with one’s lifestyle While many financially stable people assume that having a basic health insurance plan is enough to take care of their emergency medical expenses, an existing health insurance plan might not offer adequate cover to get the best treatment you want. Depending on the lifestyle that you lead, you might have a preferred hospital in your mind and might want the best hospital room or bed facilities. If your health policy is insufficient, you will end up paying from your own pocket. Super top-up plans are useful in these cases as they bolster your health insurance based on your lifestyle requirements. Make sure that you consider factors like the average hospitalisation charges in the hospital of your choice; your age, medical history and hospitalization risk; the size of your family etc. before deciding on the sum insured for the super top-up plan. For 360-degree health protection that is not event-based The pandemic proved how uncertainties and risks are a part of our lives, and that it is only bound to increase with time. This is why many people bought contingency plans like Covid insurance to sail through financially during these unforeseen circumstances. However, after two subsequent Covid-19 waves and a third wave expected to hit us really soon, people are beginning to see how a contingency plan is only a short-term solution and health expenses can vary for different people during such times. Super top-up plans come across as handy solutions in this regard by providing financial support during medical emergencies of any kind by covering hospitalisation charges when you exhaust your base amount due to repeated claims. Super top-up plans also come with a deductible waiver for accidental claims, where insurance companies waive off the general exclusion of 'Deductible' in case of accidental hospitalisation, which is one of the biggest benefits of this policy. Affordable treatment amid rising medical costs A super top-up plan becomes a cost-effective solution to beat medical inflation and access the best of healthcare. These plans come with high deductible amounts at low premium costs, primarily owing to the deductible clause. Added to this, the premium that you will pay for a super top-up plan is eligible for tax deduction benefits under Section 80D of the Income Tax Act. Many insurance companies provide cashless claim benefits on super top-up plans and they come with different deductible limit options. Super top-up plans also come with a buyback policy after 4 years, which means if at the end of four consecutive and continuous hospitalization-free policy years, if the policyholder avails the option to buy back the deductible amount then no deductible shall apply on such renewal. Also, the base sum insured under the policy shall be the sum of the expiring policy's base sum insured and the expiring policy's deductible. Super top-up plans are available in two variants- as individual plans and family floater plans, so that insurance purchasers can decide on the sum insured depending on the needs of the whole family. Choose Benefits that compliment your policy and add value Amid uncertainties and rising medical treatment costs, a super top-up plan also offers 360-degree support. Unlike top-up policies that get activated on a per claim basis when the claim amount is more than the cover of your health insurance plan, super top-up plans give you the option to avail cover over multiple hospitalizations. This becomes particularly helpful while seeking treatment for long-term illnesses when the insured requires hospitalization on multiple occasions, with higher chances of the base policy getting expired. Many insurance providers offer additional cover that is over and above the basic hospitalisation benefits on the super top-up policy. For instance, Reliance Health Super Top Up covers everything from emergency treatment cover for inpatient, daycare and emergency treatment worldwide, to maternity cover including prenatal, postnatal and in-patient treatment (up to Rs 2 lakh). Reliance Health Super Top Up plan also covers Emergency Air Ambulance expenses of up to Rs 2 lakhs for a sum insured of Rs 10 lakh and Rs 5 lakhs for policies above Rs 10 lakhs. To add to this, super top-up plans like Reliance Health Super Top Up also cover the medical expenses incurred during hospitalisation for organ donation surgeries as well as alternative treatment options under AYUSH treatment. The super top-up plan also offers premium waivers on detection of critical illness, free health check-ups (at the end of three consecutive and continuous policy years); and deductive waivers for accidental claims among others. Again, there are no NCB deductions post claims on super top-up plans, which means that you’ll still get a no-claim bonus once you renew the policy.

17th September, 2021

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65% women in India are unaware of PCOS symptoms: OZiva survey

National September 17th, 2021: OZiva recently conducted a nationwide survey of women to mark the PCOS month. PCOS or Polycystic Ovary Syndrome affects 1 out of 5 Indian women and has developed into a leading cause of concern. The survey conducted with 2800 respondents across India went on to reveal that a significant 25% of the Indian female population didn’t know about PCOS or PCOD while 65% women were not aware of PCOS symptoms. Though a common condition, PCOS and its symptoms are not clearly understood and there are a lot of myths surrounding the condition as well. Key Findings of the Nationwide PCOS Survey 1. 35% of women have never spoken about their condition (PCOS) to anyone. 2. Almost 15% of women never want to talk about PCOS to anyone and more than 4.5% consider talking about PCOS a taboo. 3. Almost 48% of women find it uncomfortable speaking about PCOS with their spouses and have never done so. Most women prefer discussing this with their mothers. 4. Around 65% of women have been shamed or know someone who has been shamed for having PCOS or related symptoms (like facial hair, difficulty losing weight, difficulty conceiving etc.) 5. More than 60% of men don’t know what PCOS is. Speaking on the survey, Aarti Gill, Co-founder, OZiva, said, “As a woman myself, I can truly feel the struggles of Indian women when it comes to health issues such as PCOS. The first step to managing PCOS is awareness. With a clean, plant-based diet and holistic lifestyle the condition can be managed. Unfortunately there is lack of awareness, open conversation around PCOS and as the survey revealed unavailability of authentic information related to PCOS and its management. There has to be a change in perception about the condition and accessibility to authentic and reliable information about PCOS management. We want to create much needed awareness and encourage both men and women to speak about PCOS.” The survey also revealed some surprising facts like that 45% of people shared that there is no authentic information available on PCOS and related health concerns. Almost 50% of people, including women and men, also highlighted the fact that there is a need for brands to take up this cause and get more people to openly converse about PCOS. Adds Shikha Dwivedi, Nutritionist at OZiva, “The most important step is to create a two-way conversation around PCOS to normalise this commonly occurring condition which has previously been tabooed in most parts of our country. With clean holistic living that comprises a plant-based diet and a healthy lifestyle, PCOS and its symptoms can be managed. Over the past few years, we have helped more than thousands of women successfully manage symptoms like irregular periods, weight gain etc using clean, plant based nutrition and following a healthy lifestyle. Educating women and men about this can definitely improve the quality of living for PCOS warriors and help them overcome the fear of speaking up and getting help when needed.”

17th September, 2021

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Covid may infect a higher proportion of pregnant women: ICMR Study

A new study by Indian Council of Medical Research (ICMR) suggests that SARS-CoV-2 may infect a higher proportion of pregnant women, and when symptomatic, a large proportion can develop moderate-to-severe disease. The experts have recommended that pregnant women may be counselled for vaccination to reduce the adverse impact of Covid-19 on maternal health with Covid. In their first study large-scale report of systematically collected, multicentre data on the clinical presentation, pregnancy outcomes and maternal deaths amongst women with Covid-19 in Maharashtra, the experts observed that nearly 30 per cent of the symptomatic cases had moderate to a severe disease requiring ICU/HDU admission. “Almost 96 per cent of the ICU/HDU admissions were due to Covid-19 and only 4 per cent were due to non- Covid-19 causes. Thus, our analysis suggests that SARS-CoV-2 may infect a higher proportion of pregnant women,” said the study. It said that pregnant women with Covid-19 need “immediate medical attention” from the healthcare system in India. It also said that co-infections could be a greater threat to pregnant women with Covid-19 in the Indian context. The experts analysed data of 4203 women with Covid-19 for the study. The majority of pregnant and post-partum women with Covid-19 were recruited from the Mumbai metropolitan region (1684, 40%) followed by Vidarbha (1155, 27.5%), Pune (853, 20.3%), Marathwada (351, 8.4%) and Khandesh region (160, 3.8%). The experts analysed the majority of women (3441, 82%) aged 18-30 year, with 92 per cent of the women being in the third trimester and the median gestational age was 38 week. Out of 4203 women, 3865 were registered during their ongoing pregnancy and 338 were enrolled during the post-partum period. According to the study majority (3669, 87.3%) of the pregnant and post-partum women with Covid-19 were asymptomatic and only 534 (12.7%) women were symptomatic. The study found that pregnant and post-partum women above 30 years of age had “two times higher severity" of Covid-19 disease as compared to women aged less than 30 years of age. "The study demonstrates the adverse outcomes including severe Covid-19 disease, pregnancy loss and maternal death in women with COVID-19 in Maharashtra," it said. The study revealed that there were 3213 live births, 77 miscarriages and 834 undelivered pregnancies. The proportion of pregnancy/foetal loss including stillbirths was six per cent. Five hundred and thirty-four women (13%) were symptomatic, of which 382 (72%) had mild, 112 (21%) had moderate, and 40 (7.5%) had severe disease. The most common complication was preterm delivery (528, 16.3%) and hypertensive disorders in pregnancy (328, 10.1%). A total of 158 (3.8%) pregnant and post-partum women required intensive care, of which 152 (96%) were due to COVID-19 related complications. According to the experts higher Case Fatality Rate (CFR) was observed in Pune (9/853, 1.1%), Marathwada (4/351, 1.1%) regions as compared to Vidarbha (9/1155, 0.8%), Mumbai Metropolitan (11/1684, 0.7%), and Khandesh (1/160, 0.6%) regions. Comorbidities of anaemia, tuberculosis and diabetes mellitus were associated with maternal deaths. Among severe Covid-19 cases, the most common presenting symptoms were shortness of breath (34, 85%), dry cough (23, 57.5%) and fever (22, 55%).

17th September, 2021

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With 100+ shots per session, Maharashtra has zero vaccine wastage

Skillful and efficient administration of doses have helped Maharashtra achieve ‘negative vaccine wastage’, inoculating an average of 103 beneficiaries per session as against 92-96 last month. In September so far, an average of 7 lakh vaccine shots have been administered every day. ‘Negative vaccine wastage’ means zero wastage of doses by vaccinators. Manufacturers provide 11-12 doses in each vial as against the general perception of just 10. In case of negative wastage, vaccinators extract and administer extra doses from vials to cover more beneficiaries. Vaccination data showed that at least 16 districts have vaccinated an average of more than 100 beneficiaries per session so far pushing up the state’s average. Mumbai’s average has increased from 158 beneficiaries vaccinated per session to 172 now. Pune’s average was about 106 around August 23, which increased to 112 by September 13. Health department officials said vaccinating less than 100 beneficiaries on an average per session could lead to vaccine wastage and sub-optimal use of resources. Maharashtra’s net wastage for Covishield so far has been -1.77% and for Covaxin, 0.51%. The vaccination data was arrived at by dividing the number of beneficiaries vaccinated so far by the total number of sessions conducted till September 13. The numbers are, therefore, an indicator of how state has performed per vaccination session. Dr Rajshree Patil, medical officer at Pune’s Kamala Nehru Hospital, said: “Vaccinators are drawing more than 10 doses from each 10-dose vial, which depends on their skill and practice. Competent vial use during each vaccination session has helped push the number of beneficiaries to an average of 120 per session. Even if 10 vials are used per session, we end up vaccinating 110-120 beneficiaries as more than 10 doses are being drawn out per vial.” Dr Sanjay Deshmukh, assistant director (medical), Pune circle, told TOI: “The health department has been regularly telling low-performing districts to increase the number of beneficiaries vaccinated per session. The ministry had earlier also advised that each vaccination session should cater to at least 100 beneficiaries.” He said as per the original plan, districts were told to vaccinate a minimum of 100 beneficiaries per session. “However, several districts are now surpassing that number increasingly.” Deshmukh added that an increase in vaccine supplies over the last one month also helped boost the number of beneficiaries inoculated per session.

17th September, 2021

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