Avalku Pinnale-Veendum..?:Instant Short Story

Innu Njan avale veendum kandu mutti...Pakshe avalude mukhath eppozhumulla aa deshyam kandilla...athu konduthanne nhan daiyathode chodichu..."Ninte kalyanam evide vare aayi...?" Pakaram mattoru marupadiyanu aval thannath..."Ningal aanungalk oru vicharamund...oru pennu alpaneram samsarichal avalk thannod premam aanennu.... Enikk ippo oru kalyanam venda....." Aval akalek nadannu maranhu.....appol avanod avalku premam onnum illenno...?Ente manassil mattoru LADDU Potti....... 

AVALKU PINNALE:Oru Hathabhagyanaya Kamakan-Instant short story on 04.12.11

"EEe kalyanathil ninnum ningal pinmaranam....karanam nhan ivalumayi snehathilanu...avalk ennodum snehamanu...pakshe ath aval thurannu parayunnilla enneyulluu...."  pennukanan vannavarude mughath nokki parayenda vakkukal nhan byheart cheythu.....ravile thanne  koottukarante bike um eduth avalude veetinte parisarath hajaraayi...time 10.10am.. podi parathikkond oru car avalude vedinte akathekk kerippoyi....thazhthi vacha chillinidayiloode oru nhettalode nhan kandu ...ath avan thanne.... kazhinha aazhcha avalod valare neram SAMSARIchavan....appol ...ath...avalude kamukan aayirunno...? Samadrohi....avanu kettan vere pennineyonnum kittiyille...? ente daivame..  ente hridayam karinhunangi.... "aaarada ath...?"avalude thantha erachi vettukarante ocha gateinte purathekk aayalude shareerathodoppam ethi... sankadam bhayamayi maran seconds vendi vannilla....vallathum angeru arinhu kanumo?.... enne kandathum aa shabdam onnukoodi parukkanayi..."akathekku vaa...keri iri.."... Avale pennukanan vannavurude idayiloode oru moolayilekk enne iruthi.....Avalude avan oru puthu manavalante gamayil ente munnil irikkunnu....kurach endosulphan aa vayilek ozhikkan thonni..... Koottathil vanna oru kizhavan thendi paranhu "ennappinne mole vilicholoo..."...ente manassil nerathe byheart cheytha dialogukal thelinhu vannu....ente manassu paranhu..."paranholu....ini vaikaruth...ellavarum ariyatte..." "mole...vannoluu..."irachi vettukarante ocha ente manassilek oru thalayatta aadinte chithram thiruki kayatti....oru vilariya chiriyode aa chayakudich onnum mindathe bhayam enne aa veedinte padiyirakki vittu...........bheeru...  Pranasakhi mattoralude munnil nanathode chaya nalkunna kazhcha kanendi vanna kaamukan........enne ini enthinu kollam........?"

Koovara Thanam - Kattil Veypu Chadang on 04.12.11

Koovara Sri Vayanattu Kulavan Daivasthanam,Thanathingal

കൂവാര ശ്രീ വയനാട്ട് കുലവന്‍ ദേവസ്ഥാനത്ത് കട്ടില വെയ്ക്കല്‍ ചടങ്ങ് 04.12.11 നു നടന്നു.ചടങ്ങിനു മേലത്ത് കാരണവര്‍മാരും മറ്റു മുതിര്‍ന്നവരും നാട്ടുകാരും സംബന്ധിച്ചു....

Chadangil Thazhe Parayunnavar sambandhichu...

K.Krishnan Nair,Koovara

P.gangadharan Nair,madakkallu

M.Ramachandran Nair,Kadannappalli

Janardhanan Ittakkad,

T.Balakrishnan Akkara,

T.Raman,Koovara

T.Bamban,koovara,

Vijayakumar,kvra,

Anil punam,

Pradeep Mottammal,

Sasi Koovara,

Vijesh Punnakunnil,

and others.......

Chadangilek Oru Ethi Nottam....

Puthiya Thanathinu Vendiyulla Kattila

Vilakku theliyich chadang Aarambham

Chadanginu Van Bhaktha jana sannidhyam

Thanam karyakkaran Rameshan Vilakk theliyikkunnu

Kattila vekkunnathinu munpayi Prarthana

Karanavarmar Prarthikkunnu

kattila

Ganapathikku samarppanam

Ari Thozhal

Kattila devante aduthekk

Kattila vachu Kazhinh

Nannayi Urappicha shesham..

                                          Photos By Vgkumu

For More Information about this,Please visit  www.vgkumu.blogspot.com later.

Thanks for visiting my blog......visit again .....

AVALKU PINNALE-Instant Short Story 03.12.11

Nhan kattilil malarnu kidakkukayayirunnu....faninte ithalukal enne nokki pallilichu......Bheeru.... Oru peera penninte kayyil ninnum medichu vannirikkunnu......kaikal kavilil parathi nokki.....illa avide onnum illa... ullath manassilanu.... appol ente phone shabdichu.... changathiyanu... avante vakkukal ente cheviyilekk theekkanalukal vaariyittu....avale aaro nale pennu kanan varum....!!! Athe..nale sunday aanu...college illa...ente hridayam mullapperiyar pole eppol venemengilum pottumenna avastayil aayi.... Araavum avale naale pennu kanan varunnath...........?

Avalku Pinnale-pranayathinte Kaioppu-AN instant short story-02.12.11

Aval varunna vazhikku thanne njan kathirunnu..... aval aduthathethiyyappol ente sakala niyathranangalum poyi.....njan urakke alari..."ninakk enthadi enne nokkiyalu.....? premichalu.....? enikk enthadi oru kuzhappam..? parayedi...." ente vakkukalil deshyam aalikkathi.... athodoppam njan avalude chumalil kai vachu..... "trrrrraaaash..." ente thadicha kavilukal oru vashathekk ulanhu... kannil ninnum ponneechakal parannu....krithyamayi paranjal oru 35 nakshathrangal thalayku meethe karangi.... athe....... aval enne thalli.....nhan tharichirunnu.. ente kopamellam...aaavi aayirikkunnu....kazhcha mangi poyirikkunnu......kurachu nerameduthu athu thirichu varan........appozhekkum aval kazhchayil ninnum maranhirunnu.... athe, aval sundari mathramalla...., aarogyavathi koodiyanu...

Avalku Pinnale-Ente Branthan Chinthakal-Short Stoy1.12.11r

ente manassu nilavath azhichuvittathu poleyanu.... onninum oru flow kittunnilla... allelum aval athra sundariyonnum alla.... karupp valare kooduthalanu..... pakshe ennalum..... potte,... poyi thulayatte..... urakkamillatha rathrikal.... illa njan pinmarilla..... nale aval varunna vazhikk olichirunnu onnukoodi dairyathode parayum enikkishtamanennu........ aval athil veezhathirikkilla..... naleyavatte.... innu ini.....?

Bedira Kottaram Sri Vayanattukulavan Theyyam Kettu Mahothsavam-Latest News

Bedira Kottaram Sri Aadi Nalvar Daivasthanam Sri Vayanattukulavan Theyyam Kettu Mahothsavam

Bedira Kottaram Sri Aadi Nalvar Daivasthanam Sri Vayanattukulavan Theyyam Kettu Mahothsavam March 6,7,8  2012

Bedirayil innu Volunteersinu vendiyulla meeting nadannu...thazhe parayunnavare theranheduthu.

Chairman           :Mr.C.Kunhiraman Nair,Puliradi

Secretary            :Mr.madhusoodanan Nair,Kuttikkol

Treasurer            :Mr.C.Krishnan Nair,Maruthadkam

Jt.Secretary         :Mr.Choyi,Kalariyadukkam

For more information about this,visit www.vgkumu.blogspot.com tomorrow.

AVALKU PINNALE- INI NJAN POKANO?-Short Story-30.11.11

" oru karyam ninnod parayanund...enik ninne ishtamanu..othiri nalayi  ithu parayan sramikkunnu....ninak ...ninakk sammathamano...? " Valere neram alochich oduvil nhan avalod paranhoppichu..... Pakshe, avalk ottum alochikkendi vannillaa...."Enikk ishtamalla NINGALE..... ningal  vere alochicholu..." oru chammalumillathe aval paranhu.....ente hridayam neduke pilarnnath njan oru nhettalode manassilakki.... chuduchora... ente kannil ninnum adrishyamayi ozhuki..... athe... oduvil athu thanne sambhavichu....manassu vingippottukayanu...njan ini enthu cheyyum....?

Bedira Kottaram Sri Vayanattukulavan Theyyam Kettu Mahothsavam-Volunteer's meeting tomorrow

Bedira Kottaram Sri Aadi Nalvar Daivasthanam Sri Vayanattukulavan Theyyam Kettu Mahothsavam March 6,7,8  2012

Bedira Kottaram Sri Aadi Nalvar Daivasthanam Sri Vayanattukulavan Theyyam Kettu Mahothsavam March 6,7,8  2012

Bedira Kottaram Sri Aadi Nalvar Daivasthanam Sri Vayanattukulavan Theyyam Kettu Mahothsavathod anubandhich naale (10.11.11) 10 a.m nu Bedirayil vach volunteers meeting nadakkunnu.... Ella nallavaraya nattukarudeyum sahakaranam pratheekshichu kollunnu... For More Details on meeting....visit vgkumu tomorrow.

AVALKU PINNALE-Short Story 29.11.11

" oru karyam ninnod parayanund...enik ninne ishtamanu..othiri nalayi  ithu parayan sramikkunnu..pakshe innanu sadhichath...ninak ...ninakk sammathamano...? aalochichitt parayanm...."-  Kannadikku  munnilirunnu palavattam  practice  cheythittum,.. innu  avale  neritt  vazhiyil kandappol  pedi  kaaranam  ithonnum vayil vannilla.... classil poyathanennu  arinhittum  njan  veruthe chodichu.." evideppoyatha...?" ...aval  paranha  marupadi   ente hridayamidippinte ochayil njan kettilla...... EEshwara...! naleyenkilum  enik  avalod  manassu  thurakkan pattumo.....?

Avalku pirake-Short Story....28.11.11

Erachi vettukaranaya avalude pithagi(father)ye innu njan kandu...kathi kazhuthil veezhumbol undayekkavunna aa sugham oru nimisham ente manassiloode kadannu poyi....oh..pinne...vaayi nokkiyathinu vettet maricha aareyenkilum ningalku orma varunnundo...?

See...there is an easy way for Ayyappa Darshan-Book Ur Darshan time through online

Sabarimala: Pilgrims discover Q-coupon booking virtues

Sabarimala: Every year, Krishna Kumar used to spend a minimum of five hours in the queue to enter the sanctum sanctorum of the Sabarimala temple here. But this year, it just took him 15 minutes -- thanks to a new Q-coupon booking facility.

All he had to do was log onto www.sabarimala.keralapolice.gov.in, upload his picture and book the time of darshan.

A brainchild of Director General of Police Jacob Punnoose, the facility has come as a relief to thousands of pilgrims this season. 

'For some reason we were not able to launch this facility during last few years. But this time, we decided to give it a try and it has been a huge success,' Punnoose told IANS.

'On an average, we can provide advance booking to 1,000 pilgrims in an hour. The pilgrim can select his own time of darshan if time slots are available.

'At peak hours, no one will have to wait for more than an hour. They will be made to stand in a special queue located close to the 18 steps leading to the sanctum sanctorum,' said Punnoose.

Though the temple is open throughout the year, the peak pilgrimage season begins on the first day of the Malayalam month in November (Nov 17 this time) and closes on the first day of the Malayalam month in January.

'We launched the website a week back. In the first week, we received just 3,000 bookings but the number rose to 40,000 and the number of hits on our site has crossed two lakh,' said Punnoose.

Authorities are now planning to extend the facility to the special days in the two-month-long pilgrimage.

'We have not yet extended this facility for special days as the crowds are huge. Those who have made an advance booking might not be able to reach the special queue in time. We are working out ways to see what best can be done,' added Punnoose.

As many as 100 people were killed in a stampede in January this year when pilgrims were returning after watching the celestial Makara Jyothi light, the most important event of the pilgrimage, from a hillock some 30 km from the Sabarimala temple.

Situated on the mountain ranges of the Western Ghats at an altitude of 914 metres above sea level, Sabarimala temple is four kilometers uphill from Pamba in Pathanamthitta district.

It is one of the most famous Hindu pilgrim centres in India.

The temple, which bars the entry of women who have attained puberty, is accessible only on foot from Pamba.

The Sabarimala authorities have said the collection in the first two days crossed Rs.2.17 crore, Rs.37 lakh more than last year's figures.

Bedira Kottaram Sri Aadi Nalvar Daivasthanam Sri Vayanattukulavan Theyyam Kettu Mahothsavam March 6,7,8 2012- Latest News

Bedira Kottaram Sri Aadi Nalvar Daivasthanam Sri Vayanattukulavan Theyyam Kettu Mahothsavam March 6,7,8  2012

Bedira Kottaram Sri Aadi Nalvar Daivasthanam Sri Vayanattukulavan Theyyam Kettu Mahothsavam March 6,7,8  2012

Bedirayil vayanattu kulavan theyyam kettu  mahothsavathodanubandhich 27.11.2011 ,2 manikk volunteermarkku vendiyulla meetting nadannu.Akhosha paripadikalod anubandhich chila pradhana theerumangal yogathil dharanayayi.Adutha meetting ee masam 30(30.11.2011)nu Bedirayil vachu nadakkum....Eevarkkum Swagatham...


Bedirayile Meetings-Photos...

AVALKU PINNALE-Short Story

innu oru kalyanamundayirunnu....avalum undayirunnu kalyanathinu... enne nokkiyathe  illaaa...pakshe...athinekkalum eere enne vedanippichath....aval ennekkalum sundaranaya oru cherukkanumayi valare neram samsarichu....idayk nokki...pinneyum samsaram thudarnnu...aaravum avann.....?

TUBERCULOSIS:EVERYTHING THAT YOU SHOULD KNOW IN DETAIL

                                   WHAT IS TUBERCULOSIS?

                       

 "Tuberculosis (TB) is a highly infectious bacterial disease caused by  Mycobacterium tuberculi".

                                             TB can affect any part of the body. When it affects the lungs it is called pulmonary TB. The commonest form of TB is pulmonary TB.TB in any other part of the body (i.e. other than lungs) is called extra pulmonary TB.

HOW TUBERCULOSIS SPREADS?

TB germs usually spread through air. When a patient with pulmonary tuberculosis

coughs or sneezes, TB germs are spread in the air in the form of tiny droplets. When these droplets are inhaled by a healthy person s/he gets infected with tuberculosis. This infected person will have a 10% lifetime risk of developing tuberculosis.

MAGNITUDE OF TUBERCULOSIS IN INDIA

In India everyday

•  more than 40,000 persons get infected with the TB bacillus

•  more than 5000 people develop TB disease

•  more than 1000 people die due to TB ( i.e. 2 persons die every 3 minutes)

•  annually, about 18 lakh new cases of TB occur of which about 8 lakh are sputum

positive infectious cases 

Also, every year

•  about 3 lakh children drop  out from the school because of their parents had

tuberculosis

•  more than 1 lakh women are rejected by their families because of stigma due to

TB

It is estimated that in a year, about 200 TB cases may occur in a population of 1 lakh

CLASSIFICATION OF TUBERCULOSIS 

  1. Pulmonary                   2. Extra-pulmonary

                                               Lymph nodes

                                               Sputum-positive sputum-negative  

                                               Bones and joints

                                               Urogenital tract

                                               Nervous system (meninges)

                                               Intestines

"One sputum positive case, if not treated,  can infect 10 -15 individuals in one year "

A patient with at least two samples of sputum found positive for Acid-Fast Bacilli (AFB)

by microscopy is known as a sputum-positive case.

            OR  

A patient with one sample of sputum found positive for AFB by microscopy and having

X-ray abnormalities consistent with active pulmonary tuberculosis is also labeled as a

sputum-positive case. However, this is to be done only by a Medical Officer.

Smear-Positive Pulmonary TB is the most infectious form of Pulmonary TB in Adults  

A patient with all three samples of sputum found negative for AFB by microscopy, should after a course of broad spectrum antibiotics repeat the sputum examination. If found negative and X-ray abnormalities are consistent with active pulmonary tuberculosis, it is known as a sputum-negative case. The decision of diagnosing and treating such a case will be taken by the Medical Officer only.

    

  Extra-Pulmonary Tuberculosis 

A patient with active tuberculosis of any part of the body other than the lungs is a case

of extra-pulmonary tuberculosis. The decision of diagnosing and treating such a case will be taken by the Medical Officer only.

WHEN SHOULD TUBERCULOSIS BE SUSPECTED?   

     

     The symptoms of Pulmonary Tuberculosis are

              •  cough with expectoration for 3 weeks or more

              •  chest pain

              •  sometimes, blood stained sputum (haemoptysis) with systemic symptoms like

ƒ                                   evening rise of temperature

ƒ                                   night sweats

ƒ                                   loss of weight

                                  ƒ loss of appetite

A person with cough for 3 weeks or more is a suspect for TB and is  called a chest symptomatic

Extra-pulmonary Tuberculosis

In case of extra-pulmonary TB, symptoms in addition to the above mentioned, depends

on the organ involved, for eg.

                                 •  Lymph Node Tuberculosis – Swelling in the neck with or without discharging sinus.

                                 •  Tuberculous Meningitis - Headache, fever, drowsiness, mental confusion, neck

                                     rigidity.

                                 •  Spinal Tuberculosis – Back pain, fever and at times swelling of the backbone.

HOW TO DIAGNOSE TUBERCULOSIS? 

Sputum examination is the main tool for diagnosing pulmonary TB. 

Cases of pulmonary tuberculosis are further subdivided into sputum-positive and

sputum-negative cases. When pulmonary tuberculosis is suspected, it is mandatory to conduct sputum examinations to confirm the diagnosis. At least 3 sputum samples (spot – morning - spot) should be collected, preferably within two days, and examined by microscopy only at an RNTCP designated microscopy centre (DMC). A DMC is an identified sputum microscopy laboratory in a PHC, CHC or hospital for 1 lakh population (in tribal areas – 50,000 population). It is equipped with a binocular

microscope, trained lab technician and is  supervised by the Senior Tuberculosis Laboratory Supervisor (STLS) at regular intervals. A person with at least two positive sputum samples out of three is a confirmed case of sputum positive pulmonary tuberculosis. This is the most infectious form of tuberculosis. Patients who are smear-negative or have only one smear-positive sample must be referred to the Medical Officer (MO) for further evaluation as per diagnostic algorithm of RNTCP.

Diagnosis of TB must be done by a Medical Officer (MO)

NATIONAL TUBERCULOSIS PROGRAMME

The National Tuberculosis Programme (NTP) in India was being implemented since 1962 by establishing District Tuberculosis Centres (DTCs), TB Clinics and TB Hospitals. From its inception, the programme was integrated with the general health services and the service delivery was through the primary health care infrastructure. The results of NTP were not encouraging. The strategy of the NTP was reviewed in 1992. This led to the launching of the Revised National Tuberculosis Control Programme (RNTCP) in 1997, planning to cover the entire country by 2005.

Revised National Tuberculosis Control Programme 

     Objectives of RNTCP

1. To achieve and maintain a cure rate of at least 85% among newly detected

infectious (new sputum smear-positive) cases, and

2. To achieve and maintain detection of atleast 70% of such cases in the population.

RNTCP is based on the internationally recommended strategy to control TB

known as ‘DOTS’  (Directly Observed Treatment Short course) 

WHAT IS DOTS? 

DOTS is a systematic strategy which has five components

•  Political and administrative commitment.                                                                                                                    

TB is the leading infectious cause of death among adults. It kills more women than all causes associated with childbirth combined and leaves more orphans than any other infectious disease. Since TB can be cured and the problem can be controlled, it warrants the topmost priority, which it has been accorded by the Government of India. This priority must be continued and expanded at the state, district and local levels.  

•  Good quality diagnosis.

Top quality microscopy allows health workers to see the tubercle bacilli and is essential to identify the patients who need treatment the most.  

•  Good quality drugs.

 An uninterrupted supply of good quality anti-TB drugs must be available. In RNTCP, a box of drugs for the entire treatment is earmarked for every patient registered, ensuring the availability of the full course of treatment to the patient the moment s/he is  registered for treatment. Hence in DOTS, the treatment

will never fail for lack of medicine.

•  The right treatment, given in the right way. 

 The RNTCP uses the best anti-TB medications available. But unless treatment is made convenient for  patients, it will fail. This is why the heart of the DOTS programme is "Directly Observed Treatment" in which a health worker,  or another trained person who  is not a family member, watches as the patient swallows the anti-TB medicines in their presence.  

•  Systematic monitoring and accountability. The programme is accountable for the outcome of every patient treated. The cure rate and other key indicators are monitored at every level of the health system, and if any area is not meeting expectations, supervision is intensified. The RNTCP shifts the responsibility for cure from the patient to the health system.

ƒ Makes the patient the VIP of the programme

ƒ Places responsibility for patient’s cure on the health system, not on the patient

ƒ Reduces risk to the community by preventing spread of TB

ƒ The best method to ensure cure

WHAT IS ‘CURE’? 

A patient who is initially sputum smear-positive and who has completed treatment and had negative sputum smears on  two occasions, one of which was at the end of treatment, is declared a ‘cured’ patient.

IMPORTANT POINTS TO REMEMBER ABOUT TUBERCULOSIS SUSPECTS 

•  The most common symptom of pulmonary  tuberculosis is persistent cough for 3 weeks or more

•  Health workers should identify tuberculosis  suspects as early as possible to stop  spread of infection.

•  Refer all TB suspects to DMCs/ sputum collection centres for 3 sputum examinations

•  DOT is the best method to ensure cure for TB

"DOTS – sure cure for TB"

TREATMENT OF TUBERCULOSIS 

The duration of treatment is usually 6 to 8 months. There are two phases in the treatment of tuberculosis: the intensive phase (IP) of 2-4 months and the continuation  phase (CP) of 4-5 months, depending upon the  category of treatment. During IP, all doses are given under direct observation, three times a week on alternate days for 2-4  months. Thereafter, sputum  is examined and if found negative, the CP is started. During CP, the first dose of every week must be administered under direct observation. The patient collects the rest  of the drugs for that week  from the DOT Provider and consumes them at home.The following week, the patient comes with the empty blister pack, hands it over to the DOT Provider, takes the first dose under direct observation and collects drugs for the rest of the week to be consumed at home.

What are Categories I, II and III? 

There are three categories  of treatment regimens for patients suffering from tuberculosis (pulmonary or extra-pulmonary).

Drugs are supplied in a Patient Wise Boxes (PWB) containing the full course of treatment for one patient and are packaged in blister packs. The PWBs have a colour code indicating the category of treatment (red for Cat I, blue for Cat II and green for Cat 

III). In each PWB, there are 2 pouches, one for IP (marked A) and one for CP (marked B)

For IP, each blister pack contains drugs for one day. For the CP each blister pack contains one week’s supply of medication. The drugs for one month’s extension of the IP (prolongation pouch) are supplied separately.

ƒ There are 52 weeks in a year

ƒ For purpose of the programme and drug administration

ƒ 2 months have been taken as 8 weeks

ƒ 3 months have been taken as 12 weeks

ƒ 4 months have been taken as 18 weeks

ƒ 5 months have been taken as 22 weeks

ƒ

 The weeks and months specified above should be strictly adhered 

Category I (CAT-I) Treatment Regimen

The anti-TB drugs in CAT-I are supplied in patient wise boxes with red colour labels containing 24 doses for the two months of the intensive phase and 18 weekly blister  packs for the four months of the continuation phase.

 Each weekly blister pack of the CP contains anti-TB drugs for 3 days and vitamin tablets for the remaining 4 days, taken on alternate days This is prescribed for the following types of patients:

•  New sputum-positive pulmonary TB cases 

•  New sputum-negative, pulmonary TB cases, who are seriously ill 

•  New cases of extra-pulmonary tuberculosis, who are seriously ill 

•  All new TB cases with known HIV +ve status 

Drug Regimen in CAT-I

Intensive Phase for two months

During the intensive phase (IP) of treatment, each and every dose of medicine is to be taken under direct observation  of the DOT Provider. DOT  is administered at a DOT centre, which is a place convenient to both the patient and the DOT Provider Anti-TB drugs are taken three times a week on alternate days, either on Mondays, Wednesdays and Fridays OR Tuesdays, Thursdays and Saturdays for two months. All empty blister packs should be preserved in the patient wise box (PWB). The anti-TB drugs to be swallowed for each scheduled dose of the intensive phase are:

Isoniazid (H)   Rifampicin (R)   Pyrazinamide (Z)     Ethambutol (E) 

300 mg            450 mg               750 mg                      600 mg

2 tablets           1 capsule           2 tablets                      2 tablets 

If a patient in IP does not take medication as scheduled s/he should be traced and given medication within 24 hours. The medication for the following day is given as scheduled. For example, if a patient is receiving DOT on Mondays, Wednesdays and Fridays, but does not take medication on Wednesday, the patient should be found on Thursday and given medication and should take the next dose of medication on Friday, returning to the previous schedule.

Continuation Phase for four months

If the sputum at the end of  the I.P. (i.e. at the end of two months) is found to be negative, the patient is started on continuation phase for a period of four months. During the CP, the first dose of the week must be administered under direct observation. The patient collects rest of the drugs for the week from the DOT Provider and consumes them at home. The following  week, the patient comes with the empty blister pack, hands it over to the DOT Provider, takes the first dose under direct observation and collects drugs for the rest of the week to be consumed at home. The DOT Provider must collect the empty blister pack and keep it in the PWB.

  The anti-TB drugs to be swallowed on each day of the continuation phase are:

       Isoniazid (H)                         Rifampicin (R) 

         300 mg                                    450 mg

        2 tablets                                  1 capsule 

For patients weighing over 60 kgs, the Medical Officer initiating treatment may prescribe an additional tablet of Rifampicin 150 mg which also needs to be administered. Similarly for pediatric cases, the Medical Officer may adjust the dose according to weight. If the sputum test, at the end of two months of intensive phase treatment remains positive, the four anti-TB drugs of the intensive phase will be continued for one more month. If even at the end of the extended period of intensive phase the sputum test  remains positive, the patient will be started on drugs of the continuation phase. Irrespective of the duration of the intensive phase, the duration of the continuation phase remains the same (4 months). If the sputum still remains positive at the end of five months after the start of treatment the patient is taken off CAT-I treatment and the DOT Provider must ensure that the patient is referred to the MO of the PHI for further management.

Category II (CAT-II) Treatment Regimen 

This is prescribed for the following types of patients:

•  Sputum-positive relapse cases  

•  Sputum-positive failure cases 

•  Sputum-positive treatment after default cases 

•  Others; Extrapulmonary relapse or failure 

The anti-TB drugs in  CAT-II are supplied in patient wise boxes with blue coloured labels which contains 36 doses for the three months of the intensive phase and 22- weekly blister packs for the five months of the continuation phase. For the continuation phase each weekly pack contains anti-TB drugs for 3 days and vitamin tablets for the remaining 4 days to be taken on alternate days.

Drug regimen in CAT-II

Intensive Phase (I.P.) for three months

During the IP of treatment, each and every dose of medicine is to be taken under the direct observation of the DOT Provider. DOT is administered at a DOT centre, which is a place convenient to both the patient and the DOT Provider Anti-TB drugs are taken three times a week on alternate days, either on Mondays, Wednesdays, Fridays OR Tuesdays, Thursdays and Saturdays for three months. All empty blister packs should be preserved in the patient wise box (PWB). In addition to the following four anti-TB drugs, an injection of streptomycin (0.75 g) is also given intramuscularly for first two months on the same days on which the patient comes to swallow his scheduled dose of anti-TB drugs. The injection is to be given after the patient has swallowed the other drugs.

 The anti-TB drugs to be swallowed for each scheduled dose of the intensive phase are:

Isoniazid (H)              Rifampicin (R)           Pyrazinamide (Z)             Ethambutol (E) 

300 mg                        450 mg                        750 mg                            600 mg

2 tablets                     1 capsule                      2 tablets                         2 tablets 

Continuation Phase (C.P.) for five months

If the sputum test at the end  of I.P. (i.e. at the end of three months) is found to be negative, the patient is put  on continuation phase for a period of five months. Each weekly blister pack contains anti-TB drugs for three days of the week and vitamins for the remaining days of the week. During the CP, the first dose of the week must be administered under direct observation. The patient collects the rest of the drugs for the week from the DOT Provider and consumes it at home. When the patient returns the next week for the blister pack, s/he must present the empty blister pack of the drugs consumed at home. The DOT Provider must collect the empty blister packs and keep it in the patients PWB The anti-TB drugs to be swallowed for each scheduled dose of the continuation phase are:

Isoniazid (H)                   Rifampicin (R)                     Ethambutol (E)

300 mg                             450 mg                                 600 mg

2 tablets                         1 capsule                              2 tablets

If the sputum test at end of three months of intensive phase remains positive, the four drugs of the intensive phase will continue for one more month. If even at the end of the extended period of intensive phase, the sputum remains positive, the patient will start on drugs of the continuation phase. Irrespective of the duration of the intensive phase, the duration of the continuation phase remains the same (5 months). If sputum still remains positive at the end of five months of continuation phase, the DOT Provider must ensure that the patient is referred to the MO of the PHI for further management.

Category III (CAT-III) Treatment Regimen

This is prescribed for the following types of patients:

•  New sputum-negative pulmonary TB cases, who are not seriously ill 

•  New extra-pulmonary tuberculosis cases, who are not seriously ill. 

The anti-TB drugs in CAT-III  are supplied in patient wise boxes with green coloured labels which contains 24 doses for two months of the intensive phase and 18 weekly blister packs for the four months of the continuation phase. For the continuation phase each weekly pack contains anti-TB drugs for 3 days and vitamin tablets for the remaining 4 days to be taken on alternate days.

Drug Regimen in CAT-III

Intensive Phase (I.P.) for two months 

During the IP of treatment, each and every dose of medicine is to be taken under direct observation of the DOT Provider. DOT is administered at a DOT  centre, which is a place convenient to both the patient and the DOT Provider. Anti-TB drugs are taken three times a week on alternate days, either on Mondays, Wednesdays, Fridays OR Tuesdays, Thursdays and Saturdays for two months. All empty blister packs should be preserved in the patient wise box (PWB).

The anti-TB drugs to be swallowed for each scheduled dose of the intensive phase are:

Isoniazid (H)                     Rifampicin (R)                        Ethambutol (E) 

300 mg                              450 mg                                       750 mg

2 tablets                       1 capsule                                       2 tablets 

Continuation phase (C.P.) for four months If the sputum test at the end of the I.P. (i.e. at the end of two months) is found to be negative, the patient is put on the continuation phase for a period of four months. During the CP, the first dose of the week must be administered under direct observation. The patient collects rest of the drugs for the week from the DOT Provider and consumes them at home. When the patient returns the next week for his/her blister pack, he/she must present the empty blister pack of the drugs that were consumed at home. The DOT Provider must collect the empty blister  pack and keep it in his/her PWB.

The anti-TB drugs to be swallowed on each day of the continuation phase are:

           Isoniazid (H)                          Rifampicin (R)

             300 mg                                    450 mg

            2 tablets                                  1 capsule

If sputum is found positive at the end of two months of the intensive phase, the patient is withdrawn from Category III and referred to the MO of the PHI for further management. If sputum is found negative at the end of two months of the intensive phase, patient starts anti-TB drugs of the continuation phase.

Management of Contacts of Sputum-Positive Cases

Any person who has a productive cough of any duration and is in contact with a smearpositive case, three sputum samples should be examined as soon as possible for diagnosis, and if negative, s/he should be evaluated by the Medical Officer and also followed up three months later. Children who cannot produce sputum should be examined with other recommended investigations like chest X-ray and tuberculin  testing. For all such cases contact the Medical Officer.

INTERACTING WITH PATIENTS

RNTCP recognizes the patient as the VIP (Very Important Person) of the programme. RNTCP also entrusts the responsibility of curing of patients on the programme and not on patients. Therefore it is important for DOT Providers to treat the patients in friendly manner. At the DOT centre,  patients should be welcomed, made to take a seat and provided with drinking water. It is also important to ensure that the DOT centre selected for individual patients are near to their residence and are open during the time that is convenient to the patient. The DOT Provider should ensure that the patients who do not come for their scheduled doses are met with, motivated and brought back to treatment. During IP, the patients interrupting treatment should be brought back to treatment within 24 hours and during CP within a week. It is important to identify the cause of interrupting treatment and address the problem in consultation with the patient and if required with the health worker, supervisor or the medical officer of the area. If the DOT Provider is not able to retrieve the patients back on  treatment, then the health worker/ supervisor/ MO should be informed immediately. 

              For more details visit http://www.tbcindia.org for more information regarding tuberculosis and RNTCP 

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ESI MODEL QUISTION PAPER FOR STAFFNURSE

Here are 5 questions which appeared in ESIC Staffnurse Exams kollam,kerala...Have a look at this
1.Planet which is near to our earth...?
               Answer:Venus
2.Who was the first vice president of India...?
               Ans:S.Radhakrishnan
3.First clinical feature of septicemia...
               Ans:facial flushing
4.in greenwhich time,what is greenwhich?
               Ans:
5.The capital of chattisgad...?
               Ans: