Introduction: In our day today life specially related to PC settings the topic related to Survivorship amongst the patients & the family friends, caregivers, caretakers, etc are talked amongst the families only that too in closed doors, with little room for detailed discussion even without involving the patient consent or in decision making processes. Thus I do feel in this community based study which was undertaken … survivorship is an outcome indicator & further any studies related to geriatric population this becomes central point & should be in built into the health systems with convergence at the primary health care level itself.

Study objectives:
To determine the prevalence of diabetes mellitus & pre-diabetes in the NE Region of India by estimating the state-wise prevalence of the same.
To compare the prevalence of diabetes & pre diabetes in urban areas/ rural areas in the NE Region.
To strengthen the referral chain including networking with local/ regional govts in the NE Region.

Methodology:
Sample size calculation: The sample size was calculated separately for urban & rural areas as previous studies have shown large variations in urban & rural prevalence of Type 2DM. Assuming an expected prevalence of 10% in urban areas & 4% in the rural areas, allowing a relative error of 20% on these, a non response rate of 20% & an error of 5%, the sample size was estimated to be 1200nos in Urban areas & 2800 in Rural areas in each of the regions studied.
Thus every state/ province a total of 4000nos individuals/state & the total population ie 16000nos in the studied areas viz Assam, Mizoram, Arunachal Pradesh & Tripura.

Results:
The overall weighted prevalence of diabetes in the states/ province was Assam 5.4%, Mizoram 5.7%, Arunachal Pradesh 5.2% & Tripura 8.6% respectively. In Assam, the weighted prevalence of diabetes in urban areas was 12.4%, which is nearly three times the rate found in rural areas (4.4%).
Similarly, in Mizoram, the weighted prevalence of diabetes in urban areas was 8%, which is nearly two fold the rate found in rural areas (3.5%), whereas in the urban areas of Arunachal Pradesh it was 5.9%, as compared to 5.0% in the rural areas. Similarly, weighted prevalence of diabetes in urban areas was 15.4%, as compared to 7.2% in rural areas of Tripura. The ratio of known to newly diagnosed diabetes is a good indicator of the level of diabetes awareness in a population. It was observed that the overall ratio of known to newly diagnosed diabetes in Assam was 1:0.8. In the urban areas it was 1:0.5 and 1:1 in the rural areas. Similarly, the overall ratio of known to newly diagnosed diabetes in Mizoram was 1:1, while in the urban areas it was 1:0.9 and 1:1.5 in the rural areas. In Arunachal Pradesh, it was observed that the overall ratio of known to newly diagnosed diabetes was 1:1.5, while in the urban areas it was 1:1.4 and 1:1.6 in the rural areas, whereas in Tripura, the overall ratio of newly diagnosed to known diabetes was 1:1.2, while in the urban areas it was 1:0.8 and 1:1.5 in the rural areas. The overall weighted prevalence of pre-diabetes in Assam was 11.8% (IFG: 8.1%, IGT: 2.7% and IFG+IGT: 1.0%) and in Mizoram 5.8 % (IFG: 3.7%, IGT: 1.6% and IFG+IGT: 0.5%).
The overall weighted prevalence of pre-diabetes in Arunachal Pradesh was 12.8% (IFG: 9.7%, IGT: 1.8% and IFG+IGT: 1.3%) and in Tripura overall weighted prevalence of pre-diabetes was 14.6% (IFG: 9.3%, IGT: 3.5% and IFG+IGT: 1.8%).

Conclusions: This community based study was undertaken in the above states in this part of NE Region of India clearly demonstrates the power of community mobilization & engagement of various sections of tribes/sub-tribes residing in this part of region in giving a clear mandate to the project which is reflected with an average response rates >90% in the studied areas. The increased levels of referrals with the local health institutions (either at govt or at private sectors) & building up networking & advocacy programes in colloboration with the like-minded organisations is of great importance in tackling this public health problem.

Recent research deals with disorders and deficits caused by vascular syndrome in an effort of prediction and prevention. Cardiovascular health declines with age, due to vascular risk factors, and this leads to an increasing risk of cognitive decline. Mild Cognitive Impairment (MCI) is defined as the negative cognitive changes beyond what is expected in normal aging. The purpose of the study was to compare older adults with Vascular Risk Factors (VRF), MCI patients, and healthy controls (HC) in social cognition and especially in Theory of Mind ability (ToM). The sample comprised a total of 109 adults, aged 50 to 85 years (M = 66.09, S.D. = 9.02). They were divided into three groups: (a) older adults with VRF, (b) MCI patients, and (c) healthy controls (HC). VRF and MCI did not differ significantly in age, educational level or gender as was the case with HC. Specifically, for assessing ToM, a social inference test was used, which was designed to measure sarcasm comprehension. Results showed that the performance of VRF group and MCI patients is not differentiated, while HC performed higher compared to the other two groups.  The findings may imply that the development of vascular disorder affecting vessels of the brain is associated from its “first steps” to ToM decline at least as regards specific aspects of it such as paradoxical sarcasm understanding.

Introduction : A viral test is done to find  infection causing  viruses .Viruses grow only in living cells . Viruses causes disease by destroying or damaging the cells they infect , damaging the body’s immune system Changing the genetic material (DNA) of the cells they infect or causing inflammation that can damage an organ . Viruses cause many types of diseases,  such as human immunodeficiency virus (HIV) ,cold sores, chicken pox , measles , flu and some types of cancer

Project nuclear medicine:

Benefits of nuclear Medicine:

Nuclear medicine is the medicine made of nutrients mixed together and generated immune cells are mixed together and these medicines is generated in body to make new immune fight against virus.

What are nuclear proteins in virus?

When energy is released, a high amount of transformation occurs and nucleus is transformed in Nuclear proteins.

Benefits of forward rolling of DNA:

New characteristics of a particular organism grow faster and lead to proper development of organism.

DNA backward rolling:DNA backward rolling leads to the deforming the cells and lead to formation of two organism again.

Effect of DNA background rolling:

1. New characteristic does not grow fast.

2. Deformation of new organism into old two organis

Introduction of nuclear medicine :

How does nuclear medicine increase immunity of the body?

Nuclear medicine is made up of the glucose fats proteins and vitamins, huge amount of immune cells with iron oxide. The glucose fats breakdown and release energy, proteins and vitamins build up and repair damaged tissue. Immune cells released in body build up and divide the other immune cells and fight against virus and its infection.

How did nuclear medicine affect the virus?

Nuclear medicine affect the virus by increasing and repairing immunity of body by increasing energy in body and by building up the immune cells by proteins.

How much nuclear medicine should be taken by an animal in a day?

An animal who is affected by the virus should take two times a nuclear medicine in an hour, as because immune system takes large time to repair.

Benefits of nuclear medicine:

1. Nuclear medicine increases the immunity of the body and also some amount of temperature.

2. Nuclear medicine increases the energy of the body and build up the body muscles.

Side effect of nuclear medicine:

Taking large amount of nuclear medicine can lead to increase the large amount of temperature and can even lead to dehydration.

What is the effect of nuclear medicine in body?

The nuclear medicine increases the immunity ,energy in the body and even increases the temperature of the body and even build up the immune system strong and even body capacity to fight against the infection.

Effects of nuclear medicine on viruses:

Does nuclear medicine is for every virus?

Yes, nuclear medicine is for every virus because it contain glucose, fats which release energy, proteins and vitamins which repair immune system. Immune cells fight with the infection and retained the capacity of body.

Why only nutrient and strong immune cells are required to make nuclear medicine?

Only nutrient and strong immune cells are required because these are only thing which build up the immense system and built it up more strong and fight against virus.

Does nuclear medicine is necessary to take every day in case you are infected by virus?

Yes, nuclear medicine is to be taken every day in case you are infected by virus as it increase the immune cells and build up the immune system strong enough to generate immune cells to fight against the virus.

Why other type of medicine cannot affect the virus?

Other medicine does not affect the virus because virus does not use any biological path but it uses connective channels of nuclear proteins and have protein shield which destroy the immunity of body or harm immune cells and destroy them. Nuclear medicine is best medicine of virus because it build up the immune system strong, generate high amount of energy and regenerate immune cells.

What kind of ways virus used to gain energy?

Virus use connective channels used to gain energy. Virus uses their nuclear proteins to create channels and connect with the blood cells to gain energy from blood to accept food from blood.

How does virus gain energy from blood?

Virus get mix with blood cells scattered in blood vessels and with the entrance of food in blood, the virus makes the nuclear channels and first destroys immune cells and then nuclear channels takes the energy from blood cells.

 What kind of organism is virus?

Virus is a bio molecular organism having capacity to put end dead in a outer condition until it enters root body.

Which part does nuclear medicine destroy the virus part

Nuclear medicine, destroy the protein shield with the help of its immune cells and then builds up the immunity of body and destroy the virus.

In which case of DNA theory virus become?

There are three cases in DNA combination theory:

1. Both living organism:

a. When both living organism combine and are of same class organism.

b. When both living organism of different organism combine they form organism which have mixture of both DNA.

2. Died or living:

When an organism before dying combines with living and are of same class or different class they form a micro organism or they are half died.

3. Died or died:

When an organism combine when they are going to die , they form either virus or bacteria.

Is it necessary that in died and died case virus is formed?

Yes, because it is rare that in living organism case only died and living organism. In living organism case virus has to die itself and in died and living organism any organism on died organism such as fungi, bacteria and virus can be formed.

Why does in dead and dead case bacteria and virus is formed?

In died and died case bacteria and virus mostly have the dead cell organism and have no energy so most of the time in dead and dead case bacteria and virus is formed. Bacteria is also formed in dead and living and even living organism when some mal function occur in living organism in  died and living organism.

Why only in died and dead case virus is formed?

In died and died case virus is formed because when the cell combine with both dead organism the cell organs are died and according to nuclear theory when two cells combine, the energy is released by nucleus and molecules generate the energy and the stored energy is released and organism pretend to form  and that organism is virus or bacteria.

Should we eat nuclear medicine in case we are not infected?

Yes, we should eat nuclear medicine in case we are not infected because if anyone is having weakness it will build up damaged tissue and generate high energy and build up body immunity and even increase body temperature. If any body temperature is low and even help in fighting with infection and even help in proper digestion and even increase stemming of body.

DNA defect theory affect on virus:

Virus in case of dead and dead is dead but in case of living and living when some defect occurs in DNA of cell in micro organism and high amount of energy is released and many cell organs be died and virus informed and even bacteria can be formed as some times organs release energy and some organs left which become bacteria.

Virus theory:

Virus is a living organism pretend to be dead in outer condition because its most organs are dead and its structure is like a diamond from top and form down it’s like a comb

Function of its part:

1. Nuclear proteins: It is the proteins which makes the connective channels and connect with blood cells in blood cells and absorb energy.

2. Protein shield: These protein shield help to destroy the immune cells and immunity of body and protect the nuclear proteins

3. Information thread: It gives information about the surroundings.

Result:

We have found virus is living but pretending to be dead and even found its treatment and found stamina booster and even found stamina booster.

DNA Result:

According to DNA result the virus is living and it is formed in two case first in dead and dead second in living and living but different class.

Nuclear theory result:

From nuclear theory we have found why virus pretends to be dead. In this it is explain when two cell combine the high amount of energy is released like this in virus when two dead cell combine its stored energy is released as when two dead cell combined, their stored energy is released.

DNA forward rolling result:

According to forward rolling, anyone who’s DNA is rolling forward, its capabilities are coming out quickly.

DNA backward rolling result:

According to backward rolling DNA, anyone who’s DNA is rolling backward. Its capabilities become undergrowth and even it split into two old organisms.

Nuclear medicine:

Nuclear medicine is a medicine used for treatment of virus and even generate immune cells, make immunity strong and even fight infection and build up the harmed tissues and even test the protein shield of virus and increase body stemming and body temperature.

DNA defect theory:

According to DNA defect, a virus can be formed by living organism of different class if there is a defect both DNA combined and high amount of energy is released.

Working of nuclear medicine on virus:

Generation of immune cell:

Nuclear medicine contains the immune cells which build up and generate the new immune cells in our body and even contains the nutrient which helps the body to regain its immunity and generate the immune cells.

Destroying of protein shield:

Nuclear medicine is when digested a high amount of energy is released and body regains its stamming and then body start generating immune cells or WBC with faster speed and thus WBC targets the protein shield and with high amount of energy it target the protein and destroy them.

Malfunctioning of information thread:

As the protein shield is destroyed, it enters the information thread as the unknown material enters information. It focus on the unknown material and focus on the nuclear protein and information thread start malfunctioning and then WBC break down information thread into their DNA sample.

Breaking down of nuclear protein:

Immune cells or WBC take the nuclear channel protein and breakdown them into the nuclear protein and then RBC or blood vessels take them for digestion.

Working of nuclear medicine in our body:

As when nuclear medicine enters the body, stomach digest some amount of medicine and generate high amount of energy and rest medicine is taken by blood to build up the body strong and build up the immunity strong and repair n around molecules or infected muscles.

Even they increase the temperature, as the nuclear medicine is digested, it generate energy as well  as temperature to slow down the blood pressure.

How does nuclear medicine low down the BP?

As when nuclear medicine is digested, release heat energy and heat the blood vessels  and protect the blood vessels from torn out as and when blood insures  with high speed.

Working of nuclear medicine on infection:

Nuclear medicine is when digested release high amount of heat energy, which makes germ dead and slowly infection get finished and hormonal tissues are repaired.

Result: In this we have found the working of nuclear medicine and its effect on our body.

How medicine acts on virus:

Medicine generate high amount of energy and immune cells and immunity is regained by cells of body and fight against virus with high energy and vitamins, minerals, proteins helps in building of food, glucose, fats release high amount energy

A new systems approach to diseased states and wellness result in a new branch in the healthcare services, namely, personalized medicine (PM). To achieve the implementation of PM concept into the daily practice including clinical cardiology, it is necessary to create a fundamentally new strategy based upon the subclinical recognition of bioindicators (biopredictors and biomarkers) of hidden abnormalities long before the disease clinically manifests itself. Each decision-maker values the impact of their decision to use PM on their own budget and well-being, which may not necessarily be optimal for society as a whole. It would be extremely useful to integrate data harvesting from different databanks for applications such as prediction and personalization of further treatment to thus provide more tailored measures for the patients and persons-at-risk resulting in improved outcomes whilst securing the healthy state and wellness, reduced adverse events, and more cost effective use of health care resources. One of the most advanced areas in cardiology is atherosclerosis, cardiovascular and coronary disorders as well as in yocarditis. A lack of medical guidelines has been identified by the majority of responders as the predominant barrier for adoption, indicating a need for the development of best practices and guidelines to support the implementation of PM into the daily practice of cardiologists!

Implementation of PM requires a lot before the current model “physician-patient” could be gradually displaced by a new model “medical advisor-healthy person-at-risk”. This is the reason for developing global scientific, clinical, social, and educational projects in the area of PM to elicit the content of the new branch.

With the Advancement of science, human life expectancy is rising and the rising population of elderly people requires the provision of special health and medical services. By studying, planning and preventing in oral and dental field, the number of edentulous healthy people could be reduced. This cross-sectional study was carried out through 440 patients referred to clinics and dental offices and dental laboratories in Ardabil.  According to data analysis, out of the 440 patients there were 240 male and 199 female, 364 were partially edentulous and 76 were completely edentulous. Samples consisted of 49 male and 27 female. The most common cause for tooth loss was tooth decay (65.8 %) then periodontal problems (26%) and trauma (3.9%) and 5.3 other reasons. There is not a significant connection between being edentulous and gender on the other herd there is a significant relation between being edentulous and age and there is a strong connection between education and being edentulous. The prevalence of edentulous patients has a significant relation with smoking, oral hygiene, tooth decays, periodontal disease and economical condition. The edentulous is connected to age, systemic disorders, oral hygiene and tooth decays.

Aim:Gaining insight into the prescription behaviour of healthcare professionals who work in nursing homes of SVRZ in Zeeland, regarding the prescription of antibiotics for respiratory infections.

Background:These days, pneumonia is the number two most common infectious disease in nursing homes in the Netherlands, after urinary tract infections, and is associated with high numbers of mortality and morbidity.

Design:A mixed method design was used comprising a retrospective file research and a focus group. The antibiotics recipes prescribed from September 2016 to September 2017, where mapped from the files. After that, a focus group consisting of eight healthcare professionals reflected on the possibilities of adjusting prescription policy.

Results:In total 498 recipes with notice of respiratory infections were found, with 11 different sorts of antibiotics prescribed. Thereof, 63, 6% was prescribed according to the NHG guideline ‘acute coughing’and 36, 4% was not. During the focus group, consensus was reached about appropriate antibiotics for complicated respiratory infections in elderly (amoxillin/clav acid, ceftriaxon, amoxillin, and trimethoprim/sulfamethoxazol). At the same time, the focus group provided insights in the reasons for non-adherence to the NHG guidline, with clinical deterioration as the most decisive symptom to start antibiotics.

Conclusion:The results of this study show that healthcare professionals in nursing homes prescribe a variation of antibiotics which are not completely in line with the NHG guideline. Considerations regarding prescription behaviour are influenced by characterisations of vulnerability of elderly people, ‘the clinical view’ and values with regard to meaningful care.

Background Cannabis is emerging as a treatment for pain, but little in-depth research has been conducted since cannabis was just recently approved as a treatment. Due to the prevalence of low back pain (LBP) in aging populations, pharmaceutical cannabinoids have emerged as a possible treatment, although not without controversies.

Objective To assess the role of cannabis in the management of LBP.

Methods This article compiles global data related to the role of cannabis in the management and treatment of LBP in the aging population. A literature review was conducted based on the Cochrane Collaboration - Systematic Reviews of Health Promotion and Public Health Interventions Handbook guidelines, using predetermined keywords, inclusion and exclusion criteria.

Results Through the analysis of studies, data supporting and rejecting the use of cannabis in LBP treatment was made available so informed decisions can be made when choosing optimal management plan. Tetrahydrocannabinol (THC), the active ingredient in cannabis which plays a role in supressing acute, chronic, and neuropathic pain and can be used to manage malignant and non-malignant pain. Studies have found both significant, and insignificant decreases in lower back pain due to the use of cannabis. Similarly, studies reported contradicting evidence on the impact of cannabis to anxiety, and insomnia, both noted to be common comorbid LBP conditions.

Conclusion Overall, cannabis appears to be an effective treatment of LBP, and should be considered when other treatment methods have failed. Cannabis use in LBP is increasing in prevalence in our aging population, and should be researched further.

Typically, Quality of life (QoL) assessment tools measures four dimensions in quality of life: functional, psychological, physical and social status. QoL is a dynamic construct. There appears to a process of psychological adaptation that enables patients to cope and maintain good QoL, even in the face of adversity.1,2,3 We had a sense that QoL research needed to 'come alive', become more relevant in a day-to-day clinical setting in the 'Acute Hospital'. An RCT was set up to use the 'outcome' information using the Schedule for Evaluation of Individual QoL (SEIQoL) as a Clinical Tool. The Acute Hospital setting tends to focus on objective outcomes, ie, bloods, scans, ect, the many objective outcomes that subsume all a professional's time. The results were self explanatory. Increased awareness by the clinician of patient's perception of symptom bother and symptom interference (48% difference, active versus control group) with SEIQoL could significantly decrease symptom burden over time. Incorporation of patient's views could be graphically incorporated into patient charts akin to a Temperature/Pulse/Respiratory Rate (TPR) chart to aid an improved outcome of symptoms and their bother as well as interference on patient’s QoL

The engagement of staff was excellent, each patient's QoL came alive, created forum for debate and a new way to empower us all to focus on the patient's view of their symptoms, the bother of their symptoms, how those symptoms interfered with their QoL. In a way, it 'gave permission' to focus on what really mattered to our patient group.

Causes of diabetic foot wound are multiple factors including peripheral neuropathy, decreased blood supply, high plantar pressures. Elderly diabetic foot wound may be a significant risk for morbidity, limb amputation and mortality.There is no conventional guideline regarding the selection of wound care materials in elderly diabetic foot wounds. According to the colors of the diabetic foot wound (Red-Yellow-Black wound) , it may classified in four categories. Also, grading can be done using Wagner's or the Texas wound classification system. Anyway, the foot is a complex structure, which acts as a foundation for the whole body, and it is important to prevent progression of diabetic foot problems.Therefore the some specialists play an important role in wound management of diabetic foot including endocrinologist, podiatrist, vascular surgeon, microbiologist, orthotist, and nutritionist. Choice of wound care in elderly diabetic foot wounds may be based on wound healing process, patient status, and anatomical changes in foot. Revascularization, debridement, offloading, antibiotic therapy, and wound care by using dressing. There are more products which help to cleaning of the wound, improve tissue granulation and wound healing. Some of them are Polyurethane films, Polyurethane foam, Hydrogel dressings, Alginate dressings, Growth factors, Honey-impregnated dressing, Topical enzymes and also Mechanical device such as Vacuum-assisted closure which generates a topical negative pressure over the wound bed.The successful management of elderly diabetic foot wounds requires the multidisciplinary teamwork of specialists. There are various topical regimes available, but the choice depends only on the treating physicians, podiatrist, or clinical care nurse.