"A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses." - Hippocrates
90% of the world’s population cannot afford proper medical health care. Presently, 1/3 of the world’s population does not have access to the essential medial care (WHO 2010 est.). The world has 872.3 million people living below the poverty line (World Bank 2014 est.). An estimated 29.8% (179.6 million) of India's population lives below the poverty line (UN 2010 est.). The cost of medical services in India is much lower. An average first world citizen saves 65-90% on the same procedure if done in India. Physicians of Oath’s main focus will be to provide medical aid to the people who live below the poverty line in developing countries such as India, and do not have access to essential medicine.
Physicians of Oath will strive to provide medications to its patients for free; if not for free, then we will try our utmost best to provide the generic brand at the lowest possible price through the help of our member donations. Physicians of Oath will not make any profit by providing medication. We will welcome any donations from those who can afford it. The medicines our physicians will provide to our patients will be only those that have gone through the rigorous clinical trials and stages of academic scientific authority.
Physicians of Oath will work with local pharmacies, and urge national and international pharmaceutical companies to help us in providing low cost medications to those in need.
Walking is man's best medicine.- Hippocrates
Make a habit of two things: to help; or at least to do no harm.- Hippocrates
Cure sometimes, treat often, comfort always.- Hippocrates
Physicians of Oath's Physicians and members will be providing medical care and guidance on several issues. Here are some of the medical topics our organization will help control, prevent or treat.
"Family Planning" - Isaac Davidovich, MD
While the topic surrounding family planning often comes up as a controversial one, it is something that has been addressed several times within the medical community, with consensus among the major medical organizations regarding methods and timing. The basic premise regarding family planning is deciding when it is appropriate for you and your family to grow. There are many reasons, both social and financial, as to why someone may not welcome a pregnancy. With proper family planning and adherence, one can avoid encountering unnecessary problems.
Family planning can be viewed from three broad categories: actively assisting in becoming pregnant, preventing unwanted pregnancy via contraception methods and abstinence, and termination of an unwanted pregnancy. Laws may vary from country to country and state to state.
Methods used to prevent unwanted pregnancy include use of condoms (latex or lambskin) and vasectomy for men. Women have many different options, including the use of cervical caps/diaphragms, spermicide after sexual contact, emergency contraception (effective up to 3-5 days post-sexual contact), oral contraceptives, and intrauterine devices (IUDs). Oral contraceptives can come in many different forms, including estrogen-progestin, progestin only. These can be supplied as a daily pill, intravaginal ring, injection, or patch. IUD’s are supplied as either Levonorgestrel-releasing or copper-releasing.
It is important to discuss these with your doctor or medical provider, all of which can take place in the clinic.
"Vaccinations" - Isaac Davidovich, MD
What are they?
Injections (subcutaneous or intramuscular) that go into the thigh, buttock, or shoulder, and provide immunity for many life-threatening diseases.
How do they work?They work either by active or passive immunity, depending on the vaccine. Passive immunity is conferred via antibodies injected, where as active immunity occurs from injection of live attenuated organisms or inactivated ones. Examples of live attenuated vaccinations include measles, mumps, rubella, BCG and yellow fever. Examples of inactivated vaccinations include polio, hepatitis A, rabies, and pertussis. Note that inactivated vaccinations typically require boosters, sometimes up to 5 shots over time to confer immunity.
Who can get vaccinated?
While everyone is encouraged to vaccinate themselves and their children, there are some contraindications for vaccinations. For live attenuated vaccines, if you have an allergy to any component of the vaccine, are pregnant, or are immunosuppressed, vaccination is contraindicated. For inactivated vaccines, component allergy and encephalopathy are the only true contraindications. Vaccination schedules are outlined below.
Are there side effects from vaccinations?
Yes, some side effects may occur, and while most are mild, they can be serious. Pain, swelling or redness at the site of injection is common. Other side effects include fever, fatigue, headache, or allergic reactions.
The Centers for Disease Control (USA) gives recommendations on vaccinations schedules, and can be found here
"Diabetes" - Talha Ahmend, MD
Sugar consumption has drastically increased worldwide and especially in North America. An average American consumes roughly 156 pounds of sugar per year. Sugar is incorporated into most packaged foods including ketchup, soda, yogurt and many more. It is no wonder that 1 in 12 people worldwide have diabetes according to the International Diabetes Federation. In 2014, the healthcare expenditure on just diabetes alone reached US $612 billion. North America as a continent has the highest prevalence of diabetes in the world with 11.4%; Middle East and North Africa regions have the second highest with a prevalence of 9.7%.
So how does the human body manage the high sugar diet? When a person consumes a spoonful of sugar, certain hormones are activated in response to the receptors (in the digestive tract) coming in contact with the sugars. The major hormone that regulates blood sugar levels is known as insulin which is produced and secreted by the pancreas. Insulin drives glucose (basic unit of sugar) into the cells where it is digested and used for energy. Glucagon, another hormone produced by the pancreas, is activated and released if blood sugar levels drop below a certain point. It causes an increase in blood sugar levels by breaking down stored complex carbohydrates in the liver and fat cells. Normal blood sugar levels are maintained in the human body by the effect of these two crucial hormones.
There are two forms of Diabetes Mellitus (DM): Insulin Dependent Diabetes or Type 1 DM, and Insulin Independent or Type 2 DM. There is a third type, known as Gestational Diabetes, which occurs in pregnant females. Type 1 DM is an autoimmune disease where the body’s own cells attack the cells of the pancreas and thus inhibits the ability of the organ to produce insulin. Type 1 is commonly seen earlier in life and the patient is usually of thin build. Type 1 can occur with other autoimmune diseases such as Celiac Disease, thyroid disorders, and autoimmune adrenal insufficiency (Addison ’s disease). Type 2 DM occurs later in life and is caused by the insensitivity of the pancreas to glucose. This occurs because of the high sugar diet throughout a person’s life causing the pancreas to not be stimulated as much to secrete the insulin. These patients tend to be obese, inactive and on a poor high-calorie diet.
IDF Diabetes Atlas: Sixth Edition. International Diabetes Federation, 2014 Update. http://www.idf.org/diabetesatlas
Despite the many people worldwide with newly diagnosed DM, there are no screening standards as of yet for the disease. Some have recommended screening every three or so years in patients over the age of 45, especially for those who are overweight. Mostly, patients are diagnosed when they present with sxs and have developed diabetes for several years. The diagnosis for diabetes requires one of the following four: fasting plasma glucose of >126 mg/dL; one 2-hr oral glucose tolerance test >200 mg/dL; one hemoglobin A1C reading of >6.5%; or one random glucose reading of >200 mg/dL with symptoms of diabetes such as increased thirst and urination. These are all obtained through blood tests and are quite accurate in diagnosing diabetes.
Diabetes, whether it’s Type 1 or 2, can present with many symptoms and lead to many complications if not controlled. Few of the initial symptoms that people present with are increased urination and thirst. Long-standing DM can lead to cataracts in the eye, increased susceptibility to infections, and neuropathies such as extremity numbness and tingling and impotence. Perhaps the most dangerous aspect of diabetes is its complications and risk for other deadly diseases. Diabetes, if poorly controlled, holds a significant risk for heart attacks, kidney failure, stroke and bone and joint diseases. Patients can also present acutely with Diabetic Ketoacidosis, a potentially fatal complication of Type 1 DM. The patients present with extremely high blood glucose levels causing dizziness, altered mental status, and decreased appetite. Type 2 diabetics more commonly present with Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) with even higher blood glucose levels and similar symptoms. These are usually treated in the hospital with hydration, insulin administration and electrolyte maintenance.
The treatment for DM type 1 and 2 also differ slightly. Type 1 diabetics can only benefit from insulin injections because their pancreas is ineffective in making insulin. Type 2 diabetics however can benefit from oral medications as well as insulin injections depending on the severity of their disease. Regardless, both types of patients are counselled for maintaining a healthy diet, exercising regularly, maintaining hydration, and constantly monitoring blood glucose levels. Type 2 diabetics are usually offered a trial of lifestyle modifications to assess for any improvements in their blood glucose levels. If those fail, then oral meds are initiated. There are many types of oral medications out there but most people are started on Metformin because of its proven effect to lower blood glucose. Metformin is not given to patients with kidney diseases and so other forms of medications are sought out. Some patients may even be on 3 oral medications to decrease blood glucose levels. However, if oral medications yield no results, then insulin injections are initiated.
Research on diabetes has come a long way in determining the causes, effects and treatment recommendations. Despite the proven benefit of medications and insulin, an individual with diabetes still needs to make certain lifestyle changes in order to suppress the disease completely. Thanks to the high-calorie and sugar diet of today’s world, diabetes has become one of the most infamous diseases of the century worldwide.
"Hypertension" - Talha Ahmed, MD
Your every visit to the doctor’s office starts with the nurse wrapping a blood pressure cuff to your arm. This is to screen for one of the most common and silent diseases in the world, Hypertension (HTN). Blood pressure (BP) is measured with two numbers: systole and diastole. The higher number is systole and the lower number is diastole; these determine the pressure in your arteries that carry blood from the heart. A normal BP reading is below 120/80 mmHg. HTN is divided into 3 stages: prehypertension with systolic 120-139 or diastolic 80-89; Stage I HTN with systolic 140-159 or diastolic 90-99; Stage II HTN with systolic or diastolic >160 and >90 respectively. The diagnosis of HTN can be made easily in a clinical setting without any painful tests or procedures. Currently the diagnosis for HTN requires a total of three high blood pressure readings checked on two or three separate appointments.
The most common cause of high blood pressure is Primary HTN which includes factors such as genetics or environmental. Secondary HTN includes renal, endocrine or vascular causes. Once a diagnosis is made for HTN, further workup is usually done to assess for end organ damage and determine the potential causes for HTN (eg: renal artery stenosis, endocrine dysfunction). The doctor will also assess your risk factors which can increase your susceptibility to severe complications such as stroke, kidney failure, heart attack and many more. Risk factors for HTN are divided into modifiable and non-modifiable. Modifiable risk factors are those that you have control over including your smoking status (greatest risk factor), high salt diet, excessive alcohol intake and lack of physical activity. Non-modifiable risk factors are those that you have no control over such as ethnicity, age (>55 years old), sex (males more commonly affected) and family history.
HTN usually presents with no symptoms which is why it is such a dangerous disease. People can appear normal and have HTN which is why it is also called the “silent killer”. The high pressure stretches and damages the arteries causing them to lose their elasticity, become tortuous and bleed, or even rupture. Acute cases of HTN do exist however. Hypertensive crisis is defined as BP >180/110 with symptoms such as headaches, nosebleeds, palpitations blurry vision, dizziness and signs of end organ damage. Hypertensive crisis is usually the reason for an individual to seek medical help in an otherwise healthy looking person.
Patients who are newly diagnosed with HTN are usually offered a trial of lifestyle modifications. These include smoking cessation, reduction of sodium and fatty foods intake, weight loss, exercise programs and reduction of alcohol intake. If lifestyle modifications are ineffective, then BP medications are initiated. There is a large list of medications that doctors can choose from to treat HTN. The right BP medication for each individual is done by further evaluating the presence of other diseases, end-organ damage, drug allergies, etc. Some medications work on dilating the arteries thereby causing a decrease in BP while others work in the kidneys to inhibit certain hormones that cause increased BP.
Prevention and controlling HTN can significantly increase an individual’s life. Patients should be counselled at a young age to maintain a healthy diet, exercise regularly and stay away from cigarettes and other drugs. Such practices can not only increase the quality of life, but also prevent other diseases such as Alzheimer’s dementia and cancer. Hypertension is an issue in countries where the diet predominantly consists of high cholesterol, high sodium and low nutritional value foods. Unfortunately, United States holds one of the highest populations in the world with diagnosed Hypertension.
"Food Borne Illness" - Jacque Schrack, MD
Food borne illness, also commonly referred to as food poisoning, is any illness resulting from eating contaminated food. Typical contaminants are bacteria, viruses, parasites or poisonous chemicals. Over 250 different contaminants have been described and can cause a wide range of symptoms. Since most of these infections begin in the gastrointestinal track, the symptoms generally start there with nausea, vomiting, fever, abdominal cramps and diarrhea.
Food borne illness is generally the result of improper food handling, preparation, or storage. Regular hand washing when working with food is the most effective defense against food poisoning. It is also important to wash fruits and vegetables to remove any pesticides that might remain on the food. When preparing the food, maintaining a clean work environment is essential; try to avoid recontamination by cleaning utensils after each use and avoid putting your cleaned food back in with your unclean food. Also, properly cooking food will eliminate most of the contaminants causing illness. Lastly, storing food at the correct temperature will prevent bacteria from growing.
Diagnosing Food borne illness is done by specific laboratory tests looking for the specific organism. The most commonly done tests are the stool culture and antigen tests. People with diarrhea are advised to see their medical provider for testing if they have the following signs: fever over 101.5, blood in the stool, vomiting that prevents keeping liquid down, signs of dehydration (dry mouth/throat, decreased urination, light-headedness when you stand up) or diarrhea lasting more than three days.
More often than not food borne illnesses are only treated with supportive measures; meaning plenty of fluids to stay hydrated, replacing electrolytes if needed, and bismuth subsalicylate (Pepto-Bismol) can reduce the duration and severity of the diarrhea. Antibiotics are rarely used because viruses cause more cases of food borne illness than bacteria and most cases of food borne illness will resolve on their own in 2 to 3 days. The most important point about treating diarrhea is proper hand washing to prevent the spread of disease.
"Tuberculosis" - Jacque Schrack, MD
Tuberculosis or TB is typically an infection of the lungs; however, it can affect other parts of the body. It is believed one-third of the world’s population has been affected with TB at one time; and new infections are occurring in 1% of the population each year. The risk for becoming infected is closely linked to population overcrowding and poor nutrition. In 2013, an estimated 9 million people became infected and 1.5 million people died due to TB; mostly developing countries.
TB is caused by a type of bacteria called Mycobacterium tuberculosis. This bacteria is easily transmitted in the air when an infected person coughs, sneezes, or even speaks. TB usually causes a chronic cough (sometimes with blood), fever, chills, night sweats, fatigue, and weight loss. People can also develop a latent or silent infection with no signs or symptoms. About 10% of these silent infections will eventually become active infections.
Diagnosing Tuberculosis can be a difficult using only the signs and symptoms. A chest x-ray and multiple cultures of the respiration sputum are the first steps in someone with active TB. In a person with latent TB, a PPD test or Purified Protein Derivative test is used to diagnose the disease.
Treating TB can also be a challenge with multiple drugs required and treatment over several months. When a person is first diagnosed as having active TB, an antibiotic regimen with four drugs is recommended for two months followed by two drugs for an additional four months. Because this disease is so difficult to treat and is able to become resistant to antibiotics, the WHO (World Health Organization) has recommended directly observed therapy. This is where a health care worker watches the patient take their medication.
As always, prevention is better than treatment. Infants in high risk countries are vaccinated with the BCG vaccine. This reduces the risk of becoming infected by 20%, and the risk of an infection becoming active TB by 60%. The only problem with this vaccine is its effectiveness decreases after 10 years. As a result, the best way to prevent TB is by appropriately diagnosing active cases quickly, isolating patients to prevent spreading the disease, and ensuring the drug regimen is followed completely.
"Malnutrition" - Joseph Daniel Hogue, MD
Malnutrition is a condition that results from eating a diet in which nutrients are not enough or are too much such that it causes health problems. The nutrients involved can include: calories, protein, carbohydrates, vitamins or minerals. It is often used specifically to refer to under-nutrition where there are not enough calories, protein or micronutrients; however, it also includes over-nutrition, which most people do not think about. If under-nutrition occurs during either pregnancy or before the age of two years for children, it may result in permanent complications in physical and mental development. Extreme under-nourishment, also referred to as starvation, may have symptoms that include: stunted growth, thin body, poor energy levels, and swollen legs and abdomen. Moreoever, people often get infections and are frequently cold and infections due to undernourishment. The symptoms of micronutrient deficiencies depend on the micronutrient that is lacking and can have isolated symptoms depending on the micronutrient that is deficient.
Undernourishment is most often due to not enough high quality food available to eat and can be detrimental in so many ways to the individuals involved. This is often related to high food prices and poverty. A lack of breast feeding may contribute as well as a number of infectious diseases such as: gastroenteritis, pneumonia, malaria and measles which increase nutrient requirements and exhaust the patient of his/her nutrient stores.
Marasmus and Kwashiorkor are two main types of under-nutrition that fall into the protein-energy malnutrition while micronutrient deficiencies fall into the dietary deficiencies categories. Protein-energy malnutrition has two severe forms: marasmus which is a lack of protein and calories while kwashiorkor is defined as a lack of just protein. Common micronutrient deficiencies include: a lack of iron, iodine and vitamin A as well as many other vitamins and essential nutrients needed by the body to survive. During pregnancy, due to increased demand, deficiencies can become more common. In some developing countries, over-nutrition in the form of obesity is beginning to present within the same communities as under-nutrition. In the elderly, malnutrition has become more prevalent and is commonly due to physical, psychological and social factors.
Signs and symptoms of Malnutrition:
Face: Moon face (kwashiorkor), simian facies (marasmus)
Eye: Dry eyes, pale conjunctiva, Bitot's spots (vitamin A), periorbital edema
Mouth: Angular stomatitis, cheilitis, glossitis, spongy bleeding gums (vitamin C), parotid enlargement
Teeth: Enamel mottling, delayed eruption
Hair: Dull, sparse, brittle hair, hypopigmentation, flag sign (alternating bands of light and normal color), broomstick eyelashes, alopecia
Skin: Loose and wrinkled (marasmus), shiny and edematous (kwashiorkor), dry, follicular hyperkeratosis, patchy hyper- and hypopigmentation, erosions, poor wound healing
Nail: Koilonychia, thin and soft nail plates, fissures or ridges
Musculature: Muscles wasting, particularly in the buttocks and thighs
Skeletal: Deformities usually a result of calcium, vitamin D, or vitamin C deficiencies
Abdomen: Distended - hepatomegaly with fatty liver, ascites may be present
Cardiovascular: Bradycardia, hypotension, reduced cardiac output, small vessel vasculopathy
Neurologic: Global development delay, loss of knee and ankle reflexes, poor memory
Hematological: Pallor, petechiae, bleeding diathesis
Behavior: Lethargic, apathetic
There are many ways to help improve the growing challenge of malnutrition in developing countries. Education about breastfeeding can reduce rates of malnutrition and death in children, and efforts to promote the practice have increased the practice of breastfeeding across the world. This not only saves money but also promotes healthier grow in the neonate. In young children providing food in addition to breast milk between six months and two years improves outcomes. There is also good evidence supporting the supplementation of a number of micronutrients during pregnancy and among young children in the developing world. Education has also worked for those who have severe malnutrition complicated by other health problems treatment. This often involves managing low blood sugar, body temperature, dehydration, and gradual feeding.
"HIV" - Joseph Daniel Hogue, MD
Human immunodeficiency virus, also known as HIV, is the virus that causes AIDS. HIV/AIDS weakens a person's ability to fight infections. It is contracted through exchange of blood fluids. An HIV test can be performed to confirm the transmission and diagnosis of the virus. Today there are medications that may suppress the virus and delay the onset of AIDS. Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype. Some methods of transmission of the infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells.
The HIV virus attacks and infects vital cells in the human immune system such as helper T cells which we refer to as CD4 cells, macrophages, and dendritic cells which normally all work together to fight off infections. HIV infection leads targets and kills the body’s defense cells leading to low levels of CD4 cells through a number of mechanisms. When CD4 cell numbers decline below a critical level, cell-mediated immunity (protection) is lost, and the body becomes progressively more susceptible to opportunistic infections. This is when the patient is classified as having Acquired Immune Deficiency Syndrome also known as AIDS.
Common symptoms of HIV:
Lack of energy
Frequent fevers and sweats
Persistent or frequent yeast infections
Persistent skin rashes or flaky skin
Short-term memory loss
Mouth, genital, or anal sores from herpes infections
AIDS is the final stage of the HIV infection that occurs when your immune system is badly damaged and you become vulnerable to infections and infection-related cancers. We call these opportunistic infections. AIDS is defined by having one’s CD4 cell count fall below 200 cells per cubic millimeter of blood (200 cells/mm3). A person is also considered to have progressed to AIDS if one develops one or more opportunistic illnesses, regardless of your CD4 count while being infected with HIV. Without treatment with anti-retroviral medication, people who progress to AIDS typically survive only about 3 years. Once you have a dangerous opportunistic illness, life-expectancy without treatment falls to about 1 year or less. However, if you are taking anti-retroviral medication and maintain a low viral load, then you may enjoy a near normal life span and have a low probability of progressing to AIDS.