rkdhaugoda's concept of IMHI
INTEGRATED MANAGEMENT OF HUMAN ILLNESS
CONCEPTED BY- DR. RAJ KUMAR DHAUGODA OF NEPAL
IMHI is the system of relative integration of philosophical-Psycho-social-bio-mechanical, multi-concepts, multisystem, holistic, Multi-approach, effective and simple way of management of human illness and assessment of well-being scientifically and humanly.
IMHI – covers the following subjects relatively and broadly as integrated concepts, knowledge and practices for better and easy management of human illness in view of personal- socio-economical and environmental background.
1. It is a system of co-ordination relatively and related all motions of nature, society and mind.
2. It is basically integrated with fundamental and scientific philosophical view of world and its contents that is dialectical materialistic view.
3. It is related to holistic approach of various useful concepts, systems, practices and methods in the management of whole human and social illness in relation to human and his environment, from the beginning of history of human society up to-now.
4. It is a dynamic, continuously changing, developing integrated concepts and practice of management of human health globally, in its accessibility, assessibility, affordability with simplicity.
5. It is the unification of all the modalities or systems of human illness managements in our societies in scientific bases with effectiveness of their efficacy.
6. It really coordinates the fundamental human social factors, like human thought process, human practices up on nature or environments and societies. And feedback of society and environments to human thought, attitude and practices.
7. It shows that nothing is complete and isolated things, concepts, system and methods, practices. And needs integration for more worth-full achievement in the field of any human thought and practices and for understanding of laws of nature and human body and their relation with other various natural, social and human psycho- biological phenomena.
8. It explains that the simplicity of working mechism of universe and its contents with complexity of their manifold inter relation. Like every human disease is differentiated and has specific as well vague manifestations. but all most all human disease have some basic and fundamental pathologic processes in nature ,that is vasculitis , there are fundamental role of prime cytokine ,TNF-alpha and NFkB in the human disease pathogenesis and there are fundamental role of master anti-stress factors like IkBa and X-factor, master light therapy( UVBI) ,master ANEROBIC EXERCISE ( YOGA ), vaccination principle ( LIKE KILLS LIKE ),and other various naturotherapies, psychotherapies , health education promotions, philosophico-social therapy.These all are the all rounder methods of management of human illness.
9. Philosophically its basic principle is the key law of dialectics called THE RKDHAUGODA’S KEY LAW OF DIALECTICS - Any event, system or unit contains opposite phenomena which are also connected relatively by means varying degree of reciprocal association dynamically with other sets of opposite phenomena again.
10. Logically this new concept of IMHI covers the wide veraities of subjects in co-ordinated form.It relates the illness of human from head to toe, illness due to diabalance of external and internal environments of the body.
11. Immunity and stress factors are linked with human health and diseases. Productive mind of human is linked with economical prosperity and human wisdom, there by the relative release from most of human disease including poverty, hunger and social unpeace.
12. According to guideline of this IMHI- it makes easy and simple assessment of human diseases and provides quick and quality management as early as possible in preventive as well as palliative and curative, cost effective heath care provision.
13. IMHI aims to reduce death, illness, disability, early diagnosis and early qualitative cost effective management of human illness and to access world wide health promotion in scientific and humanly way. IMHI includes preventive, diagnostic, palliative and curative elements that are implemented by families and communities as well as by health facilities and also as world health policies.
14. People seeking for medical treatment in the developing as well as developed world are often suffering from more than one condition, making a single diagnosis is error of the old health care system. IMHI is an integrated strategy, which takes into account the variety of factors that put people at risk philosophically, ritually, physically, mentally, familiarly, socially, environmentally, economically, politically and as well globally. It ensures the combined treatment of the major human illnesses, emphasizing prevention of human illness and crisis through health promotion, dialectical materialistic educational promotion, immunization and improved nutrition. It consists of continuous evaluation of impact, cost and effectiveness.
15. The strategy includes following main components:
· Improving case management skills, concepts, practice of health-care staff in integrated scientific way.
· Improving overall health systems in new holistic integrated way
· Improving family, community and institutional health practices.
· improving integration of main modern medical heath care system with other alternative health care system like ayurvedic system like YOGA , homeopathic system ( vaccination principle , like cure like ) , light therapy ( UV, LLLT ),PHYSIOHERAPY , HOT SPRING DEAD SEA THERAPY etc. as far as possible in the course of management of various human illness in appropriate way.
· Improving world wide world view of dialectical materialistic educational promotion as well establishment and development of this new integrated health care education system globally.
· In health facilities, this IMHI promotes the quick and quality diagnosis and management of most of the human illnesses in grass root level as well as tertiary level in an integrated way with various systems of health care management easily and cost effectively.
16) To establish world wide this new IMHI concept and practice in correlation with WHO and national health programmer and policy makers of particular countries.
17) Background theories of this new concept of IMHI are the R.K.Dhaugoda’s key law of dialectics (Any event, system or unit contains opposite phenomena which are also connected relatively by means varying degree of reciprocal association dynamically with other sets of opposite phenomena again) , R.K.Dhaugoda’s general theory/equation of vasculitis and R.K.Dhaugoda’s general ratio of health and disease ( HEALTH : DISEASE = 4:1 )
18 ) This newly designed concept and practice of IMHI reviews the concepts and definition of health given by WHO and the existing world health concepts and practices in various isolated form rather than interrelated form .It helps in the development and easy approach of world heath care system in a very comprehensive , integrated multi-healthcare systems , simple and cost effective world wide management of human illness and related problems. In other words, this is not only a one of the great revolutionary, scientific, dialectical-materialistic concept of health and disease, but also which is basically quite opposite to the old existing concept of health and disease.
19) WHO (World Health Organization)-
World Health Organozation is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.
The wrong WHO definition of Health
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. This Definition has not been modified since 1948. Health is not a absolute phenomena, so the lack of operational value and the problem created by use of the word "complete”- according to dialectical law ,Nature is a state of motion and change According to Angels, “All nature from the smallest thing to the biggest, from grains of sand to sun, from the primary living cell (protista) to man, has its existence in internal coming into being and going out of being, in a ceaseless flux, in unresting motion and change. So health can not be a complete or absolute thing."
“The phrase absence of disease or infirmity” is also a great fundamental problem in the definition of health by WHO .this last phrase says that concept of absolute health and health is taken as isolated form from disease side , which is opposite to reality. Health never can be isolated from disease. if there is no disease in a man there shouldn’t be existence of health simultaneously , it is possible the detachment of health and disease only after death of a person. According to dialectical law (Contradictions inherent in Nature) every thing or system in the universe and its contents there should be opposite system or things simultaneously and they are interchangeable, contradicted in nature.
In the 21st century, health is a shared responsibility, involving equitable access to essential care and collective defense against transnational threats.
So working guideline of this IMHI is the recent dialectical and scientific definition of health- given by Dr. Raj Kumar Dhaugoda of Nepal, which is formulated according to the R.K.Dhaugoda’s key law of dialectics.
Health is defined as the relative balance level of the dialectical materailistic thought and practice in comparision to idealistic thought and practice of an individual with high self esteem ; and Relative balance level of cellular antistress factors (IkBa and X-factor) in comparision to cellular stress factors (TNF -α / active NFkB) in the body of an individual.
20) THE ROLE OF SELF ESTEEM IN MAINTAINING PERSONAL MENTAL HEALTH
Personal mental health is an important to build our self esteem and self-assurance. Personal mental health guides towards happiness and success.Personal mental health comes from the doing right things to find inner strength.Personal mental health is something we should give priority . We need to feed the brain inspirational and positive messages and maintain self esteem. Are we healthy in mind and body? There is relation between mind and body always.Personal mental health comes from good attitudes, good thought and thinking and knowing reality and understanding of natural laws. Evil leads to sickness of the mind. Happiness is only possible for us if we choose to be a good person. Helping others brings immense benefits and satisfaction, therefore happiness.
To maintain our personal health , we
- Should Smile, laugh more and think positively.
- Should not give any stress to others, and should think our enemy is just our ignorance and poor knowledge regarding ourself and the world in scientific way.
- Shouldn’t take ourself or life so seriously
- Should realize that if we fail it is not the end of the world, there is always hope after any failure, as day comes after night.
- Should walk everyday whenever we can (for exercise but also our brain needs fresh air)
- Dream about new possibilities and new hopes.
- Should reflect on our successes and believe in ourself
- Should do things we love as often as possible
- Should welcome new challenges and experiences
- Should work on self-confidence
- Should know that low self esteem is one of the prime sourse of human illness.
- Should identify triggers, a place, a task, a person, or combination of all three etc. and seek help especially through the family physician doctor.
So, self eteem is a major component of the newer dialectical and scientific definition of health given by Dr. Raj Kumar Dhaugoda of Nepal, very recently (2011).
21) Logic of concept and practice of IMHI (integrated management of human illness) is the successful implication of IMCI (integrated management of child illness) in more than 75 countries around the world. IMHI is the basically, broadly, philosophically, scientifically and newly integrated expansion of IMCI TO CAPTURE MOST OF THE HUMAN POPULATION AND THEIR ILLNESSS. CAH a Multi-Country Evaluation (MCE) has evaluated the impact, cost and effectiveness of the IMCI strategy .The results of the MCE support planning and advocacy for child health interventions by ministries of health in developing countries, and by national and international partners in development. To date, MCE has been conducted in Brazil, Bangladesh, Peru, Uganda and the United Republic of Tanzania.
The results of the MCE indicate that:
- IMCI improves health worker performance and their quality of care;
- IMCI can reduce under-five mortality and improve nutritional status, if implemented well;
- IMCI is worth the investment, as it costs up to six times less per child correctly managed than current care;
- child survival programmes require more attention to activities that improve family and community behavior;
- the implementation of child survival interventions needs to be complemented by activities that strengthen system support;
- a significant reduction in under-five mortality will not be attained unless large-scale intervention coverage is achieved.
METHODS OF IMPLEMENTATION OF IMHI
The implementation of the IMHI strategy in a country is a phased process that requires a great deal of coordination among existing health care systems, concepts, interest, programmes, policies and services. It involves working closely with local governments and ministries of health, ministry of education, ministry of environment to plan and adapt the principles of the approach to local circumstances. The main steps are:
- Adopting an integrated approach to human health and development in the national health policy.
- Adapting the standard IMHI clinical guidelines to the country’s needs, available drugs, available health care systems, understandings, policies, and to the local foods, rituals, environment and language and practice used by the population.
- Upgrading care in local clinics by training health workers in new methods and in new concepts to examine and treat infant, children, adult, women, and elders, and to effectively counsel family members or parents.
- Making upgraded care possible by ensuring that enough of the right low-cost medicines and simple equipment or techniques are available.
- Strengthening care in hospitals for those persons mild to moderate sick to be treated in an outpatient clinic. And severe one in hospital setup.
- Developing support mechanisms within communities for preventing disease, for health and educational promotion, for helping families to care for sick any family member, and for getting person to clinics or hospitals when needed.
- Adopting new general educational system and new health training curriculum that is Compulsory inclusion of dialectical materialism education in curriculum of all systems of education of the country.
OBJECTIVES OF IMHI
- Understand the basic philosophy (dialectics), principles, spheres, broad integrative comprehensive guidelines and methods of IMHI.
- Describe the rationale for the
evidence-based syndromic approach to
case management as described in the
IMHI.
- List the clinical illnesses included in the
IMHI concept and their relevance in
situations associated with disasters.
- Assess and classify the condition of a
child to determine its severity and
establish the relationship between this
classification and the subsequent
management.
- List the danger signs and aggravating and risk factors that should be
routinely checked in all patients.
- Look for environmental, cultural, economical, educational level, concepts and psychological status of patient and family member and of particular society.
- Look for other existing alternative medical system which patients have accepted and their spheres and try to correlate them logically.
TECHNICAL BASES FOR INTEGRATED MANAGEMENT OF HUMAN ILLNESS (IMHI)
BASICALLY –human diseases/illnesses are categorize in the following ways
1) infectious diseases
2) non-infectious diseases
3) Malnutrition or overnutriton.
4) Physiologic distresses maintenance e.g. pregnancy, childbirth, child growth, immunizations, nutrition management.
5) traumatic disorders
6) Enzymes and hormone imbalances.
7) mental illness and emotional maladjustment conditions
8) oncogenic disease
9) genetic disorders
10) poisoning/ bites
11) Conceptual and ritual illness – racial, ethnical, cultural and religious myths.
12) socio-economic maladjustment
13) terrorism induced situation
14) natural and man made disaster
15) Other nonspecific known and unknown syndromes and disorders.
· Fundamentally above all illnesses and disorders are related to subjective and objective phenomena induced as a sequence of maladjustment of external as well as internal environment of the body with abnormal stress to body, family, society, nation and world and vice versa.
· For much population, a single diagnosis may not be appropriate or relatively associated with manifold problems in a single person.
· External stress factor , phenomenological events which may be single or multi factorial and multidirectional , stimulates, as main pathway, the internal stress factor that the prime cytokine TNF-ALPHA AND NFkB ( essential core internal stress factors), basically initiating varying degree of pathogenesis as inflammation of endothelial cells of various organs as endotheliatis or vasculitis , overall resulting relative intracellular x-factor imbalance causing immunity imbalance in human body relatively all most all cases.
BASIC OPERATIONAL PRINCIPLES OF IMHI-
To use background theories for this new concept of IMHI namely the R.K.Dhaugoda’s key law of dialectics (Any event, system or unit contains opposite phenomena which are also connected relatively by means varying degree of reciprocal association dynamically with other sets of opposite phenomena again) , R.K.Dhaugoda’s general theory/equation of vasculitis and R.K.Dhaugoda’s general ratio of health and disease ( HEALTH : DISEASE = 4:1 )
To define immunity specifically first, as it is essential thing to do in any sort of human disease management. "Immunity is defined as relative balance level of dialectical materialistic thought and practice; and cellular anti stress factors (IkBa & x-factor) in a individual with high self esteem".
· Before this, no one has been defined immunity in molecular level yet, so the old concepts of disease management are being difficulty in spite of development of advanced medical science.
· To establish the fundamental pathology of most illness and disease as endothelialitis or vasculitis or inflammation of concepts and beliefs of person or society.
· To establish that relative intracellular level of antistress factors ( IkBa and X-factor ) is the core influencing factor of immunity and is related for maintaining relatively healthy human body. Whatever the method of management of human illness, there is ultimately influence in the intracellular level of antistress factor quantitatively or qualitatively.e.g in various infectious disease the causative agents like virus microbes ,parasites ,fungus, these all use the host antistress factors primarily causing decrease level of intracellur x-factor level of host for this it is recommended specific therapy for to attenuate the particular causative agent and nonspecific or general management is antistress factor replacement in appropriate way for quick and quality recovery from the illness. UV light therapy , LOW LEVEL LASER THERAPY ( LLLT) – photons absorbed by body cells ultimately stimulate the ions of cells causing more active and more production of ATP into the body . Light rays having some specific wave length can directly destroy the microbes and virus also.
· In the ayurvedic system of management of various chronic illnesses via anaerobic or concentration diversion method that is YOGA and Meditation acts by ultimately influencing the relative intracellular level of antistress factor in the body .It is experimentally proved that any kind of anaerobic or meditation causes decreased in basal metabolic rate of the body which helps in conservation of biological energy that is ATP, and also helps in decreasing sympathetic activity and decreased heart rate causing increased in energy conservation, thus there is ultimately relatively increased antistress factors into the body. Psycho-behavioral therapy- also ultimately influences the intracellular antistress factors level of the body , by proper counseling to stress-full human , it works by increasing self-steam and avoiding unnecessary mental thinking by patient, it basically decreases brain metabolic rate ultimately causing relative increased in conservation of biological energy ATP.Most of the surgical attempts is the basically the attempt of release of stress of body , again there is indirectly maintaining of intracellular ANTISTRESS FACTORS. Nutritional therapy- ultimately increased intracellular ANTI-STRESS FACTORS of the body by balanced diet .
THE-FUNDAMENTAL APPROACHES-OF IMHI
These are syndromic, diagnostic or combined or empirical for unspecified conditions.e.g APPROCH IS BASICALLY DEPENDED ON STAGING AND QUANTIFYING THE MOST OF THE HUMAN DISORDERS FOR EXAMPLE SIRS , SEPSIS , SEPTIC SHOCK, MOD : ACUTENESS, CHRONICITY, VISIBLE OR UNVISIBLE DIASBILITY OR DISORDERS, EMOTIONAL UPSET, DEGREE OF MENTAL DISFUNCTION,ENVIROMENTAL,PERSONAL,FAMILIAL, PHILOSOPHICO-SOCIO-ECHONOMICAL, AND GLOBAL INTEGRATED ASSESSMENT FOR MULTI-ENFLUNCING FACTORS.
Shortly – The method of approach of IMHI is holistic, comprehensive and integrated form that is philosophico-psycho-physiological-biomechanical-emotional-educational-realisational-environmental-socio- global ranges.
The IMHI clinical interventions ensure that every person receives the benefits of preventive measures, as well as appropriate care for their illnesses, based on strong evidence and updated technical knowledge.
IMHI - COMPONENTS OF IMPROVEMENT
- Degree of the need of understanding of dialectical –materialistic philosophy in human health management by concern authorities, service providers and general people too.
- Improvement of health care system in new concepts and new ways.
- Improvement of scientific dialectical educational system
- Improvement of adopting newer concepts worldwide quickly
- Improvement in need of realization of new concepts and practice of IMHI
- Improvement of family and community practices
- Improvement of case management skills of health staff
- Upgrading in National policies
- Strengthening of management capacity
- Availability of medicines, techniques, equipments.
- Quality of care with humanly approach.
- Referral and counter referral system
- Information system
- Sector reform
- Improvement in Accessibility and affordability, provision for health insurance, and government responsibility, production and distribution of quality health resources (human resources and infrastructures) in grass root level.
- Others –Improved partnerships between health facilities & communities they serve.
KEY FEATURES OF
IMHI
1. It’s a great example of grate application of , R.K.Dhaugoda’s general theory of vasculitis in the management of human illness and integrated general health care system in the world
2. It brings up a new solution of undefined immunity and old concepts and definition of Health by WHO; and general concepts of disease pathogenesis as well as management in new way.
3. It integrates the modern medicine with other various alternative medicine system or techniques in scientific bases.
4. Its objectives and actions, is the quick, quality, efficacious, cost effective, accessible syndromic approach as well as prompt diagnosis of person’s illness in integrated form and their management via integrated systems or techniques, which can be modified according to time, place , person, costs, realization and need.
5. It is designed as its general improvement depends on in accessibility and affordability, provision for health insurance, and government responsibility, production and distribution of quality health resources (human resources adequately trained by dialectical philosophy and infrastructures) in grass root level.
6. its FUNDAMENTAL APPROACHES – Are very ,broadly scientific ,philosophic integrated concept and practice , are syndromic, diagnostic or combined or empirical for unspecified conditions.e.g APPROCH IS BASICALLY DEPENDED ON STAGING AND QUANTIFYING THE MOST OF THE HUMAN DISORDERS FOR EXAMPLE SIRS , SEPSIS , SEPTIC SHOCK, MOD : ACUTENESS, CHRONICITY, VISIBLE OR UNVISIBLE DIASBILITY OR DISORDERS, EMOTIONAL UPSET, DEGREE OF MENTAL DISFUNCTION,ENVIROMENTAL,PERSONAL,FAMILIAL, PHILOSOPHICO-SOCIO-ECHONOMOCAL, AND GLOBAL INTEGRATED ASSESSMENT FOR MULTI-ENFLUNCING FACTORS.
7. It categorize the human illnesses in newly, broadly and interconnected form rather than isolated form , in terms of approach, diagnosis, and holistic, cost, effective easy and scientific management.
8. It educates the general people and health personnel timely about prompt health concepts, awareness in terms of preventive , curative and cost effective aspects.
9. It is based on the importance of simple R.K.Dhaugoda’s basic law of dialectics (Any event, system or unit contains opposite phenomena which are also connected relatively by means varying degree of reciprocal association dynamically with other sets of opposite phenomena again) , R.K.Dhaugoda’s general theory/equation of vasculitis ( vasculitis = TNF-alpha and activated NFkB: IkBa and X-factor ) and R.K.Dhaugoda’s general ratio of health and disease ( HEALTH : DISEASE = 4:1 ), and ,clinical signs and symptoms, the proper classification of the disease, timely integrated treatment, and interventions for prevention and follow-up. It is particularly useful in the all level of care, i.e., camps, medical offices, health care centers or hospital primary care departments, tertiary and super tertiary level too.
10. It conceptualizes the simple meaning of health, disease, core stress factors (TNF-Alpha, and active NFkB), immunity (core antistress factors as IkBa and X-factor, philosophical understanding of people and society and interrelation to each other and self esteem of an individual ). It also gives simple comprehensive, pathogenesis of human diseases and their simple and effective managements and limitations.
11. It has simple guidelines/principles of management :- Syndromic or diagnostic or combined – first action is the detection of severity and dangerousness sign of any illness of person.e.g –ABNORMAL VITALS SIGNs-(BP,PULSE,TEMPERATURE, SPO2,PAIN,POSITION,SEIZURS,RESPIRATION ,DEHYDRATION.BLEEDING )SIRS,SEPSIS,SEPTIC SHOCK, MOD,LEVEL OF CONSIOUSNESS , LEVEL OF EMOTIOANAL UPSET OR ANXIETY ,PANICNESS ,PSYCHOSIS,DEPRESSION,SEVERITY OF VOMITING ,LEVEL ,PLACE AND, TYPE OF PAIN, DEGRRE OF FOOD INTAKE ,HX OF POISONOUS AGENTS MISSUSED , ABSENT OF PASSING URINE OR STOOL OR FLATUS, LEVEL OF ACTIVITY OR MOVEMENT OR ORGAN FUNTIONS,LEVEL OF ORGANIC OR FUNCTIONAL DISORDERS-IN SIGHT,HEARING,SPEECH,MEMORY, THOUGHT,BEHAVIOUR, SWALLOWING, DYSPNEA ,,PALPITATION,SENSATION,EATING, ABNORMAL BODY DISCHARGES/FLOW, ABNORMAL ORGAN SIZE AND FUNTIONS.SEXUAL DISFUNCTIONS/ REPRODUCTION,
12. It captures most of the common human illnesses but not all. And advice the use of limited essential drugs and whatever the techniques from alternative medicine useful to treat the diseases chronic illnesses.
13. It’s a only conceptual guideline theory and hasn’t hard and fast rule for better management OF HUMAN ILLNESS, continuous update is necessary, CAN BE MODIFIED ACCORDING TO SCIETIFIC EVIDENCES and RESEARCHES.
IMHI PRINCIPLE GUIDELINES
· Simple approach and problem identification in integrated form eg. Syndromic or diagnostic or combined – first action is the detection of severity and dangerousness sign of any illness of person in relation to psychological, physical, biomechanical, spiritual/emotional, economical, traumatic ,infectious ,noninfectious ,environmental ,nutritional maladjustments,acutenss,cronicity,genetic,oncog-enic,traumatic,disastes,te-rrorism related, physiologic distresses, hormone,enzymes,electrolyte disbalances.etc.
· Prompt use of information technology that is Quality networking or communications for updated self information , to patients , family members , health resource persons , and society members or, authorities regarding problem approach, problem identification process , staging of illness and system involvements ,prompt possible diagnosis, multi-way communication ,for data collection, and thereby making appropriate impression and person’s economic ,social, educational ,cultural status etc.
· Assessment of sick PATIENTS:- The assessment procedure for child and adult age group includes a number of important steps that must be taken by the health care provider: (1) Take a history and talk
with family member or patient itself or with the caregiver about the child’s problem; (2) check for general danger signs; (3) assess major symptoms; (4) evaluate nutritional, emotional ,behavioral, psychological drug or substance abuse status; (5) assess for child the child’s feeding; and for adult appetite (6) check immunization status; and (7) assess for philosophic-psycho-socio-economic-familial -environmental status.( 9) check for other related problems.
· IDENTIFICATION OF VERY SEVERE AND CRITICAL ILLNESSSES AND ASSESSMENT OF TIMELY REFERAL TO RIGHT PLACE FOR EARLY PROMPT MANAGEMENT OF SEVERE ILLNESSES AFTER PRIMARY SUPPORTIVE MANAGEMENT AS FAR AS POSSIBLE.
· SELF AND LOCAL MANAGEMENT OF HUGELY .At Home- self or family members ,Grass root level clinics private or government ,health posts, health centers, regional health centers , district hospitals ( primary or secondary health facility ) providers are- axillaries health workers , local clinicians , drug retailers, midwifes, nurses ,CMA,health assistants, MBBS, BDS, FAMILY PHYSICIANS ( ALL THESE MAN POWERS WORK AS VITALLY AND MULTI- APPROACH AND IN INTEGRATED WAY WITH NEED OF MINIMAL REFERAL TO HIGHIR OR TERTIARY CENTRES).
· Non- specific management of any problem has great value( treatment of person rather than disease )., should behave person as a human, humanly understand emotions and support this appropriately, assures and communicates to patents and family member. Understand any physical illness generally associated with psychological upsets and vice versa. Make an inter-personal relation as a friend with patient and parents for friendly, familial environment or attachment, for more effective health and disease management.
· The combination of individual signs leads to a patient’s classification rather than a diagnosis. This classification indicates the severity of the condition and calls for specific actions based on whether the patient (a) should be urgently referred to a higher level of care, (b) requires specific
treatments, or (c) can be safely managed at home. The classification is stage-coded: stage –IV- NEEDS REFERAL TO SUPER TERTIARY LEVEL HOSPITAL, stage –III requires hospital referral or admission; stage-II indicates the need to initiate treatment; and stage-I indicates
home management.
G
G
· METHODS OF SPECIFIC MANAGEMENT:
-depends on acute severe vs. chronic illness.
–NON-SPECIFIC-SPECIFIC- use of general anti-stress factors ( good reassurance, patient education promotion, IkBa agonists, x-Factor in appropriate way), act to decrease aggravating, factors or outer stress factors, arrange for stabilizing basic vital factors – for very severe and unconscious patients should follow emergency management protocols like MAINTAINANCE OF ABCDE ( 5 TUBES – O2 LINE, ECG LINE, IV LINE, BP MONITORING LINE,SPO2 NONITORING LINE , IF NECESSARY- INSERT OTHER TUBES LIKE:- NG,FOLLEYS’S ,CHEST TUBES, CVP LINE ,ENTUBATION TUBE). ,(BP,PULSE,TEMPERATURE, SPO2,PAIN,POSITION,SEIZURES,RESPIRATION ,DEHYDRATION.BLEEDING ) and other various supporting
management like, nutritional support..
Management of timely appropriate referral system to right place where can be available specific prompt management of very critical and specific patients.
SPECIFIC- SPECIFIC – as far as possible according to causative agent or illness specific final treatment (like antibiotics, antidaibetics,hormonal , surgery, reduction and plaster, chemotherapy, antidepressants, etc) with coordination of non-specific-specific treatment and non-specific treatment.
Review of effectiveness of management; quick re-evaluate the impression, diagnosis, action and outcome, if necessary modify the treatment.
POST-SPECIFIC -TRAETMENT - management of post illness situations- rest ,physiotherapy, socio-economic, rehabilitation and counseling for emotional , psychological, disability, change of suitable profession ,sexual disorders and dissatisfaction and alternatives etc.and preventive educations to family and social members.; and follow up .
DANGER SIGNS
OF HUMAN ILLNESS
1) Signs of severe SIRS, SEPSIS, SEPTIC SHOCK, MOD
2) Seizures during the current illness. Seizures may result from fever. Febrile seizures do little harm beyond frightening the parents. But seizures may also be associated with
meningitis, cerebral malaria, or other life-threatening conditions
3) Unconsciousness or lethargy or GCS level. An unconscious patient is likely to be seriously ill. These signs can be associated with many conditions, including
severe dehydration, severe hypoxia, sepsis, or meningitis. cerebral edema, tumors .etc.
4) Inability to drink or breastfeed or intake of food.
5) Persistent vomiting. Vomiting/diahorrea it may be a sign of serious illness. This symptom may also prevent the child from taking medications or fluids for rehydration.
6) Persistent Inability to pass urine, stool, flatus with or without distention of abdomen. Signs of obstructions- Distension of body parts or disorders of lumens of organs. Distal ischemia, not passing urine, baby, fluids, bloods, bile, CSF, stool, flatus, ovum, semen, lymph or body
7) Persistent crying of child or persistent/ intractable pain
8) Persistent dyspnoea/ dysphasia, cough, hemetemeis, hemoptysis, edema.
9) Persistent discharges from body and heavy bleedings and signs of sudden internal blood loss – sock, dypsnea, anemia, tachycardia
10) Persistent ECG, pulse, BP-abnormality.
11) PERSISTENT SEVERE EMOTIONAL UPSETS, ABNORMAL THOUGHT AND ABNORMAL BEHAVIOURAL DISORDERS.
12) SUDDEN SYNCOPE, LOC, CHEST PAIN, LOSS OF VISOIN, HEARING SPEECH, SWALLOING.
13) HX OF INGESTION OF SUSPECTED POISON, OR BITE FROM SUSPECTED SNAKE, ANIMAL-ETC.
16) Severe wt. loss, anemia, passing of black stool, rashes, jaundice. Enlarged lymph nodes.
17) Persistent and severe dizziness, vertigo, abnormal movement or tremors, weakness or paralysis of limb.
18) Others known and unknown signs can be mentioned as long lists.
UNDERSTANDING OF
HUMAN DISEASE PATHOGENESIS
AND GENERAL PATHOLOGY
It is applied here especially the RKDHAUGODA’S GENARAL THEORY OF VASCULITIS to understand the human disease pathogenesis and general pathology and management.
RKDhaugoda’s-General theory of vasculitis
From the various conclusions of various literature reviews, discussions, and various studies and findings, which are presented various chapters (THE BOOK - RKDHAUGODA'S GENERAL THEORY OF VASCULITIS -PART-I). It is hypothesized to build the Rkdhaugoda’s general theory of vasculitis, with the help of guide line theory that is dialectical materialism, to express the objective reality of the physiological and pathological laws within the human body and to solve many problems in the field of management of health and disease in the huge proportional of population, in terms of effective, preventive, curative with least costs and simple techniques and coordinating with other various scientific approaches.
According to this theory:
(1) Any inflammatory (infectious or non infectious & endogenous or exogenous originated disease is associated with varying degree of vaculitis in relation to time, space, motion and matter (antigen specific/strss factors/antistress factors). It means the main / key pathology of any inflammation is the vaculits (primary or secondary vaculitis). Vaculitis is the inflammation of vascular system, and associated with inflammation of any types of cells of the body. The vascular system in human body is widely and extensively distributed (except hair, nail and cornea). The vascular system e.g. micro vessels namely capillaries, sinusoids, venules are connected with every cells of the body by means extra cellular fluids. Hence any tissue or cell damage is associated with vascular abnormalities.
(2) All the inflammatory originated diseases having the common pathology vasculitis are principally mediated by the major factor TNF- alpha and activated NFkB). It means TNF- alpha and NFkB are the principle stress factors, and principle pathogenic mediators for all types vasculitis diseases (from boils to cancer pathology).
(3) All these vasculitis pathology have relatively high level of TNF- alpha and activated NFkB in the circulation, which are associated with relative hypo- ANTI-STRESS FACTORS (Low level of IkBa and X- factor). Because in any hypo- ANTI-STRESS FACTORS condition, there is increased synthesis of TNF- alpha and increased amount of activated NFkB, they CAUSE appearance of inflammatory response, and then various degree of vasculitis process is developed called the disease.
(4) These relations of vasculitis, CELLULAR STRESS FACTORS (TNF- alpha and activated NFkB) relative level of intracellular ANTI-STRESS ELEMENT ( IkBa and X- factor) , remains in functional state, when there remains constant i.e. the possibility of reversion of pathogenesis of involved organ. This functional limitation of reversibility of pathogenesis is represented by the R.K.Dhaugoda’s. constant equals to 1, this value remains constant up to before irreversibility damaged of organic function (e.g. chronic renal failure, chronic liver failure, brain death, chronic brain damage /severe encephalopathy).
(5) All these disease, which is associated with vasculitis pathology, are treated with pharmacotherapy of ANTI-STRESS ELEMENTS principally, and with adjunctive therapeutic tools, antimicrobials, antiviral, antifungal, antiparasitic, and other various supporting drugs and techniques viz biomechanical (surgical/mechanical ventilation) until stabilization of severe disease pathology, and clinical stability. Then oral ANTI-STRESS ELEMENTS ARE given for chronic and long-term preventive as well as curative management of various incurable diseases are treated with various integrated ways (to maintain the optimum level of intracellular ANTI-STRESS ELEMENTS relatively), e.g.
(a) By increasing education level of individual/ society regarding scientific understanding of disease process, causation, intervention, complications, prevention, and ways of scientific management, and the biological, physiological role of ANTI-STRESS ELEMENT and its importance via increasing the knowledge and practice of dialectical materialism thought and principles, broadly throughout the world. Because this dialectical materialistic view is the core/root science for all the remaining branched sciences. Without its knowledge, we can’t understand the laws of universe and its contents scientifically.
(b) By modifying nutrition, lifestyle and behaviors (being anti sadists to own self and to others). Viz taking, low fat diet, low sugar diet, moderate physical exercise, relatively high ANTI-STRESS ELEMENTS containing diets avoiding smoking, alcohol, excess tea, coffee, sodium, azinomotto ( mono-sodium-glutamate), INCREASING SELF ESTEEM and avoiding excessive worryness and anxiety , all these positive activities cause increased intracellular ANTI-STRESS ELEMENTS relatively.
(c) Practicing various types of physical exercises:-anaerobic exercise, yoga, pranayam –THESE MEASURES CAUSE- POSITIVE BALANCE OF INTRACELLULAR ANTI-STRESS FACTORS-AND FINALLY DECREASE OF ANY TYPE OF INFLAMMATIONS OR VASCULITIS.
(6) In this theory, it is estimated even sub clinical stage of diseases or pre-estimation of relative risk of diseases. By measuring, the relative level of the C- reactive protein (a functional biological marker of hypo-ANTI-STRESS ELEMENTS, inflammation in the body, and the level of cytokine e.g. TNF- alpha and activated NFkB in the circulation). It says that even a person with relatively non-significant clinical disease, by measuring of C-RP level, if it is relatively high comparing to normal value, it is predicted the various risk for various diseases, especially chronic diseases. A person having Type -2 DM, arteriosclerosis, vascular diseases and with high C-RP level has more risk for cardiovascular diseases e.g., Heart attack, Angina, Ischemic heart disease, CRF and stroke etc.
(7) In this theory, it is applied the dialectical materialism principle which is the root science for all the branched sciences. The pathology of any disease is represented relatively & commonly by vasculitis. The intracellular relative level of ANTI-STRESS ELEMENTS ( IkBa and X- factor) represents body’s physiological status (immune status), Vasculitis and magnitude of Intracellular ANTI-STRESS ELEMENT (immune status) are opposite phenomena in the human body but not isolated from each other, but interdependent and interrelated each other by the relative level of TNF- alpha, activated NFkB and C-reactive protein or stress factors in the circulation. In the physiological level range there is relatively less stress factors and less level of TNF- alpha, activated NFkB, and C- reactive protein (very low level is dominated by body’s immune status) and not causing disease. But when there is relative low level of intracellular ANTI-STRESS ELEMENTS. Relative hypo-ANTI-STRESS ELEMENTS in comparison to stress factors. Then it is started to synthesis and activations of TNF- alpha and activation of NFkB , and starts activation of inflammatory response by the body causing various degree of tissue / cell injury. Causing pathogenesis of
Vasculitis and synthesis of C-RP in the liver is increased in response to inflammation in the body, overall causing increased level of TNF- alpha, C-RP and appearance of various degree of vasculitis, (Sub clinical to clinical stages). Hence, here the two opposite phenomena immune status (optimum level of intracellular ANTI-STRESS ELEMENTS) .
disease process / Inflammation (vasculitis) is connected in terms of TNF- alpha,NFkB and C-RP and OTHER stress factors like low self esteem and unscientific thought and practices.
(8) In this theory, it is correlated the level of intracellular ANTI-STRESS ELEMENTS (IkBa and X- factor), STRESS-FACTORS (TNF- alpha and activated NFkB), and degree of various vasculitis, by blood circulation level of highly sensitive C-reactive protein. In practice, it is very difficult to measure sub clinical & clinical vasculitis, likewise the TNF- alpha level and intracellular ANTI-STRESS ELEMENTS level very difficult, needs sophisticated instruments, highly qualified man power and excessive costly. But here it is correlated by the level of C-RP with the level of other three parameters e.g. severity of vasculitis, level of TNF- alpha and intracellular ANTI-STRESS ELEMENTS level. When there is increased value of C-RP there should be relative hypo-ANTI-STRESS ELEMENT, increased level of TNF- alpha and various degree of sub clinical to clinical form of vasculitis. In absence of other interfering factors for C-RP level in the body e.g. use of Steroids, NSAIDS, Vigorous exercise, excessive Coffee / tea, Hormone replacement therapy, Intra-Uterine device, Pregnancy, use of Statin etc.
(9) highly sensitive C-RP is non-specific biological marker of inflammation and body stress, raised its value in various types of Inflammations and exposure to stress factor by the body systems.
Operational classification
of human illness
ACUTE CONDITIONS
² ALLERGY/ HYPERSENCITIVE RXN
² ACUTE POISONING AND BITES ,STRESSESS, TRAUMA RELATED CONDITIONS,BITES
² ACUTE VITALS SIGNS, CONCIOUSNESS, ORGAN FUNTION DISTURBANCES ,
² ACUTE PSYCOTIC, NEUROSIS, EMOTIONAL UPSETS
² ACUTE LOCAL INFLAMMATORY-LOCALISEZED MINOR DISODERS-PAIN,SWSELLING ,FRACTURES
² ACUTE CONDITION --SIRS-(SYSTEMIC INFLAMMATORY RESPONSE SYNDROME) -INFECTIOUS/ NONINFECTIOUS (Medical, traumatic, surgical cases)
² ALI, ARDS, MODS, SEVERE SEPSIS, ARF, ACUTELY ORGAN FAILURE CONDITIONS.
² ACUTE ABDOMENS,CHEST,HEART AND BRAIN SYNDROMES
² ACUTE TRAUMATIC CASES.
² ACUTE PHYSIOLOGIC EVENT MANAGEMENT CONDITIONS-PREGNANCY RELATED CASES.
² Other various acute conditions- according to time, place and persons experty.
CHRONIC CONDIDION
² slow inflammatory response syndrome --oncogenic/rheumatic /MOST OF THE CHRONIC DISEASE -INFECTIOUS/ NON-INFECTIOUS
(SLOW STEADY RISE OF PRIME CYTOKINE –TNF-ALPHA)
² DM.HTN,CHF,CHRONIC MENTAL ILLNESS,CKD,COPD,ENZYMES/HORMONE DISORDERS,DEGENEARATIVE,RHEUMATIC/aging related conditions,osteoarthritis,SNHL, CATARACT etc.
² ACUTE ON CHRONIC- EXACERBATION OF CHRONIC CONDITIONS OR MIXED (ANY ACUTE + ANY CHRONIC)
² SEVERE SIRS---RAPID ONSET OF MOD------DISABILITY/DEATH
² MILD SIRS-----RESOLVED- OR SEVERE SIRS
² SLOW IRS--------SLOW ONSET OF MOD------DISABILITY/ DEATH
² Systemic or slow inflammatory response syndrome OUTER MANIFEATATION OF HUMAN ILLNESS (increase TNF- ALPHA and increased activity of NFkB level ), OCCURS PATHOLOGY AS VASCULITIS OR ENDOTHELIATIS AND REALTIVE LY DECREASED INTRACELLULAR ANTISTRESS FACTORS-(IkBa and X-factor)
² Chronic complications of drugs, operations, trauma, stress, or procedures- related conditions.
² Various disabilities/ handicap
² Chronic national, social, familial problems ,civil war, regional wars, racial wars, religious wars
² Chronic economic shutdown conditions
² Chronic psycho-sexual dysfunctions
² And many more long lists may be added for place and experty wise.
MANAGEMENT PRINCIPLES OF ACUTE HUMAN ILLNESS
1) BASIC/ADVANCE LIFE SUPPORT ACTIONS
(SPPORTIVE MX –VITAL SUPPORT (ABCDE)- AND USE OF EMMERGENCE DRUGS OR PROCEDURES AND PROPER COUNCELLING TO PATIENT AND PATIENT PARTY ABOUT THE PROBLEM, MANAGEMENT , LIMITATIONS, OUTCOME OR PROGNOSIS , USE OF PROPER COMMUNICATION SKILLS.
2) QUICK SYMPTOM RELIFE ACTIONS /DRUGS PAIN/TEMPTR/VOMITING/SEIZURE,HIGH/LOW PRESSURRE KILLERS—
3) COUNCELLING- MAKING PT. STABLE- DECISION MAKING AFTER IDENTIFICATION OF SEVERITY OF CASE- FOR LACALLY RX OR HIGHER CENTER REFER )
1) LOCALLISED OUTER (VISIBLE) MILD ACUTE ILLNESSS – BOILS RASHES, FURUNCLES, SOFT TISSUE ENJRY, SMALL BURN, CUT, WOUNDS, ( MANGEMENT FOR PAIN, ITCHING,SWELLING, AND CLEANING ,SIMPLE I AND D ,DRESSING, SUTURING,COUNCELLING, TOPICAL OR SYSTEMIC ANTIBIOTIC ) – SITE FOR MX IS HOME OR LOCAL CLINIC,HEALTH POST )
2) LOCALLISED INNER (NON- VISIBLE) MILD ACUTE ILLNESSS- SMALL DEEP ABSCESS, INFECTIONS, FRACTURE, DEEP SOFT TISSUE INJURY, HEAMATOMA, SMALL COLLECTIONS, GROWTHS, NEEDS SKILL MEDICAL PERSIONS – LOCAL CLINIC WITH PHYSICIAN OR HEALTH CENTER OR DISTRIC LEVEL HOSPITAL WITH TRAINED HEALTH ASSISTANT OR MBBS .( MANGEMENT FOR PAIN, ITCHING,SWELLING, AND CLEANING , DEEP I AND D ,DRESSING, SUTURING,COUNCELLING, TOPICAL OR SYSTEMIC ANTIBIOTIC , PLASTER ,CAST ,SPLINT ,HEMOSTASIS,
3) LOCALISED ACUTE ILLNESS WITH DANGER SIGNS – EG ELECTRIC SHOCK, COMPARTMENT SYNDROMES,EXCESSIVE BLEEDING,COMPOUND FRACTURES ,NEEDS REFER-HOSPITAL MX. ( LIFE SUPPORTING MX ABCDE- AND SPECIFIC LOACL TRAUMA OR WOUND MX + SYSTEMIC MX WITH MX ( PAIN KILLER, FLUID, ANTIBIOTICS, ANTISTRESS FACTORS )
4) LOCALLISED SIGNIFICANT ACUTE ILLNESS IN VITAL ORGANS ( EYE,NOSE EAR,GENITALS LIVER KIDNRY, HEART-LUNGS, MOUTH THROAT, INTRAABDOMEN BRAIN. REFER TO HOSPITAL LEVEL ATLEAST MBBS OR FAMILY PHYSICIAN AVAILABALE.
5) ACUTE NON SPEFIFIC SYNDROMIC DIEASES----
(SYMPTOMATIC MANAGEMENT – IF NOT IMPROVED
WITHIN 1-2 HOURS – TRY TO FIND OUT CAUSE AND TX, OR REFER)
SHORTNESS OF BREATH
VOMMITING—
SEIZURES
HEADACHE-
ANXIETY-
PAIN ABD
FEVER
COUGH AND COLD
DIZZINESS
LOSE MOTION /APD
EPISTAXIS
BODY ACHE
ARRYTHMIAS
SYNCOPE
6) ACUTE SPECIFIC SYNDROMIC DISEASE, MULTI-SIGNS AND SYPMTOMS. WITHOUT DANDER SING S- RX LOCAL CLINICS, HEALTH POST, BUT WITH DANGER SINGS – HOSPITAL REFER
HEADCHE ,FEVER,WEAKNESS, BURNING MICTURITION, VOMITINGS , SEIZURES, LOC- OR ANY DANGR SIGN—REFER TO HIGHER CENTER AFTER SYPTOMATIC AND SUPPORITIVE MX
SEVER PEUMONIA, MENINGITIS, SEPSIS, ARDS, SEPTIC SHOCK, ACUTE ABD. CASES, AGE, SEVER MIGRAINE,
7) POISON, BITES , SEVERE TRAUMA, UNCONCIUOS , SEVRES CHEST PAIN, SEVRERE SOB, VOMITING, NOT EATING,SEVERE NON STOP SEIZURE, SEVRE VITAL SIGN DISPARITY-QUICK REFER TO HIGHER CENTER AFTER SUPORTING MX AS FAR AS POSSIBLE.
8) ANY TRAMATIC- ACCORDING TO PRIMARY TRAUMA CARE GUIDE LINE.
(Many things will be updated in next edition after gathering your valuable feedback and critics regarding this newly concept of IMHI-it’s in a just initial stage and needs further works to make ready to use practically.)
QUANTITATIVE DIAGNOSIS OF SEVERITY OF
DISEASE OR HUMAN ILLNESS IS DONE BASICALLY -BY
Colorimetric ELISA kit for measuring human tumor necrosis factor alpha (TNFa) in cell culture supernatant, plasma and serum
2.NFkB p65 ELISA Assay Kit, EZ-Detect, Chemiluminescent from Thermo Scientific Pierce Protein Research Products
The Uscn (TM) product for Human NFkB ELISA Kit(E91824Hu),ELISA Kit for Nuclear Factor Kappa B (NFkB)
.3. IkB alpha, Total, Human (IkBa) BioAssay™ ELISA Kit
4. Quantitative measurement of intracellular or serum X-factor level via analyser.
5.Quantitative measurement of high sensitive CRP
6. Quantum Resonance Magnetic Analyzer
THESE ALL ADVANCED PROCEDURES WILL HELP IN THE QUANTIFYING THE HUMAN ILLNESS EVEN IN SUB CLINICAL SATEGES.
7. Other various conventional diagnostic tools-Also will be used. ECG,CT,MRI,ENDOSCOPY,USG,X-RAY,HPE,BLOOD,URINE,BODY FLUIDS,STOOL TESTS.
