The salient features are as follows:

1. Every clinical establishment should register for provisional registration as early as possible. The link for the registration is: 

https://clinicalestablishment.gipl.in/

2. On clicking the link, an introductory video would appear on the screen which shows how to register.

3. Fire NOC and BMW certificates are mandatory requirements.

4. If the establishment is having its height lesser than 9 meters than it is exempt from fire NOC.

5. There is absolutely no requirement of 'Building Use Certificate' (BUC)

6. In hospital registration section 'list of clinical equipments' might not open. Don't bother about it.

7. It is advisable to use the e-mail ID of the owner of the hospital or the chief administrator. Your submitted e-mail ID would be your user ID. It would not be possible to change your user ID.

In case of any query, you may connect with 

Dr CB Patel,

President.

9904510100

Dr Hiren Vaidya,

Secretary.

7990691909

Dr Parul Vadgama 

(Jt. Secretary,

AKNSI, IMA HQ)

9879533318

Dr Jagdish Vaghasia

Vice President.

9879519702

Dr Mukur Petrolwala

President elect.

9925122232

Indian Medical Association, Surat.

Introduction

Obstructive sleep apnea (OSA) is a serious disorder of repetitive pharyngeal collapse during sleep due to decreased pharyngeal airway size because of craniofacial structure or body fat. Patients with OSA report snoring, witnessed apneas, waking up with a choking sensation, excessive daytime sleepiness, fatigue, tiredness, and headache.1 Moderate to severe OSA has been found to affect 50% males and 25% females in the middle-aged population.3

OSA is an emerging public health concern globally. It has been linked to several comorbidities like metabolic syndrome, diabetes mellitus, insulin resistance, hypertension, coronary artery disease, stroke, increased risk of vehicular accidents, and various psychiatric disorders.4 

Causes of OSA

The predisposing factors of OSA can be divided into anatomical and physiological factors (Figure 1).1,3

Figure 1: Etiological factors of OSA (Adapted from Whyte A et al. 2020)3

Risk factors for OSA

The Indian Initiative on Obstructive Sleep Apnea (INOSA) guidelines suggest the following risk factors linked to OSA (Figure 2).4

Figure 2. Factors that may contribute to OSA (Adapted from Sharma et al., 2014)4

Modification of certain risk factors can modulate the incidence of OSA

Hormonal changes: Males are more commonly affected than females, possibly due to hormonal effects on upper airway muscles and collapsibility. Post-menopausal women have a three times higher risk of developing OSA than premenopausal women due to dramatic changes in sex hormone levels.7

Obesity: Increased levels of cholesterols and obesity are major modifiable risk factors for sleep-related disorders, which predispose individuals to OSA due to mass loading in the upper airway.7

Smoking and alcohol: Smoking can cause airway inflammation and smoking-related diseases. Nicotine levels can also affect sleep stability. These effects of smoking could contribute to OSA. Alcohol consumption reduces motor output to the upper airways, causing hypotonia of the oropharyngeal muscles.7

Consequences of OSA on other systems

OSA significantly affects the social, emotional, and physical health of the patients. The consequences of OSA are characterized by overlapping symptoms such as lack of concentration, fatigue, loss of interest, and decreased libido.11 Figure 3 highlights the disease progression of OSA.3,5,6

Figure 3. OSA disease progression (Source: Whyte A et al., 2020; Kim H et al., 2013; Arnaud C et al., 2020)3,5,6

The disease progression of OSA has a deleterious effect on various systems of the body (Figure 3).4

Figure 4. Complications of OSA (Adapted from Whyte A et al., 2020)3

OSA and comorbidities – A cross-linkage

A strong correlation exists between OSA and comorbidities due to common risk factors contributing to the etiology of one another.7

Hypertension: OSA is particularly common in patients with resistant hypertension. Evidence suggests that the chances of developing hypertension increase with a consecutive decline in nocturnal oxygen saturation.7

Cardiovascular diseases: The prevalence of OSA is high in patients with congestive heart failure. Recent studies suggest that the treatment of OSA in patients with congestive heart failure has improved symptoms over time.7

Stroke: OSA is highly prevalent in patients with stroke and transient ischemic attacks, leading to lower functional capacity and longer hospital stay.7

Diabetes Mellitus: Diabetes mellitus and OSA often coexist. Studies have demonstrated that poor metabolic and glycemic control have a significantly higher apnea-hypopnea index. Anti-diabetic medications, physical activity, and diet are reported to alleviate OSA-related effects.7,8

Conclusion

Obstructive sleep apnea significantly affects the quality of life and is associated with several long-term comorbidities. Therefore, spreading awareness about OSA and its proper diagnosis and treatment among the general population and healthcare practitioners is imperative

The COVID-19 pandemic had a “devastating” impact on the fight against HIV, tuberculosis and malaria in 2020, according to a report released by the Global Fund.

“To mark our 20th anniversary, we had hoped to focus this year’s report on the extraordinary stories of courage and resilience that made possible the progress we have achieved against HIV, TB and malaria over the last two decades,” said Peter Sands, the Global Fund’s executive director.

“But the 2020 numbers force a different focus. They confirm what we feared might happen when COVID-19 struck,” he said.

“The impact of COVID-19 on the fight against HIV, TB and malaria and the communities we support has been devastating. For the first time in the history of the global fund, key programmatic results have gone backwards.”

There were “significant” declines in HIV testing and prevention services, the fund said.

Compared with 2019, the number of people reached with HIV prevention and treatment dropped by 11% last year, while HIV testing dropped by 22%, holding back new treatment in most countries.

Nevertheless, the number of people who received life-saving antiretroviral therapy for HIV in 2020, rose by 8.8% to 21.9 million “despite COVID-19”.

The impact of the coronavirus pandemic on the fight against TB worldwide had similarly been “catastrophic”, the report said.

The number of people treated for drug-resistant TB in the countries where the Global Fund invests dropped by “a staggering” 19 percent, with those on treatment for extensively drug-resistant TB registering an even bigger drop of 37 percent, it said.

The fund calculated that around 4.7 million people were treated for TB in 2020, around one million fewer than in 2019.

Interventions to combat malaria “appear to have been less badly affected by COVID-19 than the other two diseases,” the report found.

“Thanks to adaptation measures and the diligence and innovation of community health workers, prevention activities remained stable or increased compared to 2019.”

The number of mosquito nets distributed increased by 17 percent to 188 million and structures covered by indoor residual spraying increased by three percent.

Nevertheless, the Global Fund — which brings together governments, multi-lateral agencies, bilateral partners, civil society groups, people affected by the diseases and the private sector -- said that its “rapid and determined response to Covid-19 prevented an even worse outcome”.

In 2020, the fund disbursed $4.2 billion to continue the fight against HIV, TB and malaria and approved an additional $980 million in funding to respond to COVID-19.

The Global Fund said that since it was set up in 2002, it has saved 44 million lives and the number of deaths caused by AIDS, TB and malaria decreased by 46 percent in countries where it invests