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Ms powerpoint presentation in tamil - learn computers ep 3/10.

MS POWER POINT TUTORIAL IN TAMIL 

கணிணி கற்போம் - பகுதி 3/10 

MS POWERPOINT 

மைக்ரோசாப்ட் பவர்பொயின்ட் (Microsoft PowerPoint) என்பது ஓர் இலத்திரனியல் நிகழ்த்துகை மென்பொருள் ஆகும். இதனை உருவாக்கியது மைக்ரோசாப்ட் நிறுவனமாகும். மே 22 ,1990 அன்று மைக்ரோசாப்ட் ஆபிஸின் ஒரு பகுதியாக மைக்ரோசாப்ட் பவர்பொயின்ட் தொடங்கப்பட்டது. இம்மென்பொருள் பல்லூடக நிகழ்த்துகைக்கு மிகவும் பயனுள்ளதாக இருப்பதுடன் தற்காலத்தில் அதிகமாகப் பயன்படுத்தப்படும் இலத்திரனியல் நிகழ்த்துகை மென்பொருள் ஆகும்.

Microsoft PowerPoint is an electronic presentation program that helps people present a speech using a collection of slides. A PowerPoint presentation is a collection of slides that can be used to create oral presentations

MS POWERPOINT  TUTORIAL IN TAMIL 

Link : https://youtu.be/mxkIpQfdeI8

MS POWER POINT BASICS

Link : https://youtu.be/CeUF7-EyKIo

MS POWER POINT TUTORIAL PDF 

Click here to download MS POWER POINT PDF

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73 Best Tamil-Themed Templates for PowerPoint & Google Slides

With over 6 million presentation templates available for you to choose from, crystalgraphics is the award-winning provider of the world’s largest collection of templates for powerpoint and google slides. so, take your time and look around. you’ll like what you see whether you want 1 great template or an ongoing subscription, we've got affordable purchasing options and 24/7 download access to fit your needs. thanks to our unbeatable combination of quality, selection and unique customization options, crystalgraphics is the company you can count on for your presentation enhancement needs. just ask any of our thousands of satisfied customers from virtually every leading company around the world. they love our products. we think you will, too" id="category_description">crystalgraphics creates templates designed to make even average presentations look incredible. below you’ll see thumbnail sized previews of the title slides of a few of our 73 best tamil templates for powerpoint and google slides. the text you’ll see in in those slides is just example text. the tamil-related image or video you’ll see in the background of each title slide is designed to help you set the stage for your tamil-related topics and it is included with that template. in addition to the title slides, each of our templates comes with 17 additional slide layouts that you can use to create an unlimited number of presentation slides with your own added text and images. and every template is available in both widescreen and standard formats. with over 6 million presentation templates available for you to choose from, crystalgraphics is the award-winning provider of the world’s largest collection of templates for powerpoint and google slides. so, take your time and look around. you’ll like what you see whether you want 1 great template or an ongoing subscription, we've got affordable purchasing options and 24/7 download access to fit your needs. thanks to our unbeatable combination of quality, selection and unique customization options, crystalgraphics is the company you can count on for your presentation enhancement needs. just ask any of our thousands of satisfied customers from virtually every leading company around the world. they love our products. we think you will, too.

Widescreen (16:9) Presentation Templates. Change size...

Presentation theme with panorama of famous tamil nadu landmark - shore temple world heritage site in mahabalipuram tamil nadu india

PPT layouts enhanced with vintage retro effect filtered hipster style image of statues on hindu temple gopura tower menakshi temple madurai tamil nadu india

Slide set featuring man weaving silk sari on loom in kanchipuram tamil nadu india kanchipuram is famous for hand woven silk sarees and most of the city's workforce is involved in weaving industry

Presentation design featuring town tiruvannamalai with arulmigu arunachaleswarar temple tamil nadu india aerial view

Theme enhanced with hindu temple gopura tower menakshi temple madurai tamil nadu india

Slide set having famous tamil nadu landmark - shore temple world heritage site in mahabalipuram tamil nadu india

Presentation theme featuring bas relief depicting durga slaying demon maheeshasuramardini brihadishwara temple tanjore thanjavur tamil nadu india the greatest of great living chola temples - unesco world heritage site background

PPT theme enhanced with airavatesvara temple darasuram tamil nadu india one of great living chola temples - unesco world heritage site backdrop

Presentation theme having famous tamil nadu landmark - shore temple world heritage site in mahabalipuram tamil nadu india

Theme having fishing boat on the beach chennai tamil nadu india

Slides featuring lingam shivalingam -symbol of shiva in hindusim airavatesvara temple darasuram tamil nadu india one of great living chola temples - unesco world heritage site background

PPT layouts having famous tamil nadu landmark - shore temple world heritage site in mahabalipuram tamil nadu india

Presentation consisting of vintage retro hipster style travel image of shiva and parvati on bull images sculptures on hindu temple gopura tower menakshi temple madurai tamil nadu india

Slide deck consisting of krishna bas relief in hindu temple sri ranganathaswamy temple tiruchirappalli trichy tamil nadu india

PPT layouts enhanced with famous tamil nadu landmark - shore temple world heritage site in mahabalipuram tamil nadu india

PPT theme having famous tamil nadu landmark - shore temple world heritage site in mahabalipuram tamil nadu india

PPT theme enhanced with kodaikanal upper view tamil nadu india

Presentation theme featuring vintage retro hipster style travel image of famous tamil nadu landmark - shore temple world heritage site in mahabalipuram tamil nadu india with grunge texture overlaid

Presentation theme having sri meenakshi hindu temple in madurai tamil nadu south india

Presentation theme having auroville meditation hall auroville is a human unity where people could live in peace and progressive harmony above all creeds politics and nationalities pondicherry tamil nadu state india background

Presentation theme enhanced with gopuram tower of hindu temple kapaleeshwarar chennai tamil nadu india

Presentation design enhanced with famous tamil nadu landmark - shore temple world heritage site in mahabalipuram tamil nadu india

PPT theme featuring mountains in clouds kodaikanal tamil nadu backdrop

Presentation theme with hindu goddesses parvati lashmi and saraswati statues in tock temple tiruchirappalli tamil nadu india background

Theme featuring city lit up at night chennai tamil nadu india backdrop

PPT layouts having vintage retro hipster style travel image of rural indian scene - rice paddy field and palms tamil nadu india

Slides consisting of gopuram tower of ancient hindu temple ekambareswarar kanchipuram tamil nadu india

PPT theme consisting of rural indian scene - rice paddy field and palms tamil nadu india backdrop

Presentation theme enhanced with famous shore temple at mamallapuram tamil nadu india

Presentation theme having airavatesvara temple darasuram tamil nadu india one of great living chola temples - unesco world heritage site

Presentation design consisting of vintage retro hipster style travel image of krishna's butterball - balancing giant natural rock stone with grunge texture overlaid mahabalipuram tamil nadu india

PPT theme enhanced with mountains in clouds kodaikanal tamil nadu

Slide set enhanced with mandapam shiva temple on top main hill in mamallapuram tamil nadu india

Presentation theme with roof of sri meenakshi hindu temple in madurai tamil nadu india

PPT theme enhanced with holy mountain arunachala in tiruvanamalai tamil nadu india

PPT theme consisting of ramana maharshi ashram in tiruvanamalai tamil nadu in india

Presentation theme featuring panorama of rural indian scene - rice paddy field and palms tamil nadu india

Slide deck having indian food on a restaurant table chennai tamil nadu india

Theme featuring fishing harbor with large church in background laccadive sea kanyakumari tamil nadu india

Slides enhanced with view from gingee fort thiruvannamalai in tamil nadu india known as the troy of the east gingee fort rises out of the tamilian plains lying in villupuram district of tamil nadu in india background

More tamil templates for powerpoint and google slides:.

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Tamil Nadu Culture PowerPoint Templates And Google Slides Themes

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7th science powerpoint.

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Tamil Coolie - PowerPoint PPT Presentation

Tamil Coolie

Reporting to the japanese government on the conditions of ... malaysians, japanese, and ... narrator (japanese) and malaysian prince both use malay word raja ... – powerpoint ppt presentation.

• Translating the Translation
• Curtis Gutter
• Earlham College, May 2004
• Born 1901, in Kandan, Tokyo
• Writer of Detective Stories
• Perfect Crime (????)
• Murder Incident at Black Death Hall(????????)
• 1941 Traveled with Sendenhan to Malaysia
• 1943 Published Tamil Coolie in Shintaiyo
• 1946 Died of cerebral hemorrhage
• Shintaiyo (???) is a magazine
• whose name means The New Sun
• Department of Propaganda/Public Relations
• Two purposes
• Reporting to the Japanese Government on the conditions of another country
• Spreading Essentialist philosophy (Unified Asia, under Japan, against Europe)
• Tamil Coolie is an example of the latter
• ??????? (Proclamation of Universal Brotherhood)
• Written in 1942, written as Oguris experiences in Malaysia
• Tamils, Malaysians, Japanese, and British.
• Tells of plight of Tamil Indians in Malaysia under British low wages, social inferiority, alcoholism, massacres.
• WW2 viewed as an embarrassment in Japan
• Korea and China still trying to convince Japanese government to modify textbooks so that they dont Whitewash Japans Colonial Past1
• Those who do not remember the past are condemned to repeat it2
• Past does not belong to Japanese alone
• 1 Korea Herald
• 2 George Santayana
• Before beginning any translation, must decide what the purpose of the translation to know how to translate
• Purpose of this translation so that we (English and Spanish Speakers) may learn from the history of others. I.e., reader should identify with Japanese storyteller
• Domestication instead of Foreignization
• Foreignization
• Reader enters foreign world of the text
• Faithful to the letter
• One look is better than hearing a hundred times
• Domestication
• Text enters domestic world of the reader
• Doesnt sound like a translation
• Seeing is believing
• ?? (seisen) Holy War? Crusade? Jihad?
• Holy War literal meaning of each kanji. Originally a neutral term, it is now associated with religious fanaticism/Islam.
• Jihad loan word from Arabic, this would definitely imply religious fanaticism. ?
• Crusade originally applied to religious struggle based in Christianity, has acquired meaning of fighting for a cause in general.
• Christianizes author / Blatant domestication
• Connotations draw Christian reader closer to narrator
• Acquired secondary meaning of fighting for a good cause.
• I chose Crusade
• More literal translation
• ??War justified by religion. Holy WarWar to spread ones religion
• Connotations with religious fundamentalism, especially Islam. (I.e., pushes narrator away from Christian reader).
• The linear Domestication / Foreignization concept needs to be adapted when the TT itself involves more lingua-cultures.
• Furthermore, I must take into account the fact that one of these groups is inherently closer to the English reader (not so much a problem with the Spanish translation). That is, history as it is, my audience probably already identifies with the British more than any other group (fig. 2).
• I had to decide whose voice to adapt to the audience and whose voice to leave as the other. I realized I had two options to choose from. The one would be a completely neutral, translation where everyone is equal in relation to the reader (fig. 3).
• This approach was hard to justify, as Oguri had not intended to write a neutral story, nor did his readers read the story without a clear understanding of who were the good guys, and who were the bad guys.
• My other option would be to create a translation that my reader could connect with in the same way that Oguris audience had. In other words, shift the readers bias to the Japanese character.
• I opted for this philosophy, as I found it more natural, as well as consistent with my motive for translating in the first place.
• How should we spell the name of the son of Mary in the New Testament? In Aramaic, it was ???? (Yeshua). In Greek, our source of the New Testament, it was spelled ??s??? (Iesous).
• YeshuaFar Foreignization
• JoshuaFar Domestication
• Far Translation
• More realistic
• Disadvantages
• More risky in cases where the original is lost/doesnt exist
• Near Translation
• Accurate to what we know.
• Less realistic.
• Punjabi soldiers name how to spell in English?
• Shikutichaddo Exact transliteration of Japanese (not a Punjabi name).
• Shiktichad educated guess
• (e.g., ??????Kaatisu?Curtis)
• Kshitij Actual Punjabi name, sounds similar (k is silent)
• Korampo (N)
• Kuala Lumpur (F)
• Mr. Naeel (N)
• Nasi Minyari (N)
• Nasi Minyak (F)
• Bunga Kerou (N)
• Bunga Kelang (F)
• ????????????
• Agile and Southerland (N)
• Argyll and Sutherland (F)
• Words in italics were used
• Kanji Characters borrowed from China
• ? ? ? ? ? ?
• Kana Phonetic symbols derived from kanji
• Hiragana standard ??? ???
• Katakana loan words ??? ???
• Furigana small kana originally invented to help reader with kanji (fig. 1).
• Ateji Using furigana to tell the reader how the author wants the kanji to be read (fig. 2). Can also be used to write non-Japanese words with Japanese kanji (fig. 3).
• How should I translate these words
• 1) Kampong Malaysian Village
• 2) Tamil Coolie South Indian Coolie
• 3) Callu Paithyam Palm-wine disease
• 4) Bohon Lie
• Word on the left is based on how
• the katakana is pronounced
• Word on the right is based on what
• the kanji mean
• English and Spanish handle the foreign in similar ways, so my approach was the same in both languages
• Italicize the word in the story, include it in the glossary (e.g., kampong)
• Let the reader rely on context clues (e.g., Tamil Coolie)
• Offer a translation in the text (e.g., so-called Callu Paithyam Toddy dementia.)
• Include a footnote (e.g., Bohon means lie in Malay)
• Narrator (Japanese) and Malaysian Prince both use Malay word Raja at some point, but author uses different kanji depending on who says it
• Though both kanji have the furigana ???? (rajaa), the kanji used when the Malaysian prince spoke means local ruler (fig. 1), while the kanji used when the narrator spoke means royalty. The difference is subtle, and impossible to preserve without lengthy footnotes.
• Natural tendency to use Spanish when English was problematic
• Optional Subject in Japanese and Spanish, not English
• Simplistic reasoning Spanish is no closer to Japanese. Grass looks greener on the other side.
• Frustration of Multiple Translations
• Japanese?Spanish via English
• In support of Bilingual USA?
• The fact that Spanish is my second language influenced some choices I made.
• ????????????????
• I ever saw a Tamil Coolie, and that
• image has stuck with me ever since
• la imagen del Culi Tamil se me
• quemó en la memoria
• Spanish had more Foreignization than English
• Less comfortable with Spanish
• Understanding Connotations
• To translate literature, one must be a writer in the TL. I barely claim to be a writer in English, let alone Spanish.
• In the end, Japanese words ?English brain?Spanish text Spanish is still a translation of a translation!
• Nami Ujihara
• Kumiko Sato
• Kathy Taylor
• Chisato Murakami, Chiemi Hanzawa, Sudha Sukumaran, Marc Benamou, Sangmi Choung, Michael Birkel, Kushboo Goel, and Pumla Pamla

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Jan 01, 2020

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KRISHI KARMAN AWARD 2014-2015 FOR FOODGRAIN PRODUCTION. TAMIL NADU. BY DR. M. RAJENDRAN , IAS., DIRECTOR OF AGRICULTURE. ACHIEVEMENTS OF TAMILNADU IN FOODGRAINS AND OILSEEDS PRODUCTION – 2014-2015. (4 th ADVANCE ESTIMATE).

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• 47 lakh acres
• farm management system farms

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KRISHI KARMAN AWARD 2014-2015 FORFOODGRAIN PRODUCTION TAMIL NADU BY DR. M. RAJENDRAN, IAS., DIRECTOR OF AGRICULTURE

ACHIEVEMENTS OF TAMILNADU IN FOODGRAINS AND OILSEEDS PRODUCTION – 2014-2015 (4th ADVANCE ESTIMATE)

PERFORMANCE OF TAMIL NADU AS PER EXISTING CRITERIA – TOTAL FOODGRAINS

MEASURES TAKEN FOR INCREASING THE PRODUCTION INVIGORATING AGRICULTURAL EXTENSION MACHINERY • Fixed schedule visits by extension functionaries • 385blocks segmented as 16936 micro groups • 2117 Extension worker covers all the allocated villages in a fortnight • Technical skill of Extension Workers Enriched every fortnight NUTRIENT CONSERVATION AND FARM SOIL PRESERVATION • individual Farm wise soil sampling and analysis of 67.45 lakh farmers • Farmers Integrated Hand Book (FIHB), an information digest on soil nutrient status distributed • Eco-friendly sustainable agricultural practices • 5 model organic villages ; 150 model IPM Villages • 7 Liquid Biofertilizers Laboratories – 2.5 Lakh litres/year • 2 New Organic Fertilizer analysinglaboratories • Increasing Organic Content of the Soil • State Sponsored Schemes for distribution of Green Manure seeds, Blue Green Algae, Azolla, Pleurotus Kits, and Demonstrations cum training on Vermicomposting

MEASURES TAKEN FOR INCREASING THE PRODUCTION ESTABLISHMENT OF STATE SEED DEVELOPMENT AGENCY • Exclusively for Seed Production activities • Ensuring farmers preferred quality certified seeds, and fixation of uniform procurement and sale price INCREASING THE NET CULTIVABLE AREA UNDER FOOD GRAINS • 12500 Acres of fallow lands broughtback to Millets and Pulsescultivation • Special scheme for Kuruvai (June-July) Paddy cultivation (Additional area of 1.5 lakh Ac. covered) • 12 hours uninterrupted 3 phase power supply, • Distribution of seedlings raised through community nursery and Inputs at free of cost AGRO ECOSYSTEM ANALYSIS (AESA) BASED INTEGRATED PEST MANAGEMENT SYSTEM • Refined Plant Protection approach based on defender pest ratio and other eco parameters • 10926 MT Technical grade Pesticides drastically reduced to 2142 MT (80%) over a period of 30 years WATER USE EFFICIENCY • Augmenting Water Harvesting Resources • 70,000 new farm ponds by dovetailing MGNREGS • 497 Recharge Shafts established • 973 Farm ponds deepened • Increasing Water Use Efficiency • Precision farming in 2500 acres of redgram • Crop Specific Technologies • System of Rice Intensification (SRI) in 51%of the total paddy area) • 3000 whole villages - 2.61 L.Ha. • 2000 System of Pulses Intensification (SPI) villages - 1.25 L.Ha. • Micro Irrigation in Millets and Pulses

Government Sops to Farmers • 100% subsidy for micro irrigation to small and marginal farmers • 50 to 55% premium subsidy for enrollment under NAIS • State support for price realisation- incentive over & above MSP announced by GOI • Rs.5 lakhs cash prize to the farmer obtaining highest yield adopting SRI • Interest free advance of Rs. 150 crores to TANFED • Waiver of 4% VAT on sale of chemical fertilizers • Exemption of 5% VAT on Naphtha to sustain urea production • Massive Rodent Pest Management demonstration – 1844 village Panchayats ; 1.84 crores rat burrows covered – • Farmers training in all blocks in co-ordination with Animal Husbandry Dept. – Dairy Farming, Goat Rearing, Desi-bird rearing, Pisci culture, cocoon production, etc.,

NEW INNOVATIONS/INITIATIVES FOODGRAIN MISSION • Express Plan Approach • Integrated package of three sub-missions to bridge the yield gap at farm level • Farm Level Planning • Strategies adopted based on Yield gap • Systematic Yield Monitoring • Micro level planning uploaded in FCMS and monitored Paddy • Interventions • Community Nursery in 1743 acres and transplantation in 39240 acres • Direct sowing in 8.47 lakh acres • Productivity enhancing Inputs • Liquid Bio-fertilizers for the first time in 52765 acres • MN Mixture, Zinc Sulphate , Gypsum , Plant Protection chemicals • Mechanisation • Mechanized Planting in 42830 acres • Assistance for • Custom hiring of Transplanters & Combined harvesters • Power weeder, Rotovator, Paddy Thresher, Self propelled Paddy transplanter • Solar pumpset linked with micro irrigation • Varietal Replacement • Promotion of Less than 10 year old Paddy varieties • Flood tolerant variety Swarna Sub-1 tried for the first time in 1500 acres • Impact - Swarna Sub-1 – average rice yield was 5239 kg / ha

NEW INNOVATIONS/INITIATIVES Millets • Interventions • Seed drill sowing ; Community sowing • Intercropping with pulses ; Micro irrigation • Cluster Demonstration involving NGOs - 37845 acres (including remote villages) • Impact – Increase in area ; 15 - 20% 18% Yield increase in millets • Productivity enhancing Inputs • Liquid biofertilizer, Maize booster / plant growth regulator & Biopesticides • Water use Efficiency • Digging of micro farm ponds (5x5 x1.5 m)-162 units • Installation of portable mobile sprinklers • Mechanisation • Rotary cleaner cum grader, Destoner, Dehuller and packaging units to 100 commodity groups Pulses • Interventions • Redgramtransplantation - 1.30 lakh acres • Precision farming - 1428 acres • Area Expansion • Cluster and cropping system based Demonstrations- 34320 acres • Bund cropping & bush cropping – 5.00 lakh seedlings • Promotion of Rice fallow Pulses (Jan-Feb) • Productivity enhancing Inputs • PusaHydrogel, DAP 2% Foliar spray • Water use Efficiency • Sprinklers, mobile rain guns and pipes • Value addition & Marketing • Farmer clusters and Farmer Producer Organisations (FPOs) formed • Mini Dhall Mills • Pulses Procurement through Tamil Nadu Civil Supplies Corporation

NEW INNOVATIONS/INITIATIVES • Comprehensive Input Supply Management System (CISMS) / Online Billing • Integrated input supply chain • Transparency in Benefits availed • Information on Availability of inputs • Module to monitor the seed stock position on real time basis and mobilization to needy places • Online tracking of farm machinery distribution under different schemes • Stimulating Group Farming • Empowerment of Farm Women in the whole gamut of agricultural activities - 770 Food Security groups formed • IT based Service deliverance • Automation of the scheduled visit by the extension functionaries to establish a virulent extension machinery • Ensuring service to farmers by cluster approach. • Facilitating farmers to contact extension workers • Online fertilizer and seed stock monitoring • All private and co-operative dealers are mapped • Stock update through mobile application • Soil Fertility Mapping • Online generation of soil test based Soil Health cards

PERFORMANCE AS PER EXISTING CRITERIA – RICE

PERFORMANCE AS PER EXISTING CRITERIA – COARSE CEREALS

PERFORMANCE OF TAMIL NADU AS PER EXISTING CRITERIA – OILSEEDS

EXPENDITURE UNDER VARIOUS SCHEMES SUPPORTING FOOD GRAIN PRODUCTION Rs. in Crores

INTER-DEPARTMENTAL CO-ORDINATION

POST HARVEST MANAGEMENT & MARKETING SUPPORT • 28 Farmer Producer Organization (FPO) • Post Harvest Infrastructure • 277 Regulated Markets, 179 Farmers Markets • Market complexes for paddy, • 10 rural business hubs • 99 cold storage units • 585 storage godowns and 1998 drying yards • 100 Integrated Agricultural Extension Centres • 30 AGMARK laboratories • Pledge loan issued to 3114 farmers & 467 traders – Rs. 35.71 crores • Agro Marketing Intelligence and Business Promotion Centre (AMI&BPC) - Crop advisory and Market price information to 22.50 lakh farmers • e- Auctioning facility for and maize

FUTURE STRATEGIES & ROAD MAP FOR ACHIEVING HIGHER PRODUCTION • State Seed Farms as Model Farms • Identification and development of fallow lands • Ecologically based principles and farming practices • paired row cultivation of Green manure with paddy • Intensification of Bio-pesticide production • On-farm soil fertility enrichment in sugarcane - bio-compost using Bio-mineraliser • Group farming to promote inter-personal relationships • Rainfed Area Development through community based approach • Pulses intensification through technology adoption • State Balanced Growth Fund to remove the regional imbalances and the disparities in per capita income • Integrated Farming including animal husbandry and Farm pond allied activities for sustainable livelihood • Strategic Input Management System • Fertilizer Enforcement Management Information System (FEMIS) • Seed Production Enforcement & Certification System (SPECS) • Micro Irrigation Management Information System (MIMIS) • Farm Management System (FARMS) • Linking of AADHAR number in AGRISNET – FCMS farmer Database

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• 1. HIV AIDS DR.R.TAMILARASI, ASSISTANT PROFESSOR, DEPT. OF COMMUNITY MEDICINE. 27-07-2021 1
• 2. AIDS Acquired immuno deficiency syndrome Caused by a retrovirus -HIV Fatal illness It breaks down the body's immune system, leaving the patient vulnerable to a host of life threatening opportunistic infections, neurological disorders or unusual malignancies. 27-07-2021 2
• 3. GLOBAL HISTORY • 1981 – Beginning of the epidemic in United States - Centers for Disease Control and Prevention (CDC) published a report about five previously healthy homosexual men becoming infected with Pneumocystis pneumonia - Because the disease appeared to affect mostly homosexual men, officials initially called it Gay-related immune deficiency, or GRID. - CDC noted that this type of pneumonia had never affected people with uncompromised immune systems. • 1983 - Lymphadenopathy-Associated Virus (or LAV) retrovirus was discovered • 1984 - National Cancer Institute found the cause of AIDS to be retrovirus HTLV-III. 3 27-07-2021
• 4. • 1985 - Food and Drug Administration licensed the first commercial blood test for HIV • 1986 - the International Committee on the Taxonomy of Viruses officially named the virus as HIV (human immunodeficiency virus) • 1988 - The World Health Organization declared December 1st to be World AIDS Day. • 1991 - The red ribbon became an international symbol of AIDS awareness. • 2008 - Luc Antoine Montagnier was awarded Nobel Prize in Physiology and medicine for his discovery of the human immunodeficiency virus (HIV). 4 27-07-2021
• 5. GLOBAL BURDEN- 2019 • People living with HIV = 38 million [31.6 million–44.5 million] - 36.2 million  adults(>or=15 years) - 1.8 million  children (<15 years) • Newly infected with HIV = 1.7 million [1.2 million–2.2 million] • 81% - knew their HIV status • 6.9 lacs died due to AIDS related illness • Antiretroviral therapy accessed = 25.4 million 5 27-07-2021
• 6. INDIA • Suniti Solomon-first AIDS case was diagnosed in Chennai in 1986. • In 2009, she was awarded , “National Women Bio-scientist Award” by Ministry of Science and Technology, Govt. of India. • On 25th January 2017, Govt. of India announced “Padma shri” award for her contribution towards Medicine • “what has been killing people with AIDS more is the stigma and discrimination” 27-07-2021 6
• 7. HIV- Agent It is a RNA virus Which replicates in actively dividing T4 lymphocytes. Unique ability to destroy T4 Helpercells Reservoir- Once a person gets infected virus remains in his body lifelong. And the person is a symptomless carrier for years before the symptoms actuallyappear. 27-07-2021 7
• 8. Structure of HIV 27-07-2021 8
• 9. OTHER NAMES FOR HIV • Former names of the virus include: • Lymphadenopathy associated virus (LAV) • Human T cell lymphotrophic virus (HTLV-III) • AIDS associated retrovirus (ARV) 27-07-2021 9
• 10. HIV-1 AND HIV-2 • HIV-1 and HIV-2 • Transmitted though the same routes • Associated with similar opportunistic infections • HIV-1 is more common worldwide • Groups M, N, and O • Pandemic dominated by Group M  Group M comprised of subtypes A – J • HIV-2 is found primarily in West Africa, Mozambique and Angola • less easily transmitted • is develops more slowly • MTCT is relatively rare with HIV-2 27-07-2021 10
• 11. Source –The virus is found in great concentrations in blood, CSF and semen. Lower concentrations have been found in tears, saliva, breast milk, urine, cervical and vaginal secretions. Also isolated from brain tissue, lymph nodes, bone marrow cells and skin. However only blood and semen are known to transmit the virus. 27-07-2021 11
• 12. 11 HIV in Body Fluids Semen 11,000 V aginal Fluid 7,000 Blood 18,000 Amniotic Fluid 4,000 Saliva 1 Average number of HIV particles in 1 ml of these body fluids 27-07-2021 12
• 13. Host Age- Most cases are among sexually active people aged between age 20-49 years. High risk groups- Male homosexuals, hetero sexual partners, i.v. drug abusers, blood transfusion recipients, haemophiliacs and patients having STDs. 27-07-2021 13
• 14. Modes of HIV/AIDS Transmission 27-07-2021 14
• 15. 13 HIV Transmission HIV enters the bloodstream through: Open Cuts Breaks in the skin Mucous membranes Direct injection 27-07-2021 15
• 16. 14 Routes of Transmission of HIV Sexual Contact: Male-to-male Male-to-female or viceversa Female-to-female Blood Exposure: Injecting drug use/needle sharing Occupational exposure Transfusion of blood products Perinatal: Transmission from mother to baby Breastfeeding 27-07-2021 16
• 17. 15 Routes of Transmission of HIV Occupational Transmission Health care worker/ hospital staff Laboratory workers Other routes Organ transplantation Artificial insemination Needle-prick 27-07-2021 17
• 18. ROUTE OF TRANSMISSION 88% 5% 3% 2% 1% 1% percentage heterosexual PTCT not specified needle and syringe homosexual blood and relatedproduct 27-07-2021 18 Route Efficiency Sexual 0.01 to 1 Transfusion of blood products >90 Sharing needles/syringes 3-5 Percutaneous exposure 0.4 Mucocutaneous exposure 0.05 Mother to child transmission 25-30 RISK OF TRANSMISSION
• 19. •*Not transmitted by urine, faeces, sputum, nasal secretion, saliva, sweat, tears, or vomit that does not contain blood that is visible to the naked eye, human bite. 27-07-2021 19
• 20. Incubation Period The incubation period is from HIV infection till development of AIDS. It is from a few months to 10years or even more. However it is estimated that 75% of people infected with HIV will develop AIDS at the end of 10years. Severity of illness determined by: amount of virus in the blood (viral load) and the degree of immune suppression (decreasing CD4 count) Higher the viral load, sooner immune suppression occurs 27-07-2021 20
• 21. WHO CLINICAL STAGING • I Primary HIV Infection: • Asymptomatic • Acute retroviral syndrome Window period: • Time between potential exposure to HIV infection and appearance of Antibodies in blood: 2-12 weeks - Highly infectious period. • II Asymptomatic carrier state: • Asymptomatic • Persistent generalised lymphadenopathy 27-07-2021 21
• 22. III AIDS related complex: • Diarrhea , fatigue , malaise, fever • Moderate unexplained weight loss (<10% of presumed or measured body weight) • Recurrent respiratory tract infections (sinusitis, bronchitis, otitis media, pharyngitis) • Herpes zoster • Angular cheilitis,Recurrent oral ulcerations • Papular pruritic eruptions, Seborrhoeic dermatitis • Fungal nail infections of fingers 27-07-2021 22
• 23. IV AIDS: • Severe weight loss (>10% of presumed or measured body weight) • Unexplained chronic diarrhoea for longer than one month • Unexplained persistent fever (intermittent or constant for longer than one month) • Oral candidiasis • Oral hairy leukoplakia • Pulmonary tuberculosis (TB) diagnosed in last two years • Severe bacterial infections (e.g. pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, bacteraemia) • Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis • Unexplained Anaemia(<8gm/dL), Neutropenia (<0.5x10*9/L) And/Or Chronic Thrombocytopenia (50x10*9/L) • AIDS Dementia 27-07-2021 23
• 24. AIDS: • HIV wasting syndrome • Pneumocystis carinii pneumonia (PCP) • Recurrent severe bacterial pneumonia • Chronic Herpes Simplex infection ( Orolabial, Genital or ano-rectal of <1 months duration or visceral at any site) • Candidiasis (Esophageal/ Trachea/ Bronchi/Lungs) • EPTB • Kaposis Sarcoma • CMV infection (Retina or other organs) • CNS Toxoplasmosis • HIV Encephalopathy 27-07-2021 24
• 25. 27-07-2021 25 • Extra-Pulmonary Cryptoccocosis • Disseminated Mycosis • Recurrent Septicaemia • Lymphoma (B-cell Non Hodgkins) • Invasive Cervical Carcinoma • Atypical disseminated Leishmaniasis • Symptomatic HIV-associated Nephropathy or Cardiomyopathy.
• 26. OPPORTUNISTIC INFECTIONS 27-07-2021 26
• 27. Opportunistic Infections associated with AIDS CD4<200 • Pneumocystic carinii • Toxoplasmosis • Cryptococcosis • Coccidiodomycosis • Cryptosporiosis • Non hodgkin’s lymphoma 27-07-2021 27
• 28. CD4 <50 • Disseminated mycobacterium avium complex (MAC) infection • Histoplasmosis • CMV retinitis • CNS lymphoma • Progressive multifocal leukoencephalopathy • HIV dementia 27-07-2021 28
• 29. TB & HIV CO-INFECTION • TB is the most common opportunistic infection in HIV and the first cause of mortality in HIV infected patients (10-30%) • 10 million patients co-infected in the world. • Immunosuppression induced by HIV modifies the clinical presentation of TB : 1. Subnormal clinical presentation 2. High rate of MDR/XDR 3. High rate of treatment failure and relapse (5% vs < 1% in HIV) 27-07-2021 29
• 30. • MAJOR SIGNS 1. Weight loss > 10% body wt. 2. Chronic Diarrhoea for > 1 month. 3. Prolonged fever for > 1 month • MINOR SIGNS 1. Persistent cough for > 1 month. 2. Generalized pruritic dermatitis. 3. History of herpes zoster. 4. Oropharyngeal candidiasis. 5. Chronic herpes simplex infection. 6. Generalized lymphadenopathy. 27-07-2021 30 CLINICAL DIAGNOSIS WHO case definition for AIDS surveillance- 2 major signs in combination with 1 minor sign.
• 31. LABORATORY DIAGNOSIS • Viral infection • Viral Load • p24 Antigen • Immune response • Antibody (IgG, IgM) • Cellular response (CD4) HIV TESTING: Pretest information and Post test counselling WHO’s FIVE “C” - Consent, Confidentiality, Counselling, Correct test results, Connection to care and treatment. 27-07-2021 31
• 32. Blood Detection Tests HIV enzyme-linked immunosorbent assay (ELISA) Screening test for HIV Sensitivity > 99.9% Western blot Confirmatory test Speicificity > 99.9% (when combined with ELIZA) HIV rapid antibody test Screening test for HIV Simple to perform Absolute CD4 lymphocyte count and CD4 Percentage Predictor of HIV progression Risk of opportunistic infections and AIDS when <200 CD4 % < 14 HIV viral load tests Best test for diagnosis of acute HIV infection Correlates with disease progression and response to HAART 27-07-2021 32
• 33. CONTROL OF AIDS I PREVENTION - Education, Prevention of blood borne HIV, Combination HIV prevention. II ART III SPECIFIC PROPHYLAXIS IV PRIMARY HEALTH CARE 27-07-2021 33
• 34. TREATMENT 27-07-2021 34
• 35. GOALS OF ART • Virological goals : Greatest possible reduction in viral load for as long as possible • Clinical goals : Prolongation of life and improvement in quality of life • Immunological goals : Immune reconstitution that is both quantitative and qualitative • Therapeutic goals : Rational sequencing of drugs in to achieve: • limiting drug toxicity and facilitating adherence • Reduction of HIV transmission in individuals : by suppression of viral load 27-07-2021
• 36. WHEN TO START ART ADULTS (>19 YEARS) • All adults regardless of WHO clinical stage and at any CD4 cell count. • Preference: Severe or advanced HIV clinical disease (WHO clinical stage 3 or 4) and adults with CD4 count ≤350 cells/mm. 27-07-2021 36
• 37. WHEN TO START ART PREGNANCY / BREASTFEEDING • All of them regardless of WHO clinical stage and at any CD4 cell count and continued lifelong. 27-07-2021 37
• 38. WHEN TO START ART PREGNANCY / BREASTFEEDING • All of them regardless of WHO clinical stage and at any CD4 cell count and continued lifelong. ADOLESCENTS (10-19 YEARS) • All adolescents regardless of WHO clinical stage and at any CD4 cell count. • Preference: Severe or advanced HIV clinical disease (WHO clinical stage 3 or 4) and adolescents with a CD4 count 27-07-2021 38
• 39. WHEN TO START ART CHILDREN < 10 YEARS • All of them regardless of WHO clinical stage and at any CD4 cell count. • Preference: All children ≤2 years of age or children younger than 5 years of age with WHO clinical stage 3 or 4 or CD4 count ≤750 cells/mm3 or CD4 percentage <25%, and children 5 years of age and older with WHO HIV clinical stage 3 or 4 disease or CD4 count ≤350 27-07-2021 39
• 40. WHEN TO START ART ADULTS / CHILDREN WITH TB • All TB patients living with HIV, regardless of CD4 cell count. • TB treatment should be initiated first, followed by ART as soon as possible (within the first 8 weeks of treatment; if CD4 count is <50 cells/mm3 - within 2 weeks of TB Rx.). 27-07-2021 40
• 41. WHAT TO START 27-07-2021 41
• 42. ANTI-RETROVIRAL DRUGS NRTI (Neucleoside R T Inhibitors) PI (Protease Inhibitors) NNRTI (Non-Neucleoside R T Inhibitors) Zidovudine (AZT)* Indinavir (IDV)* Nevirapine (NVP)* Lamivudine (3TC)* Nelfinavir (NFV)* Efavirenz (EFV)* Stavudine (d4T)* Saquinavir (SQV)* Etravirine, Delavirdine (DLV) Didanosine (ddl)* Ritonavir(RTV)* INTEGRASE INHIBITORS Zalcitabine(ddC)* Amprenavir(APV) Raltegravir (RAL) Abacavir (ABC)* Lopinavir (LPV)* CCR5 antagonists Tenofovir (TFV)* Atazanavir (ATV)* Maraviroc Emtricitabine(FTC) Foseamprenavir 27-07-2021
• 43. INITIATION OF ART BASED ON CD4 COUNT AND WHO CLINICAL STAGING WHO Clinical Stage Recommendations HIV infected Adults & Adolescents (Including pregnant women) Clinical Stage I and II Start ART if CD4 < 350 cells/mm3 Clinical Stage III and IV Start ART irrespective of CD4 count For HIV and TB co-infected patients Patients with HIV and TB co-infection (Pulmonary/ Extra-Pulmonary) Start ART irrespective of CD4 count and type of tuberculosis (Start ATT first, initiate ART as early as possible between 2 weeks to 2 months when TB treatment is tolerated) For HIV and Hepatitis B and C co-infected patients HIV and HBV / HCV co-infection – without any evidence of chronic active Hepatitis Start ART if CD4 < 350 cells/mm3 HIV and HBV / HCV co-infection – With documented evidence of chronic active Hepatitis Start ART irrespective of CD4 count 27-07-2021 43
• 44. First-line ART regimens for adults (Fixed dose combinations) • Principles: 1. Choose 3TC (Lamivudine) in all regimens 2. Choose one NRTI to combine with 3TC {AZT (Zidovudine or TDF(Tenofavir)} 3. Choose one NNRTI (NVP or EFV) • E.g. Tenofovir + Lamivudine + Efavirenz • If TDF + 3TC or FTC(Emitricitabin) + EFV contraindicated/not available • AZT (Zidovudine) + 3TC (Lamivudine) + EFV (Efavirenz) • AZT + 3TC + NVP (Nevirapine) • TDF + 3TC (or FTC (Emtricitabine)) + NVP TREATMENT REGIMEN 27-07-2021 44
• 45. 27-07-2021 45
• 46. 27-07-2021 46
• 47. FIRST LINE DRUGS DECEMBER 2018 UPDATE • DTG (Dolutegravir)-based regimen is recommended as the preferred first-line regimen for adults, adolescents, infants and children. • RAL-based regimen may be recommended as an alternative first-line regimen for infants and children for whom approved DTG dosing is not available. • RAL-based regimen is recommended as the preferred first-line regimen for neonates. 27-07-2021 47
• 48. DTG IN PRECONCEPTION / PREGNANCY • DTG appears to be safe when started later in pregnancy: after the period of risk of neural tube defects, after the first trimester. • EFV-based regimen is recommended at conception and up to the end of the first trimester. 27-07-2021 48
• 49. OLD GUIDELINE NEW GUIDELINE Adults (>19 yrs) TLE TLD Adolescents (11-19yrs) TLE TLD Pregnancy TLE TLE -> TLD Child 3-10 years ALE ALD Child <3 years A/Z+L+LPV/r ALD Neonate A/Z+L+LPV/r ZLRal 27-07-2021 49
• 50. SECOND LINE DRUGS 27-07-2021 50
• 51. • PEP involves taking anti-HIV drugs as soon as possible after having been exposed • To be effective, PEP must begin within 72 hours after exposure, before the virus has the time rapidly replicate in your body • PEP consists of 2-3 anti-HIV medications taken every day for 1 month(28 Days) • 3 drugs within 3 days for 28 days. 27-07-2021 51
• 52. • PEP is usually used for anyone who may have been exposed to HIV. • Healthcare workers have the greatest risk. They can be exposed to HIV by: – Needle sticks or cuts – Getting blood or other body fluids in their eyes or mouth – Getting blood or other body fluids on their skin when it is scraped, or affected by dermatitis • The risk of HIV transmission in these ways is low—less than 1% for each exposure 27-07-2021 52
• 53. Whycan’t PEP therapybetakenafter 72 hours from the point of exposure? • HIV grows faster and faster once it enters your body. • If you start taking PEP more than 72 hours after exposure, the meds can’t keep up,and research has shown that PEP has little or no effect in preventing HIV infection after the 72-hour mark. • Better if PEP starts within 6 hours from injury 27-07-2021 53
• 54. PEP DECEMBER 2018 UPDATE • Regimen with two ARV drugs is effective, but three drugs are preferred. • Adults: TDF + 3TC (or FTC) + DTG(Dolutegravir) • Children: AZT / ABC + 3TC + DTG • If DTG N/A -> ATV/r, DRV/r, LPV/r and RAL are alternatives for both groups. 27-07-2021 54
• 55. INFANT PROPHYLAXIS • No changes in recommendations. • High risk infants should receive dual prophylaxis with AZT (twice daily) and NVP (once daily) for the first 6 weeks of life, whether they are breastfed or formula fed. • High risk breastfed infants should continue infant prophylaxis for an additional 6 weeks (total of 12 weeks of infant prophylaxis) using either AZT (twice daily) and NVP (once daily) or NVP alone. 27-07-2021 55
• 56. PROPHYLAXIS OF OPPORTUNISTIC INFECTIONS • HIV infected adults with CD4 <350 cells/mm3 OR • WHO clinical stage 3 or 4 irrespective of CD4 count • Recommendation: Commencing primary Cotrimoxazole Preventive Therapy CD4 awaited CD4 available WHO clinical stage 3 or 4 (includes all patients with TB) Any WHO clinical stage, CD4 <350 cells/mm3 and if patient is symptomatic or WHO stage 3 or 4 irrespective of CD4 count Dose One double-strength tablet or two single-strength tablets once daily– total daily dose of 960 mg (800 mg SMZ + 160 mg TMP) When to stop If CD4 count >350 for at least 6 months and If patient is on ART for at least 6 months, is asymptomatic and well 27-07-2021 56
• 57. MONITORING OF EFFICACY OF ART 1. Clinical improvement - Weight gain. - Decrease in occurrence and severity of HIV related disease. 2. Increase in Total Lymphocyte count. 3. Improvement in biological markers of HIV. - CD 4 + T – Lymphocyte count. - Plasma HIV – RNA levels. 27-07-2021 57
• 58. Specific prophylaxis • P.carnii - CD4 <200 Cells/ml Trimethoprim-sulfamethoxazole, Pentamidine, Dapsone • M.avium complex - CD4 <200 Cells/ml Rifabutin • M.tuberculosis - Isoniazid 300 mg for 9 months 27-07-2021 58
• 59. NATIONALAIDSCONTROL PROGRAMME(NACP)-IV 27-07-2021 59
• 60. Classification of states • High prevalence (Generalized level HIV Epidemics) – >5% in HRG & >1% inANC – Maharashtra, TN, Andhra, Manipur,Karnataka, Nagaland • Moderate prevalence (Concentrated HIV Epidemics) – >5% in HRG & <1% inANC – Gujarat, Puducherry, Goa • Low prevalence (Low level HIV Epidemics) – <5% in HRG & <1% inANC – All other states/UTs 27-07-2021 60
• 61. AIDS Control Programme in India • HIV infection first detected in India in 1986, when 10 HIV positive samples • were found from a group of 102 female sex workers from Chennai. • In 1986 Government set up an AIDS Task Force under ICMR and established a • National AIDS Committee (NAC) chaired by Secretary, • Department of Health and Family Welfare. • In 1987, National AIDS Control Programme was initiated, • with help from the World Bank. • In 1989, a Medium Term Plan for AIDS Control was • developed with the support of the WHO. 27-07-2021 61
• 62. AIDS Control Programme in India • First National AIDS Control Programme (NACP- I) was launched in 1992. • NACP-II launched in 1999: decentralization of programme implementation to State level and greater involvement of NGOs. • NACP- III implemented during 2007-2012: scaling up HIV prevention interventions for HRG and general population, and integrate them with Care, Support & Treatment services. • NACP-IV has been developed for the period 2012-2017 • National Strategic Plan for HIV/AIDS and STIs - 2017 - 2024 27-07-2021 62
• 63. 27-07-2021 63