Anthrax Outbreaks in Indian Livestock: Diagnosis, Treatment, and Preventive Strategies

Anthrax, an acute to per acute infectious disease of all domestic animals and human beings, is caused by Bacillus anthracis and characterized by septicemia and sudden death with the exudation of dark tarry colored and unclotted blood from the natural orifices. Human beings can get anthrax from contact with infected animals, wool, meat, or hides. Occurrence of anthrax in humans is correlated with industrial activities such as handling potentially contaminated materials like hides, fur, wool, hair, meat, or bone meal . The spores are very resistant to unfavorable environmental extremes of heat, cold, desiccation, chemicals and irradiation. The incidence of anthrax varies with the type of the soil and climate. It is many times restricted to a particular area where it is endemic and such areas are known as “Anthrax belts”. Cattle and sheep are very susceptible to anthrax and dogs and cats are quite resistant. There are only few reports of anthrax outbreak in domestic animals in India.

Anthrax spread in animals by bacteria. Anthrax disease is a vital domestic animal disease, occurs majorly in goats, cattle, sheep, and horses. Anthrax also happens in wildlife, such as hippos and elephants. It is occasional in humans and occurs mainly in countries that do not prevent industrial or agricultural exposure to infected animals or their products like uncooked infected meat.

Ecological factors can influence when anthrax outbreaks occur.

Precipitation

Rain concentrates spore-containing soil into low-lying areas and surface waters. The spores are hydrophobic and float from groundwater to surface of soil, and they cling to vegetation or roots. Outbreaks occur primarily in hot, dry months following spring rains, which promote pasture growth and grazing. In addition, prolonged spring rains promote large tabanid (biting) fly populations, which may serve as mechanical vectors.

Seasonality

Anthrax is a hot season disease, as the outbreaks most often occur during hottest summer months or at the end of drought. Animals may gather in low-lying, high-anthrax risk areas to graze on remaining vegetation as spring growth dries up in the heat. Additionally, animals are drawn to new vegetation that occurs following rains at the end of a drought. In both instances, animals may graze down to surface soil or roots. This dry vegetation is abrasive and may cause mucosal trauma to the animals, thus increasing the chances of infection. Also, the animals may consume anthrax spores along with the surface soil and roots. Finally, drought conditions may reduce the animal’s resistance to infection by increasing stress and causing nutritional changes.

Soil factors

Soil alkalinity, high calcium content, moisture, and high organic matter content favor spore survival. Calcium preserves spore latency. Spores will disappear from soils with pH less than 6.1. Soil disruption by human activity (loosening and excavating soil from prior anthrax graves or contaminated sites) or natural events causes spores to surface and promotes increased growth of vegetation, which may be contaminated and attract more animals, resulting in new infections.

Symptoms

The symptoms of anthrax depend on the type of infection and can take anywhere from 1 day to more than 2 months to appear. All types of anthrax have the potential, if untreated, to spread throughout the body and cause severe illness and even death. Sudden passing away (often within 2 or 3 hours of being apparently normal) is by far the most common sign. Very occasionally some animals may show trembling, a high temperature Difficulty breathing, collapse and convulsions before death. This usually occurs over a period of 24 hours; After death blood, may not clot, resulting in a small amount of bloody discharge from the nose, mouth and other openings. Sometimes animals may have a fever and a period of excitement followed by staggering, depression, unconsciousness, difficulty breathing, seizures, and death. Dark blood may ooze from the mouth, nose, and anus. Signs in pigs, dogs, and cats may be less serious.

How animals get infected with anthrax —

Domestic and wild animals such as cattle, sheep, goats, antelope, and deer can become infected when they breathe in or ingest spores in contaminated soil, plants, or water. In areas where domestic animals have had anthrax in the past, routine vaccination can help prevent outbreaks.

Anthrax and it’s Cycle

Anthrax is an exceedingly infectious and deadly disease of livestock. Anthrax is affected by a relatively large spore-forming rectangular shaped bacterium called Bacillus anthracis. Anthrax can be found naturally in soil and commonly affects domestic and wild animals around the world. Although it is rare in the Idia, people can get sick with anthrax if they come in contact with infected animals or contaminated animal products. Anthrax can cause severe illness in both humans and animals. Anthrax causes acute mortality in ruminants. The germs produce extremely effective toxins which are responsible for the ill properties, causing a high mortality rate. Symptoms of the illness normally appear 3 to 7 days after the spores are swallowed or inhaled. Once symptoms begin in animals, they normally die within 2 days. Hoofed animals, like cattle, deer, goats, and sheep, are the major animals affected by this disease. They normally get the disease by swallowing anthrax spores while grazing on pasture contaminated with anthrax spores. Inhaling (breathing in) the spores come inside the animal, which have property like odourless, colourless, and tasteless, that cause infection in animals and human also.

Preventive Measures for disease control

Regular annual vaccination of animals in endemic areas will prevent the disease from occurring. Vaccination may be carried out at least a month prior to expected disease occurrence in endemic areas. 3. Never open a carcass of an animal suspected to have died from anthrax. Contact a veterinarian immediately if the following symptoms are seen and seek advice on control measures to be adopted. i. Fever (106-108°F), loss of appetite, depression and dullness ii. Suspended rumination3. Rapid pulse and heart rates iii. Difficult breathing (dyspnoea) iv. Lameness in affected leg v. Crepitation swelling over hip, back & shoulder vi. Swelling is hot & painful in early stages whereas cold and painless inter. vii. Recumbency (prostration) followed by death within 12-48 hrs.

Treatment and Control

Due to the acute nature of the disease resulting in sudden death, treatment is usually not possible in animals even though Anthrax bacilli are clines. Treatment is of use in cases showing sub-acute form of the disease. In most cases, early treatment can cure anthrax. The cutaneous (skin) form of anthrax can be treated with common antibiotics.

A vaccine for livestock is commonly used in areas that have anthrax. To be effective, it must be used before the animal is exposed to the bacteria. The vaccine for livestock is not the same as the one for humans. The human vaccine has limited availability, such as for military personnel. No vaccine is available for pets. Handling a dead or sick animal or eating a dead animal infected with anthrax can spread anthrax to humans and other animals. Anthrax is not spread by sneezing or coughing. Person-to-person spread of the disease is unlikely. Animals that die of anthrax can contaminate the soil with anthrax spores, so the bodies should be burned, not buried. Wear a mask and gloves when handling sick or dead animals. Vaccinate livestock as recommended.

Preventing Anthrax Outbreaks In Animals: Effective Strategies And Measures

Anthrax is a deadly bacterial infection that can devastate both human and animal populations. While it is a rare disease, the impact it has can be catastrophic. Fortunately, there are various measures that can be taken to prevent anthrax in animals, which not only safeguard their health but also protect humans from potential exposure. By implementing effective vaccination protocols, implementing strict biosecurity measures, and promoting proper disposal of animal carcasses, the spread of anthrax can be significantly reduced, ensuring the well-being of both animals and humans alike.

Characteristics	Values
Administering anthrax vaccines	Regularly vaccinating animals
Practicing good biosecurity measures	Reducing the risk of contamination and spread
Implementing proper husbandry practices	Maintaining cleanliness and proper animal care
Quarantining and monitoring new animals	Preventing introduction of infected animals
Controlling and reducing wildlife populations	Limiting contact between domestic animals and wildlife
Proper disposal of carcasses	Preventing further spread of anthrax
Routine surveillance and testing	Identifying and addressing anthrax cases promptly
Educating farmers and animal owners	Raising awareness about anthrax prevention and management

FAQ ON ANTHRAX

What are the best practices for preventing anthrax in animals?

Animals, both domestic and wild, are susceptible to anthrax, a deadly and highly contagious disease caused by the bacteria Bacillus anthracis. Anthrax is a zoonotic disease, meaning it can spread from animals to humans, posing a significant health risk. Therefore, preventing anthrax in animals is of utmost importance not only for animal welfare but also for human health. This article will outline some of the best practices for preventing anthrax in animals.

• Vaccination: Vaccination is one of the most effective preventive measures against anthrax in animals. Proper vaccination protocols should be followed, especially in areas where anthrax is endemic or has been previously reported. Vaccinating animals can create herd immunity, preventing the spread of the disease within a population.
• Quarantine and testing: When introducing new animals to a herd or farm, it is crucial to establish a quarantine period. During this time, the animals should be closely monitored for signs of anthrax and tested if necessary. This practice helps to identify any potential carriers of the disease and prevents its introduction to the rest of the herd.
• Good husbandry practices: Maintaining good animal husbandry practices is essential in preventing anthrax. This includes providing clean and hygienic living conditions for animals, proper nutrition, regular veterinary care, and implementing biosecurity measures. Biosecurity measures can include controlling the movement of animals and people, disinfecting equipment, and maintaining proper waste management.
• Surveillance and reporting: Surveillance systems should be in place to monitor the prevalence and occurrence of anthrax in animals. Veterinary and agricultural authorities need to be promptly informed of any suspected or confirmed cases. This allows for early detection and swift intervention to prevent further spread.
• Proper carcass disposal: Infected animals, or carcasses suspected to be infected with anthrax, should be handled and disposed of correctly. Burning or deep burial of the carcasses is recommended to prevent exposure to the bacteria. This practice reduces the risk of spore contamination in the environment, limiting the chances of transmission to other animals or humans.
• Education and awareness: Education plays a vital role in preventing anthrax in animals. Farmers, livestock owners, and veterinarians should be educated about the signs, symptoms, and transmission of anthrax. Awareness campaigns can emphasize the importance of vaccination, proper hygiene, and early reporting of suspected cases.
• Collaboration and coordination: Collaboration between veterinary services, agricultural departments, and other relevant authorities is crucial in implementing effective anthrax prevention strategies. Coordination allows for a comprehensive approach, including surveillance, vaccination campaigns, and response plans in case of an outbreak.

Example: In a region where anthrax is endemic, farmers and livestock owners collaborated with local veterinary authorities to establish a vaccination campaign. The campaign involved educative sessions on the importance of vaccination and proper carcass disposal. As a result, the incidence of anthrax decreased significantly, and the community became more aware of the disease and its prevention.

Preventing anthrax in animals requires a multi-faceted approach, encompassing vaccination, good husbandry practices, surveillance, and education. By implementing these best practices, the risk of anthrax can be minimized, protecting both animals and humans from this harmful disease.

Are there any vaccines available for anthrax prevention in animals?

Anthrax is a highly contagious and often fatal bacterial infection that affects both humans and animals. It is caused by the spore-forming bacteria Bacillus anthracis, which can survive in the environment for long periods of time. In order to prevent the spread of anthrax, vaccines are available for use in animals. These vaccines have proven to be effective in reducing the incidence of the disease and protecting animals from infection.

The anthrax vaccine for animals is typically administered by injection, and it is important to follow the recommended vaccination schedule to ensure maximum effectiveness. The vaccine stimulates the immune system to produce antibodies that can recognize and neutralize the bacteria, preventing them from causing infection. Vaccinated animals are less likely to become infected with anthrax, and they can also act as a barrier, preventing the spread of the disease to other animals and humans.

The anthrax vaccine for animals is generally safe and well-tolerated. However, as with any vaccine, there can be some side effects. These are typically mild and transient, such as local reactions at the site of injection or minor swelling. In rare cases, more serious reactions can occur, but these are very uncommon.

In addition to vaccination, there are other measures that can be taken to prevent anthrax in animals. This includes good management practices, such as proper disposal of carcasses and contaminated materials, as well as regular surveillance and monitoring for signs of the disease. It is also important to practice good biosecurity measures, such as controlling access to the farm or facility, and implementing proper hygiene and sanitation protocols. These measures can help reduce the risk of anthrax and protect the health of animals.

In conclusion, vaccines are available for the prevention of anthrax in animals. They are safe and effective, and can help reduce the incidence and spread of the disease. It is important to follow the recommended vaccination schedule and implement other preventive measures to protect animal health and prevent the spread of anthrax. By taking these steps, we can help ensure the well-being of our animals and safeguard public health.

What are the most common sources of anthrax in animals, and how can they be avoided?

Anthrax is a bacterial disease caused by the spore-forming bacterium known as Bacillus anthracis. It primarily affects herbivorous animals such as cattle, sheep, goats, and horses. In rare cases, humans can also contract the disease through exposure to infected animals or contaminated animal products.

The most common sources of anthrax in animals include contaminated soil, vegetation, and water. When an animal grazes on contaminated vegetation or drinks contaminated water, it can ingest the spores of Bacillus anthracis. Once inside the animal’s body, the spores germinate and multiply, leading to an infection.

To avoid the risk of anthrax in animals, several preventive measures can be taken. The first step is to ensure proper sanitation and hygiene practices in animal farming and husbandry. This includes keeping animal enclosures clean, disposing of animal carcasses properly, and regularly disinfecting equipment and facilities.

In areas where anthrax is endemic, vaccination programs are essential. Regular vaccinations can help protect animals against the disease and prevent its spread. It is crucial to consult with a veterinarian to determine the appropriate vaccination schedule for each species and to ensure all animals are properly protected.

Another important aspect of anthrax prevention is the identification and quarantine of infected animals. If an animal shows any symptoms of anthrax, such as sudden death or bleeding from natural orifices, it is essential to isolate and report the case immediately. This helps prevent the spread of the disease to other animals in the herd or flock.

Livestock owners should also be aware of the potential sources of anthrax spores in their environment. Areas with a history of anthrax outbreaks should be approached with caution, and animals should be kept away from standing water or areas where animal carcasses might be present. Farmers should also test soil and water sources for the presence of Bacillus anthracis spores regularly.

In cases where anthrax is suspected or confirmed, prompt veterinary intervention is crucial. Animals with suspected anthrax should be euthanized and disposed of properly to prevent the further spread of the disease. Carcasses should be burned or buried deep underground in a designated area, away from water sources and areas prone to flooding.

It is important for farmers and animal owners to stay informed about anthrax outbreaks in their region. Local veterinary services, agricultural extension services, and government agencies often provide updates and guidance on anthrax prevention and control measures. By staying informed and implementing proper preventive measures, farmers can significantly reduce the risk of anthrax in their animals.

In conclusion, anthrax in animals is primarily caused by the ingestion of spores from contaminated soil, vegetation, or water. To prevent the disease, farmers should maintain good sanitation practices, implement vaccination programs, and promptly respond to any cases of suspected anthrax. By taking these steps, the risk of anthrax can be reduced, ensuring the health and well-being of both animals and humans.

Are there any specific biosecurity measures that can be taken to minimize the risk of anthrax in animal populations?

Biosecurity measures play a crucial role in minimizing the risk of anthrax in animal populations. Anthrax is a highly contagious bacterial disease that affects both humans and animals, causing severe illness and even death. Implementing strict biosecurity protocols can help prevent the spread of this disease within animal populations and ultimately protect both animals and humans.

One of the first steps in minimizing the risk of anthrax is to establish a comprehensive biosecurity plan. This plan should include measures such as identifying potential sources of anthrax contamination, implementing control measures to prevent exposure, and procuring appropriate vaccines. Additionally, regular training and education programs should be implemented to ensure that all personnel working with animals are aware of the risks and understand the necessary biosecurity protocols.

A key component of anthrax prevention is maintaining strict control over livestock movements. This can be achieved through the creation of restricted access areas, where animals are closely monitored and only authorized personnel are allowed entry. Additionally, quarantining animals and conducting regular health checks can help identify and isolate any potential cases of anthrax, preventing its spread to other animals.

Proper disposal of carcasses is another important aspect of anthrax prevention. Carcasses of animals that have died from anthrax should be handled with extreme caution and disposed of in a manner that prevents contamination of the surrounding environment. This can include burial, incineration, or the use of approved rendering facilities. It is essential to follow local regulations and guidelines when disposing of anthrax-infected carcasses.

Regular vaccination of animals in high-risk areas is crucial in preventing anthrax outbreaks. Vaccines for anthrax are available for both animals and humans. Farmers and animal owners should work closely with veterinarians to ensure that their animals are up to date with the appropriate vaccinations. It is important to note that vaccination alone is not sufficient, and it should be combined with other biosecurity measures for effective prevention.

Proper hygiene practices are essential in minimizing the risk of anthrax. This includes maintaining clean and sanitized animal housing facilities, proper waste management, and regular cleaning and disinfection of equipment and tools. To further reduce the risk of contamination, it is recommended to implement strict biosecurity protocols for visitors, prohibiting entry to individuals who have been in contact with anthrax or other contagious diseases.

In the event of an anthrax outbreak, immediate response is essential to prevent the spread of the disease. This includes isolating infected animals, implementing strict quarantine measures, and reporting the outbreak to relevant authorities. Disinfection of affected areas and monitoring of nearby animal populations are also crucial to prevent further spread.

In conclusion, the implementation of strict biosecurity measures is essential in minimizing the risk of anthrax in animal populations. This includes establishing comprehensive biosecurity plans, maintaining strict control over livestock movements, ensuring proper disposal of carcasses, regular vaccination, practicing proper hygiene, and immediate response in the event of an outbreak. By integrating these measures into animal management practices, the risk of anthrax can be effectively mitigated, protecting both animal and human health.

What steps should be taken in the event of a suspected anthrax outbreak in animals to prevent further spread?

Anthrax is a deadly infectious disease caused by the bacterium Bacillus anthracis, which primarily affects livestock and wild animals. In rare cases, it can also be transmitted to humans. When a suspected anthrax outbreak occurs in animals, it is crucial to take immediate and appropriate steps to prevent further spread of the disease and protect both animal and human health.

• Isolation: The first step in preventing the spread of anthrax is to isolate the affected animals. Infected animals should be separated from healthy animals to prevent direct or indirect contact. This will help contain the disease and minimize the risk of transmission to other animals.
• Quarantine: Quarantine measures should be implemented to restrict movement of all animals in the affected area. Animals that have been exposed to anthrax but do not show symptoms should be monitored closely and veterinary authorities should be informed. This will help prevent the spread of the disease to unaffected areas or farms.
• Vaccination: Vaccination is an effective preventive measure against anthrax. When a suspected outbreak occurs, it is important to vaccinate all susceptible animals in the affected area. Vaccination helps to build their immunity against the bacterium and reduces the risk of infection. It is also essential to ensure that vaccination programs are regularly updated to maintain long-term protection.
• Carcass disposal: Proper disposal of carcasses is crucial to prevent the spread of anthrax spores and contamination of the environment. Anthrax bacteria can survive in the soil for long periods, leading to subsequent infections. Carcasses should be incinerated, buried deep, or treated with disinfectants to destroy the bacteria. It is important to follow local regulations and guidelines for safe carcass disposal.
• Biosecurity measures: Implementing strict biosecurity measures is essential to prevent the introduction and spread of anthrax. This includes controlling the movement of animals, limiting access to the affected area, and disinfecting equipment, vehicles, and personnel. These measures help reduce the risk of contamination and further transmission of the disease.
• Surveillance and monitoring: Regular surveillance and monitoring are vital to detect and control anthrax outbreaks. Veterinary authorities should actively monitor the affected area and neighboring regions for any signs of illness in animals. Early detection allows for prompt intervention and prevents the disease from spreading to other areas.
• Public awareness and education: Educating farmers, livestock owners, and the general public about anthrax is crucial in preventing further spread. Providing information on the signs and symptoms of anthrax, preventive measures, and the importance of reporting suspected cases can help control outbreaks and protect human and animal health.

In summary, taking prompt and appropriate steps during a suspected anthrax outbreak in animals is crucial to prevent further spread of the disease. Isolating affected animals, implementing quarantine measures, vaccinating susceptible animals, proper carcass disposal, enforcing biosecurity measures, conducting surveillance, and educating the public are essential components of a comprehensive anthrax control program. By following these steps, veterinarians, farmers, and authorities can effectively manage and control anthrax outbreaks, minimizing the impact on both animal and human health.

why does the blood of animals died due to anthrax outbreak do not clott and its colour becomes tarry ?

Anthrax, caused by the bacterium Bacillus anthracis, leads to several distinctive post-mortem signs in affected animals, notably the presence of dark, tarry, and unclotted blood. This phenomenon arises due to the bacterium’s impact on the animal’s circulatory system and blood properties.

Mechanisms Leading to Unclotted, Tarry Blood:

1. Toxin Production and Hemorrhagic Effects:
   • Bacillus anthracis produces potent toxins that damage blood vessels, resulting in internal bleeding. This widespread hemorrhaging contributes to the dark appearance of the blood.
2. Inhibition of Blood Clotting:
   • The toxins interfere with the blood’s natural clotting mechanisms, leading to poorly clotted or unclotted blood observed in deceased animals.
3. Hemolysis:
   • The bacterium’s activity can cause the destruction of red blood cells (hemolysis), releasing hemoglobin into the plasma. This process contributes to the blood’s dark, tarry appearance.

Post-Mortem Observations:

• External Bleeding:
  • Unclotted, dark blood may exude from natural body openings such as the mouth, nostrils, and anus.
• Lack of Rigor Mortis:
  • Affected carcasses often exhibit rapid bloating and an absence of rigor mortis, which are characteristic signs of anthrax infection.

These clinical signs are crucial for veterinarians and livestock handlers to recognize, as they aid in the early detection and management of anthrax outbreaks, thereby preventing further spread and ensuring appropriate handling of infected carcasses.

What are the vaccination methodologies and protocols for animals in India’s anthrax-endemic regions?

In India’s anthrax-prone regions, a structured vaccination strategy is essential to prevent outbreaks among livestock. The following outlines the recommended vaccination methodologies and protocols:

1. Vaccination Protocols:

• Routine Annual Vaccination:
  • All healthy livestock aged over six months (cattle and buffalo) and over three months (sheep, goats, and pigs) should receive annual vaccinations before the monsoon season in endemic areas.
• Ring Vaccination:
  • In the event of an outbreak, a ring vaccination strategy is implemented, targeting all susceptible animals within a 5 km radius of the affected area. This approach aims to contain the spread by creating an immune buffer zone.

2. Vaccine Specifications:

• Type: The ‘Anthrax Spore Vaccine, Live, IP’ is commonly used, containing live spores from the avirulent Sterne strain of Bacillus anthracis.
• Dosage:
  • Cattle, buffalo, and horses: 1 mL
  • Sheep, goats, and pigs: 0.5 mL
• Administration: Subcutaneous injection by qualified veterinary professionals, adhering to all safety protocols.

3. Vaccination Campaigns:

• Comprehensive Drives: In high-risk districts, extensive vaccination campaigns aim to achieve 100% coverage within six months, involving coordinated efforts between veterinary departments and other stakeholders.
• Cold Chain Maintenance: Vaccines are stored and transported at 2–8 °C to maintain efficacy, with a shelf life of 12 months under these conditions.

4. Coverage and Herd Immunity:

• Achieving at least 80% vaccination coverage is crucial to establish effective herd immunity, thereby significantly reducing the risk of outbreaks.

Implementing these vaccination protocols diligently is vital for controlling anthrax in livestock, which in turn safeguards public health by minimizing zoonotic transmission.

ANTHRAX IN HUMANS

Anthrax is a rare, but potentially fatal condition caused by infection with a particular type of bacterium called Bacillus anthracis.  Normally, the spores of this bacterium reside in the soil and infect only grazing animals.  These could thrive in wild animals or cattle and livestock; the latter are the usual sources of infection in human beings.  Therefore, farmers, those who rear cattle and animal meat handlers/consumers are particularly vulnerable to developing the disease.  Potentially, anthrax can also be used as a bio-terrorism weapon.

What are the signs and symptoms of anthrax?

There may be three manifestations of anthrax in humans:

• Cutaneous:skin infection can cause blisters that may ulcerate, and are usually found on face, neck, hands and legs
• Respiratory:lung infection through inhalation of spores can lead to fever, shortness of breath, cough and extreme tiredness
• Gastrointestinal:stomach and gut infection can lead to fever, cramps, bloody vomiting, bloody diarrhea, swelling of abdomen, enlarged lymph glands and sore throat

How is anthrax treated?

Depending upon the severity of the infection, the patient may have to be hospitalized.  Antibacterial antibiotics, such as cephalosporins, penicillins and doxycycline; or anti-anthrax antitoxins are usually administered.

How can anthrax be prevented?

Anthrax vaccine adsorbed (AVA) is the generic name of the anthrax vaccine that can be given ideally before contact with the disease.  As of now, it is not recommended that anybody other than the high risk group – farmers and meat handlers – should receive this vaccine.

The best bet is to vaccinate livestock, and take precautions while handling animal products.  If a person does develop signs and symptoms of anthrax, he or she should be isolated in a safe environment and given appropriate treatment.

Should we be worried about the spread of anthrax?

As things stand now, there is no need to panic.  All the three incidents of occurrence reported above have taken place in isolated parts of the country, for very specific reasons.  In Tamil Nadu, only animals were infected, and in the two other cases, humans were infected only after consuming contaminated meat.  However,  it is advisable to keep an eye out for any signs and symptoms of the condition.  People travelling to the affected areas should take due precautions before undertaking the journey.

Compiled, Edited & Shared by-

Dr. Rajesh Kumar Singh, Editor-In-Chief, Pashudhan Praharee

Dr. Ramanuj Lal, Chief Cardiac Anesthesiologist, Brahmananda Narayana Multispeciality Hospital, Jamshedpur