Common Specialities
Common Issues
Common Treatments


Ayurvedic Ways To Treat AIDs!

Dr.Bhupinder Singh Arora 89% (158ratings)
MD- Ayurveda
Sexologist, Amritsar
Ayurvedic Ways To Treat AIDs!

The acronym for 'Acquired Immune Deficiency Syndrome' is AIDS. In fact, it must be understood that AIDS is not a singular disease, but a syndrome, or rather a set of diseases. People suffering from AIDS suffer from an immensely compromised immune system that makes them vulnerable to a number of diseases. Once infected with HIV, it may take anywhere between 5-10 years to develop AIDS.

Some of the major symptoms of AIDS are:

  1. Lethargy and fatigue
  2. Skin irritation
  3. Drastic loss of weight
  4. Loss of appetite
  5. Bronchial ailments- which often lead to end-stage tuberculosis of the lungs
  6. Diarrhea, gastritis and dysentery
  7. Prolonged fever
  8. Sleeplessness and others

How is AIDS treated by Ayurveda?
Tonics, also known as ‘Rasayanas’ in Ayurveda are administered for stimulating appetite and strengthening immunity. Once enough strength is regained, an elimination technique is administered by incorporating enemas, emesis and purgation in the treatment. This process is known as ‘Sodhana’ and is carried out to eliminate toxins from the body.

Next, the patient’s blood is purified with appropriate herbal medications. Apart from this, AIDS patients are advised to perform regular exercise, yoga and pranayama.

2681 people found this helpful

Tips Resulting Best Recovery After Hip Replacement!

MBBS, MS - Orthopaedics
Orthopedic Doctor, Pune

What aids in best results after your hip replacement?

Practising these recovery tips will help you to have a smooth and successful recovery.

1-get in a healthy exercise routine

Most hip replacement patients are able to walk within the same day or next day of surgery; most can resume normal routine activities within the first 3 to 6 weeks of their total hip replacement recovery. 
Once light activity becomes possible, it's important to incorporate healthy exercise into your recovery program. Recommended activities include gradually increased walking and light household activities (sitting, standing, climbing stairs). Movement is essential to a healthy recovery.

2-pay attention to diet and weight

Excess weight can put stress on your new hip prosthesis and increase wear and the risk of complication. 
Maintaining a healthy body weight before and after your surgery can help to improve your recovery process and the ultimate lifespan of your prosthesis. Additionally, make sure to maintain a balanced high protein diet during your recovery.

3-exercise to promote blood flow

Certain exercises can help to promote blood flow and prevent clots. These include:

  • Regularly squeezing the thigh and calf.
  • Motion exercises for the legs that utilize full range of leg motions
  • Walking with or without the assistance of supportive devices (such as walker/cane)
  • Avoid squating

4-make household preparations 

Your mobility and ability to accomplish normal, daily tasks following your surgery will be strongly reduced. Prior to your surgery, make practical modifications to your house like getting a western chair (commode) fitted.

5-alarming signs to be watched for

As you should be very well aware that prosthesis is a non living foreign body which now incorporated within your body to perform a proper function, such a body part is always susceptible to infection.

Any sort of fever or even respiratory tract infection should be well treated first hand to avoid infection around the prosthesis.

1 person found this helpful

HIV & Tuberculosis - Is There A Link?

Dr.Lt Col Adnan Masood 90% (684ratings)
MD - Internal Medicine, MBBS, Nephrology
General Physician, Roorkee
HIV & Tuberculosis - Is There A Link?

HIV and tuberculosis (TB) are two life-threatening and common diseases in the world. The two diseases are very closely connected so much so that their occurrence is normally labelled as a co-epidemic. In most cases tuberculosis is found to be the most transmissible contagion in HIV-Immunocompromised victims, proving to be the cause of their death.

What is HIV?
Human Immunodeficiency Virus, more commonly known by its abbreviation HIV, is a virus that attacks the immune system, which is the body's natural defense against illnesses. The virus terminates a kind of white blood cells (WBCs) in the immune system known as the T-helper cell also known as CD4 cells. This virus then proceeds to duplicate itself within these cells.

As HIV reduces the T-helper cells, by duplicating at an increasing rate, it slowly breaks down the patient’s immune system. This leaves the individual susceptible to other deadly diseases such as tuberculosis. HIV infection is a permanent disease with three phases of progression. HIV medications can reduce or stop the evolution of the disease from one phase to another. The treatment can also decrease the chances of spreading HIV to other people.

What is tuberculosis (TB)
Tuberculosis is a transmittable disease triggered by the presence of bacterium known as Mycobacterium tuberculosis. It is still considered a deadly disease in most developing countries where treatment is scarce. Generally, TB affects the lungs but it can also affect other parts of the body. Symptoms include – coughing with blood, fever, night sweats and loss of weight.

The relation between TB and HIV
In second world countries, most patients infected with HIV suffer from TB as the initial indicator of AIDS. Tuberculosis can occur at any phase of the HIV infection. The danger and severity of tuberculosis rises rapidly after infection with HIV. Even though tuberculosis can be a fairly primary indicator of HIV infection, it is imperative to observe that the risk of tuberculosis increases as the CD4 cell count reduces along with the progression of the HIV infection.

Positive treatment for TB usually entails 6 months of rigorous therapy. HIV patients with TB usually respond well to this therapy, if the regimen comprises INH and a rifamycin for the period of TB therapy and cure. TB generally reappears when the immune system is unable to respond to stop the development of mycobacteria. The cytokine IFN-γ plays a key role in the response of the immune system all through the contagion.
HIV and TB infections area two-directional communication of the two pathogens. TB is one of the main causes of disease and fatality among patients with HIV in Africa and other severely affected regions. With almost a 50% kill rate around the world, raising awareness about this disease and consulting doctors when signs or symptoms appear is vital in reducing the extent of this epidemic.

Rifampicin- HIV treatment are complicated by the fact that one of the key drugs used in TB treatment, rifampicin, reduces blood levels of nevirapine (Viramune) by 30 to 55% and also reduces levels of most protease inhibitors.

4106 people found this helpful

Oral Sex - What Should You Know?

MD - (Ayu.), CCP, B. A. M. S. (Bachelor of Ayurveda, Medicine and Surgery .)
Sexologist, Patna
Oral Sex - What Should You Know?

Oral sex is a form of sexual activity, which involves the arousal of one's genitalia by his/her partner using the mouth (tongue, lips and throat). It is also called Cunnilingus (performed on a female) and fellatio (performed on a male). It is done before intercourse and during foreplay for sexual arousal. It is safe as compared to vaginal or anal sex, the rate of getting a sexually transmitted disease or HIV is comparatively lower. 

Oral sex can spice up your life and can also make your partner reach orgasm. It is also a safe way of getting sexual pleasure without getting pregnant. But necessary precautions must be taken in order to have safe oral sex.

Some of these necessary precautions are:

  1. You can get throat cancer from oral sex: Human papillomavirus (HPV) is a cancerous virus found in the body of infected people. This virus can be transmitted to the person with whom you are engaging in oral sex. Studies show that people who engage with more than 6 sexual partners at once are more prone to get oral cancer. It is advisable to get your partner tested for HPV virus before engaging in oral sex.
  2. Oral sex also causes stress: Oral sex is generally related to hygiene, therefore the partner can be self-conscious and worried about his/her genital hygiene. If oral sex is performed on a daily basis, some people prefer to wax their pubic hair often. This is harmful because it can cause red bumps and burning sensation occurs. It is advisable to trim your pubic hair and wash it properly before engaging in oral sex.
  3. A condom should be worn by the male during oral sex so that there is no risk of male fluid entering the woman's body.
  4. A latex, which is made into a thin sheet called dental dam can be used on the vagina or anus. This creates a thin barrier between the mouth and the genitalia. Hence, the chances of getting infected by sexually transmitted diseases are greatly reduced.

Oral sex can be pleasurable and fun, but the risks of getting sexually transmitted diseases like herpes, gonorrhea and crabs is not altogether misplaced. So it is advisable to use proper protection and to maintain hygiene before engaging in oral sex.

1499 people found this helpful

HIV & STD - How Are They Related?

Dr.Rajiva Gupta 93% (4746ratings)
MBBS, MD - Internal Medicine, Post Graduate Program in Diabetology
General Physician, Gurgaon
HIV & STD - How Are They Related?

The general acceptance is that, when someone suffers from Sexually Transmitted Disease or STD, the risk of getting affected by HIV increases for that particular person. This is true for both biological as well as for behavioral reasons.

HIV is one of the diseases which are caused as a result of sexual transmission. Before knowing the exact link between HIV and STD, understanding what the two concepts exactly are, would be beneficial.

Let us now look at the two concepts in detail:

STD - 

  • As already mentioned earlier, STD basically stands for Sexually Transmitted Disease. This is used to refer to a condition that gets passed from one person to another by way of sexual contact. 
  • A person can develop a Sexually Transmitted Disease if anyone has unprotected sex either in the vagina, anal or orally with someone, who is already carrying a STD.
  • Sexually Transmitted Disease can also be sometimes called as a Sexually Transmitted Infection (STI) or even as Venereal Disease.
  • Still, this does not mean that sex is the only medium through which sexually transmitted diseases get transmitted from one person to another. On the basis of specific diseases under this, one can also get plagued by infections while sharing needles as well as breastfeeding.

Now, we will discuss the symptoms of STD in men and women, which would give a clear picture as to how do they differ between the two sexes:
Symptoms in Men -

  • Though there is a possibility that Sexually Transmitted Diseases may not come up with any kind of symptoms, still certain diseases under this do have some obvious symptoms. 
  • Among men, some of the common symptoms include:
  • Discomfort or Pain experienced while having sex or at the time of urination.
  • Men could also notice sores, bumps or rashes on or close to the penis, testicles, anus, buttocks, thighs and even mouth.
  • There could be unusual discharge or even bleeding from the penis.
  • Testicles might get swollen or they could cause a lot of pain.

Symptoms in Women -
Some of the common symptoms of STD among women include:

  • Discomfort or pain suffered at the time of having sex or while urinating.
  • Rashes or sores around the vagina, thighs, anus or mouth.
  • Unusual kind of discharge or bleeding from the vagina
  • Itchy feeling in or just around the vagina.

Types of STDs
HIV happens to be one of the STDs. Other diseases include:

Now, let us talk about HIV in detail:
HIV is a kind of virus that tends to damage the immune system. The immune system primarily helps the human body in fighting against infections and different kinds of diseases. HIV that is untreated causes infection and also goes on to kill CD4 cells, which are a kind of immune cell known as T cells.

Some of the early symptoms include:

Though these symptoms getaway within a month people can even carry HIV without having serious or any kind of symptoms that persist and live for many years.

Some of those symptoms are:

The relation between STD and HIV

Research suggests that Sexually Transmitted Diseases like Gonorrhea and Syphilis not only look to provide HIV very easy access to cells and tissues of the body that are vulnerable but also STD co-infection can actually lead to an increase in the infections of the person with HIV, hence making them more probable towards transmitting the virus to others.

People, who are already suffering from Sexually Transmitted Diseases, can increase their susceptibility towards HIV through a number of ways. They are as follows:

  • Some kind of Sexually Transmitted Diseases can lead to open wounds or ulcers to get formed in the genital area. These kinds of wounds can provide the virus called HIV, a direct entry into a person’s blood.
  • Certain diseases that are sexually transmitted, do not result in having open wounds but the presence of the infection itself can cause one’s body to have an increase in the concentration of CD4 T-cells in the genital region. 
  • The fact has been well established that increase in the concentration of these CD4 T-cells can give HIV with quite a favorable target for spreading the infection.
  • People, who are infected with a Sexually Transmitted Disease or STD, also have quite heavy concentrations of HIV in the liquids of semen and also in the vaginal fluid. This leads to an increase in the possibility of HIV transmission.
  • A study has even proved that Men having got infected with HIV and Gonorrhea, have HIV, at least 10 times more in their seminal fluid than those who are only infected with HIV.

Some of the major concerns are Sexually Transmitted Diseases like Infective Syphilis, Gonorrhea, and Herpes, with the strong evidence getting established regarding the fact that Chlamydia can also lead to an increased risk of HIV among women.

1945 people found this helpful

HIV - How Does Nutrition Help In It?

Dr.Hemant Kumar 95% (214ratings)
MD, Diploma in Family Medicine, MBBS
HIV Specialist, Ghaziabad
HIV - How Does Nutrition Help In It?

A healthy immune system and optimum physical strength is maintained by an adequate nutritional status of the body. Unexpected loss of weight, loss of appetite, low dietary intake due to ulcers in the mouth and an altered rate of metabolism are common in HIV infected individuals. It is essential to regain the lost weight and the muscle mass in the early stages of the infection since the correction of nutritional status becomes difficult with the progression of the disease.

Certain measures like definitive anti-retroviral therapy combined with the treatment of opportunistic infections like TB, Candidiasis and other bacterial infections along with the provision of nutritive aid in the form of a balanced diet, regular physical activity, and use of appetite stimulants help in improving the general health of the body.  A widespread deficiency of essential nutrition and micro-nutrients is observed among the HIV-infected people. Supplement composition, treatment given and characteristics of the patient vary widely across researches done.

The World Health Organization (WHO) recommends an intake of 1 Recommended Dietary Allowance (RDA) of each of the required micronutrient.  This may sometimes require taking supplements of the micronutrients.There is a direct relation between HIV infection and malnutrition, where each makes an individual more susceptible to the other. HIV infection can increase the severity of malnutrition and vice versa.

Malnutrition can worsen the progression of HIV, which further in turn further worsens malnutrition. This is an unending cycle, until an intervention occurs. An increase in the nutritional needs, poor intake of nutrients and increased losses through vomiting and diarrhea lead to a poor nutritional status.

  • This causes weight loss and wasting of muscles.
  • Loss of the lean body mass is definitively linked to disease and morbidity.
  • There is a sense of overall lack of energy, fatigue, lethargy and weakness.
  • The immune system is composed of proteins.
  • Reduced intake of proteins in the diet results in a decreased production of the immune cells.
  • Certain amino acids are responsible to aid in the efficient functioning of the immune system.
  • Deficiency of these amino acids impairs immune function.
  • This impairment of the immune system makes the individual vulnerable to various infections.
  • The opportunistic infections like tuberculosis (TB), Candida and bacterial pneumonias are commonly observed in individuals with HIV.

These diseases further strain the immune system and cause disease progression. It is important to know that nutrition acts as an adjunct to appropriate anti-retroviral therapy. Multivitamins, supplements of beta-carotene and Vitamin A, zinc, selenium and probiotics help in maintaining optimum nutrition in an HIV infected individual. Anabolic agents and appetite stimulants help in overcoming muscle wasting. Nutrient-dense meals consumed in small portions at frequent intervals are better accepted in the body rather than the regular 3 large meals.

Water consumption during meals should be avoided, to prevent a feeling of fullness in the stomach due to water rather than food. A healthy and balanced nutrition is essential in living a normal life. Maintaining the lost weight and stamina of the body, replacement of the lost nutrients, vitamins and minerals aid in improvement of the immune function. Proper nutrition can delay progression of the HIV infection into AIDS disease by improving the response of the body to the treatment given.

1108 people found this helpful

HIV - Can It Be Checked Through Oral Test?

Dentist, Mumbai
HIV - Can It Be Checked Through Oral Test?

HIV is a systemic disease which affects all parts of the body. The oral cavity also has some tell-tale symptoms which indicate HIV / AIDS. A careful examination and detailed history of symptoms is essential. In some cases, the oral manifestations could be the area where HIV is suspected. This can help in reducing morbidity and improves prognosis. The oral lesions that occur in HIV patients can vary and differ significantly in children and adults. While there are a variety of oral lesions in HIV-infected individuals, listed below are some common infections seen in HIV patients. These are a combination of fungal, viral and bacterial infections.

  1. Candidiasis: Candida is an opportunistic fungus that is normally present in the oral cavity and with reduced immunity of HIV, recurrent bouts of the infection begins to show up. It can be in the form of regular thrush which is whitish and cannot be scraped off (pseudomembranous candidiasis), hyperplastic candidiasis (white patches which can be scraped off) or erythematous (reddish patches). Candida can involve any part of the oral mucosa including the pharynx and the palate.
  2. Herpes Simplex: This is the most common viral infection seen in patients with HIV/AIDS. There could be primary or secondary infection of herpes virus, especially inside the mouth and the vermillion border of the lips.
  3. Herpes zoster: This virus, when already present in the body, can be reactivated with HIV/AIDS and with oral herpes. The distinction with herpes simplex is from their distribution. These are unilateral, along the distribution of the maxillary or mandibular nerve. The lesions appear both on the facial skin and the oral mucosa. While the facial ones break open and form crusts, the mucosal ones coalesce to form larger lesions.
  4. Hairy Leukoplakia: This is present in about 20% of asymptomatic HIV patients. Onset of hairy leukoplakia is an indication of rapid progression of HIV with increased CD4 counts. The typical lesion is a non-movable, hairy lesion along the side of the tongue and can spread to the top and the undersurface of the tongue. There are large amounts of Epstein-Barr virus (EBV) identified from biopsies of hairy leukoplakia.
  5. Cytomegalovirus: If the ulcers have a necrotic base with a halo surrounding it, it is CMV infection, usually seen on any oral mucosal surface.
  6. Periodontal disease: This is one of the bacterial infections that manifests itself in HIV patients. It can take two forms such as Linear Gingival Erythema (LGE) which can subsequently lead to Necrotizing Ulcerative Periodontitis (NUP). The oral hygiene is generally good with minimal plaque and there is rapid bone loss and soft tissue reddening and swelling. The, mouth, therefore is certainly a window to one’s health.

Diagnosing HIV with Western Blot Test-

It is a series of blood screenings are performed to test for HIV. The enzyme-linked immunosorbent assay (ELISA), also known as an enzyme immunoassay (EIA), is the first test that your healthcare provider will order to screen for HIV. ELISA, like the Western blot test, detects HIV antibodies in your blood. Antibodies are proteins your immune system produces in response to the presence of foreign substances, such as viruses. If you test positive for HIV on the ELISA test, your provider will order the Western blot test to confirm HIV infection. 

5909 people found this helpful

HIV - Know Mode Of Transmission!

MD - Internal Medicine, DIM -Diploma in Industrial Medicine, Certificate in HIV Medicine
HIV Specialist, Mumbai
HIV - Know Mode Of Transmission!

The human immunodeficiency virus (HIV) is a subgroup of retrovirus (lentivirus) that causes HIV infection. After a period of time, this infection leads to what is called acquired immunodeficiency syndrome (AIDS).


According to the Centers for Disease Control and Prevention (CDC), from 2010-2015, the estimated rate of HIV infection in all 50 US states decreased from 14.2 per 100,000 population in 2010 to 12.3 per 100,000 population in 2015. In 2015, 39,513 individuals were diagnosed with HIV infection. From 2010 to 2014, the annual number of new HIV infections decreased by 9%.

Virology HIV-1 and HIV-2 are retroviruses in the Retroviridae family, Lentivirus genus. They are enveloped, diploid, single-stranded RNA viruses with a DNA intermediate. Upon entry into the target cell, the viral RNA genome is converted into double-stranded DNA by an enzyme, reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded enzyme, integrase. HIV contains three retroviral genes, namely gag, pol, and env.

  • Gag gene: Encodes group-specific antigen; the inner structural proteins
  • Pol gene: Encodes polymerase; it also contains integrase and protease
  • Env gene: Encodes the viral envelope, the outer structural proteins responsible for cell-type specificity. Glycoprotein 120, the viral envelope protein, binds to the host CD4+molecule


HIV infects vital cells in the human immune system, such as helper T cells (specifically CD4+ T cells), macrophages, and dendritic cells and leads to cellular immune deficiency. This results in the development of opportunistic infections and neoplastic processes.

Mode of Transmission
Sexual intercourse: Unprotected sexual intercourse; especially receptive anal intercourse and different sexual partnersContact with or transfer of blood, pre-ejaculate, semen, and vaginal fluids infected with the virus. Spread from an infected mother to her infant through breast milk. An HIV-positive mother can transmit HIV to her baby both during pregnancy and childbirth due to exposure to her blood or vaginal fluid.

Signs and Symptoms There are 3 categories of infection

  • Category A: Asymptomatic HIV infection without a history of symptoms or AIDS-defining conditions
  • Category B: HIV infection with symptoms that are directly attributable to HIV infection
  • Category C: HIV infection with AIDS-defining opportunistic infections


A high-sensitivity enzyme-linked immunosorbent assay (ELISA) should be used for screening.


  • Start with antiretroviral therapy (ART) in all HIV-infected adults ready to start therapy.
  • CD4 count is no longer a criterion for starting the therapy.
  • Use of nucleoside reverse transcriptase inhibitors and protease inhibitors.
  • For refractory cases, during the failing treatment regimen and before switching therapy, use rapid confirmation, perform resistance testing and reevaluate.
938 people found this helpful

Hip Fracture - How To Avert It?

Dr.G Manjunath Reddy 87% (15ratings)
MBBS, DNB (Orthopedics), Diploma in Orthopaedics, MCH- Orthopedics
Orthopedic Doctor, Hyderabad
Hip Fracture - How To Avert It?

Old age or certain medical conditions may cause osteoporosis. In such conditions, one needs to be cautious as even the smallest of falls can cause fractures which may render the patient bed-ridden. Here are a few tips to how you can prevent hip fracture.

Read on to find out more about the prevention of hip fracture.

  1. Preventing falls: People over the age of 65 have a higher risk of falling due to various causes. To reduce such risks one should take the help of walking aids such as a walking stick. Avoid walking on slippery surfaces or wear rubber sandals and shoes to ensure that you do not slip on such a surface. One should also exercise regularly to maintain strength in the bones. Flexibility and fitness increase with exercise and thus decrease the chances of falling.
  2. Hip protectors: Hip protectors are used for lessening the impact of a fall. It is highly useful in case of older people for preventing hip fractures. Hip protectors are basically a device which uses padding and plastic material for shielding and absorbing impact and is attached to specially designed undergarments. The padding absorbs the shock and the plastic material diverts the shock away from vulnerable areas. Hip protectors in the past were sparsely used as they used to be highly uncomfortable and used to cause a major inconvenience. Modern hip protectors however have reduced the level of discomfort and also have newer features which provide ventilation, thus reducing sweating. Hip protectors are highly useful for old people who are admitted in care homes and who have a high risk of falling. It is of relatively less useful for people who are active.
  3. Frax tool: The world health organization (WHO) has developed a fracture assessment tool which calculates the risk of fracture of a person whose age is between 40 to 90 years. This tool takes into account the bone mineral density (BMD) and other factors such as age and sex to determine the chances of fracture depending on the current physical condition of your body.
1454 people found this helpful

Hearing Aids - How Can They Enhance Our Life?

Dr.Anil Safaya 87% (42ratings)
MBBS, MS - Otorhinolaryngology
ENT Specialist, Delhi
Hearing Aids - How Can They Enhance Our Life?

Hearing has a deep impact on your life. It determines the kind of life you are going to lead. It has been found by various studies and surveys that hearing aids drastically improve the quality of life you lead. It is the much-needed relief to a life, burdened by the stress and strains of living with hearing impairment. The hearing aids are not just instruments. This is a way to live a life of dignity. According to the Evaluation of the Social and Economic Costs of Hearing Impairment report, hearing loss leads to socio and economic stress in ones’ life in major continents like Europe, Australia and the United States.

Research conducted by the National Council on Aging found that over 2,000 people living with a hearing impairment or loss experienced positive changes in their respective lives after using hearing aids. They experienced improvements in social, emotional, psychological and physical spheres of life. Furthermore, a US study claims that nine in ten people using hearing aid say that their life has changed for the better after using the aids. It can also be said that hearing aid users lead a better life than non-users of these aids.

How these aids better your life?
Hearing aids gift you a life of expressions and dignity. They can connect you to the rest of the world and empower you to maintain your individualism. You are empowered to make your point in front of others and understand their perspectives too. Here’s what a hearing aid can do for you:

Users of hearing aids have a better life as they have improved cognitive functioning. The family members claim that the users of these aids become more interactive. They are lesser of an introvert than the non-users.

  1. It improves the social life of the user. He or she can participate in group activities and their family and other ties or relationships go smooth. There is no communication gap.
  2. Hearing aids build up your confidence. You regain your lost dignity and faith in your abilities. Hearing loss kicks you to a life of loneliness, alienation and leaves you with low confidence levels.
  3. It helps you in having better psychological functioning. It keeps you away from psychological problems like depression, personality disorders and over-all absurd behavioural changes.
  4. It improves the understanding of closer or personal relationships. The warmth in a relationship is regained or bettered with effective communication.
1373 people found this helpful

Book appointment with top doctors for HIV AIDS treatment

View fees, clinic timings and reviews