cover
on the
EDITION#10
1 The Parchment
THE CODE WAR
2 Global Vistas
Spi ng to health!
Moving closer to a world free of mul ple
sclerosis
3 Arbor Vitae
The Girl who won't Can't Cry!!
Behind a Darker Mind
Behind the disease: A human being
9 Theme Based Ar cles (The Code War)
MAYBE IT IS LUPUS
The Intolerant Bodies
Friend and Foe Alike
10 History Revisited
Robo cs and Minimal Invansive Surgery:
One look to the past and future
Gou e Asthénique Primi ve: How we
came to know about Rheumatoid Arthri s.
4 The New Truth
My New Pancreas
A Shot at Celiac Disease
SERENDIPTY CALLED RITUXIMAB
11 Been There, Done That
Life of a medical student: Do's and Don'ts
12 Tech-X
5 Memory Invigora on
IT'S ALL ABOUT THE GRAVE EYE!!
MNEMONICS TO THE RESCUE
ANEMIA
SPACE CENTER HOUSTON
The Bionic Man: Use of 3-D Prin ng for Tissue
Engineering
LABOR COMPETITIVENESS
13 Diverging Roads
6 Cerebro
The big picture- a quiz on basic
immunology
4 Pics 1 Autoimmune disease
14 The Rendezvous (Interview with Palash Sen
for us)
15 Acts Of Kindness
7 EduO
Interna onal conferences
8 Lexiamma's LexiGyaan
Food Fights!
Gluten Intolerence
The KETOgenic DIET
16 The Open Le er
17 Dave & Harry
The Comic Strip
18 ISMOPH Interna onal Essay and Slogan
Contest Shortlisted Entries
19 The Boards (Editorial & Administra ve)
JAN 2015
PARCHMENT
I take an immense pleasure in presen ng before all the enthusias c followers of Lexicon the second anniversary edi on tled “THE CODE
WAR”.
I have been associated with Lexicon team or we fondly call ourselves the lexiconians since the very ﬁrst edi on. It's been a journey of
learning, crea ng, interac ng, forming bonds and making an iden ty not just for myself but for each one of us associated with it.
You all must be curious to know as to what special have we created this me. Well, I will say read it to know it.
But I will surely give you the glimpse of it. Just a wee bit, mind you!!
The 10th edi on of Lexicon, “The Code War” is about a set of disorders known as the Autoimmune disorders.
Hippocrates once said,
“Natural forces within us are the true healers of the disease”
But when these “natural forces” turn against our own, autoimmune disorders are born. Autoimmune disorder incidence has seen a
tremendous rise in the past few years; some have gone to the extent of calling it a “rising epidemic”. Since most of the diseases falling into
this category do not have a cure, management of the symptoms is the key.
We as a team have come together to put with a knowledgeable ensemble for you to read and understand them be er.
I hope you all we enjoy reading it as much as we did crea ng it.
RUCHIRA DHOKE
DIRECTOR OF EDITION,
LEXICON
JANUARY 2015 • lexiconin.com
GLOBAL VISTAS
T
SPITTING TO HEALTH!
By Khushboo Gala
MBBS 3rd year, Grant Medical College, Mumbai
hese stories probably echo in millions of minds, all around the globe.
Rakesh was a 50 year old bank manager from a bustling city. His father had died at
the age of 58 from a severe heart a ack. Rakesh himself was not in the best of
health – he had a sedentary, unhealthy lifestyle. He had been advised by his family
doctor to get his blood cholesterol and sugar levels checked, so that he could start
some sort of prophylac c treatment for the deﬁnitely upcoming cardiovascular
disease.
But Rakesh had been delaying these inves ga ons for the simple reason that he
was u erly terriﬁed of needles. The thought of ge ng rou ne needle pricks just
dissuaded him from going that one step further to health.
Bajirao was a 57 year old farmer living in the far interiors of the country. His
maternal side portrayed a strong family history of diabetes – yet he hadn't go en
his blood tested for sugars, simply because the nearest health facility was a
whopping 24 km away. Who would go all the way for a disease that hadn't started
manifes ng yet?
Sneha was a 28 year old public health advisory for her town. She was a bright,
mo vated woman who wanted to implement some form of cancer screening
programme for her townsfolk. But try as she might, every known strategy was way
out of her allo ed budget. She was in a ﬁx.
There is one breakthrough study that might hold the solu on to all these very real,
very poignant problems. A group of scien sts headed by Dr. David Wong in UCLA
have conducted the most comprehensive analysis ever conducted of RNA
molecules in human saliva – and found that a simple saliva test capable of
diagnosing diabetes, cancer and CHD, and perhaps even neurological disorders and
autoimmune diseases.
Wong's research over the past decade has focused on iden fying biomarkers in
saliva. His laboratory discovered that some of the same RNA that is inside human
cells are also present in saliva and can be used to detect diseases. UCLA scien sts
have iden ﬁed more than 400 circular RNAs in human saliva, which serve as a
sponge for ny RNA molecules called microRNAs, which bind to it.
The scien sts compared microRNA levels in saliva to those in the blood and other
body ﬂuids, and found the levels of microRNA in blood and in saliva are very similar
- indica ng that a saliva sample would be a good measure of microRNAs in the
body.
In essence, saliva carries with it non-coding RNAs, microRNAs, piRNAs and circRNAs
that are biomarkers for disease and health monitoring.
The conclusion is that saliva has tremendous medical and scien ﬁc value. In the
not-too-distant future, we might be able to take saliva samples to analyze for a
variety of diseases.
This has a number of implica ons:
Inves ga ons become non-invasive, completely harmless. All it requires to
test your blood cholesterol could be a simple spit!
A whole range of self-diagnos c devices could be developed – which
could be accessible anywhere, any me, in any corner of the world.
Once a cost eﬀec ve technology for saliva tes ng is developed – it might
just become ridiculously simple and inexpensive to screen for countless
diseases. No more need of needles, asepsis, trained personnel to take
injec ons and perform complex laboratory tests!
Just some spit will do.
THINK BEFORE YOU
SPIT
JANUARY 2015 • lexiconin.com
GLOBAL VISTAS
M
ul ple Sclerosis is a chronic autoimmune
disease in which the body's immune system
mounts recurring assaults on the myelin
sheath- the fa y, protec ve coa ng around the axons
of the nerve ﬁbres. The 'demyelina on' that follows
causes a disrup on of the nerve impulses, as a result of
which the nerve signals slow down or stop and the
pa ents vision, sensa on and use of limbs gets
impaired.
MOVING CLOSER TO A WORLD FREE OF MULTIPLE SCLEROSIS
The ﬁrst treatment course is administered via
intravenous infusion on ﬁve consecu ve days, and the
second course is administered on three consecu ve
day, one year later. It is designed to re-construct the
immune system, but in doing so it makes the body
vulnerable to other diseases.
MS aﬀects more than 2.3 million people worldwide.
The progress, severity and speciﬁc symptoms of MS in
any one person are unpredictable. Symptoms range
from numbness and ngling to blindness and
permanent paralysis. Given such debilita ng eﬀects, an
extensive search is on among the scien sts to ﬁnd a
cure for MS.
Now a team of researchers, led by a biomedical
scien st at the University of California, Riverside,
reports in the latest issue of the Proceedings of the
Na onal Academy of Sciences that it has iden ﬁed a
drug that could minimize the degenera on of axons,
thus reducing the rate and degree of MS progression :
Indazole chloride (Ind-Cl). "This drug, which we
administered on transgenic mice, can poten ally halt
the symptoms and reverse ongoing motor deﬁcit due to
MS," said Seema K. Tiwari-Woodruﬀ, an associate
professor in the UC Riverside School of Medicine whose
lab led the study. "Our study shows that Ind-Cl can remyelinate axons which have go en injured not just in
MS but also trauma c brain injury and spinal cord
injury."
The FDA staﬀ last year ﬂagged risks of autoimmune
diseases including thyroid cancer, blood disorders and
lymphoprolifera ve disorders. Hence, the drug is only
available through a restricted distribu on program, the
Lemtrada REMS (Risk Evalua on and Mi ga on
strategy), which ensures that access to Lemtrada is only
through cer ﬁed prescribers, healthcare facili es and
speciality pharmacies. The program is intended to help
educate healthcare providers and pa ents on the
serious risks associated with Lemtrada and the
appropriate periodic monitoring required to support
the detec on of these risks for 48 months a er the last
infusion.
By Zenia Poladia
MBBS 3rd year, Grant Medical College, Mumbai
found in connec ve ssue in bone marrow, but unlike
their bone-marrow derived counterparts, stromal cells
from the placenta are more numerous, with one donor
able to supply enough cells for many pa ents.
"This is the ﬁrst me placenta-derived cells have been
tested as a possible therapy for mul ple sclerosis," said
Fred Lublin, MD, Director of the Corinne Goldsmith
Dickinson Center for Mul ple Sclerosis, Professor of
Neurology at Icahn School of Medicine at Mount Sinai
and the lead inves gator of the study.
"The next step will be to study larger numbers of MS
pa ents to assess eﬃcacy of the cells, but we could be
looking at a new fron er in treatment for the disease.
We're hoping to learn more about how placental
stromal cells contribute to myelin repair," said Dr.
Lublin. "We suspect they either convert to a myelin
making cell, or they enhance the environment of the
area where the damage is to allow for natural repair.
Our long-term goal is to develop strategies to facilitate
repair of the damaged nervous system."
28th May is celebrated as WORLD MS DAY. The ini a ve
was taken by MS-UK with the inten on of raising
awareness among people on mul ple sclerosis. They
believe that while the perfect cure for the disease is yet
being extensively researched, people diagnosed with
MS should not let the disease dictate their lives. That is
the ethos behind their charity. MS- UK operates on the
basis that knowledge is power and everyone aﬀected
by MS should be supported in making decisions for
The mul ple sclerosis market is increasingly moving themselves and the way they want to live.
away from injectable treatments in favour of pills such
as Novar s' Gilenya and Biogen Idec's Tecﬁdera. But
Genzyme hopes Lemtrada's ability to reduce the risk of
relapse of the disease will win it market share.
Lemtrada has already been approved in more than 40
countries and has been showing promising results so
far.
Novar s, one of the leading pharmaceu cal companies
in the world is commi ed to the research and
development of innova ve and targeted treatment
op ons for people suﬀering from diﬀerent types of MS.
T h e Nova r s M S p o r o lio in clu d es G ilenya
(Fingolimod, oral DMT) and Extavia (interferon beta1b for subcutaneous injec on) for the treatment of
Something very interes ng that was discovered by a
relapsing MS.
research team at the the University of WisconsinFingolimod, marketed as Gilenya, is approved in the US Madison was giving 'tongue shocks to improve
for ﬁrst line treatment of relapsing forms of MS in rehabilita on and hasten healing’. The nerves get
adults. Gilenya is the only DMT to impact the course of damaged in MS; loss of muscle control being one of the
relapsing MS with high eﬃcacy across four key major symptoms. The tongue has extensive motor and
measures of the disease a ack: relapses, MRI lesions, sensory integra on with the brain. Yuri Danilov, a
brain shrinkage (brain volume loss) and disability neuroscien st, heading the research team explained
progression. Gilenya targets both focal and diﬀuse that the nerves on the p of the tongue are directly
central nervous system damage that drive loss of connected to the brain stem, a crucial hub that directs
func on in relapsing MS and helps preserving an basic bodily processes.
individual's physical (e.g. walking) and cogni ve (e.g.
m e m o r y ) f u n c o n . “ G i l e n y a ( F i n g o l i m o d ) The research showed that sending painless electrical
revolu onized the treatment of relapsing MS as the impulses through the tongue ac vated the neural
ﬁrst oral disease modifying therapy”, said Vasant network for balance; such ac va on may shore up the
Narsimhan, Global Head of Development at Novar s circuitry weakened by MS. “We have probably
Pharmaceu cals. Currently, studies with Fingolimod discovered a new way for the neurorehabilita on of
are being conducted in paediatric MS, where there is a many neurological disorders, “says Danilov. The team is
also using tongue s mula on to treat pa ents with
high unmet need.
vision loss, stroke damage and Parkinson's.
Moreover, recently Sanoﬁ and its subsidiary Genzyme
have announced that the U.S. Food and Drug The use of cells from the human placental ssue is also
Administra on (FDA) has approved LemtradaTM being considered for therapy and treatment in pa ents
(alemtuzumab) for the treatment of pa ents with with mul ple sclerosis.
relapsing forms of mul ple sclerosis. Because of its
safety proﬁle, the use of Lemtrada has been reserved The study is the ﬁrst of its kind. While designed to
for pa ents who have had an inadequate response to determine safety of the treatment, early signals in the
two or more drugs indicated for the treatment of MS. data collected by the research team also suggest that a
Lemtrada has a unique dosing and administra on prepara on of cultured cells called PDA-001 may repair
damaged nerve ssues in pa ents with MS. PDA-001
schedule of two annual treatment courses.
cells resemble "mesenchymal," stromal stem cells
Advancing research and pushing science to new limits
will undoubtedly improve the lives of people with MS.
There are now promising treatment op ons for people
living with the disease. New treatments for all forms of
MS will con nue to emerge and is making us move
closer to a world free of MS.
Courtesy- medindia.net/news, MS-UK: news and
r e s e a r c h a r c h i v e , M e d i c a l N e w s To d a y,
na onalmssocirty.org
JANUARY 2015 • lexiconin.com
ARBOR VITAE
The Girl who won't Can't Cry!!
By Dr Supriya Kumar
F
rom not being able to set foot in a court to being the champion of the game
these Florida sisters have braved many odds. But the one thing they didn't do
was, give up on the dream to become no.1 in the world. Be it injuries or
sickness they con nued to amaze the world with their performance as they set the
bar for the game.
From her debut in 1994 to being World no.22 in 1997 with a quick uprise
to the top 10 in 1998 and 3 consecu ve grand slam tles, Venus
Williams has been queen of the game! And then came the dark
period of her career where shrouded by a mysterious illness
Williams suﬀered much in terms of stamina. And everybody had an
opinion about it. Some thought it was the age showing up while others
claimed Williams should have gracefully re red while in her days of glory!
2004-2011 was the darkest hour of Williams' career where she neither had a
medical diagnosis nor could she ﬁgure out why she had suddenly lost the energy to
get through a game. She even a ributed her fa gue as laziness while she toiled to
struggle against it.
2011 brought with all the explana on there was with a ﬁnal diagnosis of Venus
Williams' condi on. She was diagnosed with Sjogren's syndrome. 7 years is what it
took!
What's worse than your own body switching sides in the game?!
How far do you think you'd go when you know your days are numbered? When you
are aware that disease will slowly debilitate you to a major degree? Some of us
would crumble under the very pressure.
But then there are those who ba le it every day and emerge victorious! Pushing
their limits and challenging the disease every step of the way.
Sjogren's syndrome is an autoimmune disorder in which the white blood cells of
the body a ack the exocrine glands of the body, speciﬁcally the salivary and
lacrimal glands, causing the mouth and eyes to dry up and result in inﬂamma on.
So basically, the protector becomes the a acker. Saliva and tears, we know, are the
ﬁrst line of the defence mechanisms of the body. Damage to these is an open
invita on to a wide variety of bacterial infec ons. In Sjogren's the eyes dry up,
leading to keratoconjunc vi s. Dry, itching and watering red eyes with a persistent
gri y feeling which can escalate to corneal perfora on and loss of vision! A dry
mouth exposes the mouth to infec ons such as candida and dental caries while
also posing a substan al risk for dysphagia and ﬁssures in the tongue. Both
condi ons are extremely diﬃcult to cope up with.
But here we talk about the lady who braved it all, the lady who rose to create
records despite this disease and the hazards associated with it. In her own words,
“"I'm really disappointed to have to withdraw from this year's U.S. Open. I have
recently been diagnosed with Sjögren's syndrome, an autoimmune disease which
is an ongoing medical condi on that aﬀects my energy level and causes fa gue and
joint pain. I am thankful I ﬁnally have a diagnosis and am now focused on ge ng
be er and returning to the court soon." – Venus Williams in USA Today.
This was 2011 and she hasn't looked back since. . For an athlete of her calibre
Sjogren's can be a rather limi ng condi on. In a sport where stamina plays a pivotal
role, easy fa guability and associated arthri s are a major challenge. But this lady
with an iron spirit did not let it bog her down and rose to set newer records,
redeﬁning tennis for the world!
And she pre y much DID it!
"As an athlete, you don't make excuses.
Either you do it or you don't"
Venus Williams
JANUARY 2015 • lexiconin.com
ARBOR VITAE
Behind a Darker Mind
By Utkarsh Mishra,
MGM Ins tute of Health Sciences
"You're only given one little spark of madness.
You mustn't lose it."
-Robin Williams
"Do you not see how necessary a world of pains and troubles is to school
intelligence and make it a soul?"
-John Keats
There have been many great moments this year. Some truly impac ul and capable
of making us believe that there may as well be no limits to humans reaching the
very extremes of the universe to discover truths. And some truly harsh events
which made us believe that smiles can be also a mask covering the darker cloud
that has been consistently brewing in the mind of unsuspec ng individuals.
"I used to think that the worst thing in life was to end up alone. It's not. The worst
thing in life is to end up with people who make you feel alone”
Robin McLaurin Williams was the best at what he did. He could imitate anyone,
anywhere, any me. One minute he could be the haggling old man cursing the gods
for giving him a paining knee, the second he could be the 20 year old woman
excited about shopping at the new plaza. He had a unique charm about him. He
could make any situa on into a funny one and roast a person so well, the person
would never mind. He gave us some amazing movies like the Dead Poets Society,
Mrs. Doub ire, and, even voiced Genie from Aladdin. He spread smiles, gave
tummy aches and was never seen with a frown.
His tragic demise this year brought us close to a biological condi on that is surely
more complicated than we thought. He commi ed suicide! The reason: He was
depressed. All around the world, people weren't more shocked about his demise
than the fact that a comedic genius, a great father, and an inspira on to millions
was suﬀering from this mind numbing disorder.
Depression is a biological disorder having psychological and social implica ons. We
see it every day and most of us shun the people suﬀering from it as 'oﬀ pu ng'.
Over 350 million people are aﬀected by it worldwide and it has surfaced as real
issue in recent mes. By some it is described as 'darker than most emo ons we can
elicit and denser than most words can hurt'
It was known to be caused by the deﬁciency of serotonin. One can also dub
serotonin as the 'good feeling' chemical. But recent studies have proven a lot more
than just that. The area of the hippocampus, majorly responsible for memory, is
shown to be reduced in individuals. They show a further reduc on as stress
increases. This study concluded that neurogenesis was the major role player. Stress
played a major role in the produc on of new neuron in this area of the brain, i.e.
more the stress, more the inhibi on towards neurogenesis.
No matter what
people tell you,
WORDS
and
IDEAS
can
CHANGE
THE WORLD
Although serotonin based drugs might help some of us, the simpler things in life do
way be er. Most of us, and even I, have suﬀered from depression at some me
during our lives. But we emerged the be er person. We talked. We shared our
deepest fears. We explored the beauty that is in everyone and everything. We had
that favourite snack of ours and played that favourite video game. We helped
others and let the sa sfac on make us feel be er about ourselves. We realised that
we weren't alone, and that there were people who cared about us.
All of us have to remember that this disease is very real. Help and allow yourselves
to be helped. It is nothing to be ashamed of. There are celebs like Jon Hamm and
Gwyneth Paltrow who succeeded in ge ng out of it, but it also had it vic ms in the
form of Heath Ledger and Robin Williams.
Depression also has been proven to be passed along in families. It was concluded
that the absence of the serotonin transporter gene promoted the produc on of a
'short' gene that was directly related to inducing depression and bipolarity in the
next genera on. Say if the parents were depressed, higher chances are the kids
might be too! Not to men on, there are way too many other diseases that induce
depression, but this does imply that one cannot simply 'get over it'.
JANUARY 2015 • lexiconin.com
ARBOR VITAE
T
Behind the disease: A human being
By Pool Aguilar Leon
he proper training of medical students involves the development of the
three pillars of medical educa on: Academic, Scien ﬁc and Interpersonal.
And it is, at this point, which mostly falls.
Currently, most medical schools do not take into account the human aspect of the
profession; the importance of interpersonal rela onships and their implica ons in
growing a successful doctor-pa ent rela onship. And, currently, is widespread
prac ce of trea ng the disease and not the pa ent. This leads to the percep on of
visualizing the person as a set of signs and symptoms for discussion rather than a
human being who seeks support and love.
During rota ons at the hospital, our teacher instructed us to realize the medical
record of some pa ents and then meet to discuss the case. I was assigned the case
of a young lady of 16 years with a diagnosis of Systemic Lupus Erythematosus; she
was listless since the disease was at an advanced stage. As I sat beside her and we
start cha ng, that is when I realized how curious and smart she. So, I decided to
visit her again to check her progress.
This young woman touched my heart, and even more the indiﬀerence of my
colleagues who only saw her as "the girl with lupus" and not the human being
behind the disease.
The last day I visited her at the hospital, before leaving home I remembered the
li le picture of the Virgin Mary which was blessed by Pope John Paul II and was a
relic treasured with love and faith. And I felt that this child needed it more than me,
that spiritual guidance, faith as possible in favor of the Lord. When I reach the
hospital, I went to visit her and talking to her. Then, I gave her this present. I will
never forget her smile and gra tude.
That moment was emo onal and closed with a sincere and long hug. Babbles some
words of farewell and greet last me the mother and le that room leaving part of
my heart behind.
The following days were of reﬂec on and recollec on, the small great woman
achievement recover from their ailments and get on with life as it was what I heard
months. I, for my part, learned the beauty of our career. The interac on with our
neighbors, and I understood that those small details that touch the heart, are an
engine and reason to go ahead and give thanks for the day to day.
A lesson we should all keep in mind.
JANUARY 2015 • lexiconin.com
NEW TRUTH
As the decades pass by, India becomes a more prominent capital in the world of
diabetes mellitus. Diabetes; an endocrine disorder that leads to increased blood
glucose level; hyperglycaemia due to a rela ve or absolute deﬁciency of the
hormone, insulin. Insulin is secreted from the beta cells of the Islets of Langerhans
situated in the pancreas.
My New Pancreas
By Nikita Agarwal
Final year MBBS,
Kasturba Medical College, Manipal
The dual system ar ﬁcial pancreas also delivers glucagon, (the insulin antagonist
h o r m o n e ) t h at p reve nt s hy p o g l yca e m i a i n t h e d i a b e c p a e nt s .
Over the three visits of the 24-hour monitoring in the cross-over type RCT, it was
found that the dual system helped in preven on of hypoglycaemia be er than the
insulin only automated pumps.
The stagnant life-style usually predisposes a person to Type II diabetes, previously
known as NIDDM (i.e., Non-Insulin Dependent Diabetes Mellitus). There is a
rela ve deﬁciency of insulin, in the sense that the amount present in this condi on
is just not enough to cope up with the increased requirement by the body.
Obviously, since the increased insulin resistance can be reduced by a number of
methods ranging from exercise to hypoglycaemic or an -hyperglycaemic agents,
insulin supplementa on isn't an obliga on.
The problem with Type I, or IDDM (Insulin Dependent Diabetes Mellitus) is that
there is absolute reduc on in the amount of insulin in the body which makes
supplementa on of the hormone to the pa ent a bare necessity. This reduc on
happens due to injury to these beta cells, which is auto-immune in nature.
It can be called Islet Cell Failure where there's no produc on of insulin and the
pa ent requires a 'new' pancreas. (To be noted, the exocrine func on may also be
aﬀected in cases of chronic pancrea s). This can be done by using an ar ﬁcial
pump that delivers insulin to the body in response to either the pa ent's blood
glucose level or via a pre-set mer that delivers the drug at the es mated me of
food consump on.
In the era of 'over-treatment' where diabe cs suﬀer more from the treatment than
from the disease itself, the new pancreas seems to give them a ray of hope that may
help them to live a near normal life. It is expected to make its appearance in the
market in the next 5-7 years. The stem cell research that is being undertaking at
Harvard has also shown great promise in a possible 'cure' of type I diabetes
mellitus. Who knows in the future, we might just have a diabetes (type I) free world
a er all!
Over the years of the varied treatment modali es that have developed to control
the blood glucose level in diabe cs, hypoglycaemia is the new complica on that
has surfaced as a part of treatment. The majority of Type I diabe cs are young
individuals and o en children where the calorie (read glucose) intake is
unpredictable. This increases the chances of the most dreaded side-eﬀect of
insulin, hypoglycaemia. That can in turn lead to varied complica ons like confusion,
disorienta on and, in extreme cases, loss of consciousness, coma and seizure.
To combat this, a trial was conducted by researchers at the Clinical Research
Ins tute of Montreal and the University of Montreal (IRCM) which was done to
compare the eﬀec veness of two versions of an external ar ﬁcial pancreas with
conven onal insulin-pump therapy in helping type 1 diabetes pa ents control their
glucose levels.
JANUARY 2015 • lexiconin.com
NEW TRUTH
A Shot at Celiac Disease
Trusha Taneja
Pharm.D., Nova Southeastern University
H
ow much do you like your bread? What about food processed from bread,
such as pizza, muﬃns, or the Indian staple ro ? If you had to, would you be
able to give it up? This is the plight of over 3 million people in the United
States and about 1 in every 100-300 worldwide. Gluten-intolerance or Celiac
disease is an immunological form of enteropathy, in which an autoimmune
response to gliadin, a gluten protein is triggered in the body by the consump on of
wheat and wheat-containing products.
Since a remedial drug is yet to be discovered, pa ents insensi ve to gluten only
have the op on of elimina ng it from their diet. This means adop ng a stringent
diet plan for life to ensure complete remission from the ailment. However, owing to
its nature, this treatment plan is hard to comply with and pa ents, more o en than
not, succumb to the challenge.
As such, it is impera ve to ﬁnd alterna ve therapeu c op ons, preferably those
that are restora ve in nature.
One such recent breakthrough is the Nexvax2 vaccine which not only works on
preven ng the autoimmune a ack but also aids in restoring the pa ent's intes nal
health. The goal of vaccine therapy at present is to enable pa ents to resume a
normal diet and reduce the enteropathic inﬂamma on associated with the
disease.
How does it work?
In order to understand the mechanism of ac on of Nexvax2, it is essen al to have a
look at the e ology of the disease. People suﬀering from celiac disease commonly
have a gene c predisposi on towards it. Generally, there is a variant HLA-DQ allele,
which is referred to as the risk allele. Another gene c factor purported to put
pa ents at risk of developing celiac disease is varia on in CD recogni on.
Nexvax2 works by modula ng the immune response to the discrepant gene. The
gluten-speciﬁc T cells are reprogrammed by Nexvax2 by ini a ng a conﬂa on of
three implica ve pep des in pa ents possessing the immune recogni on gene
HLA-DQ2.
Further Advancements
A private biotechnology company, ImmusanT is focused on exploi ng innova ons
in the ﬁeld of immunology in an eﬀort to improve the diagnosis and treatment of
celiac disease and ameliorate the pa ent's health and quality of life. It has ini ated
Phase 1b clinical trials of Nexvax2 in New Zealand, Australia and the United States.
These are dose determining studies used to evaluate ascending doses of the
vaccine under considera on, necessary to induce gluten tolerance in pa ents on a
gluten-free diet. Further, these clinical studies will also assess the safety,
tolerability and the pharmacokine c proﬁle of Nexvax2.
ImmusanT is aiming for a 2017 mass market launch of the vaccine. If all clinical
endpoints are met and its safety and eﬃcacy is established, the vaccine would
serve as a boon to innumerable suﬀerers of celiac disease, who have been deprived
of a nourishing diet owing to the pernicious ailment.
References:
1
.
World Gastroenterology Organisa on (WGO) Prac ce Guidelines: Celiac Disease
2
.
New Advances in Celiac Disease (h p://www.jove.com/blog/2013/02/19/newadvances-in-celiac-disease-treatment)
3
.
ImmusanT Ini ates Clinical Trials of Nexvax2 Therapeu c Vaccine for Celiac Disease
(h p://www.prnewswire.com/news-releases/immusant-ini ates-clinical-trialsof-nexvax2-therapeu c-vaccine-for-celiac-disease-168439876.html)
4
.
Celiac Disease (h p://en.wikipedia.org/wiki/Coeliac_disease#Cause)
5
.
Nexvax2 (h p://en.wikipedia.org/wiki/Nexvax2)
JANUARY 2015 • lexiconin.com
NEW TRUTH
“Des ny with a sense of humour”- went the tagline for the famous movie
Serendipity. I could co-relate this innumerable mes in the ﬁeld of Pharmacology. I
think about a speciﬁc drug and then chuckle at its usefulness in some unknown
disease. Be it an accidental discovery of Penicillin: the wonder drug, or roden cide
warfarin that became a life-saving drug; also sildenaﬁl that was used to lower blood
pressure was later known to us as Viagra.
One such drug that was developed to treat B-cell lymphomas but showed eﬃcacy
in Auto-immune is 'Rituximab'. It all started in 1991, when IDEC Pharmaceu cals
developed a gene cally engineered an body against CD-20, present on B-cells.
They combined human IgG 1 kappa an body with Murine an CD-20 an body
isolated from mouse variable immunoglobulin region. Clinical trials took place
from 1993 to 1996. It was in 1995, when big players like Genentech and LaRoche
collaborated with IDEC to manufacture this drug on large scale. Rituximab got its
USFDA approval on 26th November 1997 for its use in CD-20 posi ve NonHodgkin's Lymphoma. It was postulated that rituximab works by 3 modesan body dependant cytotoxicity, complement mediated cytotoxicity and
apoptosis induc on.
Rituximab and Transplant pa ents
In 2005, Genberg et al showed eﬀec ve deple on of B cells in renal transplant
pa ents opening a new avenue for the drug. A er similar posi ve studies many
transplant physicians started using rituximab oﬀ-label for treatment of posttransplant lymphoprolifera ve disorders, preven on of rejec on, ABO
incompa bility and treatment of rejec ons.
Rituximab and Pemphigus Vulgaris
Heizmann et al (2001) used rituximab for the ﬁrst me in treatment of autoimmune
bullous diseases and reported a case of paraneoplas c pemphigus successfully
treated by rituximab. The drug has been eﬀec ve against recalcitrant disease as
reported by many authors.
Rituximab and Mul ple Sclerosis (MS)
Clinical trials for primary progressive and relapsing remi ng type of MS have
shown posi ve results. There was reduc on in relapse rate by 50% in relapsing
remi ng MS and it decreased inﬂammatory response in primary progressive MS.
Due to various adverse eﬀects and small pa ent popula on; it is not likely to be
further developed for FDA approval. However, next-genera on an -CD20
monoclonal an bodies have been developed to build on the encouraging data
from Rituximab's MS studies.
Rituximab and Myasthenia Gravis
Myasthenia gravis is an autoimmune disorder aﬀec ng oculo-bulbar system and
limb weakness. Rituximab is beneﬁcial and well tolerated in managing refractory
myasthenia gravis. An CD-20 an body therapy can become an a rac ve tool for
pa ents' refractory to steroid therapy as proposed by Dr. Richard Nowak of Yale
University.
Rituximab and Autoimmune Hemoly c Anemia (AIHA)
Established data have demonstrated that rituximab is eﬃcacious and eﬀec ve in
treatments of Warm AIHA, especially those resistant to steroid therapy. The
mechanism behind controlling AIHA is not understood. It is proposed that
rituximab helps in suppressing the pathogenic an bodies. Besides Primary AIHA,
Rituximab is shown to be highly useful in pa ents having AIHA associated with
chronic lymphocy c leukaemia or Non-Hodgkin's lymphoma.
Apart from the above diseases, rituximab has been used in treatment of systemic
lupus erythematosus, idiopathic thrombocytopenic purpura, an -neutrophil
cytoplasmic an body associated vasculi s, Grave's disease, hemophilia A, cold
agglu nin disease, Sjogren's syndrome, gra vs. host disease, thrombo c
thrombocytopenic purpura, cryoglobulinemia, IgM mediated neuropathy,
neuromyeli s op ca, idiopathic membranous nephropathy, dermatomyosi s, and
opsoclonus myoclonus. The eﬃcacy varies among diﬀerent autoimmune diseases.
Dr. Nikhil N. Tambe
M.B.B.S. , Instructor (American Heart Associa on)
Lifesupporters Ins tute of Health Sciences, Mumbai
The cumula ve sta s cs suggests that it has a favourable role in their treatment.
While rituximab is very eﬀec ve in the deple on of B cells, current research
suggests it may also inﬂuence other cells of the immune system by re-establishing
immune homeostasis and tolerance. The safety proﬁle reveals that most reac ons
are infusion related. In pa ents with autoimmune diseases the incidence of serious
and severe side eﬀects is low.
Protocols for treatment in NHL and RA are established. Protocols for individual
auto-immune diseases need to be devised a er carrying out thorough clinical
trials. Already, an improved humanized version of rituximab that might decrease
the likelihood of development of neutralizing human an bodies against the
chimeric murine por on of the molecule and facilitate chronic dosing is currently in
clinical trials.
Rituximab which was developed for trea ng B cell lymphomas have been
progressively used for wide array of auto-immune disorders.
Serendipity: Can once in a life me, happen twice?
“Des ny with a sense of humour”
Rituximab and Rheumatoid Arthri s
Edward et al in 2004 used B cell deple on therapy for treatment of Rheumatoid
arthri s using rituximab. In 2006, Rituximab was approved for its use in rheumatoid
arthri s in combina on with methotrexate. Combina on helps reduce the signs
and symptoms caused due to Tumor Necrosis Factor response.
SERENDIPTY CALLED RITUXIMAB
JANUARY 2015 • lexiconin.com
MEMORY INVIGORATION
IT'S ALL ABOUT THE GRAVE EYE!!
By Dr Hiral Mehta
Bachelors in Dental Surgery (BDS)
Currently pursuing- Masters in Public Health at the University of Sheﬃeld, UK
Ever dreaded the endless list of eye symptoms in Grave's disease?? Well Dr Lee is at
your rescue folks!! Just remember Dr LEE and he will do the rest of your job!!
Please Call Dr LEE, I Lost my Blood
Please- Photophobia
Call- Conjunc vi s or Corneal irrita on
Dr- Diplopia
L- Lid lag
E- Exophthalmos
E- Oedema (periorbital)
I – Infrequent blinking
Lost – Limita on in eye movement
Blood – Blurring of vision
A TO I of Cushing's syndrome
Here is an easier way to remember the signs and symptoms of Cushing's
syndrome!!
Hint: Just think of 'cushioning' and remember the fat cushioning (fat deposi on) in
Cushing's syndrome.
A – Amenorrhoea
B – Buﬀalo hump
C – Central obesity
D – Dila on of capillaries
JANUARY 2015 • lexiconin.com
MNEMONICS TO THE RESCUE
MEMORY INVIGORATION
BY CHAITALEE GHOSHALKAR
Second year student of pharmaceu cal management,
SIES College of Management Studies, Nerul.
I am sure many of us have struggled and sweated over diseases with details o en jumbled up in our mind. Personally, I always struggled to remember the side eﬀects of
medicines, so much so that I ended up wri ng nausea, headache and vomi ng for every drug.
There is a way out of the kno y problem, by way of mnemonics.
Let us remember symptoms of various auto-immune
disorders through diﬀerent mnemonic techniques.
I
.
Acronyms:
1
Rheumatoid arthri s- SLIP of joints
S- S ﬀness
L- Loss of mobility
I - Inﬂamma on
P- Pain
3
Celiac disease
Warner Bros. Developed A Cartoon For Males
W- Weakness
B- Bone pain
. D- Diarrhea
A - Anemia
C- Cons pa on
F- Fa gue
M- Muscle cramps
2
.
Allergic granulomatosis and angii s or Churg-Strauss
syndrome
Depending upon organs, symptoms are EVA
E- Eosinophilic phase with weight loss and sweats
V- Vasculi c with pain, numbness & weakness in
extremi es
A - Allergic with asthma, sinus pain, headache
I
I
Acros cs:
1
Thyroidi s with hyperthyroidism
So What? I Dig Ninja Hatori In perputuum.
S- Swea ng
W- Weight loss
I - Increased appe te
D- Diarrhea
– Nervousness
H- Heat intolerance
I – Insomnia
2
Autoimmune pancrea
s
4
Kawasaki disease
.
.
Herbs Roots Bulbs Show Signiﬁcant Success
H- High fever
R- Red eyes
B- Body rash
S- Swollen tongue
S- Sore throat
S- Swollen glands
.
I
I
. Rhyme/poem
1
Systemic lupus erythematosus.
I
.
.
A rash in the shape of a bu erﬂy,
The muscle ache that o en makes you cry,
Ulcers in the mouth and nose,
Poor circula on in ﬁngers and toes,
Inﬂamed pleura and pericardium,
This isn't the work of a bacterium,
Arthri s and low grade fever go hand in hand,
Photosensi vity ensures outdoor visits are banned,
. With fa gue as an added plus,
To o m a n y a s y m p t o m s i n S y s t e m i c L u p u s
Erythematosus.
Jeez! Do We Act Insanely?
J- Jaundice
D- Diabetes Mellitus (recent onset)
W- Weight loss
A - Abdominal pain
JANUARY 2015 • lexiconin.com
MEMORY INVIGORATION
ANEMIA
By Maye Nazario,Peru
Anemia is both a common ﬁnding in world, as well as a non-speciﬁc one. There are
many diﬀerent condi ons that can cause a lower in hemoglobin. As future medical
doctors, it is our duty to inves gate the cause of this, but this task is not an easy one.
The origin of anemia may vary depending on what type of anemia we are facing.
Half public hospitals don't have the resources necessary to cover a ba ery of
laboratory tests, so we have to be "primi ve", conscious and try to order possible
causes according to our presump ve diagnosis.
* ANEMIA: MACROCYTIC = "BIG FAT RED CELLS"
B-B12 Malabsorb on
I-Inherited
G-Gastrointes nal disease or surgery
F-Folic Acid Deﬁciency
A-Alcoholism
T-Thiamin responsive
R-Re culocytes miscounted as large RBCs
E- Endocrine - hypothyroid
D-Dietary
C-Chemotherapeu c Drugs
E-Erythro Leukemia
L- Liver Disease
L- Lesch-Nyhan Syndrome
S-Splenectomy Index
*ANEMIA: NORMOCYTIC = "NORMAL SIZE"
N - Normal Pregnancy
O - Over hydra on
R - Renal Disease
M - Myelophthis c
A - Acute Blood loss
L - Liver Disease
SI - Systemic Infec on or Inﬂama on
Z - Zero produc on - Aplas c
E - Endocrine: Hypothyroid, hypoadrenal, decreased androgen Index
Also, an easier way to understand normocy c anemia!: ABCD:
Acute blood loss
Bone marrow failure
Chronic disease
Destruc on (hemolysis)
*ANEMIA: MICROCYTIC = "TICS"
T - Thalassemias
I - Iron Deﬁciency: Source: GI Bleed 56%, Menses 29%, Diet 19%
C - Chronic Inﬂamma on
S - Sideroblas c -lead toxicity Index
*ANEMIA: HEMOLYTIC : "HEMATOLOGIST".
H - Hemoglobinopathy: Hb SS, SC, S beta Thal
- Hemoglobinuria: Paroxysmal Nocturnal Hemoglobinuria.
E - Enzyme Deﬁciency- Inherited Pyruvate Kinase (PK) deﬁciency and pyrimidine-5'nucleo dase deﬁciency
M - Medica on - Drug induced immune hemoly c anemias
A - An bodies, autoimmune
T - Trauma to the red cells. Fragmenta on (Microangiopathic)
O - Ovalocytosis - This is an autosomal dominant disorder seen in people from
South East Asia. Signs and symptoms are minimal.
L - Liver disease .
O - Osmo c fragility in Hereditary spherocytosis and in Hereditary Eliptocytosis
G - Glucose - 6 - Phosphate Dehydrogenase Deﬁciency (G6PD)
I - Infec on: Intra-erythrocy c parasites (malaria and babesiosis)
S - Splenic destruc on in hyperslenism. Splenomegaly,
T-Transfusion related
- Thalassemias
JANUARY 2015 • lexiconin.com
CEREBRO
THE BIG PICTURE- A QUIZ ON BASIC IMMUNOLOGY
By Sneha NandySETH G.S MEDICAL COLLEGE,
MUMBAI
JANUARY 2015 • lexiconin.com
CEREBRO
4 Pics 1 Autoimmune disease
By Swa Shriyan
Execu ve Editor, Lexicon
The four pictures represent one autoimmune disease. The picture could be of the organ aﬀected, a symptom, one of the dignos c technique used or a possible
treatment op on for the respec ve autoimmune disease.
1
2
3
4
5
6
JANUARY 2015 • lexiconin.com
CEREBRO
4 Pics 1 Autoimmune disease
By Swa Shriyan
Execu ve Editor, Lexicon
The four pictures represent one autoimmune disease. The picture could be of the organ aﬀected, a symptom, one of the dignos c technique used or a possible
treatment op on for the respec ve autoimmune disease.
7
1
8
9
10
4
JANUARY 2015 • lexiconin.com
Answers
CEREBRO
Answer : THE BIG PICTURE
Answer : 4 Pics 1 Autoimmune disease
1. Addison’s disease
2. Juvenile diabetes (Type 1 diabetes)
3. Myasthenia gravis
4. Graves’ disease
5. Crohn’s disease
6. Mul ple sclerosis
7. Pernicious anemia
8. Kawasaki disease
9. Vi ligo
10. Rheumatoid arthri s
JANUARY 2015 • lexiconin.com
EduO
By Sankhya Saroj,
PSG Ins tute of Medical Sciences and Research
The conferences listed below are interna onal conferences chaired by professors from pres gious universi es like Stanford and Harvard. These conferences have a
special edge to them, which is why they deserve to be brought to the a en on of readers.
These conferences allow young budding doctors from the undergraduate and post-graduate level to present in the open among a community of doctors who are
highly experienced in their respec ve ﬁelds. These are namely:
Topic: Advancements in diagnosis, preven on and
management of pediatric diseases and stresses upon General
Pediatrics, Preterm-birth Complica ons and Neonatal
Intensive Care, Pediatric Immunology and Infec ous Diseases,
Pediatric Hematology and Oncology, Pediatric Allergy and
Respiratory Disorders, Pediatric Cardiology and Research,
Pediatric Neurology and Research, Gastrointes nal and
Urogenital Complica ons in Pediatrics, Pediatric Mental
Health and Psychology, Pediatric Emergencies and Trauma
Treatment
Date: May 18-20, 2015
Venue: San Antonio, USA
Type of Event: Conference & Workshop
Registra on Fees: Student - $300
Website Link: h p://pediatrics.conferenceseries.com/
Ÿ
Ÿ
Ÿ
Ÿ
Ÿ
3) Name of the Event:
4th International Conference on Gastroenterology
Brief Descrip on: It is conference focusing on Advances in
Gastrointes nal Diseases, Gastrointes nal Oncology,
Gastrointes nal Surgery, Advances in Liver Diseases,
Gastrointes nal Immunology, Clinical Nutri on in
Gastrointes nal Disease, Endourology- Clinical Update,
Neurourology & Urodynamics, Urologic Oncology, Pediatric
Urology
Date: July 20-22, 2015
Venue: Florida, USA
Type of Event: Conference/Workshop/Lecture/Others
Abstract Submission dates (if any):
Registra on Fees: $300
Website : h p://gastroenterology.conferenceseries.com/
Ÿ
Ÿ
Ÿ
Ÿ
Ÿ
Ÿ
Events & Activies
1) Name of the Event:
3rd International Conference on Pediatrics
2) Name of the Event:
2nd International Conference and Exhibition
on Rhinology & Otology
Theme: “Implica ons and Current concepts in the ﬁeld of
Rhinology & Otology and includes topics like, Anatomy and
Physiology of Ear and Nose, Anatomical and Physiological
Disorders of Nose, Rhini s and Rhinosinusi s - Types and
Treatment, Sinonasal Disorders and Surgical Treatment,
Common Cold- Causes and Treatment, Sinusi s- Types and
Treatment, Ear Disorders, Diseases of Middle and Inner Ear,
Hearing Impairment and Deafness- Causes and Treatment,
Endoscopy, Diagnosis and Imaging Techniques, Surgical
Approaches for Nasal Disorders, Surgical Approaches for Ear
Disorder, New Treatment Approaches for Hearing Disorder,
Surgical Approaches for Larynx in Adults and Pediatrics, ENT
Infec ous Diseases, Anesthesia and Pain Relief in ENT Surgery
Ÿ
Ÿ
Ÿ
Ÿ
Ÿ
Date: March 18-20, 2015
Venue: Dubai, UAE
Type of Event: Conference/Workshop/Lecture/Others
Registra on Fees: $249
Website Linkh p://otolaryngology.conferenceseries.net/
4) Name of the Event:
World Congress on Hepatitis
Brief Descrip on: “Raising global awareness on hepa s and
ﬁgh ng the s gma surrounding the disease” with topics
including
Hepa s : Care and Cure, Diagnosis and Assessment of Liver
Diseases, Liver Pathology / Case Studies, Liver Cancer and
Hepatocellular carcinoma, Advanced Management of Liver
Diseases, Clinical Liver Transplanta on and Liver Surgery,
Eﬀect of Industrial Pollutants on Hepa s, Advancement in
New Drug Discovery for Treatment of Hepa s, Advance
Technologies for the Treatment of Hepa s, Current Research
in Hepatology
Ÿ
Ÿ
Ÿ
Ÿ
Ÿ
Date: July 20-22
Venue: 2015 Florida, USA
Type of Event: Conference/Workshop/Lecture/Others
Registra on Fees: 300$
Website Link: World Congress on Hepa s
5) Name of the Event:
International Conference on Parkinson’s disease and Movement Disorder
Brief Descrip on: “Leading innova on and remedial insight of Parkinson’s disease” with topics including Causes and Impacts for Parkinson’s
disease, Parkinson’s disease symptoms and diagnosis, Novel Therapy and Advances in Drug Treatments for Parkinson’s disease, Basic Science,
Life with Parkinson', Cogni ve disorder. Hun ngton’s disease, Vascular Factors in Parkinson’s disease, Ataxia and Clinical
manifesta ons/pathophysiology
Ÿ
Ÿ
Ÿ
Ÿ
Ÿ
Date: August 11-13, 2015
Venue: Frankfurt, Germany
Type of Event: Conference/Workshop
Registra on Fees: $300
Website Link: h p://parkinsons.conferenceseries.com/
JANUARY 2015 • lexiconin.com
LEXIGYAAN
Food Fights!
By Haleema Munir
4th year, M.B.B.S, Allama Iqbal Medical College, Lahore, Pakistan
An apple a day, keeps the doctor
away: who knew that this quote
might one day actually lead up to a
scien ﬁc theory! It is thought that
several environmental factors may
trigger the body into a state where it
is unable to diﬀeren ate between
friends and foes. One of the major
environmental factors that may set
oﬀ autoimmunity is the food we eat.
Bioﬂavonoids are a class of
chemicals found in plants that has
been recently discovered to reduce
inﬂamma on that is the major
pathology underlying the numerous
clinical manifesta ons of
autoimmune diseases. Apples and
tea are at the top of the list of the
foods that contain bioﬂavonoids like
querec n and theaﬂavin.
Carotenoids in the carrots and
prostaglandin-ﬁgh ng abili es of
ginger have been shown to ward oﬀ
inﬂamma on. Well-known for their
role in promo ng general health,
ﬁbers and omega-3, show good
promise in comba ng
autoimmunity.
So, as Lexiamma puts it, “Eat well,
and stop a acking yourself!”
JANUARY 2015 • lexiconin.com
LEXIGYAAN
I had an American friend who was here in India for a month stay. She stayed in our
house quarter as a pay guest. During breakfast when I oﬀered her chapa which we
used to have daily but to my surprise, she kindly refused to have it and asked for
some cornﬂakes. Fortunately I had some and gave it to her. Later that day she told
me that she was suﬀering from gluten intolerance and her mother also had the
same. I was really curious about it and what type of disease it was. Well I gathered
some informa on about it and want to share it with you all.
So here it goes beta aur be s:
What is Gluten?
It is a type of protein found in wheat and wheat products like rye, barley etc.
Then what is Gluten Intolerance?
This term might be new for many of us. As gluten intolerance is more common
among people from western part of the world and it is es mated that as much as
15% of the US popula on is gluten intolerant.
At ﬁrst the symptoms are mild and go unno ced but later manifests with variety of
symptoms that can even turn into fatal disease.
So, how to know if we are intolerant to gluten?
If we have any of the following symptoms it could be a sign that we can have it:
1. Gastric problems such as gas, bloa ng, diarrhea and even cons pa on.
Cons pa on is seen par cularly in children a er ea ng gluten containing food.
2. Keratosis Pilaris, (also known as ‘chicken skin’ on the back of the arms). This is as a
result of a fa y acid deﬁciency and vitamin A deﬁciency secondary to fatmalabsorp on caused by gluten damaging the gut mucosa.
3. Fa gue, brain fog or feeling red a er ea ng a gluten meal.
4. Diagnosis of other autoimmune disease such as Hashimoto’s thyroidi s,
Rheumatoid arthri s, Ulcera ve coli s, Lupus, Psoriasis, Scleroderma or Mul ple
sclerosis.
GLUTEN INTOLERENCE
BY Rika Rjl
KEEP
CALM
AND
SAY NO TO
WHEAT
5. Neurologic symptoms such as dizziness or feeling of being oﬀ balance.
6. Hormone imbalances such as Premenstrual Syndrome, unexplained infer lity.
7. Migraine headaches.
9. Inﬂamma on, swelling or pain in the joints of ﬁngers, knees or hips.
The only way to treat gluten intolerance is restric on and only restric on from
gluten containing food. Even a trace amount of it can be enough to cause immune
reac on in the body. We can also look up for other alterna ve food items that are
equally nutri ous as the gluten rich food. Lets eat healthy and live healthy.
So from that day onwards I used to cook her rice and curry instead of bread and she
happily seemed to enjoy it. She also informed me that there are special menus in
the restaurant where they have indicated gluten free food which becomes easy for
her and many like her suﬀering from such disease.
Source:www.mindbodygreen.com
8. Diagnosis of chronic fa gue or ﬁbromyalgia.
JANUARY 2015 • lexiconin.com
LEXIGYAAN
Low-carb diets, also more commonly referred to as the ‘Keto Diet’ or ‘Ketogenic
diet’, have shown surprisingly good and superior results as compared to other
contemporary diets. Earlier, thought to be meaningless diets, studies have shown
the beneﬁts of Keto diet plans. In addi on of encouraging weight loss, it leads to
signiﬁcant improvements in risk factors such as reducing cholesterol, blood
pressure and controlling diabetes & Polycys c Ovarian Syndrome (PCOS).
A keto diet, involve following a higher fat, moderate protein, low carbohydrate food
plan. About 70-75% of calories are from fat, 20-25% from protein, and 5-10% from
carbohydrates.
Here are several beneﬁts to adop ng a low carb diet:
•
Low-Carb Diets contain your hunger: Hunger is regarded as the singular prime
nemesis to a diet. However, when people cut carbs, their appe te tends to go down
and they o en end up ea ng much fewer calories without trying.
•
Low carbs lead to increased weight loss: The reduc on of carbs is seen as the most
simple and eﬀec ve way to lose weight. Almost without excep on, studies have
shown the superiority of low carb diets as compared to others. And, this fast loss is
seen around abdominal areas.
•
Decrease in Triglycerides(fat molecules) : Since the body draws energy by burning
up fat in the absence of carbs, there is a no ceable decrease in triglycerides (a wellknown factor of heart disease)
•
Reduced Insulin and Blood Sugar Levels : This is especially prevalent in type 2
diabetes. Since the best way to reduce blood sugar and insulin levels is to reduce
intake of carbohydrates, such diets are instrumental in controlling type II diabetes,
and also helps to deal with insulin resistance in case of PCOS.
•
Decrease in Blood Pressure: Studies have shown that reducing carbs leads to a
signiﬁcant reduc on in blood pressure decreasing the risk of hypertension, which
should lead to a reduced risk of many common diseases.
•
Mood stabiliza on: Ketone bodies have been shown to be beneﬁcial in stabilizing
neurotransmi ers such as serotonin and dopamine which result in be er mood
control.
Before you start a keto diet, you should deﬁnitely read and talk to your physician
about it.
Have you ever tried a low carbohydrate diet? What were your experiences, either
posi ve or nega ve?
The KETOgenic DIET
By, Spandita Ghosh,
Correspondent, KPC Medical College & Hospital
Image 1 : h p://www.ketogenic-diet-resource.com/ketogenic-diet-plan.html
References :
1
h p://www.ketogenic-diet-resource.com/ketogenic-diet-plan.html
2
h p://authoritynutri on.com/10-beneﬁts-of-low-carb-ketogenic-diets/
.
.
JANUARY 2015 • lexiconin.com
For those who came in late, autoimmune diseases are, as the name suggests, a
group of disorders wherein your body develops an immune response against itself.
The defence mechanisms in your body normally responsible for keeping infec ons
and invasions at bay turn on the host and the results are not pre y. Most
autoimmune diseases a ack mul ple organ systems contribu ng to severe
discomfort. Joints, muscles and even nerves are shredded causing excrucia ng
pain and disability. The smallest secondary infec on can trigger weeks or months of
hospitaliza on. The lack of worldwide knowledge about autoimmune diseases
means that they are o en misdiagnosed or dismissed by healthcare professionals.
Co workers, friends, and rela ves too, being unaware of what the illness entails,
o en expect the pa ent to stop whining or complaining, believing the disorder to
be only ‘in their minds’.
“This is my life: Pain 24/7/365. There is not a second that I am not in pain. Every
second, of every minute, of every hour, of every day. I've learned to sublimate a
great deal of it. The constant, low-grade, eternal pain has simply become a way of
life. I don't really even no ce a lot of it - un l it starts grinding me down, which
happens a few mes a day, as the pain meds wear oﬀ. But then there are the days
when nothing works. When every joint, every muscle, every nerve ending shrieks
at me at 120 decibels. When my brain ceases to func on and I can't think, can't
form a coherent sentence, can't concentrate for more than 20 seconds on anything.
When my balance goes to hell and I ﬁnd myself falling for no apparent reason. This
is my "normal." And no one can see it.” – Aji.
The above excerpt is from an ar cle (link given below) wri en by an autoimmune
disease suﬀerer. Aji narrates the struggles of her day to day life and how she has to
be extremely careful with her health. Her story is one among hundreds found
online in various forums and autoimmune disease support groups. They make for
some very compelling reading and demand greater understanding for suﬀerers of
this tanic group of illnesses. Autoimmune disease pa ents walk on a knife edge in
terms of resilience and despair, and every passing day tests that resilience just so
much more. There are stories of pain, of giving up and giving in to the urge of ending
it all, but also strong messages of hope and surviving. There is also a persistent
clamour for health care providers to not be dismissive of pa ent complaints, and it
is a call worth responding to.
-Dr. Rohin Manipur
Dr. House – knowyourmeme.com
For the working professional, few things are worse than a Monday. The weekend
wears oﬀ, and a long work week stares you in the face. It is diﬃcult to get your body
out of bed, and contempla ng work makes it worse. You move around your house
possessed by a debilita ng desire to simply not do things. Why work when you’d
rather recline in bed watching one of a hundred Sooryavansham reruns that Sony
Max airs. You grumble about your bad luck, curse the men who didn’t invent
something like a three day weekend, and generally mill around breakfast in a dour
mood while your re red parents simply laugh, ask you to get a move on and stop
feeling sorry for yourself. You might not feel like it in that moment, but you’re
actually having it pre y easy.
Now imagine every moment of the rest of your life as a Monday morning. Aside
from the chill that just ran down your spine, think about what that would be like.
Forever having a chronic desire to remain in bed and not do anything, despite
knowing that you had to do something worthwhile. This would be accompanied by
the feeling that the foreseeable future had nothing be er in it. No weekends either.
You would look upon your life as one uninteres ng and painful experience, and
hope that things were diﬀerent. You’d also be derided by the people around you
and asked to stop feeling sorry for yourself. Crank all that up about ten mes.
Welcome to the world of the autoimmune disease suﬀerer.
MAYBE IT IS LUPUS
Despair – Despair 2 by TheCraftyDen
THE CODE WAR
Every year hundreds of autoimmune disease suﬀerers end their lives, unable to
bear the burdens of living with their condi ons. The maladies have no cure, and
medica on oﬀers li le solace. They o en lead secluded lifestyles, wary of catching
an infec on that might exacerbate their symptoms. They, along with their families,
sacriﬁce much in trying to live as normal a life as they can. As health care providers,
we must strive towards providing greater understanding and support for these
pa ents.
To know more about how an autoimmune disease suﬀerer spends her day, check
out
h p://www.dailykos.com/story/2010/10/24/910538/--160-KosAbility-160-ButYou-Look-So-Normal-160-Living-With-Mul ple-Autoimmune-Disease
JANUARY 2015 • lexiconin.com
THE CODE WAR
H
ello! I am a thyroglobulin an body and my name is TgAb. It is ﬁ ng that I
narrate this story for it was my discovery in the rabbit’s blood that made Dr
Noel R Rose, the Father of Autoimmunology. I remember it was just
another day in the laboratory circa 1957. Dr Noel R. Rose was quietly working at his
desk on the rabbits. Li le did he know that by the end of this experiment he and Dr
Ernest Witebsky would be making a discovery that will change the face of medicine.
Dr Noel Rose
Image source:
h ps://d3n8a8pro7vhmx.cloudfront.net/cooperformaryland/pages/51/a achm
ents/original/1385170790/NoelRose.jpg?1385170790
It was Dr Witebsky suggested that they work on the thyroid gland because he had
some experience sugges ng that it had a very powerful organ-speciﬁc an gen. The
substance speciﬁc for the thyroid is a protein called thyroglobulin. It could be
denatured very easily, and Dr Witebsky wanted Dr Rose to prepare thyroglobulin in
a natural state. At that me, it was assumed by everybody that an animal could not
respond immunologically to one of its own proteins. So he prepared thyroglobulin
from rabbit thyroid and tested it by injec ng it into another rabbit. It was assumed
that if he had prepared it well and it had not denatured, the animal would fail to
respond. This was the pivotal test.
The results were devasta ng: They found me!!!The rabbit had produced an body
speciﬁc for thyroglobulin. Is it actually possible that an animal can respond to its
own an gen? Under the microscope, the thyroid was severely inﬂamed. Dr
Witebsky insisted that the next step was to inject rabbit thyroglobulin into the very
same rabbit. With the help of an adjuvant they could induce immunity in this rabbit
as well. They ﬁnally realized my importance and the fact that they had that they had
essen ally induced an autoimmune disease experimentally.
An bodies a acking thyroid
Image source:
h p://img.webmd.boots.com/dtmcms/live/webmd_uk/consumer_assets/site_i
mages/ar cles/health_tools/thyroid_symptoms_and_solu ons_slideshow/an b
odies_a acking_thyroid.jpg
So what exactly happened? The lymphocytes failed to iden fy that the injected
thyroglobulin was a part of the body’s own self an gen system and recognized it as
a foreign ar cle. Thus they produced me and my abnormal fellow an bodies that
then a acked the healthy thyroid ssue. In humans a similar process occurs where
an bodies against thyroid peroxidase or thyroglobulin and TSH receptors are
produced which results in diseases we call Hashimoto’s thyroidi s and Grave’s
disease.
The next major discovery was the gene c basis of autoimmune disease. Dr Rose
showed for the ﬁrst me that something called the major histocompa bility
complex contains the main genes determining the risk of all autoimmune disease.
The major histocompa bility complex (MHC) is a set of cell surface molecules
encoded by a large gene family which controls a major part of the immune system
in all vertebrates. MHC molecules mediate interac ons of leukocytes with other
leukocytes or with body cells. The MHC gene family in humans is divided into three
subgroups: class I, class II, and class III which encode for proteins for an gen
presenta on and processing along with complement proteins to ini ate the
cascade. Human MHC class I and II are also called human leukocyte an gen (HLA).
The A, B and C genes belong to MHC class I, whereas the six D genes belong to class
II. For Hashimoto’s thyroidi s HLA-DR5 and CTLA-4 genes are most strongly
implicated.
On a molecular level, in their development in the thymus and bone marrow,
lymphocytes are selected to recognize MHC molecules of the host and thus not
recognize them as foreign an gens. But something goes awry in the autoimmune
thyroidi s.
The Intolerant Bodies
By Ashwini Ronghe ,
Grant Medical College, Mumbai
Mechanism of Thyroidi s
Image source: h p://www.nature.com/nri/journal/v2/n3/images/nri750-f5.gif
All forms of thyroid autoimmunity are
associated with a lymphocy c inﬁltrate in the
thyroid. These lymphocytes are largely
responsible for genera ng both T- and B-cellm e d i ate d a u to re a c v i t y. T h e i n i a l
autoimmune response by CD4+ T cells
appears to up regulate the secre on of
interferon-gamma resul ng in enhancing the
ex p re s s i o n o f M H C I I m o l e c u l e s o n
thyrocytes. This most likely triggers the
expansion of autoreac ve T cells and gives
rise to the characteris c inﬂammatory
response, and as the disease progresses,
thyrocytes are targeted for apoptosis resul ng in hypothyroidism. Graves’ disease
on the other hand represents the other end of spectrum wherein the pa ents
suﬀer from hyperthyroidism. The ac va on of thyroid speciﬁc CD4+ T cells leads to
the recruitment of autoreac ve B cells and the moun ng of thyroid s mulatory
immune response via an thyroid an bodies. Autoimmunity is thus a failure of selftolerance-a mechanism by which the cells are “educated” in the bone marrow and
thymus.
However it’s not just the genes. Environmental factors like excessive iodine intake
or selenium deﬁciency, radia on exposure, smoking, stress releasing cor sol
causing immune hyperac vity and certain infec ons like HHV-6 along with drugs
cause molecular mimicry and have also been implicated in autoimmune thyroidi s.
But they have to be inves gated in detail.
So you see tolerance is the key. The immune system couldn’t tolerate the an gen
and I ended up wreaking havoc in your body. It is certainly an interes ng point, isn’t
it? In an eﬀort to destroy the supposedly foreign an gen, the immune system
launched a full blown a ack and ended up damaging its own cells. Something we all
can apply to our lives, can’t we?
The most important thing to understand is an autoimmune condi on is not a
disease but a survival mechanism for the body. A clear understanding of this
mechanism can help us tackle these condi ons and develop treatments for the
same. For even broken crayons can s ll color right?
References:
1)
h p://hub.jhu.edu/gaze e/2014/july-august/what-ive-learned-noel-rose
2)
CHRONIC THYROIDITIS AND AUTOIMMUNIZATION. Ernest Witebsky, M.D.; Noel R.
Rose, Ph.D.; Kornel Terplan, M.D.; John R. Paine, M.D., Ph.D.; Richard W. Egan, M.D.
JAMA. 1957;164(13):1439-1447. doi:10.1001/jama.1957.02980130015004.
3)
Autoimmune Thyroid Disorders, M. A. Iddah and B. N. Macharia ISRN
E n d o c r i n o l o g y, v o l . 2 0 1 3 , A r c l e I D 5 0 9 7 6 4 , 9 p a g e s , 2 0 1 3 .
doi:10.1155/2013/509764
4)
h p://en.wikipedia.org/wiki/Major_histocompa bility_complex#Class_I
5)
h p://en.wikipedia.org/wiki/Hashimoto's_thyroidi s
6)
h p://en.wikipedia.org/wiki/Autoimmune_thyroidi s
JANUARY 2015 • lexiconin.com
THE CODE WAR
“What happened to my Biju?” asked the old man, vehemently following us a er the
admission of his 21-year-old grand- son with a diagnosis of Behçet's disease. As we
sat down in the counselling room to address his concerns, I could not help but
no ce the worry, hidden beneath the wrinkles on his forehead. As his frail hands
shook, struggling to pull a chair, his silver hair spoke of the youth they had once
seen. Biju's parents had passed away in a road traﬃc accident leaving the weight of
their only child's responsibili es on his shoulders, which have grown weary of
carrying their own. “Why should something so strange and ugly befall on his
innocent child? Doctor, why is my Biju falling apart?” He persisted for answers.
His pensive eyes reminded me of my professor in Medical School who once
explained to us, passing to be a doctor isn't answering to a blank sheet of paper in
an exam but it is to answer real pa ents who will confront you 'a er the exam'. The
blank sheet was so much easier to write upon. It never ques oned.
He pa ently waited for me to answer as I ﬁlled the air with calmness. How could I
explain to him that there are 'none'? Well, we have found some genes to blame but
no body really knows why would body ﬁght against itself or against substances that
do no harm. To me, it is completely understandable that mankind which otherwise
is in conﬂict with answers from common cold to keeping interna onal peace
agreements should be able to answer these ques ons but the old man wouldn't
take it for an excuse. I had a degree to uphold and I am supposed to know answers
that were never taught to me.
Friend and Foe Alike
-Dr. Raviteja Innamuri
Soul Surgeon CMC, Vellore.
The ques on remains why would our bodies ﬁght themselves or harmless
substances under any circumstances? Why do we ﬁght in our homes, with our
society, country, world and our own species? Why has the incidence of the autoimmune diseases increased in the recent mes? Is auto- immune an expression of
unresolved conﬂicts both within and outside our bodies?
Perhaps, answers are at sight only if we willing to look for the ﬁre rather than
disarming the smoke alarm through immunosuppressants. With technological
advancements, humans have adapted to live in a cleaner ar ﬁcial world of their
own (including social networks) missing out on the tender care and dirt of Mother
Nature, which would otherwise adopt us to be er survival and acceptance of
fellow organisms in the natural world. Are we progressing more rapidly than our
minds and bodies are des ned for or perhaps in the wrong direc on? Will
resolu on of this problem externally bring a peace internally as well? This me, I
am willing to wait for an answer.
This ar cle was wri en on a compara ve note between the psychology of man and
auto- immune disorders explaining both, at the same me.
I asked the gentleman, “Sir, are you aware of what the Indian army does?”
“Ah? Hmm, yes doctor, it protects us from our enemies?” he replied pensively.
“Who are these enemies, Sir?”
“Enemies are the ones outside the Indian border. They do not belong here and are
trying to harm us,” he said eloquently.
“And what would happen if the very same army begins to a ack us, Indians?”
“Everything would collapse, everything would fall apart,” he said, bringing his head
down decreasing his tone with each passing word. “Thank you doctor,” he said and
shuﬄed out of the room.
Since birth, we are struggling to establish boundaries that deﬁne us, ini ally from
the mother and then the world. Similarly, our immune system also learns to
dis nguish self from non-self. We deﬁne ourselves but don't remain completely to
ourselves either. Just as we grow tolerant with the mul tude of human rela ons
that we develop over a life me, our bodies on the inside too enter a symbio c
rela onship with the millions of organisms ('human micro biome') in the oral cavity,
intes ne etcetera and remain immune tolerant to them (without a acking them).
As we remain suspicious of strangers and keep ourselves on guard both on the
inside and the outside, all it takes is just enough confusion in diﬀeren a ng friends
from foes who closely resemble each other. In this molecular mimicry, we could
end up hur ng ourselves if we a acked our friends by mistake (as in Rheuma c
fever where an bodies to strep a ack the valves and joints) or through an
exaggerated response to enemies (super an gens) that might bring damage to our
walls as well. Just as we learn to curtain our weaknesses, we provide immunologic
privilege to an gens that we fail to develop tolerance for such as the lens and the
sperm.
Life teaches us to recognize friends and foes carefully and so with me, we did learn
to ﬁnd these substances that ac vate these responses and avoid them. Like all
great lessons learnt during crisis, we (Sir Harold Ridley) also learnt during World
War 2 that sha ered canopies in the eyes of pilots remained inert and began to use
PMMA for cataract opera ons and other similar substances for various surgeries.
The complica ons of these diseases that we call auto- immune are innumerable
aﬀec ng a single organ to several systems in the body having consequences into
the biological and social life of the aﬀected individual- from how his liver would
detoxify to how his brain would perceive the world around him. Since we do not
know the exact reason for the friendly cross- ﬁre, we suppress their mighty force by
disarming them (inhibi ng eﬀector mechanisms such as cytokine blockade),
further decrease their numbers (using steroids) and if necessary, kill them (by
hiring an external agency (immunoglobulin). The course of auto immune diseases
is embedded with mul ple relapses and recurrences and every me we ﬁght back,
ﬁnding no way to make peace with the traitors.
JANUARY 2015 • lexiconin.com
History Revisited
Robo cs and Minimal Invansive Surgery: One look to the past and future
By Óscar Alberto Castejón Cruz. M.D.
Choluteca Regional Hospital. Honduras. Central America.
The history of the surgery is as old as man's life on the earth, being the surgical procedure of the oldest therapeu c
procedures.
No medical act is possible without the knowledge of the previous steps -even failed minds that reﬂected on the
problem. Therapy tends to be increasingly less aggressive, non-invasive and, speciﬁcally, in the surgery is looking
for minimum holes for your realiza on.
The great ﬁgures of the surgery of the Arab Middle ages were Abulcasis (Abul Qasim al-Zahrawi, 936-1013), born in
Medina Azahara, on the outskirts of Cordoba and Albahad Mamad (939-1020). The works of Abulcasis (Al-Tasrif)
contains all the know the surgical me by way of encyclopedia.
The surgery does not develop un l the twel h and thirteenth centuries. In the thirteenth century, the studies of
surgery more important are carried out around Bologna, where it creates a school of surgery. The most important of
the surgeons is Lanfranci in Milan, who wrote a surgery magna, which is an encyclopedia of the surgical know un l the
thirteenth century.
Despite all these advances produced in previous centuries, the surgery of the nineteenth century will face several
problems: the pain, infec on and hemorrhage, which dodge with three new discoveries: the anesthesia, the an sepsis
and hemostasis. The surgery of the twen eth century, once solved the problems, it had a rapid development, which
include: the use of an bio cs for prophylaxis and treatment postop, transplanta on and laparoscopic surgery.
Laparoscopia surgery is a surgical technique that is prac ced through small incisions, using the assistance of an op cal
system that allows the medical team see the surgical ﬁeld within the pa ent and act in the. Calling these techniques of
minimally invasive surgery or minimalinvasive, because avoiding the big cuts of
scalpel required by open surgery or conven onal and make it possible, therefore, a
postopera ve period much more rapid and comfortable applied in a mul tude of medical
special es because it is a global concept that frames today to almost all the disciplines. In
addi on, framed amplitude of techniques including endoscopy, or laparoscopic surgery and
percutaneous. These therapeu c approaches are very complementary, and increasingly are
applying combined for the treatment of individual cases, thus oﬀering a number of advantages
over tradi onal open surgery:
Dras c reduc on in pain.
Accelerated recovery / return to walking and daily ac vity.
Reduc on of the intensive care unit and hospital stay.
Improves postopera ve pulmonary func on.
Improvement of the quality of life of life.
Reduc on in the need for inpa ent cardiac rehabilita on.
Highly improved aesthe c results.
The minimal invasive surgery is considered to be one of the most outstanding scien ﬁc advances of the last 10 years. There are many hospitals in which surgeons operate
si ng 15 meters from the table that is the sick. Aided by robots, specialists achieve fantas c results. In addi on, the use of the navel to make the interven on or the use of
natural oriﬁces (mouth or vagina) to remove the whole organ is revolu onizing surgery.
JANUARY 2015 • lexiconin.com
History Revisited
Gou e Asthénique Primi ve: How we came to know about Rheumatoid Arthri s.
By Shinjini Chakraborty
Introduc on
The most signiﬁcant contribu on of the historical development in understanding rheumatoid arthri s was the segrega on
of its ae ology and pathophysiology. Rheumatoid arthri s (RA) is an autoimmune condi on in which, the synovial joint is
inﬂamed. Osteoarthri s is characterised by way of wear and tear of the joint, while gout is accumula on of uric acid
crystals in the joints. This ae ological isola on was a result of years of research and inquisi on into the human physiology,
and began way back in 1500 BCE. The entwined path of this discovery would fascinate one, when the brief history of
autoimmune disorders is looked at.
The likelihood to incidence of this disease was ﬁrst indicated in the Ebers Papyrus. Egyp an mummies were magniﬁcent
examples of rheumatoid arthri s case studies, and its prevalence was quite an intriguing aspect to suspect a possibility of a
newer variety of disease pathology. Hippocrates a empted to describe arthri s in the vaguest form around 400BCE, but
couldn’t idealise the dis nc veness that the various forms were vested with. In India, the Charak Samhita took to
describing the cardinal signs of inﬂamma on with an arthri c condi on, namely dolor (pain), calor (heat), rubor (redness),
and tumor (swelling). However, the ﬁ h cardinal sign, func on laesa, or loss of func on was an impera ve to this condi on
and not reported. In 129 CE-219 CE, rheuma smus was a nascent introduc on to the yet indis nguishable disease and one
may ﬁnd Galen’s involvement in the same. In the late 15th and early 16th centuries, Paracelsus crudely described
accumula on of substances in joints that couldn’t make ay through urine.
In Art and Paleopathology: Looking at Rheumatoid Arthri s
Source: h p://www.ncbi.nlm.nih.gov/pmc/ar cles/PMC3119866/
The Three Graces is an oil pain ng by Peter Paul Rubens. Interes ngly, if one takes a close-up at the hand of the le most ﬁgurine, you may look at the typical deformity
that accompanies many RA pa ents. But, this cannot be considered scien ﬁcally signiﬁcant evidence to the prevalence of RA and its typical phenotypic manifesta on.
Skeletal damage as perpetuated by RA was seen in post-mortem studies conducted by Sir Armand Ruﬀer and Flinders Petrie, on Egyp an Mummies. Ruﬀer conducted
these studies of mummies of Macedonian, Egyp an and Greek origin, and reported of unique degenera on of bones, and Petrie conﬁrmed to similar evidences. Yet, what
wasn’t considered was the existence of years of preserva on and/ or eﬀects that might have aﬀected the bones otherwise. Years of went by un l these studies matured.
Beauvais and Garrod: Paving way to Modern Descrip on of RA
Augus n Jacob Landré-Beauvais took this ﬁrst a empt in the early 19th century. As a young Physician at
28, he saw pa ents, especially penurious individuals and the womenfolk and couldn’t categorize them
under the already exis ng tenets of gout or rheuma sm. He consequently named this unnamed disorder
as “Primary Asthenic Gout” or Gou e Asthénique Primi ve, nevertheless, his descrip on contained
discrepancies.
Alfred Garrod and his son Archibald Garrod, soon followed up this misinterpreta on. Alfred Garrod
described the diﬀerences between gout and arthri c condi ons and this was related with high blood
levels of uric acid in the former and not in the la er. Archibald Garrod carried out extensive work in the
same ad documented evidences in a Trea se, though, it was opposed with vehemence from an American
physician named Charles Short, in the 20th century.
Ancient or Modern? The genesis of RA and Disputes
Short pointed out how Archibald Garrod couldn’t precisely put forward a deﬁni ve diagnosis to RA. He
tried to convince the RA wasn’t of older origins, but a more modern spurt that aﬄicted people. This idea is
s ll under rigorous controversy and counter claims, but remains to be one of the most researched
autoimmune disorders. Its ae ology has developed into more established descrip ons, the role of
autoan bodies and how the immune system of our body chooses to selec vely target our own selfan gens.
JANUARY 2015 • lexiconin.com
Been There Done That
Life of a medical student: Do's and Don'ts
By Dr Yashada Nabar, University of Sheﬃeld
Ever wondered what happens in the strange and fascina ng world of upcoming medicos and den sts? The seemingly adventurous journey that we, as medical students,
undertake is nothing short of a brave feat. Since the grass is always greener on the other side, I will take this opportunity to go through some of the joys (just kidding) and
sorrows in the life of your average medical student in India. We enter medical school, with the conﬁdence and happiness equivalent to emerging victorious in a war, which
is soon squashed out by professors and seniors who want to “know” us be er by making us sing songs and dance in local trains. I was fortunate enough to not have been
ragged, and for that, I am eternally grateful. This journey culmina ng into me ﬁnally gradua ng as a den st has been full of various ups and downs. Having bravely
emerged rela vely unscathed, I can provide a few Do’s and Don’ts for other upcoming den sts.
Do’s
Don’ts
1)
Always be polite to all the professors. You never know who will take that ﬁnal exam
viva.
1)
Never. Ever. Ever complain about being ragged unless it’s insul ng to your personal
image and dignity. You should know the diﬀerence between harmless fun and
inappropriate behaviour.
2)
Can’t say this without sounding like a prude, but don’t procras nate, you will suﬀer
in the end.
3) It is good to be compe ve, but don’t do it at the cost of antagonising your
peers.
4) Never say Never. There are hard mes, there are mes when your conﬁdence
and pa ence is tested, but never lose faith in yourself.
2)
Try to be as nice and amicable you can to your seniors, even if they rag you, they will
admire this quality in you.
3)
Take part in all extra curricular ac vi es and college fes val events. These will be
treasured memories in the near future.
4)
Take up responsibili es and part- me work only if you can balance it with your
studies; in the end it’s your degree which is going to be most important.
Degree college days are the most memorable days of a person’s life. For us, it’s even more special because we spend 5-7 years with our classmates unlike the usual 3 year
degree courses. You will make the best of friends in degree college, and it’s said that the friends you make here, are with you, for all your life. We tend to grumble about
studies, lectures, pos ngs and professors all through our life as medical students, but it’s only when you graduate, you realise that you would do anything to go back to
medical school, and to live that life again. Make the most of these years; I would like to conclude by using lyrics from Summer of ’69; Those were the best days of my life.
JANUARY 2015 • lexiconin.com
Tech-X
SPACE CENTER HOUSTON
By Naren Srinath Nallapeta,
House Surgeon,
JJM Medical College, Davanagere
My experience at the Houston Space Center is one worth sharing. It was a
mesmerizing day for me to see the marvels of modern day technology and
advancement in the ﬁeld of science and it is very fascina ng to see the
advancements that humans have made in the past century in the ﬁeld of avia on
and space travel. Space Center Houston is the oﬃcial visitor center of the Lyndon B.
Johnson Space Center—the Na onal Aeronau cs and Space Administra on's
(NASA) center for human spaceﬂight ac vi es—located in Houston, Texas.
It is very astonishing to know that there are 2,465 ar ﬁcial satellites orbi ng the
Earth today. It is even more astonishing to know that a total of 536 people from 38
countries have gone into space as of November 6, 2013. I was always fascinated
about space and what lies beyond the stratosphere. Seeing these many
achievements in just a span of about 50 years makes me feel that we are not away
from a me where space travel will become a daily aﬀair and what we as kids
watched on The Jetsons show would soon become a reality.
The NASA Space Center at Houston has a large number of original space cra s
which have travelled the space and also has a large number of replicas of the space
cra s. Of these the Space Shu le Explorer (now known as the space shu le
Independence) has been placed right at the entrance of the place. It is a massive
shu le and is a full-scale, high-ﬁdelity replica of the Space Shu le.
There are a lot of guided tours that one can go on once you have entered the Space
Center at Houston.
Of these is a tram tour which goes to Building 30 North and South (old and new
Mission Control Centers), Building 9 (the Space Vehicle Mockup Facility), and a
Rocket Park, including a restored Saturn V. Saturn V has been restored as a
landmark in human space explora on as this was the space cra which took
humans to moon for the ﬁrst me. This is something you have to see to believe.
Saying that it’s unbelievably massive just doesn’t do it jus ce. This is the Saturn V
Rocket, the most powerful rocket ever built and operated. It’s design played a
major role in successfully transpor ng and landing American astronauts on the
moon during the Apollo missions. Over 36 stories tall, this Saturn V is one of only
three le in existence. And if we ever needed to go back to the moon, chances are
this would be the rocket to get us there. Houston Space Center restored the
landmark and opened the gates for general public on 20th July, 2007.
I also learnt about the Interna onal Space Sta on (ISS) which is another marvel of
humans which is the only habitable ar ﬁcial satellite in low Earth Orbit. The ISS
serves as a microgravity and space environment research laboratory in which crew
members conduct experiments in biology, human biology, physics, astronomy,
meteorology and other ﬁelds. The sta on is suited for the tes ng of spacecra
systems and equipment required for missions to the Moon and Mars.
Lastly I think it’s worth men oning about the space food!! Yes the space food which
is a variety of foods that we eat everyday are specially processed in these space
centers across the world wherein the food prepared are used by the astronauts and
contain speciﬁc ingredients which mimic various food tastes eaten here on earth
but the amazing part of these foods are that they do not perish so easily as they
contain very negligible water content in them. These foods can be used up to 2
years without ge ng spoilt. I was lucky enough to taste this food which was
available at the souvenir shop, I got to taste the cookie and cream ice cream
ﬂavored space food which is not actually ice cream, which means it needn’t be
stored in a refrigerator and can be taken into space. Amazingly the prepara on
tastes exactly like cookie and cream ice cream although it looks like a cake of
powdered sugar wrapped with biscuits on both sides. One has to taste it to know it.
All in all the whole visit to Houston was fulﬁlled and is a must visit place for anyone
who goes to Houston. The achievements that humans have made over the decades
only gives us more hope everyday and who knows our children might be living in
Mars in their life. The capaci es of human brain are limitless, the universe is
limitless, it is we who need to exceed our own expecta on everyday and keep our
The Space center also has other replicas of mercury 9 capsule, Gemini 5 capsule
and Apollo 17 command module and many others. They give a brieﬁng about how
all these spaceshu les and how they came into existence. Looking at it at a very
close distance is a experience of it’s own. These shu les are massive and to see how
humans even thought of such a space cra brings awe to me.
They have various audiovisual shows at the Houston Space Center where you get to
know about how all this started. The number of lives lost as a result of this daring
adventures that these astronauts who ventured into space for the ﬁrst me makes
you feel that there is nothing that a human cannot achieve. The inspiring speech by
John F Kennedy in 1970 when the ﬁrst shu le was about to touch the surface of
moon is really an inspiring speech to listen to. I also paid my tributes to Kalpana
Chawla the ﬁrst Indian astronaut who ﬂew into space, unfortunately who lost her
life in the Space Shu le Columbia disaster in 2003.
They have displayed the pictures of each and every crew who ever ﬂew in an aircra
and I paid my tributes to each one of them. There are very many fascina ng rides
where you get to wear the space jacket and also get a chance to try the simula on
rides where you can experience what an astronaut experiences in a space shu le.
This is one other experience worth sharing, you do feel gravity but that’s ar ﬁcial
gravity which is a diﬀerent feeling, it is only 2 minutes simula on ride and is worth
spending money on.
JANUARY 2015 • lexiconin.com
Tech-X
Quite contrary to its controversial poten al for weapon manufacturing, 3-D
prin ng has recently become the most promising up-and-coming tools harnessed
for addressing human health issues. From its wide range of surgical applica ons
involving, Hip replacement surgeries, customised jaw braces, temporary heart
replacements, 3-D prin ng is now being used for ssue engineering, in order to
eventually address the concerns of inﬂammatory ssues associated with autoimmune diseases.
The phrase generally referred to as “addi ve manufacturing” by the developers, it
involves the sequen al building of coa ngs of material to create a threedimensional form. The en re process begins with the crea on of a digital ﬁle in
detail for the desired object describing its dimensions, internal structures and
surface textures. 3-D prin ng has an imagina ve range of applica ons, is eﬃcient
and does not involve the use of metallic equipments while freeing product design
from many current limita ons imposed by the reali es of manufacturing.
But the ques on remains, how does this inven ve, and rela vely easier technology
translate into the crea on of human parts and the ushering in of a new era of ssue
engineering? The answer lies in 3D prin ng's capability to precisely and speciﬁcally
replicate the human structure, a feat that is increasingly impera ve. Already, 3D
prin ng has altered the crea on of inert biomaterials. In 2012, the company Align
3D printed 17 million sets of Invisalign braces – clear, custom-made retainers that
are designed based on an individual's own teeth. Millions of contact lenses and
hearing aids are also manufactured by 3D prin ng on an annual basis, and Quite
recently woman in received a new tanium 3D-printed jaw, and a man received 3D
printed Hip replacement, ar ﬁcial prosthe cs, which have conven onally been
made from a cut-and-paste mould, can now be 3D printed based on CT scans of the
pa ent's exis ng limb and even tailored to suit their lifestyle and character.
Moreover, new therapies targe ng the protein arginine deiminases, a class of
enzymes that mediate protein citrullina on are being developed. Protein
citrullina on leads to the crea on of potent autoan gens implicated in the very
earliest events that lead to rheumatoid arthri s and drives inﬂamma on and
immune complex forma on in ac ve autoimmune disease.
The Bionic Man: Use of 3-D Prin ng for Tissue Engineering
Apurva Lunia,
Mahatma Gandhi Medical College, Jaipur
Addi onally, the ability to manufacture human ssue would help lessen the
exorbitant expenditure, me required for replacement organs, as well as reduce
the complica ons allied with permanent regimens of immunosuppressive drugs or
an -coagulants.
In deference to the scien ﬁc community, 3D-printed human ssue has been
embraced as a way of linking the gap between research studies and clinical trials
which can be used to test drugs, chemicals and animal models of disease.
Despite its recent advances, 3D prin ng has a long way to go before it will be
competent enough to produce completely serviceable human organs for
signiﬁcant clinical use or accurate scien ﬁc study.
3D prin ng may expand the realm of possibili es, but only as far as as our
imagina on and so ware facul es allow. The bo om line? “3D-printed body parts
are s ll the stuﬀ of ﬁc on”, and for the me being, plas c legs and donor kidneys
are here to stay.
3D printers are being developed in order to navigate the intricacies of human
ssuesoverruling the diﬃcult seeding process extensively used for ssue
genera on. The process itself is also rela vely simple.
The ability to 3D print components of the human body has across-the-board
implica ons for the future of medicine. Genera ng new ssues from a pa ent's
own cells not only dras cally reduces the jeopardy of cell mediated immune
response and subsequent transplant rejec ons, but also eradicates the innate
immune responses that can be precipitated by tradi onal biomaterials.
JANUARY 2015 • lexiconin.com
Tech-X
LABOR COMPETITIVENESS
By Claudia Jimena Arévalo Santa María
We o en develop ourselves emo onally and cogni vely, this implies a progressive
growth of who we are. The cogni ve development doesn´t have to do with
becoming a professional, the knowledge is assimilated constantly but it also
depends on how much anyone wants to learn.
The clichés “Success at all costs”, “Be winners” in the name of compe veness is
used very o en. Being a doctor is much more than having a degree or wearing a
white lab coat, and be pa ent involves not only having a physical disease, but also
having an emo onal pain. Every human being carries a need that must be covered
by another human being, hence before doctors have been called to be full people,
perhaps a Doctor is deﬁned as a person with suﬃcient sensi vity to be willing to
serve at all mes. We all have a need. A Doctor is also someone who cares others;
serve others, or who covers their needs. Everyday we can be doctors of someone,
we are doctors when we hear someone or when give love through a word or care.
Therefore, anyone can be a doctor, and anyone can be our pa ent.
And the cliché comes again "I'm be er than anyone else ", etc ... We have in mind
the idea of we compete against others, and we have to defeat them to ﬁnally
achieve success. This is a wrong idea, the compe on is not with those "others" but
with ourselves, we compete every day to be be er than we were before, we
compete against our reluctance, our distrac ons, and we do it because nothing can
keeps us away from what we really want to achieve. If we think about a career as a
meaning to get money, then our focus will be to compete for money; but if only we
see a career as a meaning to ﬁnd the needs of our society, our search will be
constant, learning will be a meal we are going to look for everyday steadily, and I'm
sure that will not ma er much to accept the idea that another is be er than
another one, because on the contrary, it will be a joy to know that just like you,
others look for learning for social good.
The success is to be be er everyday and on how much you can give and how
commi ed you are with your service. But ﬁrst we have to understand that this
commitment shouldn't be vain. This commitment comes from love, the love is what
you are commi ed with that's why the couples are commi ed to marry for love and
not for obliga on. When one makes a commitment, it is self-love which moves us
to assume it. I mean that the only way to achieve succeed is completely ed to
something you really love, to do what you love, but above all to love what you do
constantly. Mother Teresa of Calcu a said: “it is not how much we do, but how
much love we put in the ac on that we do.”
You love medicine, you love your career, you love learning; but if you don't love to
care for someone, if you don't love to prepare yourself for them (who need you), if
you don´t love what you do in a hospital every day, we are doing nothing. Even with
all the awards in the world, with all the money in the world, and all the recogni on
you get, we couldn't call us successful people. The success has another meaning.
Labor compe veness is to compete to do a good job. Doctors, what are you willing
to do today?
JANUARY 2015 • lexiconin.com
DIVERGING ROADS
By Priyanka Manghani
3rd year, Terna Medical College
Dr Raju Manghani is a medical graduate from Grant Medical College and JJ group of Hospitals. He did his residency in Medicine (MD) from the Pres gious Armed Forces
Medical College and served in the Indian Navy for 14 years managing various cri cal cases, training interns, serving in various hospitals and also being a postgraduate
teacher. He has presented research papers at various conferences, a ended various CME's. He took voluntary re rement from the Indian Navy in October 2004 and since
then has been a Senior Consultant in Medicine at Inlaks and Budhrani Hospital, Pune and a DNB teacher as well conduc ng various post graduate lectures and clinical
mee ngs
While current medical graduates are confused about MD or DNB and the variance in the scope of DNB v/s MD, We get Dr. Manghani to clear no ons about DNB...
Excerpts from the Interview…
1-What are the major diﬀerences in training of DNB as compared to MD/MS?
There is no diﬀerence in training of DNB from MD/MS It covers academics, prac cal trainings, clinical mee ngs , journal clubs ,clinical and thesis work , log book and a host
of other training ac vi es
2-Why is there a bias between the two? Why do people think one is superior and the other not as much?
There is no diﬀerence between md and DNB .They have equal status for jobs, government appointments and super specialisa on
3-Why is the passing rate in DNB so low?
DNB passing rate has improved. It is an examina on of very high standards equivalent to foreign medical grades.
4- Scope of DNB – in India and abroad
DNB is recognized more than md in many countries. The scope in India is very good
5- Would you suggest a candidate to take up a DNB course if he /she isn't able to crack the MD/MS entrance rather than taking a drop to try again?
DNB has good opportuni es and certainly the candidate can take up a DNB course
6- Best and most demanding special es in DNB according to you ?
DNB medicine, DNB radiology , DNB ophthalmology , DNB orthopaedics are the most demanding speciali es
7- Your advice to current medical graduates looking forward to pursue residency?
DNB is an excellent course with equal recogni on to md and should be persued.
8- Would the level of prep for MD/MS entrance suﬃce for DNB entrance as well? Any addi onal requirements?
The level of prep for MD/MS entrances would suﬃce for DNB as well
JANUARY 2015 • lexiconin.com
Rendezvous
Interview with Palash Sen
Palash Sen is an Indian singer, songwriter, musician, composer and actor best known as the founder and frontman of India's
biggest band Euphoria. He lives in New Delhi, India.
Born to doctors, Palash is of Bengali heritage from his father's side and Dogra heritage from his mother's. He was born in
Lucknow, brought up in Delhi, and used to stay in Connaught Place's Railway Colony and Srinagar.
He did his schooling from St. Columba's School, Delhi where he met and became friends with Indian superstar Shah Rukh
Khan. Palash was ac ve in theatre and singing right from his school days and that's where he realised his singing capabili es.
Therea er he studied medicine at the University College of Medical Sciences (UCMS), New Delhi, and received an M.B.B.S.
degree.
1. With a medical degree in your pocket, what was the inspira on that led you towards Euphoria? What were your biggest inﬂuences in the ﬁeld of music?
Ans: I started Euphoria when I was in medical college. What started out as a series of weekend jams and get togethers over lunch, has now become a global phenomenon.
I never imagined that we would come so far and it would be so good. But we have, and it is! My biggest inﬂuences were my father, Elvis Presley and Kishore Kumar. That's
how it started for me. These were my heroes. I wanted to be like them. And trust me, i'm s ll trying!
2. What would you credit as being the biggest ingredient in Euphoria’s success?
Ans: The fans undoubtedly! We are what we are because people chose to listen to us! The industry is completely ﬁlm dominated and for people to choose a small band of
middle class individuals from Delhi over star studded ﬁlmy songs backed by corporate and money muscle, it's as Euphoric as it sounds!
3. What is more intriguing medicine or making music?
Curing a pa ent and crea ng a song are equally sa sfying, exci ng and fulﬁlling. I'm one of the few blessed ones who cures the body through my medicine and heals the
soul through my music.
4. In your medical career, was there any challenging case that you would want to share?
All my heartbreaks, and I've already shared them with the world through my songs. Hahaha.. On a serious note, every case is a challenge because I only treat but He
cures..
JANUARY 2015 • lexiconin.com
Interview with Palash Sen
Rendezvous
5. Were you ever tempted to walk away from the
pressures of Medicine and focus solely on music since
you had such a successful band?
Never. I am and will always be DR. Palash Sen. I look at
both my professions as my passion and I hence I would
never need to give up on either.
6. Did you want to pursue post gradua on a er
MBBS?
I could not complete my post gradua on as my father's
death turned my world upside down. I took up the
challenge of looking a er his clinic and life took an
uncertain turn. As des ned, my success as a musician
was a bigger shock to me and I just accepted the turn of
events as god's plan for me
7. What was THE life changing moment in your life?
Deﬁnitely my father's death in 1992 which broke my
heart and I lost my faith. Till the birth of my son in 1995 and I found a reason to live again. Every song I create is a catharsis for the sadness and the happiness of the 2
greatest events of my life.
8. What advice would you like to give to the medical students who also have interests in other arenas?
Ans: The advice is very simple. Follow Your Dreams, work hard and never give up. It's never too late to do what you love and never too late to start. Keep the faith and
believe in a simple thought that I follow. Haar Na Maan Na!
9. What do we look forward to at Euphoria front, any new album?
Ans: You will hear new Euphoria music in an upcoming ﬁlm tled Aisa Yeh Jahaan. It's a sensi ve and sensible story of a young couple trying ﬁnd their way through the
circle of life. I am also ac ng in the ﬁlm, along with the supremely talented Ira Dubey. Apart from that, work on our next non ﬁlm album is on in full swing!
JANUARY 2015 • lexiconin.com
ACT OF KINDNESS
By Priyanka Manghani
3rd year, Terna Medical College
Leaving a troubled childhood which was scarred by repeated sexual abuse behind, he rose like a Phoenix to become an icon for the common people. You can call him an
Equal Rights Ac vist, Mo va onal Speaker, Cause Crusader as he is all that.
An Equal Rights Ac vist, he is best known for his quirky campaigns for the rights of Homosexuals, Women, Children and Animals. His life and experiences has been the
subject of a book and two movies.
Harish is one of the most vocal voices for the LGBT campaign worldwide. His accomplishment landed him in the posi on #71 in the World Pride Powerlist 2013. He shares
the honour with Stephen Fry, Ricky Mar n, Elton John, Mar na Navra lova to name a few. He is the only Indian Na onal in the list.
Harish is one of the 10 winners of the Zindagi Live Awards an award ins tuted by Network 18 which is the Indian partners of the CNN news group. He won this award for his
work in crea ng awareness on the issue of child sexual abuse. He is best known for turning his personal blog as a helpline during the 26/11 terror a acks.
Read the Interview to know the man yourself…..
1. You've been involved a lot of Social Causes from working for lgbt rights to end
child sex abuse and women's safety. What are the major issues you have faced as
an ac vist for these causes?
I think that prejudice like love is not just very common but also is universal. People
ﬁnd it diﬃcult to fathom that someone is able to do so much and is able to see so
much that others. It is a mix of jealousy, helplessness and ignorance. I think most
ac vists face such issues from peers.
2.You have been a vic m of child sex abuse for 11 years . What long term eﬀects
do u think does abuse have on an individuals personality and his mental health ?
How did it change you as a person ?
All that happens to us has an impact on us. It changes us in some way or the other.
About my abuse, I would say that when you are forced so deep to the ground, and
you survive it, the only way you will travel now is towards the sky.
Abuse makes some people bi er, I'm glad that it made me humble instead. I am
more aware of the niceness of life and value every living moment. I think that if I
have been brought to it, and now I am through it, the onus of holding a torch to
show the way out should be mine. Hence I listen to stories of abuse by people and
help them ﬁnd their own ways through the challenges of a disturbed childhood.
3.Do you feel sex is an over rated term in India ? We s ll think that an intact
hymen is a sign of virginity . Comment.
If men had a hymen, virginity would have been a myth.
Of course virginity is overrated. It is seen as a symbol of purity. The stress on hymen
specially is nothing more than a means of subjuga ng women further.
I don't value sex so much in life. Not that I patronize anyone, for the sake of sta ng
an example though, I could rather be married to a commercial sex worker with a
golden heart, than to a wicked virgin.
Sex and sexual rela onships are not the measure of purity.
4.In an era where rapes, child abuse and other crimes are on the rise, media focus
is more towards –“The Cleavage Row” , like the recent incident with actress
Deepika Padukone . What are your views on the same and what do you think of
Deepika's brave move to speak about it vocally and stand up for a woman's
dignity ?
Deepika was really brave. What a woman ﬁnds oﬀensive and what she doesn't, can
only be deﬁned by the woman in ques on herself.
I don't think there's anything wrong in cleavage, if it is shown in a ﬂa ering way
rather than in a demeaning way. There is a thin line that demarcates, and o en too
bleak to be no ced.
Some people have said that Homosexuality is a mental disease .Your comment on
that? Also why is it so tough to come out of the closet as an homosexual in India ,
where as abroad they are quite open to gay and lesbian rela onships.
I feel homophobia is a mental disease. Homosexuality though has been declassiﬁed
from the list of mental disorders by Indian Psychiatrists Associa on. Sadly,
educa on even among the medical fraternity is lacking and ridden with personal
biases.
Regarding rela onships and coming out, well, it has been Indian culture to be open
about ones sexuality. It is the Brit who got their Victorian mindset along with their
rule, a mindset that saw homosexuality as unnatural. Things are changing now.
Things are ge ng be er in the social scene, though we have sec on 377 lurking
over us in the legal scene .
5. Some people have also said that porn is one of the reasons for increased rapes.
Also rape in our country is always linked to the lady's a re. Please comment.
Why is it that abroad a lady in a bikini will not be raped but here even a lady fully
clothed also has high chances of ge ng raped?
I think rapes happen because rapists rape, everything else is bullshit.
A lot of transgenders face a lot of discrimina on when seeking medical help. How
do you think we can bring an end to this ? Do you feel tolerance and acceptance will
ever come in ?
We cant aﬀord to lose hope. And we will not.
The medical fraternity needs to get more sensi ve to Transgender rights. Let's
begin with health as a basic need, and get prejudice out of clinics and hospitals.
AS LONG AS I LOVE THE MAN IN THE MIRROR, I WOULD BE LOVED
-HARISH IYER
6.Tell us about the workshop you did post 26/11 to help ci zens recover from the
incident and the campaign you did with Shobha De to condemn an a ack on
women.
During 26/11 I set up a blog called mumbaiterrorhelpline.blogspot.in to help
rela ves of those trapped in taj and oberoi who were seeking informa on about
their loved ones. I was pos ng real me informa on about those dead and injured
in the massacre. I received several phone calls and emails. Also many people
vented by screaming and yelling about security systems in India, and also there
were some who had to be paciﬁed and consoled. The pain was unbearable.
I started the Sita Sena to condemn the a acks done by Ram Sene in mangalore on
women who were at a pub. The idea was of my BlogDost (as I fondly refer to her as)
Shobhaa De. I invited women to blow the whistle on men who eve tease. The
cap on was “Sita Sena See Bajaao”. The full form of Sita was Sensi vity In True
Ac on. We went about the city Arming women with Whistles and asking them to
blow it loud. It resulted in a lot of awareness, and of course, we had a lot of fun.
7.Your views on SECTION 377 verdict
How would you feel when you have the state peeping in your bedroom and
prescribing what kind of sex you should have with your consen ng adult partner?
JANUARY 2015 • lexiconin.com
Open Le er
By Archit Rastogi,
Final Year Student,B Tech Biotechnology, VIT University, Vellore
Dear Beta Cell,
I write to you with distressing news! A tragedy has befallen me. If the fast ﬂowing Red Blood Cells did not tell
you ll now, we were recently infected by a li le known virus, the Coxsackie B4. Now you may wonder, and
rightly so, why this is important. Well, it's really simple. You see, that darned li le virus had an gens almost
iden cal to yours! How do I know this? Because I was the T Cell that detected the virus and signaled the B
Cells to make an bodies against it.
Now normally, the an bodies the B Cells make are able to diﬀeren ate between self and non self an gens.
Unfortunately, this once the an gens are similar enough to confuse even our best soldiers. It is pre y
evident that the viruses have managed to trigger a very strong autoimmune response. You my dear friend
are the unfortunate target! The proverbial deer in the headlights; you are simply the cell with the wrong
an gens in the right place.
As I write this sad le er, I become more and more confused as to whom tragedy has actually befallen. You of
course will lose everything due to this deadly disease. But, I too, will lose a lot. Bound by my du es to the
body, I was forced to give the signal that sealed your fate and made your death imminent. What's worse, I
have to live with the weight of killing one of my best friends! I have to go about impar ng my du es and
giving signals as if nothing had happened. You decide who the bigger loser is. I guess tragedy has befallen us
all.
I wish it could have been diﬀerent. Sadly, it cannot. We all play our roles in the body. I hope you can
understand and forgive me. Just like you produce insulin whenever you detect glucose, I produce cytokines
whenever I detect foreign an gens. These cytokines then signal B Cells and make them produce an bodies
to destroy the an gens, just like your insulin breaks down the glucose.
Though it is probably a small consola on, I can assure you your presence will be sorely missed and your
absence extremely no ced. The day you die will be a black day for the en re body. Soon a er, without your
insulin, there will be no way to check the glucose and the body will develop Diabetes Mellitus Type I. I just
hope this le er reaches you in me. I bid you adieu, my dear friend. With a heavy heart, I apologize once
again.
Sorrowfully,
A T-Cell
JANUARY 2015 • lexiconin.com
The Comic Strip
Dave and Harry
By, Bianca Honnekeri, Grant Medical College, Mumbai
AND Arbaz Memon, Pune
JANUARY 2015 • lexiconin.com
Compe
on
1.
Zenia Poladia,
Terna Medical College, IIIrd M.B.B.S- Part 1, Mumbai
ENVIRONMENT- AN AGENDA FOR HEALTH PROMOTION
The environment in which people live, learn, play, work and worship profoundly
aﬀects their health. It not only aﬀects the health prac ces, but also has an eﬀect on
the resilience, health outcomes and the overall development of an individual.
Inequi es in the environment are the root cause of health inequi es among
people. The World Health Organiza on (WHO) deﬁnes environment, as it relates to
health, as “all the physical, chemical and biological factors external to a person, and
all the related behavior”. Recognizing that health behaviors are unlikely to change
in a las ng manner unless environmental factors that give rise to them are also
changed, health promo on takes an ecological approach and focuses on
community engagement and environmental change in addi on to individual
behaviors. Health promo on could involve any combina on of health educa on
and related organiza onal, economic and poli cal interven ons designed to
facilitate behavioral and environmental changes conducive to health. The central
goal is to promote health for all through a healthy environment. Maintaining a
healthy environment is central to increasing quality of life and years of healthy life.
Globally, nearly 25 percent of all deaths and the total disease burden can be
a ributed to environmental factors. Environmental factors are diverse and farreaching. They include exposure to hazardous substances in air, water, soil and
food, natural and technological disasters, physical hazards, nutri onal deﬁciencies
and the built environment.
One of the essen al public health care element is safe drinking water and
sanita on. Faeces deposited near homes, contaminated drinking water, ﬁsh from
polluted rivers and coastal waters, and agricultural produce, fer lized with human
waste are all health hazards. Water quan ty is as important as water quality.
Washing hands a er defeca on and before preparing food is of par cular
importance in reducing disease transmission, but without abundant water in or
near home, hygiene becomes diﬃcult or impossible. The lack of water supply and
sanita on is the primary reason why diseases transmi ed via faeces are common in
developing countries. The most important of these diseases, diarrhoea and
intes nal worm infesta ons, account for 10 per cent of the total burden of disease
in developing countries. In addi on, an inadequate water supply increases the risk
of schistosomiasis, skin and eye infec ons, and guineaworm disease. Changes
needed to achieve “Health for All” are concerned with a healthy environment and
healthy lifestyle and require ini a ves by the individual, the family and the
community.
Environmental health must address the societal and environmental factors that
increase the likelihood of exposure and disease. The goal of the Preven on Agenda
is to prevent health problems before they occur, or before they worsen. Health
promo on and disease preven on can help us eat healthier foods, successfully quit
smoking, and enjoy living in safe environments with clean air and water. Health
promo on and disease preven on ac vi es might include inves ga ng disease
outbreaks, labeling foods that are high in fat, counseling and drug treatments to
help people quit smoking, and tes ng water supplies to make sure they are free
from chemicals or other pollu on. Laws such as the Clean Indoor Air Act that bans
smoking in public buildings, bars and restaurants protect people's health. Keeping
people healthy by preven ng illness in the ﬁrst place makes much more sense than
having to treat them when sick.
Health promo on is the process of enabling people to increase control over, and to
improve, their health. To reach a state of complete physical, mental and social wellbeing, an individual or group must be able to iden fy and to realize aspira ons, to
sa sfy needs, and to change or cope with the environment. Health is, therefore,
seen as a resource for everyday life, not the objec ve of living. Therefore, health
promo on is not just the responsibility of the health sector. Linkage of environment
and health promo on requires intersectoral eﬀorts. Countries ought to develop
plans for priority ac ons which are based on co-opera ve planning by various
levels of government, non- governmental organiza ons and local communi es,
such as:
Mee ng primary health care needs, par cularly in rural areas
Control of communicable diseases
INTERNATIONAL ESSAY CONTEST 2014
·Protec ng vulnerable groups such as infants, children, pregnant women, geriatric
age group, etc
·Mee ng the urban health challenges
·Reducing health risks from environmental pollu on and hazards by maintaining
outdoor and indoor air quality, protec ng water sources from contamina on by
infec ous and chemical agents, reducing exposure to toxic and hazardous wastes,
etc.
·Promo on of a safe food supply and proper nutri on.
·Par cular a en on should be directed towards food safety, with priority placed on
the elimina on of food contamina on; comprehensive and sustainable water
policies to ensure safe drinking water and sanita on to preclude both microbial
and chemical contamina on
·Promo on of health educa on, immuniza on and provision of essen al drugs.
Health promo on policy requires the iden ﬁca on of obstacles to the adop on of
healthy public policies in non-health sectors, and ways of removing them. The
conserva on of natural resources throughout the world should be emphasized as a
global responsibility. Systema c assessment of the health impact of a rapidly
changing environment - par cularly in areas of technology, work, energy
produc on and urbaniza on - is essen al and must be followed by ac on to ensure
posi ve beneﬁt to the health of the public. The protec on of the natural and built
environments and the conserva on of natural resources must be addressed in any
health promo on strategy.
While health protec on focuses on removing nega ve inﬂuences on health, health
promo on aims to enhance health in terms of developing healthy public policy,
healthy environments and personal resiliency; this reﬂects a philosophy of
suppor ng communi es and individuals to take charge of their own health.
Wielding the broom, the Prime Minister of our country Narendra Modi launched
'Swachh Bharat Abhiyaan'- the country's biggest-ever cleanliness drive, on 2nd
October, 2014. Expressing conﬁdence that the na on can achieve the target of
becoming one of cleanest in the world, the Prime Minister dwelt upon the low cost
success of the Mars Orbiter Mission. "If people of India can reach Mars with
minimal expenditure, why can't they keep their streets and colonies clean," he said
asking people to take up the responsibility to make the mission a success.
Administering a pledge to people to make India clean, he said that this task is not
the responsibility only of safai karamcharis or the government but of all the 125
crore Indians. “If we make it a public movement, we can make our country being
counted as one among the cleanest na ons," he said.
This campaign aims to accomplish the vision of 'Clean India' by 2 October 2019, and
is expected to cost over Rs.62000 crores. The high death rate, infant mortality rate,
sickness rate and poor standards of health are infact largely due to defec ve
environmental sanita on. Improvement of environmental sanita on is therefore
crucial for the preven on of disease and promo on of health of individuals and
communi es. Hence the major components of 'Swachh Bharat Abhyaan' include
construc on of household toilets, community and public toilets, solid waste
management, raising public awareness by informa on, educa on and
communica on. Since more than 70 per cent of the popula on of India lives in rural
areas, the problem is one of rural sanita on. The cabinet had last month decided to
merge the 'Nirmal Bharat Abhiyaan', a campaign for rural sanita on with Swachh
Bharat mission. While ruing that 60 percent of populace in rural areas s ll defecate
in open, the Prime Minister said the s gma of women lacking toilet facili es has to
be removed. Modi said that he has requested the corporates to evolve plans under
corporate social responsibility to build clean toilets especially for girl students in
schools. India, he said, should learn from foreign countries, where people are
disciplined and do not li er in public places. He said though it is a diﬃcult task, it
can be achieved and for that people will have to change their habits. Quo ng a
WHO es mate, he said a person in India loses about Rs 6,500 per annum due to
illness and poor health as he is unable to perform day-to-day du es. He said if the
surroundings are kept clean, then people will remain healthy and such losses can
be minimized.
The O awa Charter for health promo on states that: Our socie es are complex
and interrelated. Health cannot be separated from other goals. The inextricable
links between people and their environment cons tutes the basis for a
socioecological approach to health. Enhancing suppor ve environments and
encouraging healthy behaviors using a health promo on approach contributes to
primary preven on of disease, but is also intended to have a broader beneﬁcial
eﬀect in terms of encouraging people to take responsibility for their health.
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Hasan Parvez, Final year Biomedical Engineering,
Karachi, Pakistan
PUBLIC HEALTH BEYOND THE MILLENNIUM DEVELOPMENT GOALS
The concept of public health care is not new to human civiliza on when we look
into the history we witness many examples and prac ces. These prac ces s ll
persists in diﬀerent parts of the world such as China, India and Greece. Most of
these ancient systems were preven ve and simple. Simplis c approach was
adopted where a solu on to a single disease was discussed, viewed and remedies
were shared. Indian and Chinese methods speciﬁcally are extensively used today
and they are carried out prac cally, one such example is of ayurvedic system.
In ayurvedic system Charaka, Susruta and Vagbhata are s ll used. A er par on
Chopra Commission was formed to emphasize on ancient methods such as
ayurvedic medica on. Some ins tutes were established where the research was
carried out on the herbs and on other ancient methods, they were successful to
some extent. One of the example is “rauwolﬁa” drug which is used for hypertension, likewise there are many other Indian Himalayan herbs. Chinese yellow
emperor's classic used combina on of both modern and ancient methods. Some
other examples are of “Deng Xiao” health care model during 1930s to 1950s which
is promoted by John B. Grant, then by CC Chen and Jimmy Yen from China, they
spread it to many other countries. Rockefeller founda on has a major contribu on
developing health care centers in India, Srilanka and other countries. So all
countries and communi es have infrastructure of health care system tradi onally
which exhibits that public health is always the prime concern for society since
ancient mes.
Now in 21st century, since me has progressed new diseases have evolved which
are biologically and economically very challenging, In order to ﬁght against these
major issues Millennium Development Goals were established in 2000. Millennium
Development Goals or MDGs were made to eradicate and lessen the major
problems which diﬀerent socie es are facing around the globe and improve the
quality of life. MDG's are composed of 8 primary goals which are targeted to be
completed by 2015. These goals are:·
MDG1 :Eradicate extreme poverty and hunger
·
MDG2: Achieve universal primary educa on
·
MDG3: Promote gender equality and empower women
·
MDG4: Reduce child mortality
·
MDG5: Improve maternal health
·
MDG6: Combat HIV/AIDS, malaria and other diseases
·
MDG7: Ensure environmental sustainability
·
MDG8: Develop a global partnership for development
Many goals of MDG's are achieved, major example is of Ghana and Ethiopia where
the eradica on of poverty at high levels is witnessed, Tanzania's primary educa on
rate has climbed up from 50% to an almost perfect ﬁgure of 99.6%. In addi on
Mali's rate increased from very low 23.4% to a respectable 74.7%. Child mortality
also seen some sharp decline in some countries for instance Vietnam witnessed
child mortality rate drop from 56 casual es in 1000 to 14 casual es in 1000. Further
Turkey has also improved its ﬁgures from 84 in 1000 to impressive 22 in 1000
casual es.
Despite the fact many countries have shown major and minor progress in the last
15 years, the ﬁgure doesn't properly illustrate the whole scenario. Countries such
as Congo experience a hunger index rate increase from 29% in 1991 to 75% in 2005,
which is a very high ﬁgure considering their total popula on is 67.51 million. Kenya
has seen child mortality rate going up from 105 in 1000 to 128 in 1000. So what we
witness from these ﬁgures is that achieving goals in a limited period of me is a
daun ng task. There are several key issues which a health care team and society
has to face when working to eradicate the problem.
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Regions where goals are not met should be handled strategically. Many steps can
be taken in-order to bring the stats down to targeted ﬁgures. Awareness among
society can itself resolve the problem by half, it should be spread through
workshops, conferences, se ng up of diﬀerent community fes vals and visits of
health workers in supervision of society and community leaders. Furthermore
adver sement can help the cause, adver sements of public awareness which
exhibit their customs and culture, so the message is loud and clear to the society.
Remaining issues can be resolved by using tools such as KPI (Key Performance
Indicators) and SWOT analysis (Strength, Weaknesses, Opportunity and Threats).
All the ac vity should be monitored by third party to ensure that the whole
procedure is carried out in a disciplinary manner.
Many key issues were missing from the MDG's such as cervical cancer and NCD's.
Cervical cancer is one of the deadly diseases which causes over 0.27 deaths per
year and most of the deaths are in the region of underdeveloped countries, around
85%. This needs to be addressed on the forum of MDG because it is es mated that
that cervical cancer will be one of the most fatal diseases in the upcoming decade
so this issue needs to be resolved by be er understanding and awareness. In
addi on to that NCD contributes to 2/3rd deaths in the world and most alarming
fact is that 80% of deaths have occurred in the developed regions.
NCD's (non-communicable diseases) include cardiovascular disease, chronic
respiratory disease and diabetes, as it is es mated that world popula on will
con nue to grow at a higher rate limited access to clean water, sanitary and fresh
air will increase the risk of NCD's. All the diseases are linked to one another in a very
close cascade manner. Many steps can be taken to decrease NCD cases, one prime
example to lessen the NCD is Physical exercise. Physical exercise should be given
special priority because it will signiﬁcantly reduce the risk of any disease and inturn would be beneﬁcial for the society. Many healthy ac vi es should be
encouraged such as cycling, one of the main advantage of cycling is co2 emission
can be reduced, as most of our transport resources run on fuel which in-return
produces abundant quan es of global warming gases. Natural fossil fuel reserves
accounts for almost 86% of all energy resources that we use and currently we
haven't produced any eﬃcient alternates yet to replace oil, coal and natural gas. So
it is very important to take steps to promote healthy ac vity. One of the reason of
NCD is unhealthy food which is low on calorie value, fast foods and other unhealthy
food, proper awareness at all levels should be given regarding NCD.
In conclusion MDG's have achieved many of its goals which they have targeted but
regions where targets are not achieved should be monitored strategically as
men oned. Many of the new goals should be added to MDG's such as NCD and
cervical cancer, which are causing millions of deaths around the globe and proper
planning should be implemented to eradicate it at the ini al level.
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Rashid Haider, 2nd yr MBBS, Mahatma Gandhi Ins tute of Medical Sciences,
Maharashtra
PUBLIC HEALTH BEYOND THE MILLINEUM DEVELOPMENT GOALS
Health indeed a beau ful gi bestowed to us by nature. Though degrading day by
daydue to our endless eﬀorts to deto ate it and con nuous neglect.
Over 1 billion people lack access to improved water sources and 2.6 billionlack
acess to appropriate sanita on, greatly contribu ng to the global burden of
diseases.The interna onal community has commited to reducing by half the
popula on of the worlds popula on lacking acess to water and sanita on as a part
of Millineum Development Goals .Innova ve approaches are required to ensure
the availability of low cost, simple and locally acceptable water and sanitable
resources. Interven onal approaches should be integrated into exis ng social
ins tu ons such as schools ,markets and health facili es.
A new post 2015 era demands a new vision and a responsive framework,
sustainable development enabled by the integra on of Economic growth, social
jus ce and environmental stewardship. We need to embrace a more coherent and
eﬀec ve response to support the agenda.
Heads of states and governments during the Millineum summit in 2000 has
analy cally anchored in the human development and the human rights paradigm
represen ng the global commitments.
Five overall issues that is of paramount importance for Millineum Developmental
Goals.
..Set of goals and targets
..Assessment of Needs
..Policies and strategies
..Resources, ins tu ons and coordina on
..Monitoring progress and gaps and repor ng
List of health Millineum Development Goals related to public health.
Goal4:Reduce child mortality.
Goal5:Improve maternal health.
Goal6:Combat HIV/AIDS, Malaria and other diseases.
The period since the start of Millineum Development Goals has seen a gradual shi
from a focus on a single diseases or health topic to a more systema c approach
which reorganises that successful health outcomes depend on a variety of health
inputs which has to be integrated at the na onal, district and local level.
E.g: Reducing the under ﬁve mortality rate requires a systema c focus on material
and infant nutri on, preven ng mother to child transmission of HIV, protec ng
infants against malaria, improving water quality and so on.
A new post 2015 agendas should be adopted having in vision upcoming new
diseases in the mind. There must be adop on on the UN poli cal declara on on the
ugly rising head of cancer, non communicable diseases recognizing it as good
health and development priority which must be supported through innova ve
partnership and public awareness.
Our new targets must be::::
..Health systems must be strengthened to ensure sustained delivery of eﬀec ve
and comprehensive pa ent centred cancer control programmes across the life
courses.
..Popula on based cancer registries and surviellence systems must be established
in all countries to measure the global cancer burden and the impact of na onal
cancer control programmes.
..Global tobacco consump on, overweight and obesity , unhealthy diet,alcohol
intake and levels of ohysical inac vity as well as exposure to other known cancer
risk factors will have fallen signiﬁcantly.
..cancer causing infec ons HPV and HBV will be covered by universal vaccina on
programme.
..S gma associated with cancer will be reduced and damaging myths and
misconcep on about the disease should be dispelled.
..Popula on based screening and early detec on programme must be universally
implemented and levels of public awareness and important cancer warning signs
and symptoms must be improved.
..Acess to accurate cancer diagnosis , quality mul modal treatment rehabilita on ,
suppor ve and pallia ve care services including the availability of aﬀordable
essen al medicines and technologies must be improved.
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..Eﬀec ve pain control and distress management services must be universally
available.
..Innova ve educa on and training opportuni es for health care professionals in
all disciplines of control must be improved signiﬁcantlypar cularly in low and
middle income countries.
The mental health checkup which are now adays rising at amuch greater pace due
to the stressful society must be given due accordance to deal with.
..The women reproduc ve health,improvement of maternal health help in
reducing childs mortality.
..Injury preven on and control.
..Non communicable diseases like diabe es mellitus, asthama, Arthri s and
musculoskeletal diseases, obesity –to deal with these we must sort out some
deﬁnite plan.
..Inclusion of both conceptual work and the ﬁndings of primary and secondary
research.
..Strength-learning communi es and knowledge transla on pla orm working to
support people centered health system across various disciplines, sectors and
countries and par cularly bridging prac oners , ac vists and researcher
communi es.
Rapid spread of re-emerging infec ons , diseases across geographic and social
boundaries with increased pathogen resistance due to widespread an bio c and
chemical use.
Pandemics of obesity and malnutri on and testament to a food system that no
longer supports human health or sustainable agriculture and is implicated in the
devasta ng global burden of non communicable diseases.
The concept of “ ONE HEALTH” recognizes that all animal species(including human
being) provide a shared reservoir for pathogen gene exchange and spread.
..Drug development for the neglected diseases should be given priority.
There should be mul secteral approach and perspec ve while implemen ng
this,health system should be equty oriented health system, research should
generate the evidence for ac ons. We should develop an eﬃcient health system to
avoid system failure as in case of ebola crisis.
CRITICISM: A cri cism of the current Mellienium Developmental Goal is that they
do not take into account inequi es in the provision of health services and
achievement of health outcomes amongst the diﬀerent segments of popula on.
E.g: A 2010 UNICEF report found that health Millienium Development Goals
indicators are typically worst among the poorest, in rural areas , among children of
less educated mothers and for boys under mortality(UNICEF 2010) .
Uneven distribu on:A UN study says that aid has shi ed since 2000 to focus on
countries that need to make the most progress on Millineum Development Goals
and geopoli cal interest and policy condi on of the country also determines it.
In order to shape the future of health in our future genera on we need to have a
deﬁnite vision to pave way for it .
Also a deﬁnite plan to execute it.
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Shivedita Singh, 1st year B.Tech, Malaviya Ins tute of Technology, Jaipur
PUBLIC HEALTH BEYOND THE MILLINEUM DEVELOPMENT GOALS
REMEMBER THE THREE MAGICAL WORDS BACK-'HEALTHY, WEALTHY AND WISE'
“Pioneering spirit should con nue, not to conquer the planet or space … but rather
to improve the quality of life.” — Bertrand Piccard
Today what do we talk most of…..city of skyscrapers…buildings that seems touching
the sky….fast growing industries…posh residen al buildings…expensive and lavish
malls…entertainment areas and that is all what brings sparkle to our eyes but just
remember the most important thing which we have le behind 'Our health'.
Even the wisest and the richest man of the world will be living a sadist and mournful
life if he is not healthy enough. Health is something which incites more lively
character and energy to work hard and pursue one's goal but if knowingly we keep
neglec ng it and keep compromising for increasing development stats then that
will be the most slowest and unhealthy phase we will be living into….Lets transform
our scenario of 'All wealth and No health' to 'Good health and Smart wealth'.
Let us look back at the environment we were living….fresh air, lot of greenery,
healthy produc ve food and where we have reached to? We are living in packed
compartments, agricultural areas being transformed in residen al and industrial.
More we have increased in numbers, more use of fer lizers and pes cides for
increased produc vity and hence degrading quality of food, land, water and
environment. Yes the same cycle we remember back each me and the problem is
same- we are compromising with the health of our environment and hence our
health; just for increasing development pace.
“Every 10 seconds we lose a child to hunger. This is more than HIV/AIDS, malaria
and tuberculosis combined.” — Jose e Sheeran
This is just the one aspect…remember those million children living in Asian and
African countries devoid of even bread to sa sfy their hunger…the quality of food
and water comes a lot a er. We are yearly seeing woman and lot of children
entrapped in diseases and mostly comes due lack of sanita on, quality and lot
more….so today we need to ask a ques on…..building a new nuclear reactor,
building of one more skyscraper, investment on moderniza on is more necessary
than providing basic ameni es to those children? Absolutely, No…because if today
a child dies of hunger then we all should be ashamed and will be held responsible…
We are looking at these problems from years and now we understand this fact well
.Today we need to embrace this fact ﬁrst and then move to the right solu on.
Do start from the environment ﬁrst; we all know healthy environment is the key to
good health. The real requirement is of maintaining the balance and my friend it's
never too late. Let our policies be implemented in such a way that we must keep
stepping forward and keep maintaining good health too.
Nature share no boundaries, we may poli cally do; hence its conserva on needs
global integra on. We require integra on in terms of help, support and
responsibility, which needs coming out of our internal conﬂicts.
We have limited resources. Today we are exceeding in our numbers beyond a
controlled extent. Some do already know and some s ll needs to know. It should be
administra ve responsibility of countries to teach its people 'Small family, be er
family' and 'less people, be er development'. Let support the authori es by
embracing as well as popularizing these quotes as our foremost responsibility.
We can't neglect the danger involved in working in nuclear power plants and
mining sites. Un l and unless it is safe enough, no human resources should be
allowed working. It must be kept in mind that the life of individual is equally
important as genera on of electricity in nuclear power plant and being advanced
scien ﬁcally we know the safety measures to their level best.
These days what mostly troubling us out are unhealthy food products. We need to
shi back to organic farm prac ces. Just look at the data and its clear we are
consuming dangerous chemicals in our food products. A green and fresh looking
leaﬂet is healthy? No……it's just ll the me we are looking with close eyes because
reality is far beyond. Why can't government support the farmers ini ally during
organic farming? Once it will sustain for a year or two, we will reach to same
produc vity levels. But we will save a lot…precious health of our people and our
precious land and water resources.
INTERNATIONAL ESSAY CONTEST 2014
A large shi to vehicles and industrializa on is the reason our sky is black and misty
and hospitals are ﬁlled with asthma c pa ents, skin pa ents and lot many
diseases. This is an industrialized era but the point where we can use human
resources in place of industries hence shi ing only to the required level will be a
great choice. The eﬄuents discharged from industries need proper a en on and
we need to develop more technologies for proper discharge and decomposi on of
these eﬄuents.
“When elected oﬃcials abandon our environment and ruin our natural resources,
public health is endangered. I know the importance of providing a clean
environment for our children; I have a ended more than one funeral for a child
who has died from an asthma a ack.” – Gwen Moore
Today this is not the scenario of everywhere but many locali es…waste thrown
outside, alongside roads or in open places. Each of the individual equally shares the
resources as well as the responsibility to use it to a sustainable level, responsibility
of its maintenance and protec on. Do inculcate in each mind to properly
decompose the waste…of the individuals in dustbins and of the authori es at
decomposi on sites.
Each of us loves to sit in a green environment so why not each of us can contribute
in building a green environment. 'Each one, plant one' and remember my friend
when each en ty works for a certain goal, it's not only achieved but do bring in each
feeling of sa sfac on, contribu on and unity.
Coming back to the most important point again, each individual is special. A child
born in well to do family is same as child born in any poor African family. Those who
are made self-suﬃcient have responsibility to support those who are not. No
na on and society is developed if its individuals are suﬀering from poverty, dying
from hunger…….let we be a li le slow in our development and look at those eyes
which are dying with hope that god will look upon them…someone will give them
food to eat…someone will move along with them in the phase of development….
we must remember, this is needed not only for a healthy surrounding but we will be
more empowered in terms of human resources and more blessed in terms of
humanity.
Anything taken for granted results in reduced eﬃciency. Nature is our best friend so
why we should be its foe? It's gran ng resources in ample amount so now there lays
our responsibility of using it sustainably. No more taken for granted a tude. A
healthy society can help us to achieve our millennium goals even faster. Believe me
my friends; the key is in our hand…..
“Salubrious environment
Be er we,
Increased pace
Be er eﬃciency”
JANUARY 2015 • lexiconin.com
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Dr. SONAL AGRAWAL,
All India Ins tute Of Hygiene & Public Health, Kolkata
Diploma in Public Health Course (2014-2016), 1st year
PUBLIC HEALTH BEYOND MDGs
Public health is the science and art of preven ng disease, prolonging life and
promo ng health and eﬃciency through organized community eﬀorts. It is HEALTH
FOR THE PEOPLE, BY THE PEOPLE. Undoubtedly, this is a very big mission requiring
lots of resources and eﬀorts which, in turn, requires sound planning. Many plans
have been made of which the MILLENNIUM DEVELOPMENT GOALS, signed in
September 2000 by 191 countries, have proved to be the most successful in global
mobilisa on towards the achievement of agreed upon basic social priori es. These
are set to be achieved by 2015. The goals are1.To eradicate extreme poverty and hunger.
2.To achieve universal primary educa on.
3.To promote gender equality and empower women.
4.To reduce child mortality.
5.To improve maternal health.
6.To combat HIV/AIDS, malaria and other diseases.
7.To ensure environment sustainability.
8.To develop a global partnership for development.
They have a package of well-deﬁned, me-bound targets and indicators. Clearly,
the ﬁrst seven goals are interdependent and reinforcing and eighth is a way to
achieve them. They have placed HEALTH at the “Heart of Development” which is
reﬂected by the fact that 6 of 8 goals, 8 of 18 targets and 18 of 48 indicators are
health related. They address the various basic problems which have been realised
to synergis cally improve the health outcomes. E.g. Reduc on of Under-5
Mortality Rate requires focus on maternal and child nutri on, preven on of HIV
transmission, improvement in sanita on and hygiene etc. They also provide a
framework for interna onal development and coopera on and have led to the
crea on of various interna onal organiza ons, like the Overseas Development
Agency (ODA), which provide aids for achieving the MDGs.
But are these goals REALISTIC? E.g. The ﬁrst goal to eradicate extreme poverty and
hunger. These two are the major demonic problems faced by human society since
its concep on. No solu on has been found since years. Se ng a goal to eradicate it
within 15 years is clearly OVERZEALOUS. Also, there has been no considera on
about BASELINES while se ng targets. E.g. For exhaus ve goals like hal ng
HIV/AIDS, well-to-do countries like USA, (prevalence 0.6%) may achieve it but not
countries like Africa (prevalence 18%). On one hand there has been no special
provision for such countries. And on the other hand even if Africa decreases
HIV/AIDS prevalence to 10%, which is an 8% decrease (signiﬁcantly greater even if
USA halts HIV/AIDS), yet the goal remains unachieved and no recogni on is made in
this regard. Also, even if USA achieves 7 of 8 goals, its main problem of Environment
Sustainability remains underachieved. This reﬂects the need for LOCAL
PRIORITISATION of the goals as despite achieving majority of the MDGs, the
improvement in health status of the community will not be upto the expected level.
MDGs also fail to emphasize on the SUB-NATIONAL level progress. A country has
various sec ons in the society each of which individually progresses towards
development at a diﬀerent pace. This should be taken into considera on so that
the weaker sec ons may be assisted to keep their pace at par with others. There
has also been NO SPECIAL CONSIDERATION OF VARIOUS CULTURAL PRACTICES
having important bearing on health and health related factors. e.g. a) Pure
Vegetarianism prac sed by orthodox Hindus may lead to Vitamin B12 deﬁciency
(main source is animal food), b) In case of the recent outbreak of EBOLA virus in
Africa, cultural prac ces like ritual prepara on of the body for burial and hugging
and kissing of the dead body are some of the high risk prac ces resul ng in the
transmission of the virus. These have deep roots in the society and have laid down
the basic norms required for personal and social survival. In short, they are related
to the emo ons of the people and it is a set of cultural prac ces and beliefs which
makes the various groups of society diﬀerent. They have become the
iden ty/hallmark of the groups. Clearly, these are the most diﬃcult to change. So,
much of the eﬀorts and planning would be required to make a community change
the harmful cultural prac ces. This has not been realised in the MDGs. Also, the
INDICATORS AND MONITORING SYSTEM should be locally feasible and acceptable
otherwise it would lead to unnecessary increase in expenditure further straining
the resources. e.g. It is not possible for Africa to do household surveys even with
external aid. So, the choice of indicators should be le on the individual countries
rather than ﬁxing and applying them globally.
INTERNATIONAL ESSAY CONTEST 2014
The other problem is the SUSTAINABILITY OF THE ACHIEVED SUCCESS. This will
require me culous monitoring and con nuous eﬀorts which will put a heavy strain
on country's ﬁnance and resources. This would be almost impossible for the poor
countries which are already in Debt for achievement of MDGs. Thus, the eﬀects of
success would be lost eventually. The Rio +20 Conference (June, 2012) has come up
with the SUSTAINABLE DEVELOPMENT GOALS in their document “The Future We
Want”, which acknowledges the need to mainstream sustainable development at
all levels integra ng economic, social and environmental aspects and recognizing
their interlinkages, so as to achieve sustainable development in all its dimensions.
Lastly, the ques on arises that WHETHER THESE GOALS ARE RELEVANT in the
present scenario? The MDGs were formulated in an era of economic stability. But
the world has been ever changing and has seen a period of economic crisis. The
world economy has undergone a change from the previous G8 leaders to the
present G20 leaders. There has been a rapid increase in urbanisa on which has
shi ed focus to non-communicable diseases. Addic ons have become rampant.
There has been a widespread increase in the problem of drug resistance in the
pathological agents of communicable diseases. There has been increase in
communica on technology leading to the emergence of eHealth and mHealth (i.e.,
use of mobile and wireless technologies to support the achievement of health
objec ves.). Many new problems like adolescent health, social jus ce, climate
change (making incorpora on of disaster management important), etc have
emerged, which need immediate a en on. Bioterrorism may emerge as a
signiﬁcant threat, like the 2001 Anthrax a acks. Some of the problems like peace
and security, which are more relevant in today's scenario, were listed in the
Millennium Declara on but not incorporated in the MDGs as they were not
poli cally palatable. There has also been emergence of new communicable disease
epidemics like the SARS epidemic. A small outbreak in any part of the world
becomes epidemic/pandemic in a very short period of me, mainly due to
improved transport facili es, posing threat to whole world, unless rapid protec ve
measures are taken, like the recent EBOLA outbreak in Africa. Thus, no doubt many
of the goals listed in MDGs are the basic requirements for a healthy community but
they are not self suﬃcient to be relevant in this era.
The me-period of MDGs has reached its end in 2015. So, we have to plan our next
step which may be one of the followinga)Increasing the dates of the targets to be achieved so that the ones lagging behind
can make up, or
b)Adding some new targets to the Goals, or
c)Redeﬁning the Goals and establishing a new framework.
In the light of above discussion, it is clear that the exis ng goals are not suﬃcient in
today's scenario. Therefore, a new POST-2015 DEVELOPMENT AGENDA needs to
be planned keeping in mind the lessons learned from the MDGs, though it is not
easy to weigh their strength and weaknesses as they cannot be clearly stated in
terms of success or failure. It is an undebatable fact that the MDGs have provided
the greatest impetus globally for improvement of health status and without them
we could not have achieved the present health status. So, in the Post-2015 Agenda,
the strengths of MDGs should be retained, likea)The core principles are relevant (though not self suﬃcient) even today,
b)Clear-cut, me-bound targets,
c)A framework has been laid down of eﬀec ve planning system,
d)Some ﬂexibility has been allowed by not men oning the ways to achieve targets,
etc.
And weaknesses should be overcome, some of recommenda ons are –
a)Goals should be relevant, simple and precisely deﬁned to enable clear-cut
planning,
b)Goals may be set globally but have to be priori sed locally/na onally. Individual
targets need to be set locally,
c)More focus on qualita ve aspects of the achievements,
d)Indicators should indicate SUB-NATIONAL progress rather than na onal/global
progress,
e)Provisions for evalua on at short intervals so that the lag can be iden ﬁed and
rec ﬁed,
f)More ﬂexibility to include various na onal policies, cultural prac ces,
demographic dynamics etc,
g)Accountability,
h)Strong poli cal commitment,
i)Inclusion of principles of public private partnership.
No plan/programme can, single-handedly, make the world HEALTHY. Though
eventually eﬃcient planning and well-directed eﬀorts may make it possible to
achieve even the idealis c deﬁni on of Health given by WHO !!!
JANUARY 2015 • lexiconin.com
Compe
INTERNATIONAL ESSAY CONTEST 2014
on
6.
Narkhajid Davayyam
Public health beyond the millennium development goals
The millennium development goal health program started in 2008 January 31st as a
program to develop the economy, ecology, mining and public health. I think that
public health is more important in our country but what is public health? Public
health is to protect and prevent the people's health. By protec ng and preven ng
the health of many people we can lower the number new cases, mortality,
morbidity and also increase the educa on and prac ce of the popula on. Then
how do we protect the popula on's health? The public health's goals are :
1.Physical training and exercise
2.Prac ce and educa on of preven on
3.Healthy food and water
1.Today, many people are ge ng overweight and the complica on of that are
cardiovascular disease or diabetes for example or even worse, death. There are
17,6 million overweight children in the developing countries. And one of the cause
of overweight is not exercising enough or no exercising at all. Let's take an example :
/Mongolia/
·
Not all people have access to public health care services
·
There are few mo va onal events like sport compe ons that include the
popula on
·
In Ulaanbaatar there are few places (not including ﬁtness gyms) for people to
exercise and technology has taken a place in people's life so most of them forget to
exercise.Working every me and everyday causes stress for many people so they
don't have enough me exercise
·
In the winter season running outside is diﬃcult cause every year the air pollu on
increases
Exercise center or ﬁtness centers are expensive, so for people who have minimal
paychecks can't or doesn't go to gyms. From these reasons the government with
the collabora on of health care service centers are created a program to help the
popula on. Firstly, the air pollu on is accumulated in the center part of the city
while the outer parts have less density of pollu on in the air. In Mongolia Per capita
toxic substance is 243.6 kg. The government distributed smokeless furnace for the
"Ger" districts. Unfortunately not only it didn't resolve the issue it also caused a
problem for the economic. I think instead of distribu ng furnaces, people should
use smokeless gas fuels. If we work together as one we can get rid of the air
pollu on in a short me and exercise much be er. Secondly, there should be free
exercise centers or places in all districts. As a result the number of people who
exercise will increase. Thirdly, to make people exercise they need free me or spare
me, so we should decrease the me of the hours in work. Fourthly, the standard
me for exercising is 30 minutes with a medium tempo exercise, 3 mes a week or
ten thousand steps every day. Fourthly, improve the health care system in the
public health sector.
2.Second For a healthy lifestyle the basic is educa on, prac ce and a tude. Most
of the popula on have high knowledge but the educa on in health is below
average and because of that many people tend to get sick. This reason can be
primary or secondary cause to poor health. Even though the primary schools teach
math, literature , language and such, they don't tech enough about how to live
healthy and happy. For example: /Mongolia/
·
Health lessons are taught once a week for 45 to 90 minutes and cause of that
c h i l d r e n t a ke i m p e r fe c t k n o w l e d g e a b o u t h e a l t h f r o m s c h o o l ·
Family doctors give li le educa on about health and because of that people tend
to a doctor when their sick but not about preven on
So the government should a end to these issues even more to prevent future
problems. I think we should add more me for health lessons in schools and
broadcast health educa on through the media, for example the internet,
television, newspaper and etc. Even though there are TV broadcasts about health
educa on many people don't watch it so we should promote and raise the
interes ng things that people want to watch or change the way to spread the
educa on. For example health educa on for children like brushing your teeth
should be in cartoons or in story books and for adults we can spread educa on
through the radio or newspaper.
3.Many scien st have asked this ques on and a er many long years of studying the
answer has been found. The ques on is "Do people eat to live or live to eat?". And
the answer is of course people live to eat. One of the vital needs of a human being is
to consume food and water to stay alive. Food can be found in many diﬀerent ways
and every na onality has their own unique food. For example in the 13th century
the Mongolian people ate dairy products and cooked meat to build up strong body
and mind. We can't say but maybe the food could have aﬀected the Mongolian
people to conquer half of the world. Dairy products contain a large amount of
calcium, protein, carbohydrate and various vitamins. But today not only Mongolia
but in other countries the fast food industry has taken a place in the food market.
Everywhere you see there are fast food places opening and closing. For example
McDonalds, Kentucky Fried Chicken, Pizza hut, Subway and etc. Many doctors
advise ea ng a large amount of fast food is bad for their health. People understand
that and wish to stop but can't because fast food has many advantages compared to
regular food. For example :
·
It is quick
·
It is easy to get to
·
The food is tasty
·
It is cheap
·
I'm too busy to cook
·
It's a "treat" for myself
·
I don't like to prepare foods myself
·
My friends/family like them
·
It is a way of socializing with friends and family
·
It has many nutri ous foods to oﬀer
Not only in America there are many overweight people all around the world and
fast food is one of the cause. So what should we do besides exercise and training?
What should we do ? We should :
·
Teach about how to choose healthy food
·
Increase the price of fast foods
·
Broadcast cooking shows and raise the interests of the people
·
Distribute broachers about healthy food and diet informa on
·
Teach about how to make healthy food
·
Adver se about danger of fast food.
·
Make the people understand that ea ng healthy food will cost less money
·
Healthy food = Healthy body
Finally public health depend one person's health, one person's health depend
public health.
JANUARY 2015 • lexiconin.com
Compe
on
7
Ashwini Patankar, 2nd M.B.B.S., MGM Medical college, Navi Mumbai.
Public health beyond the millennium development goals
A li le girl in the slums of Mumbai typically begins her day at four in the morning
every day. With du es of ﬁlling water and o en cooking meals when her mother
leaves early for work, are among the few daily chores assigned to her. All of this
because water is yet unavailable all day in the slums. She does all of this while her
father is dead drunk and sleeps through the day and drinks through his evenings.
She goes to school only because the school provides mid-day meals and that too for
free. A par cular liking of educa on, even if, is inculcated in this li le innocent
mind, how far will it go? Such gender equality in the very economic capital of a
na on makes one wonder, how have the past millennium development goals
helped? Has poverty been eradicated? Will the diseases in such a society be
successfully eliminated?
Malnutri on, poverty, illiteracy and many more are commonplace problems
encountered in developing na ons and widely in developed na ons too. These
problems are being primarily focused upon and correc ve measures have been
coerced, but it brings us to a thought; what brought this change?
The 20th century was ﬁlled with wars and disasters both natural and man-made. It
drew a large burden and took a toll on development and health industry all over the
world. It brought realms of poverty with it. The end of major wars peaceful na ons
were in dire need of a new policy, a hope to hold onto.
The Y2K or the year 2000 brought about these very changes that amassed the
future of the world for ten centuries to come. Among many such grand goals that
shimmered in the eyes of the world's leaders was this one, which the 189 members
of the UN (United Na ons) set in stone, in September that year. In purview of the
past diﬃcul es, 8 millennium development goals (MDG's) were decided upon to
mark the fate of the world.
The millennium development goals focus systema cally on these very problems
that are prevalent. MDG's are formed in such a way that they pinpoint the
problems and send packing these very, in a methodical pa ern.
However, all ﬁngers are not the same, that implies that the problems of any na on,
even though are similar largely, diﬀer greatly. The variable geography, economy,
a tude of the populace, bureaucracy, varia on in intensity of problems etc has not
been taken into account by the MDG's. Hence certain goals beyond the MDG
especially for public health are inevitable to be formed. Public health at large
always encompasses the overalls of the individuals in a region. These country
speciﬁc measures need to be altercated.
The year 2015 being the deadline for the MDG's a new pro forma had to be
established and a high panel report on the same hence has been put together. It will
be valid up to the year 2030 and aims at eradica on of poverty from the face of
earth.
This Panel report drives ﬁve major changes that target poverty by entailing goals
including Leave no one behind, drawing the sustainable development at core,
transforming economies and crea ng new jobs, improving peace and forging
be er global partnership including all the previous fallouts.
Beyond 2015, the picture of the society has changed tremendously. The
empowerment of women all over has brought about be er incomes and increased
literacy and educa on is improving the varied prac ces.
However the child mortality in countries like India although has improved greatly,
the problem persists. Obnoxious cultural prac ces like hot oil baths leading to
seizures in children, ﬂoppy baby syndrome due to feeding honey to newborn's,
poor weaning prac ces, applica on of dung on stump of an infant's cord and so
many more need to be abolished. People need to be educated about prac ces at
the grassroots level and that to region and prac ce speciﬁc.
Maternal mortality, especially due to illegal abor ons needs to be inspected and
scru nized in all the na ons, irrespec ve of their level of development. Because in
most developed countries abor ons are illegal and may lead to use of unsanitary
and illicit ac vi es. Maternal mortality due to lack of facili es for puerperal
diﬃcul es are s ll prevalent in rural India and in many developing and under
developed countries. Also provision of be er facili es for deliveries in regions of
war or regions with disharmony must be be ered.
Not only children and mother's but the rising diseases need to be focused upon.
Vaccina ons must be be ered and con nued. Addi on of vaccines to the UIP
(Universal immuniza on program) is necessary in purview of the rising diseases,
while vaccines to eradicated disorders should be removed from the UIP.
In addi on, comba ng the rising an bio c resistance must be incorporated in the
development goals. An bio c resistant strains of diseases like tuberculosis,
staphylococcus is increasing the burden on the public health sector throughout the
world. Cost eﬀec ve policies must be embarked for the same.
INTERNATIONAL ESSAY CONTEST 2014
Human traﬃcking, though not primarily a public health burden, must be looked
into. Bringing in bans and use of be er safety precau ons and barriers for
preven on of sexually transmi ed diseases can be a strong addi on.
Lifestyle diseases inclusive of obesity, diabetes, hypertension and more are
although almost nulliﬁed in the developed na ons; s ll present a signiﬁcant
burden in the developing na ons. Educa on about these, compulsory regula ons
and laws need to be implemented on a global level.
Be er environmental solu ons to provide cleaner air and water , although was a
part and parcel of the previous MDG's needs to be con nued for a longer dura on
as it is a never ending problem and poses a larger danger to the public health
throughout the world.
A whooping one billion people all over the world s ll lack access to improved water
sources and a two to three million lack proper sanita on. These happen to be a
herculean onus to the public health system. Lack of these very basics irked the
spreading waterborne and food borne disorders.
Various industrial health hazards have been overlooked in the past and need to be
brought to the forefront. The recent event of the abandoned asbestos mines in the
Roro village in India is one such ruling example of the many.
One is ought to realize that the society is made by its men and that the eﬃcacy of its
people depends upon their health. Meliora ng these will beneﬁt not one but the
en re mankind. It is hence a need to put forth a set of goals that will encompass
these very as the crux of its ideology.
If such incorpora ons are made, not just one but many li le innocent children and
the society as a whole will be saved from the clutches of poverty and diseases. This
will ensure that the coming future genera on will ﬂourish in the rays of hope,
making the world a much happier place to live in.
JANUARY 2015 • lexiconin.com
Compe
on
8
Hindol Maity
Research AssistantManipal Centre for Virus Research (MCVR)
Manipal University, Manipal
Public health beyond the millennium development goals
“Pioneering spirit should con nue, not to conquer the planet or space ... but rather
to improve the quality of life.” — Bertrand Piccard
According to United Na ons' World Health Organiza on's deﬁni on of public
health, it is "the science and art of preven ng disease, prolonging life and
promo ng health through the organized eﬀorts and informed choices of society,
organiza ons, public and private, communi es and individuals”.1 Ironically,
despite several diseases being preventable and treatable, signiﬁcant por ons of
the developing con nents s ll remain aﬄicted, with li le/no signs of
improvement. Negligence towards maternal and child health, fuelled by poverty
and malnutri on, are among the painful truths imposing serious concerns on the
face of growing economies. The world is confron ng public health related issues on
a rou ne basis. Emerging and re-emerging infec ous diseases such as Severe Acute
Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), Ebola
Virus Disease (EVD) etc., ambigui es in health insurance programs, upsurge in
childhood obesity and type II diabetes, and the health challenges post natural
disasters / calami es / war, have emerged as key concerns inﬂuencing public
health.
The topic 'Public Health Beyond the Millennium Development Goals' compels to
look at a big picture with a microscopic lens to probe into the minutest details of the
staggering issues that every country on this planet is facing today, which is tackling
its people's health. Twen eth century culminated with the dawn of the United
Na ons' Millennium Declara on, presen ng an agenda to achieve the eight
Millennium Development Goals (MDGs) by 2015. These targets were primarily
focussed on poverty eradica on, improvement of maternal and child health and
overall advancement of na ons. The colossal health challenges confronted by the
world's underdeveloped economies together with the ambi ous drive behind
these goals, witnessed the birth health ini a ves such as the Integrated
Management of Childhood Illness, Global Alliance for Improved Nutri on, Global
Alliance for Vaccines and Immuniza on, the Global Fund to Fight AIDS, TB, etc.
Indeed these ini a ves improved public health apparently; however, on the global
canvas the change has not been quite remarkable. As observed from the WHO
reports on HIV deaths , there has been a marginal reduc on from 1.7 million (3.2%)
deaths in 2000 to 1.5 million (2.7%) deaths in 2012.2 Approximately, 1.5 million
lives succumbed to diarrhea in 2012 itself, though the disease has moved from 5th
posi on to 10th posi on in causing death.2 The MDGs nowhere talk about
counterac ng the worldwide leading causes of death such as Ischemic heart
disease, stroke, lower respiratory infec ons and chronic obstruc ve lung disease.
Under these circumstances, achieving the MDGs' health targets by 2015 seems at
stake.
The roads to eﬀec ve health systems in every governance and worldwide
economies confront hurdles related to human resources, funds, therapeu c drugs
and supply systems, crea on and dissemina on of informa on. These hurdles lead
to failure in prac cal implementa on of successfully planned health schemes. The
instrumental lead player in direc ng a country's health policies is its government.
Government strategies inﬂuence public and private health sectors considerably
and therefore reforma ons are sought at this rudimentary level in the very ﬁrst
place in order to witness an overall transforma on in the country's health proﬁle.
Strategic management in the health sector policies is required to ensure
preparedness for tackling na onwide health related issue or unexpected health crisis. To fulﬁll this gigan c task, are
required, poli cal commitment to issues governing health, overcoming ﬁnancial
crisis, judicious bifurca on of resources, synchroniza on between health and
ﬁnancial sectors, co-ordina on between funding agencies, non-governmental
organiza ons and government bodies in providing health services, imposi on of
strict legisla ve regula ons on public and private stakeholders, deployment of
monitoring systems for gathering informa on from public and private sector and
use it eﬀec vely in improving health services. In the current scenario, it can be very
well argued that alongside increasing expenditures on health, strengthening the
policies and ins tu ons within and beyond the health sector is also important. A
serious transforma on is sought in the health services delivery systems as well. The
focus should be on building an infrastructure that will be capable of providing equal
medical facili es to all the classes of the society. However, s gma associated with
infec ous diseases and socio-economic/gender inﬂuences on behavior, access and
use of care have been found impeding the health progress throughout the socioeconomic strata markedly. Deploying a well-balanced systemic approach,
INTERNATIONAL ESSAY CONTEST 2014
contribu ng to overall system strengthening, needs to be considered. This will
facilitate capacity building for eﬃcient execu on of health goals in a mely manner.
Public health infrastructures are in nascent phase in many developing countries,
lacking adequate trained health personnel and ﬁnancial sources, thus failing to
deliver even a primary level of medical facili es. Consequently, a vicious circle of
disease associated morbidi es and mortali es resul ng from and contribu ng to
extreme poverty and malnutri on, is created. Considering the disparity that exists
in accessing health care facili es and in implemen ng public health ini a ves, the
developed countries need to come to the forefront in aid of the developing na ons
to strengthen their economies and health structures. Adop ng an interdisciplinary
approach towards global public health needs to be considered seriously for the
be erment of genera ons together to come. Inputs of professionals hailing from
health services, epidemiology, biosta s cs, medical insurance companies and
disaster management may be put together to design prac cally feasible, resultoriented health plan.
background, dealing with day to day rou ne diagnosis of several infec ons, gives us
an advantage to look at the current scenario of diseases from a wider angle. It can
be clearly quoted here that 'Humans are standing at the brink of emerging and reemerging infec ons'. In order to predict, avert or mi gate these events, a ﬁeld and
laboratory research ini a ve rather than a rou ne surveillance and reference
diagnos c approach is required to cater global public health needs. The 'OneHealth approach' imbibing collabora ve eﬀorts of mul ple disciplines, working
locally, na onally and globally, to a ain op mal health for people, animal and
environment,3 incorpora ng the bio-security issues, is the need of the hour. This
may be the most cost-eﬀec ve and most eﬃcient approach to address the threats
posed by emerging viral
Being from a virological
infec ons to global health.
Talking next about zoono c diseases such as EVD, SARS, H1N1, H5N1, Rabies, etc. a
perpetual lack of awareness exists among the common people, which indicate that
in order to prevent an outbreak, more than taking appropriate public health
measures, right spread of informa on about the disease and its consequences is
equally important. On that note, it won't be totally wrong to quote here, that
public-private partnership can be instrumental in spreading awareness, about
diseases looming at the human-animal interface, among the people. Sociological
aspects related to certain disease epidemics should be addressed sensi vely. In
addi on, there is a need to ﬁght
rumors and hoax calls regarding disease outbreaks. Health also encompasses "a
state of complete physical, mental and social well-being and not merely the
absence of disease or inﬁrmity", as quoted by the WHO. However, increasing
addic on to smoking/ alcohol/ drugs together with growing number of depression
cases among the new genera on strongly hampers the mission- 'complete health'.
The focus of public health interven on should be on improving health and quality
of life by adop ng four core strategies, which are promo on of hygienic prac ces,
refrain from deteriora ve addic ons, disease management and surveillance of
ecosystem. This will transpire the much awaited dream of 'health for all' into reality,
which will sustain ll many millennia to come. Complemen ng good health every
country should aim at achieving wellbeing of its
ci zens.
Wellbeing is a more pragma c approach to health and life, which encompass
mental,
physical, cultural and spiritual health and is of utmost importance in achieving
posi ve life outcomes. This is also principle of the Ayurveda, a system of Hindu
tradi onal medicine of Vedic tradi on. On that note, United Na ons adopted
Indian Prime Minister Mr. Narendra Modi's proposi on and declared June 21 as
'Interna onal Yoga Day', as recogni on to ancient India's 'holis c approach' to
health and well-being. With the foresight of the great historians who brought
public health to life, every na on should not only aim but achieve good health for
its
inhabitants,
“For he who has health has hope; and he who has hope, has everything.” – Owen
Arthur
JANUARY 2015 • lexiconin.com
Compe
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9..
Harika Peke ,
House Surgeon, Andhra Medical College,Visakhapatnam, Andhra Pradesh.
Environment- An Agenda for Health Promo on
Living in mes where our highest potent an bio cs have become resistant and
newer, deadlier strains of microbes are emerging every day, our best bet has been
promo ng health than trea ng disease per se. We have embraced various health
promo on policies, but crea ng a stable and healthy environment is of paramount
importance, as human interact with environment constantly. These interac ons
aﬀect the quality of life, years of healthy life lived and dispari es in disease
incidence. The inextricable links between people and their environment have been
the basis for socioecological approach to health. WHO has advocated the need to
encourage reciprocal maintenance – to take care of each other, our communi es
and our natural environment. Further, it has been proved that, globally near 25% of
all deaths and the total disease burden can be a ributed to environmental factors.
Thus environmental health has become a major part in health promo on and
disease preven on.
How does environment eﬀect health?
Environmental health includes all the aspects physical, chemical and social aspects
external to a person and the related factors impac ng behaviours. There are
diverse aspects that can aﬀect health, but primarily these are the following factors:
·
Exposure to hazardous substances in the air, water, soil and food
·
Natural and technological disasters
·
Physical hazards
·
Nutri onal deﬁciencies
Air quality- outdoor and indoor:
Poor air quality is linked to myriad of respiratory tract infec ons, cancer and long
term respiratory and cardiovascular problems. WHO es mates that 7 million
deaths are caused by air pollu on in 2012 covering both household and ambient air
pollu on. Of these 4.3 million deaths every year are due to indoor smoke from
cooking fuels, whereas 3.7 million are due to outdoor pollu on. Approximately
88% of these deaths occur in low and middle-income countries, where around 40%
of household use solid and biomass fuels for cooking purposes causing pollu on,
and indoor tobacco smoking adds to the menace.
Surface and Ground water, Land ﬁlls
Contamina on of water by micro organisms and chemicals cause mild to severe
illness, from diarrhea to arsenic poisoning. Dumping house hold waste, medical
wastes and other industrial wastes in landﬁlls have been pollu ng soil. Though we
have advanced in leaps and bounds in terms of technology, there are places in a few
countries where proper sewerage and public hygiene and sanita on are nothing
but a myth. These toxic chemicals and micro organisms are ﬁnding their way into
humans through food or water. In an intricately woven ecosystem like ours,
disturbing the balance at one end will topple the balance of the en re system,
crea ng disasters of a greater magnitude.
Apart from these, the unforeseen disasters that occur now and then pose a threat
to the health on a major scale, like Chernobyl of Russia or Bhopal gas tragedy. These
destroy environment to such a scale that not only that genera ons, but future
genera ons too are aﬀected.
How can environment be used as an agenda for health promo on?
As the mul factorial theory goes, several factors can cause a single disease and a
single factor can cause many diseases. Environment is one such factor, which can
cause a mul tude of diseases ranging from deafness caused by sound pollu on to
lung carcinoma caused by smoking and asbestos exposure, from diarrhea to
radia on poisoning. And crea ng a stable and sustainable environment can
decrease the incidence of these diseases. To create a suppor ve environment, we
need to:
·
Understand the dynamics between environment and health hazards caused by it.
·
Create policies for health promo on.
·
Raising awareness among the public regarding these policies
·
Revising them on a mely basis.
INTERNATIONAL ESSAY CONTEST 2014
Many a mes, a bigger problem is conquered by a much simpler solu on, as hand
washing among doctors have decreased the rate of transmission of infec ons from
one pa ent to another. For instance, the indoor pollu on caused by cooking fuels
can be controlled by making alternate sources of fuel available aﬀordable for the
lower income group. Providing people with healthy choices will help us in a crea ng
a healthy environment, and making these healthy choices easier choices ensures it.
Awareness should be raised about:
·
Diseases caused by open defeca on and the lack of sanita on. It will prevent the
contamina on of water bodies, thus curtailing the spread of water borne diseases.
·
Health hazards caused by dumping hospital wastes without any precau on should
be explained to all the personnel.
·
Health hazards caused by dumping industrial wastes. Stringent laws should be
made about industrial eﬄuents being released into air, water and soil. Industries
should be established a safe distance away from the inhabited areas. Green belts
should be arranged near industrial areas to curb the level of noxious gases being
emi ed from industries.
·
Nutri onal deﬁciencies due to environmental causes. Safe prac ces regarding
removal of ﬂuorine from drinking water, iodina on of salts should be promoted.
While these cons tute the physical and chemical aspects of environmental health,
there is another important aspect of environment aﬀec ng health, social aspect.
Only a stable environment can ensure perfect emo onal health. In the present day
busy world, human rela ons have hit a new low. Adding to this, rampant
alcoholism, drug abuse, higher stress levels at the work place are wreaking havoc
on one's emo onal health, as well as physical health. To combat this, we need to
raise awareness regarding the issue and to promote policies and community health
interven ons regarding alcohol and drug abuse.
While crea ng health policies is the ﬁrst step to ensure health promo on, it alone
will never be suﬃcient to create a stable environment. Any health policy can be
frui ul only when the general popula on is made aware of the policy and its
beneﬁts. Increasing community par cipa on makes it possible for the message to
reach to grass root levels, only then we can see the change happening due to these
health policies.
Since WHO has proposed in its O awa charter, in 1986, about crea ng suppor ve
environments as an important step in health promo on, governments have made
laws and policies to promote health and to prevent damage to our environment.
We have come so far from then, but have we really established safe environment?
Have our policies been successful? These are the ques ons we need to ask
ourselves. More so, we should ask these ques ons now, for we are in a transi on
stage, comple ng the self imposed me frame for Millennium development goals
by 2015.
Governments and NGO should focus on ways to promote stable environment and
health. But, as an individual, we should contribute, by prac cing healthy habits and
educa ng others. Respec ng the diversity and complexity of environment is
important as our health and environment are interrelated.
“Man, in his selﬁsh pursuit to conquer the world, has advanced so much in terms of
technology, yet in his a empt to achieve; he ended up destroying his home,
environment. It is me to wake up and to save what has been le of it”
JANUARY 2015 • lexiconin.com
Compe
on
INTERNATIONAL SLOGAN CONTEST 2014
1.Haris Qasim, Pakistan
M.Phil/MS, Hamdard University, Karachi. Pakistan.
“Suitable socio-poli cal and economic global environment is a need of food security and healthy life”
2. Dr.Sarmistha Sinha [a person with Spinal Cord Injury]
Dept.of Physiology
R.G.Kar Medical College & Hopital
Kolkata-700004, India.
"To achieve the Universal Goal of Public Health Care,
Let Us..
Remove Barriers,
Open Doors,
&
Embrace All"
3. S.Fa ma Lakha MSc, PhD (C )
Ins tute of Medical Sciences
Collabora ve Program of Global Health
University of Toronto
"Food Insecurity: A Mul -faceted Issue Threatening Global Public Health"
4. Yves Robitaille
Prevost, Quebec, Canada
“MAKEroomFORpublicHEALTH”
5.Rashid Haider
2nd year MBBS at Mahatma Gandhi Ins tute Of Medical Science,MAHARASHTRA
“Every me Gazelle wakes up it runs faster than the fastest lion else killed.
Every morning lion wakes up he outrun the slowest Gazelle else starve to death.
Doesn't ma er who you are when the sun comes , you'd be er running.
JANUARY 2015 • lexiconin.com
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