- Lexicon - The Online Medical Magazine
Transcription
- Lexicon - The Online Medical Magazine
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. JANUARY 2015 • lexiconin.com Compe on 2 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. INTERNATIONAL ESSAY CONTEST 2014 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. JANUARY 2015 • lexiconin.com Compe on 3 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. INTERNATIONAL ESSAY CONTEST 2014 ..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. JANUARY 2015 • lexiconin.com Compe on 4 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 Compe on 5 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 on 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 THE BOARDS BOARD OF DIRECTORS CORRESPONDENTS Spandita Ghosh Editorial Director – Dr. Suranjana Basak Dr. Caren Otadoh Executive Director – Abhijeet Sharma Dr. Naren Nallapeta Governor – Dr.Sakhi Shah Chaitalee Ghosalkar Director of Finance – Dr. Raviteja Innamuri Priyanka Manghani Director of Administration – Dr. Aakash Doshi Chiranjeevi Naik Director of Edition – Ruchira Dhoke Dr. Yashada Nabar Assistant Directors – Archit Rastogi and Haymanti Saha Deeksha Seth Dr. Rohin Manipur Zenia Poladia Nikita Agarwal Sneha Nandy Dr. Nikhil Tambe Utkarsh Mishra Geeta Sundar Sankhya Saroj Trusha Taneja Anirban Chatterjee Bianca Honnekeri Dr. Shreya Agarwal Swati Shriyan Khushboo Gala Ashwini Ronghe Dr. Supriya Kumar Ms. HaymantiSaha Basalathullah Mohd. SUB-EDITORS EXECUTIVE EDITORS Dr. Hiral Mehta Ms. ShruthiVishwanathan Apurva Lunia Haleema Munir Shinjini Chakraborty Shrayash Khare Rika Rijal Mitali Gupta MARKETING EXECUTIVES Shruthi Vishwanathan Dr.Esha Gupta WEB ADMINISTRATOR Mr. KaustubhBarde CREATIVE DIRECTORS Mr. ArbazMemon Mr. Urvish Bhatt JANUARY 2015 • lexiconin.com AN SRB EDUCATIONAL TRUST INITIATIVE