Joint Academic Meeting - Schedule for the year 2010

Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 

• Please ensure that you present interesting cases/case series which will interest members of other departments as well.  Presentation of a research work, the findings of which   are of interest only to the concerned department should be avoided as far as possible, unless it has meaningful impact on practice of health care.
• All departments are requested to send a brief summary of about 400-500 words and the title, 5 days before their scheduled presentation by mail to sgpgitelemedicine@yahoo.com for forwarding to Rohtak Medical College and Berhampur Medical College. Further, departments are requested to paste notices of their title on A4 size paper at the notice board placed at Doctors Cafeteria, OPD, Gastro Department, and G block lifts as well as send an e-mail notice to all concerned at least 4-5 days prior to the presentation.

                                                                                          

What Internet is Teaching our Brains

While excessive computer use can lead to conditions such as attention deficit disorder, depression anxiety and proneness to violence, recent research has shown that internet is not all that bad after all! The web may in fact be teaching our brains, subtly rewiring the way we respond, think and behave.

The book iBrain – Surviving the Technological Alterations of the Modern Mind, by Dr Gary Small, provides new insight through research undertaken at UCLA, and reveals that an hour of internet use every day may boost brain function. “We learn to react more swiftly to visual stimuli, improve our ability to sift through large amounts of information, and decide what is important and what isn’t”. This training is most evident when we scan our e-mails, quickly deciding and deleting what is spam, while focussing on those that are important.

“If you never use computers, then start”, Professor Small recommends. “As we found, even an hour a day can vastly improve yor infrmation processing skills, even in people aged 55 – 60”.

Internet Search boosts decision-making skills. The rapid spurt of directed concentration for internet research enhances our ability to focus our attention, analyse information and make instant decisions. Web surfers typically spend two seconds or less on any particular website before moving on to the next. In her study, Professor Briggs found that internet users sifted information accurately, despite operating at high speed, stopping only at sites that contained relevant information. She found that within 5 days of regular use, novices showed improved activity in the prefrontal cortex of the brain, that control our ability to make decisions and integrate complex information, indiating that the brain could learn and improve in short time.

General browsing however encourages use of continuous partial attention and multi-tasking, which can impair cognition and can cause irritability.Hopping from one subject to the next on the web without a specific goal, may lead to computer fatigue, as this person might be simultaneously clicking on websites, replying to e-mails or speaking on the phone.

Playing computer games may improve multitasking skills, memory and peripheral vision, but can also lead to antisocial behaviour. Hightened stress levels due to increased levels of adrenaline and stress hormones have been highlighted earlier. But not all games are equal; specialized ones such as Nintendo’s Brain Age and Brain Fitness Program have been specifically designed to enhance memory and cognition, and can stave off age related diseases and Alzheimer’s.

Use of emoticons exercises brain centers linked with emotion and social connection and can be particulary useful to those who use computers for long periods. Use of ‘smileys’ stimulate the part of the brain that is activated by one-to-one emotion contact, and can offset feelings of emotional isolation often seen during excessive computer use.

Benefiting most from computers and technology is however all to do with balance.” If you work all day at a computer, make sure you mix with real people in the evening, rather than using social networking sites or playing computer games”, says Dr Small. And if you never use computers, then start, even if you are a  60 plus.

 As published in HT City ( Hindustan Times) dated 6 december , 2009.

GAYS Die Young!

Until the recent Delhi High Court judgment decriminalizing homosexuality, this subject was seldom discussed in public.  Sex between 2 people of the same sex was considered unlawful, immoral and hence remained clandestine. The extensive media coverage of exuberant gays and lesbians hugging and petting each other in the open, after the judgement, has made many wonder if being gay has become the latest “in thing”.

Homosexuality poses a hazard to health. In a study of 5406 homosexual men in Canada, Dr Robert Hogg noted that their life expectancy was reduced by 8 to 20 years (http://ije.oxfordjournals.org). Through another recent study, researchers from Center for Disease Control (CDC), USA, reconfirmed that gays die around 10-20 years younger than those who engage in normal sexual practice. “These sobering results of our research should encourage our society to reaxamine what it’s doing with those who engage in homosexuality”, says Dr Paul Cameron, President of the Family Research Institute, who headed the study. He went on to say “schools are doing a fine job educating students about the dangers of smoking and use of illegal drugs, but are increasingly teaching that homosexuality is normative and safe as heterosexual behaviour. It is NOT. Homosexual activity is much more dangerous to health than smoking” (LifeSite News.com).

The most common health problems in homosexual men are:

1.      Increase in infections: especially HIV / AIDS, syphilis, gonorrhea, pubic lice, Hepatitis B, papilloma and warts.

2.      Increase in cancers: especially of large intestine (colon), prostate, and testes.

3.      Increased incidence of eating disorders such as bulimia, anorexia nervosa and obesity

4.      Increased incidence of psychological problems: such as anxiety and depression. Suicides are 6 times more common among homosexuals than straight people.

5.      Increased incidence of addiction problems especially: tobacco (50% more than in straight men) alcohol, drugs.

In addition, problems with body image are more common among gay men. They more often indulge in muscle building, ear piercing, tattooing, and use substances like anabolic steroids and supplements that can adversely affect their health.

Lesbians also have increased similar health risks; they are particularly prone to breast and gynecological cancers.

In India, atleast 2.5 million men self identify as exclusively homosexual; the actual number could be much higher. It is postulated that while 95% of people get attracted to the opposite sex from the time they become adolescent, 5% are sexually oriented to the same sex. Environmental pressures probably contribute in shaping sexual preferences; it is common knowledge that homosexuality is more prevalent in same sex hostels, jails and barracks, and when opportunities for normal heterosexual exposure are denied for prolonged periods.

As published in HT City ( Hindustan Times) 

Making Hospitals Better Places

In this column last Saturday, we discussed how hospitals, which most citizen behold as morbid,  frightful places can be transformed into  pleasant , stress free, clean places, where people take care not only of the sick patients, but provide opportunities for the “healthy” attendants to check the staus of their health as well.  This could be your wish list from your hospital:

1.       The whole hospital environment becomes “health promoting”; for example a patient who comes with a minor skin problem also gets an opportunity to get his BP, blood sugar, weight checked and get gets to know if he is overweight or has a cardiac risk.

2.       While waiting for your doctor, you watch a glow screen or CCTV informing  about the benefits of taking the 3 shots of Hepatitis B vaccine, and are reminded to vaccinate your children and spouse as well.

3.       The hospital is spotlessly clean with no gun toting or paan-chewing goons. None of the hospital staff consumes tobacco, and colorful posters confront and remind you of the risk you run and confer to your family in continuing with your smoking habit or by remaining obese.

4.       The hospital respects your time: you do not have to wait long, as you have prior information of which doctor will meet you, when and for what, all sorted out through a telephone or e-mail helpline.

5.       The doctor is understanding and answers all your questions with clarity, backed by scientifc data. He is not affronted when asked how many such surgeries, he has performed, and their outcome and risks. He also seems, stragely for UP, willing to discuss alternative forms of treatment, and is, in fact, willing to suggest names of experts should you want a second opinion.

6.       The tests he advises are easy to book and undertake. Your blood sample is collected with disposable needles and syringes that are destroyed and discarded after use, and the results of the tests are accurate and arrive quickly. You could even ask how the laboratory maintains and ensures its standards.

7.       If you are an attendant of a sick admitted patient, you have a cafeteria where you can get a healthy meal, opportunities to meet the treating team for periodic updates and opportunities like a mediatation room or soothing music or counseling to help you tackle your own stress.

8.       If your relative is a diabetic for instance, your hospital teaches, trains and prepares you to test his blood sugar when he goes home, provides you a chart to record his sugar values and insulin doses, look out for signs of low or high sugar and an opportunity to contact and seek help when in trouble.

9.       For all this and more can be achieved only with community participation. Every responsible citizen of Lucknow should join in the “Friends of SGPGI” forum to provide his observations and suggesions. Did you know that SGPGI (www.healthpromotion.in) has been the pioneer in this endeavour in India? And you could play a crucial role in shaping your hospital?

As published in HT City ( Hindustan Times) dated 22 november, 2009.

Are You Scared of hospitals?

You wouldn’t probably go visiting a hospital on a free evening, or be called a luny if you did. And if an ambulance parks outside a neighbour’s door in the colony, your heart would pound as you wonder whom you might lose soon. 

Yes, hospitals are necessary evils you can’t wish way. They often become common bashing topics at parties. And the variety of sub topics that hospitals provide are varied enough to keep a converstaion going for ages: attitude of doctors, the way nurses behave, the bedsheets, the long waits for investigations, the gentry, the inconvenience and long queues for payment, the escalating cost of care, how last time a person you knew went to that place and died (never mind if he had a terminal cancer and went there gasping), or if anyone who went in critically ill and came out better did so in spite of the hospital rather than due to it! And add to it the topics of unnnecessary investigations, delay in response, or that or that how cruel it was of the doctor to say that there was no cure for this disease, and you have your day.

 TV serials have added another aspect of this changing patient-doctor relationship. Every time a doctor faces anxious relatives overwhelemed with emotions,to say that the patient is critical or dead,  gets his collars pulled and shoved around in disbelief. If Ekta Kapoor has her way, doctors will soon become extinct.

What am I getting at? Can hospitals become friendly places that you may care to visit without feeling so nauseous? And if hospitals are essential to the society we live in, can we put in our small efforts to improve them?

The World Health Organization has initiated a new concept called Health Promoting Hospitals. They could play a larger role, not just tending to sick patients but in promoting positive health to friends and relatives who accompany the patients. For instance, a patient admitted with terminal lung cancer due to years of smoking, may have smoker friends and relatives who come calling; hospital could be a perfect setting for providing simple, attractive, IEC (Information, education and counselling) packages. This, in fact, may be the best time and place for the smoker friend to be motivated to quit smoking.

Promting Health is unfortunately much more than putting signage and passing orders. “No Smoking” does not convey quite the same meaning. Charts, pictures and friendly counselling services can achieve much more!

And what has been your role in improving the hospital in your city? It is a nasty question to ask in a party, but the responses are predictable. Businessmen say “It is the government’ job” , beaurocrats say  how they sanctioned funds to the hospital when they were in the concerned department, but sing praises of the private hospitals where they go for their own treatment nowadays, ladies aah –ooh and say “how unfortunate” , while many simply walk away to join another group.

Do you really care? You can make a difference!

 As published in HT City ( Hindustan Times) dated 15 november , 2009.

Heartburn and Acidity

Do you get burning sensation behind your chest bone, or have sour food come into your mouth? Do you wake up at night with “heartburn” or “acidity”, and need to drink water or take antacids for relief? If this happens more than once a week, you are suffering from GERD (Gastro-Esophageal Reflux Disease) one of our modern day maladies.

GERD is caused by refluxing of acid that is normally produced by the stomach, into the food pipe or esophagus, due to malfunctioning of the one-way valve located at the stomach-foodpipe junction (GE valve). A recent nation-wide survey from 25 centers, conducted by the Indian Society of Gastroenterology, found that 8.4% of Indians suffer from this disorder. If you are a sufferer, you have 80 million in India for company!

GERD is a lifestyle disorder, and hence a phenomenon of our times. Those who are overweight or obese, tend to have loose GE valves and are prone to reflux. Alcohol, nicotine (in tobacco), caffeine (in coffee and tea), fatty food ( pastries, fried food, cheese, cream),chocolates, and pungent spices cause relaxation of the GE valve and are notorious for causing GERD, accounting for the early morning “heartburn” often experienced after that perfect late night party. An aspirin or pain killer swallowed to clear the headache can worsen the reflux.

Diagnosis of GERD is fortunately not difficult as the symptoms are quite specific for this disorder. The commonest test advised is an endoscopic examination, during whcih the doctor assesses whether ulcers have formed in the foodpipe (esophagitis) by the refluxing acid chyme. In many with severe symptoms, the changes on endoscopy are surprisingly mild, prompting specialists to coin a term ENRD (endoscopy negative reflux disease).In few however, ulcers form in the foodpipe, often leading to scarring and narrowing, and sometimes to cancer. Lower esophageal cancer is on the rise in most parts of the world due to increasing frequency of GERD.

Changes in life style certainly help; the problem today is the practical feasiblity to adhere to them. Regular exercises, maintainance of ideal body weight, avoiding all the predisposing foods and beverages, a small early dinner of “sukhi roti” and boiled veggies, and elevating the head end of the bed, do work. Those who can’t change their ways, prefer to take pills that reduce acid production in the stomach (Proton Pump Inhibitors or PPIs) or tighten the GE valve. They work well, but only as long as you keep taking them.  Pharmaceutical companies claim they are safe when taken for as long as15 -20 years. Longer studies are needed as many youngsters start on them from their teens and have 50 years ahead.

Recent research has identified a phenomonon called Rebound Hyperacidity Syndrome in people who have been on PPIs for long periods. On stopping, their stomachs produce large amounts of hydrochloric acid on the rebound, making them dash back for their pills, creating a kind of dependence. Refluxers are often confronted with a life of “Pleasure and Pill”or that of a “Frugal Pauper”. Not easy!

 As published in HT City ( Hindustan Times) dated 8 november , 2009.

Let's say NO to PLASTIC BAGS

Many accused the Delhi Government‘s banning of the ubiquitous plastic bags in shops and hotels since January 2009 as overkill and unmindful of its many benefits.The court however observed that plastics had indeed become a serious hazard and upheld the decision.

Plastic carry bags that are so liberally doled out by grocers and store-keepers are emerging a major killer. They are made of polythene, a product of petroleum and can be seen littered on roadsides, drains and fields while you travel by car or train. They choke landfills and drains and have even caused floods. They block the intestines of cattle and marine animals when they are ingested mistakenly while grazing, and kill around 10, 00,000 each year by painfully strangulating their intestines or by choking. Disposing these bags is not easy; their burning releases toxins that are harmful to environment and us. Burying them causes the landfills to choke as polythene does not breakdown and decompose easily, and when they do, release toxins into the soil that find their way into the food chain.

Sometimes plastic bag litter can have even further consequences. According to Nobel Peace Prize winner, Professor Wangari Mathaai, discarded bags fill up with rainwater and become perfect breeding grounds for malaria-bearing mosquitoes. Researchers from United Nations Environment Program have recommended banning of plastic bags to check malaria and save lives in several such countries. Social costs of plastic litter add up as well; countries lacking comprehensive waste management often sprout underground economies of ragpickers — typically children who wander refuse heaps and collect potentially recyclable materials for sale to shady businessmen operating from official dump sites.

The problem with plastic bags is that it has become the victim of its own success. It is cheap, light, impervious and convenient with around 5 trillion produced each year. Their menace can be contained by the 4-Rs — Reduce, Recycle, Re-use, Repair. Encouraging the use of locally-made cotton or jute bags is more environment friendly.  Several developed countries have concentrated on re-use. Unfortunately the disposal, collection and recycling of used plastic bags in poor countries pose logistic problems with less than 1% ever been recycled.

Visionary governments may follow the Delhi’s example, but till such time, what can we do as responsible citizen? If we take our jute or cotton “jholas” when we go to the grocers, it would reduce the use of plastics. Celebrities could make it a fashion statement and the media can publicize it. Retailer chains could offer an option of jute bag carry aways, at a little extra price; many of us wouldn’t mind it. And if we could ensure clearing of the littered bags in our vicinity, we could reduce the breeding places of mosquitoes and the harm they cause to cattle. A difference, no matter how small, is urgently worth making, and we can set examples and inspire others to join in.

 As published in HT City( Hindustan Times) 

Are You Depressed ?

When Sunita, a 20 year old engineering student, was brought to my clinic by her father a few years ago, nothing seemed grossly out of place in the nvestigations that she had gone through. Yet nothing was going right for her. While she had been a topper of her batch in school, she was now struggling to pass the year ending examinations, had developed a repulsion to the college, her books and the hostel, had stopped chatting or going out with friends, and had even started avoiding going home on holidays. She was not sleeping well at night, had lost her appetitie and could not remember the last movie she had seen. My suggestion that she could be depressed met with strong disapproval from her father. He demanded that I certify Sunita to be free of any serious disease, and insisted that she had to work hard and exell in studies to compensate for all he had struggled and invested to get her to become an engineer. I heard that Sunita unable to cope and pull on, ended her life a year later. She was one of the 16000 students who committed suicide in India between 2004-8.

Depression is no longer a rare remote disease; it could be affecting someone in your home or vicinity. Its frequency in youth has increased from 2% to 12% in the last 5 years. WHO has labelled it as the No 1 occupational disease of the 21^st century and estimates that 1 of every 3 individuals will suffer it at least once in their lifetime, and could be serious enough in 1 of every 7 individuals to require specialized attention and treatment.

While life has its ups and downs, a rather prolonged, disproportionate phase of lowness should arouse concern about depression. It is characterized by sadness, hopelessness, loss of interest in usual activities, difficulty in concentrating, poor self esteem, feeling of guilt, over reaction to criticism, and sometimes anger or rage. Sleep and appetite are often disturbed. Affected people often start abusing alcohol and drugs.Friends and relatives can often recognize it if they are aware of the symptoms.

Ability to laugh becomes a casualty in this disorder. While children laugh around 300 times, adults laugh only15 to 100 times a day. Depressed people find it difficult to muster a laugh, and when they do, seem to do it sardonically. Also, vague persistent physical symptoms could have their origin in the reduced levels of energy that underlie depression.

Of further concern are studies showing that upto 50% students could be stressed or depressed, 10% seriously so, of whom 72%  admit being unaware of how to deal with their feelings. Depression and suicidal feelings are treatable disorders: the child or adolescent needs to have his or her illness recognized and treated. Encouraging group activities, social and family bonding, freqent merrymaking and laughter, and keeping career goals in proper perspective are essential preventive tools.

For parents, it is essential to remain approchable and maintain openness so that their children can share their feelings without inhibition, fear or embarrassment. And if you notice an adverse change in their nature or hear them they say they are feeling low or depressed, please do take them seriously, before it gets too late! If only Sunita’s father had listened!

As published in HT City ( Hindustan Times ) dated 1 november , 2009.

The Morning After Pill

More than a year after its introduction into India as an over the counter (OTC) drug, the Emergency Contraceptive pill seems to have become quite popular. Marketed by atleast 2 pharmaceutical companies, namely Cipla (i-pill) and Mankind (Unwanted-72), awareness about their existence among women who can watch TV has become widespread. 

Emergency contraceptive pills (ECPs)—sometimes simply referred to as emergency contraceptives (ECs) or the "morning-after pill"—are drugs that act both to prevent ovulation or fertilization and possibly post-fertilization implantation of a embryo. Hence they are distinct from medical abortion methods that act after implantation. As its name implies, EC is intended for occasional use, when primary means of contraception fail. Since EC methods act before implantation, they are medically and legally considered forms of contraception.

ECPs contain the hormone levonorgestrel, a progestin, alone in a single dose of 1.5 mg (as in i-pill) or a high dose combination of estrogen and progestin that are contained in routine contraceptive pills. When taken within 72 hours of unprotected sex, the pill offers 89 per cent protection from an unwanted pregnancy. Its effectivity is better if taken early after the intercourse. It is available without a prescription at all chemist outlets. Some side effects do occur: although they are usually mild: around 50% of women experience nausea. Some vomit or may have mild abdominal pain, dizziness, mild swelling of breasts or irregularity in the next period. Patients witha rare disorder called porphyria,can experience serious side effects. The drug is contraindicated in women with thrombotic conditions, history of stroke, liver disease or breast cancer. The pill does not protect from HIV infection.
The reason for the pill’s popularity among women is the following statistics. Around 78 % of the prgnancies in India are unplanned. The woman is faced with the choice of continuing with the unwanted pregancy or to seek an abortion, facilities for which are not easily available everywhere. Apart from being expensive and risky even in the best of centers, preganant women land up getting 5 million unsafe abortions in India every year, many dieing of their consequences. The ECP taps into the need for emergency contraception in this scenario, as a safer, cheaper and more effective option. The pill provides the woman an opportunity to decide for herself on her reproductive life and physical and emotional consequences coming off her sexual act. It could be a great saviour for victims of rape, forced sex or contraceptive failure
Concerns have however been raised about promoting the “Pop-a-pill the morning after’ culture which could popularizing and encourage sexual promiscuity, risky sexual behaviour and adventurism especially among young women. These could help spread diseases like AIDS. Further, many women frequently resort to this pill as a substitute for planned long term contraception.In England, teenage school girls can freely ask for the pill by sms after an unprotected sexual intercourse. Many conservatives would argue that teaching responsible behaviour and traditional values to young girls would be more appropriate. The Vatican has discouraged the doling out of these pills in many parts of the world.
The pill, atleast for the present, seems to be here to stay, breathing a spirit of liberalization and control in women who feel better equipped to modify their destinies with it. The long term societal consequences of the pill will however become more clear with time.

 As published in HT City ( Hindustan Times)

Ragging and Inferiority Complex

College freshers and their parents might wonder what Prof Rajender Kachroo might have felt when his son Aman was beaten to death by his seniors a year ago in the name of ragging. One may also wonder what made four “senior” medical students, aged perhaps 19 and who had chosen medicine as their carreer, gang up and beat a lone helpless fresher to death in a display of their might and supremacy.

Ragging in Indian campuses has existed for atleast 3- 4 decades. It was agonizing and humiliating even in our times in the early 70s. I recall how some students loved to rag, and were at their liveliest during the days when freshers came in. They would  terrorize trembling new comers who had just ventured out of protected homes.

In the initial days and weeks of our joining,  we saw these “senior” raggers to exude confidence and power but as we settled down and got our bearings over the next few months, we realized that most of them were phonies, repeaters or perverts of some sort. Very few were scholastically good, had any kind of leadership quality (apart from rousing a mob of frustrated raggers like themselves) or ever subsequently served as role model for their juniors.

A year later when the next batch arrived, we were surprised to find some of the quiet mates suddenly turn aggressive raggers; they were not the achievers,  leaders or the friendly types, but  the ones who had gone unnoticed the whole year, had stuck in small groups, indulged in drinking or drugs, or had come from “problem” homes. They had not attained much recognition amongst their class mates or peers the whole year, due perhaps to lack of any special skill or ability, and even gone unnoticed by girl students. Instead, as though to atone for their inadequacy, they dispalyed insatiable energy in ragging helpless freshers, and threw their weight and strength at them in desperation to be noticed and feared by atleast someone.

Raggers suffer from the INFERIORITY COMPLEX, in which they consider themselves, in their heart-of- hearts (unconscious mind) to be inferior to those of their own match. This constant gnawing feeling of inferiority drives them to bully or rag those who are younger or more vulnerable, so that they may experience a perverted sense of superiority.  Bullies in school are no exception. They indulge in fights or use force against younger and weaker kids with whom they run no risk, shying away cowardly from those who are their equals.

Apart from banning ragging, bullies and raggers should be compulsorily sent for psychiatric help. Perhaps making them understand the complex they suffer from may help restrain them from harming others and themselves.  And would medical students who rag and harbour this trait, be ever able to emerge as kind doctors who will tend to ailing and weak patients with respect and concern?

 As published in HT City ( Hindustan Times) 

Know Your Personality Type

Ever noticed how people respond and behave differently in classrooms, boardrooms, bedrooms or on playfields?  It depends on our personality type. And it is the type of personality we have that deteremines not only how we react and perform, but also our predeliction to health disorders. Try and see in whcih of these you fit best.

Type A personality is easy to recognize; people with this type are hard chargers, aggressive and ambitious. They are always struggling to win or lead, are restless with hunger in their bellies and are often dominating. They enjoy adventure and often make greatachievers.

Their constantly charged state generates frequent surges of stress hormones called adrenaline and corticosteroids, from their adrenal glands. The health price they often pay for their achievements is high blood pressure, diabetes, heart disease, stroke and peptic ulcer.

Type B personality is the opposite of type A. They are laid back, cooperative and not easily provoked to anger. They are peace loving by nature, and make good companions, friends or team members. They have larger amounts of the “calming” hormone called endorphins, in their system.Their restful nature protects them from the stress related health disorders often seen in people with Type A personality.

The typical Type C person is a martyr. He is compliant, eager to please and hence often prone to hopelessness and depression. They give up easily. Studies have shown people with Type C to be vulnerable to cancers and malfunctions of the immune system.

Type D has been relatively recently identified and studied. People of this type are notable for negative thinking, worrying, suppressed anger and a tendency to respond to stress by withdrawal and denial. They stew, simmer, and blame themselves and others. And when it comes to feelings, they rarely voice strong emotions like anger, and are disinclined to acknowledge them.

A recent piece of research by a group of Dutch scientists have shown that people with this personality type fare badly in overcoming a stressful situation such as a major illness or hospitalization. While a person with a type A will fight and come out of a difficult situation, a type D will succumb easily. Their blood carries higher levels of inflammatory mediators, generated by their constant internal conflcts.

These are the 4 major types of personalities; all of us may not be staright fits but usually show predominance of one of these. Some may have “overlap” personalities.

Learning to recognize these personalities may help in several ways; we may understand and adjust better to our bosses, colleagues, partners and children. Type A people, for instance could benefit from managing stress better from an earlier age. Recognizing these types could also help doctors tailor therapies to their patients better.

As published in HT City ( Hindustan Times)

Hepatitis B: Is your Family Protected ?

When Siddharth, a 22 year old, went to donate blood for his mother’s treatment, he was shocked to hear that he harboured the Hepatitis B infection! He was fit, played for his college cricket team and had not sufferred from jaundice. Hence his disbelief!

Hepatitis B is usually a silent infection. This year’s global awareness campaign  “Am I number 12?” was aimed at drawng attention to this frequency. In India, the rate is somewhat less; 43 of 2500 apparently healthy people tested positive during a free checkup camp in the city. Around 20-40 million people in India are infected, 6 to 10 times more than HIV. It spreads through infected reused needles, poorly tested transfused blood, sharing of instruments such as shaving blades or ear piercing needles, from a “carrier” mother during child birth, or unprotected sex with an infected person.

What makes Hepatitis B worrisome is its silent nature for many years during which the virus nibbles away at liver cells, leading ultimately to liver failure (cirrhosis) or liver cancer. These individuals feel quite normal for years. When symptoms do appear, much of he liver is already badly damaged!

Siddharth was lucky to be diagnosed before his liver was damaged; he was put on medications with which the infection is now well suppressed. His mother, who had vomited blood, was diagnosed to have cirrhosis from a prolonged infection with the virus. His younger brother also tested positive, both children having probably acquired it from her during child birth.

Screening test for Hepatitis B has become a standard recommendation during antenatal checkups so that the newborn of a “carrier” mother can be protected with immediate vaccination and Hepatitis B immunoglobulin injections just after birth. It is however hardly followed as facilities for testing are not available in most government hospitals, community and primary health centers. Routine vaccination of new borns with the vaccine (cost Rs 8/- per pediatric shot, 3 shots required for full protection, after 1 and 6 months of the 1^st) has still not been included in the government vaccination schedule in most parts of India. More than 150 countries, some less economically developed than ours, have adopted it and brought down the infection rates drastically.

The vaccine used to be fairly expensive, costing Rs 1500/- for 3 adult doses. With many companies manufacturing it, the cost  for 3 doses has dived to around Rs 50/-, for a lifetime of protection. In spite of this, we found that only one third of school students in Lucknow had received the shots. The rates were as low as 0 to 6% in rural schools. The issue is less about cost now, and more about awareness. While the Gates and other foundations have helped spread awarenss about HIV infection, Hepatitis B, which infects and kills more than 10 times as HIV, is at large. HOPE Initiative, a Lucknow based organization, through its unique B-Rodh project, with support from Bristol Meyers Squibb (BMS) Foundation, is sending this message to 5 lac children and their families in Uttar Pradesh. You can become B-safe @Rs 50/- for your lifetime, certainly a worthwhile investment.

 As published in HT City ( Hindustan Times) dated 25 october, 2009.

Shedding Weight After Diwali

In the aftermath of Diwali, most weight watchers are expected to see blue for some time. The scale will remain stubbornly up for a while, making you wonder whether you had behaved really as badly with your eats and exercise the last week to deserve this! And where exactly was the problem?  In what we ate or just the few days that we skipped our exercise routine?

Those who exercise vigorously, pile up kilos rapidly as soon as they stop. Look at the erstwhile sportsmen and dancers. Diego Maradona, the soccer legend from Argentina, became morbidly obese when he stopped playing. His condition was so desperate that he had to undergo a weight reducing bariatric surgery to loose a few score kilos! Many of our vintage cricket heroes seem to have similar problems. Dancers of Bhartnatyam and Kathak pile up kilos when they stop their rigorous practice. Similarly, gym goers are likely to put on more weight when they stop than their “regular walker” friends. My tennis buddies at SGPGI, who play 40 minutes every morning, are not getting lean either.

There is some bad news for gym goers and sports buffs from the research world. Three recent studies have shown that as many as 30% of those who exercise regularly do not lose weight. In fact a few acually gain some, raising concerns about our modern obsession of working out in gyms and taking to vigorous sports as part of our present day lifestyles.

While  exercise workouts is believed to help redistribute body weight, converting  fat into s muscles, the fat percentage in the body also seems to remain unchanged in many. The reason: increased calorie consumption resulting from enhanced appetite caused by the exercise itself. Many “reward” themselves with fatty food after their workouts.

Further, the calories that we burn by exercise are relatively small compared with what our desi mithais and snacks contain. The caloric content of some of the food that we would have eaten recently are high; a glass of soft drink (100 kcals), a sweet (100-300 kcal/piece), dry fruits (300 kcal for a handfull), a samosa or kachori (150 -300 kcal/ piece). If you have snacked through the day visting friends, you might have consumed an extra 1000 to 3000 kcals a day during this phase.

Burning them is not going to be easy. To lose 300 kcals, we have to jog 30 minutes, or cycle for 70 minutes or lift weights for an hour. My tennis buddies and I will have to play an extra set daily for 4 weeks to lose what we have recently gained.

Diet therefore holds the key to losing weight.  Try large bowls of clear soups and salads before meals, suhki roti and boiled veggies, 8-10 glasses of water a day. Stop eating when you are half full and still hungry. And get rid of all the sweets, snacks and pastries from your home.  You might then regain your shape in the next few weeks. Good luck!

As published in HT City ( Hindustan Times) dated 18 october , 2009.

Have a Safe Diwali

While Diwali is an occasion for praying, expressing love and greeting friends, we give expression to our festive spirit by lighting lamps, eating sweets, exchanging gifts and bursting crackers. The spirit of the “festival of lights” often however gets shrouded in the manner in which we celebrate it, and every year, this period of joy and gaiety turns into a nightmare for some.

Health and life come under considerable threat during Diwali: the air we breathe gets smoky and polluted with suspended particles and toxic fumes, triggering attacks of breathlessness and asthma. Crackers cause deafness, usually temporary but sometimes permanent, especially in children. The loud noise of crackers often triggers heart attacks in the elderly. Burns are common, claiming several lives and maiming many every year. Igniting of firecrackers releases fumes of cadmium, lead, copper and magnesium that cause a variety of problems from anemia to nervous ailments, making us feel tired and sleepless by late evening.  And remember that the crackers you buy and burn could be the spoils of child labour.

Gorging on sweets is a distinct Diwali health hazard. Sweets at home, sweets at any home you visit and boxes of sweets that come home as gifts. They are high in fats and sugars, make our weights and blood sugars soar, and thicken the arteries of our heart. Do we need to keep binging on them every year as tradition?

Consumerism reaches its peak this time every year. A plethora of glittering Items and goods are dispalyed on sale, and whether we need them or not, buy them we must! Jewellery, electronic items, cars, utensils, clothes, almost anything that we can splurge on seems justifiable at this time. We also spend good amounts of money beautifying and lighting up our homes and offices, to impress Godess Lakshmi who come visting. We consume large amounts of electricity and fuel, deprivng many of our less fortunate countrymen whose homes remain dark and cold.

While celebrating Diwali this year, try some of the following this year:

1.     Use diyas: they are truely traditional, aesthetic and bring home the true spirit of Diwali.

2.     Avoid crackers. If however you must, use them sparingly in open spaces and before 10 PM. Make sure you wear cotton and have a bucket of cold water nearby.

3.     Try eating and serving fruits or low calorie sweets rather than the rich commercial ones

4.     Curb your buying binge.

5.     Focus more on what Diwali is meant for: express love, greet friends and pray for peace.

6.     Try out a new way of being happy this year: the joy of GIVING. Visit a hospital, orphanage or a home for the challenged, with a few boxes of sweets or toys. See the way the faces of the sick or lonely light up with joy and gratitude. It might be the brightest light you can get yourself this Diwali. And this will certainly earn you bonus blessings from Goddess Lakshmi. Happy Diwali.

As published in HT City ( Hindustan  Times) dated 11 october , 2009.

Healthcare India- 2009-2010

Several of the hospitals in India have become world class, leaving very little to be gained by Indian patients planning to go overseas for treatment. The best scanners (CT, MRI, PET etc) are now available at home, treatment of heart diseases (coronaru angioplasty, stenting, bypass surgery, valve replacements) is widely and safely available with excellent results that are predicatable, and transplantation of kidneys, bone marrow and liver has matured with time and numbers. Cancer treatment is also excellent and avavilable through many regional cancer centers across the country. Medical tourism has become a flourishing business in India, thanks to the high quality and reliability of health care in some Indian hospitals.

The advances in medical care in India have unfortunately occured in private corporate hospitals. They cater to an urban middle class with rapidly expanding paying capacity for their health needs. They have also been quick to see and utilize the inevitable need for medical insurance to meet growing healthcare costs.

These swanky edifices with most modern gadgetary have however created a class divide within society. The poor, the official estimate of which is approximately 400 million, have only government hospitals to turn to. These crowded fly infested places with irregualr supply of vital equipment, medicines and doctors have left the not-so-rich frustrated. They are grossly inadequate: many do not have ultrasound machines, blood banks, standardized laboratories, a full complement of trained personnel, adequately stocked pharmacy or contemporary expertice.

The importance that our government gives to health can be gauged by the fact that a mere 0.8% of India’s GDP goes to health, compared withy 16% in USA and 7% in the UK. The costs of equipment, procedures and medications have risen steeply, as have people’s expectations from hospitals. Although there are over 150 government medical colleges in India, most do not even have the equipment and procedures that students are expected to see, use and learn during their training periods there.

Let us take 2 examples: while the curent appropriate treatment for gallbladder stones is laparoscopic cholecystectomy, over half the medical colleges do not provide this service. With around 5% of adult Indians estimated to harbour gallstones and many likely to become aware of their presence due to the ubiquitous availability of ultrasound clinics, most would get their surgeries done in private nursing homes or hospitals. The other example pertains to Hepatitis B: although 4% of Indians harbour this infection (40 million), the test for its detection is not available in the majority of these medical colleges. It is an essential part of anti-natal screening, but how can an expecting mother visiting these hospitals get themseleves tested and protect their newborns if the test is not available there at all? And while 160 countries have added Hepatitis B vaccination to their childhood immunization programmes, India stands out like a sore thumb as not being one of them due to financial constraints!

The selection of sites for creating new medical colleges also defies common sense. While the building can be constructed anywhere, and desperate students may travel to any corner, what about faculty and patients. Why would a talented faculty surgeon, with 2 school children stay in a remote place which does not have good schools? And are we trying to fill faculty posts somehow, or aiming to attract good faculty to ensure quality education for the nextgen docs? And why would poor patients staying in slums around big cities spend on transport to reach some remotely located medical college that is also often lacking in facilities? I leave it to you to judge!

There could have been reason for the government to argue that tertiary care, being costly, may be best left to the private sector, that medical colleges should strive towards good, standard-of-care secondary tier health care, and played a exemplary role in primary care and disease prevention. After all, foreach patient with lung cancer or heart attack, there are 100 who are waiting to be diagnosed and a 1000 at risk, waiting to get affected by disease. Our record of accomplishment in primary prevention has been dismal. The sales of tobacco, which accounts for 50% of all cancers in India, has infact gone up, alcohol shops have been allowed to crop up along highways encouraging drunk driving and road trafiic accidents, and polythene bag heaps around settlements explain why mosquitoe borne diseases continue to claim somany lives in India.

What should we expect in 2010. A thoughtful plan for our health services could be good for a start.

Happiness is all that Matters !

 It is indeed the time of the year when Indians try to reconnect with their families, travel long distances to congregate at their homes, pray and fast together, perform rituals, wear new clothes, hug each other and rejoice and try to keep their traditions and faiths alive. The food is rich, roads are crowded, and offices and businesses crawl but the air seems charged with a renewed excitement. If sceptics and cynics find it amusing to see members of a family geting together to fast, eat, pray and  celebrate togetheras meaningless old fashioned ritualds, the laugh may be on them!

It's not just lifestyle, human emotions too have a significant impact on an individual's well being, says a new study. Researchers from University of Kansas have found that positive emotions are critical for upkeep of physical health for people worldwide, especially for those who are deeply impoverished.
 "We've known for a while now that emotions play a critical role in physical health," said Sarah Pressman, assistant professor of psychology at KU and a Gallup senior research associate. "But until recently, most of this research was conducted only in industrialized countries. So we couldn't know whether feelings like happiness or sadness matter to the health of people who have more pressing concerns - like getting enough to eat or finding shelter. But now we do," she added.
 During the study, the researchers analyzed the data from the Gallup World Poll involving more than 150,000 adults. The participants reported their emotions, and also answered questions about whether their most basic needs like food, shelter and personal safety were adequately met.
 It showed that positive emotions such as happiness, enjoyment were unmistakably linked to better health, even when taking into account a lack of basic needs. While negative emotions such as worry and sadness were a reliable predictor of worse health.The association between emotion and physical health was more powerful than the connection between health and basic human physical requirements. Even without shelter or food, positive emotions were shown to boost health.

Another study affirmed that family rituals (such as birthdays, religious celebrations, and family reunions) are associated with marital satisfaction, adolescents' sense of personal identity, academic achievement, children's health, and stronger family relationships.Barbara H. Fiese, Ph.D., and colleagues at Syracuse University studied family rituals, , involve symbolic communication and convey 'this is who we are' as a group and provide continuity in meaning across generations." according to Dr. Fiese. "Also, there is often an emotional imprint where once the act is completed, the individual may replay it in memory to recapture some of the positive experience." Routines can become rituals if they move from instrumental to a symbolic acts.

Be it  Eid, Navratri or Durga Puja, celebrate it with emotional gusto. Never mind what the Westerners would say about our seemingly meaningless ceremonies. They probably envy us for them and for the fact that we remain ahead of them on the Happiness Index. What else is life all about?

As published in HT City ( Hindustan Times) dated 27 september , 2009.

ARE YOU WATCHING OR PLAYING CRICKET?

With the Asian games scheduled in Delhi next year, it is time we looked at how the crowded schedule of matches and leagues are impacting our lives and health.

The involvement that most urban Indians have with sports today is to watch it on television or to read it in the papers. We love watching cricket on TV, sometimes bunking office or college to catch it live.  Many who were not veteran cricket watchers have taken to it so as not to be left out of party or coffee shop conversation.  Watching games together with friends is even more thrilling, as passions rise higher with exchange of expert observations and comments. And  chips, pizzas, samosas  or nuts to munch during the matches adds that extra dash of fun that make these sessions so interesting, while making us couch potatoes.

In urban India, the focus has shifted from “playing it” to “following it”, Boria Mazumdar style. Amongst youngsters, the question is no longer “What games you play?” but “What is your favourite game?”, the one for which you might rattle figures and show off your GK.  You are expected to know  how many centuries Sachin has scored in a 50-50, even if you never held a cricket bat.  For school kids, palying computer cricket is another way of relishing the game.

It is hardly surprising then that over 10% of urban school children in Lucknow are overweight. In a study undertaken by HOPE Initiative (www.hope.org.in) obesity was rampant in elite Lucknow urban schools, and correlated well with time spent before the TV screen . It is hardly surprising then that India is becoming the diabetic capital of the world, as obese children grow up and develop this disease . Contrast this with rural schools where none of the 20,000 children surveyed were overweight and where children play their own versions of bat and ball in open fields.

The reasons for not playing are many. Duration of school hours has shotened, and the limited time available is considered to be  “better “ utilized for studies. After all, what are schools primarily meant for? Within the class too, there is a division of studious guys who get marks, and the “sports type” who get the runs in interschool meets but do not  make to the IITs. Homes are no longer homes with fields around. Gathering a group at a remote field to play cricket is not easy; traffic and security hurdles have to be crossed first. And coaching classes take up the evenings anyway – after all engineer ban na hai na?

Is participation in sports dwindling then? The answer is NO. More youngsters are playing games, but not for fun or to remain healthy, but as a career option making it very competitive.  But the overwhelming majority of our urban Indians are content  following it in the media.  Our national obsession for games has not translated into making most of our urban youngsters actaually play them. Let us welcome the Asian games!

As published in HT city ( Hindustan Times) dated 20 september, 2009.

Tobacco kills, SAVE Yourself

Two thosand people will die today in India due to tobacco. India is home to 250 million tobacco users with around 900,000 succumbing to tobacco-related diseases every year.  We ranks 1^st in the world for incidence of oral cancer, caused almost entirely by tobacco use. One of our senior ministers had to be operated in USA for cancer of the cheek due to his Gutka habit. Although his face reveals a lack of symmetry, it is a matter of satisfaction that he is cured of cancer, and has turned a major anti-Gutka campaigner in Maharashtra.

One wonders how this habit started and spread in mankind’s history. There is no scientific doubt that tobacco may provide even the slightest benefit to human health. It has no nutritive value. While smoking, one inhales 43 cancer causing substances, 15 harmful chemicals and 400 poisons, all in a single puff.  Tobacco contains nicotine that provides what little kick that people get of it. It is however addictive and habit forming.

The habit usually starts at a young age, usually in school or college, under “peer pressure”, when seniors get ther juniors initiated. It ususally starts with a spirit of adsolescent experimentation or rebellion, and helps a young person enjoy a feeling of having “grown up”. The occasional fag then becomes a way of life, a fashion or personality statement and then very soon, a habit that gets increasingly difficult to kick. Smoking rates in India are growing at an alarming 7% annually.

The harmful effects of smoking are well known to even those who smoke: lack of stamina, chronic cough, and increased risk of heart disease, stroke and stomach ulcers. Smokers are at high risk  of cancers, not just of lungs, but of the mouth, pancreas and bladder too. Contrary to the popular “macho” image projected by the tobacco industry, smoking reduces potency in men and causes infertility and birth defects in women.

Smokers tend to be self centered, with scant regard for the welfare of their families and those around.  Innocent children ad spouses exposed to 2^nd hand smoking because of an uncaring man, are often harmed this way. They often develop asthma and bronchitis. Sudden infant deaths occur more commonly in homes where someone smokes. Spouses of smokers are at increased risk of developing premature heart disease and cancers. Further, children growing up in a “smoking home” are more likely to take to it in life. Would any caring father then continue to smoke for that little kick they enjoy?

One often finally kicks the habit after a major health problem like a heart attack. By then much narrowing of the arteries have already occured. One wishes it was much earlier. Two drugs are now available to help those who wish to stop. But what is really required is just simple will power and a sense of concern for those around. Unfortunately, both seem to be in short supply.

As published in HT City ( Hindustan Times) dated 13 september , 2009.