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Category : All ; Cycle : September 2009
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Sep30
Memory Enhancement
For utmost intellectual performance…
Dr. Santosh Jalukar Phone: 9969 106 404
It is said that “intellectual strength is more important than just physical strength”. This is all time true statement. For significant achievement in any field, Intellectual performance is rather most important tool and there could be hardly anybody who will disagree to this. Every parent dreams about best scoring of their child in academics in all the fields. There are end numbers of products available in the market today claiming such therapeutic benefits and also new products are coming up every other day. It creates confusion amongst consumers as to which products are genuine and which are not. The advertisements are also rivalling and hence it is essential to identify the appropriate one. Besides this, what are the other treatment options, what are the correct doses, how these formulations work, how is the knowledge stored, how does the recall process work, what diet is good for nourishing the activity of brain, importance of diet, importance of prayers, significance of exercise and rest? Here you will find answers to all such questions and their scientific basis.
Three steps: While during common cold, blockage of olfactory nerve there is a total loss of sensation of smell. This is very common example experienced by most of the people. Similarly, if there is any kind of blockage in the optic nerve, the sensation of visual experience will be blocked; auditory nerve will result in impaired listening etc. For acquiring the knowledge, the body uses 5 sense organs. Ears, Skin, Eyes, Tongue and Nose are collectively called sense organs. The sensations experienced by these sense organs are transmitted to the brain. The sensory nerves conduct messages through chemical transmission and then they are stored in the brain. Unless the knowledge is stored properly, one can not use it at any point of time. To explain this concept, I wish to give one example. An infant, who is deaf since birth, remains dumb throughout the life. His vocal organs may be absolutely normal despite he could not process the knowledge of speaking which is essentially linked with hearing. Hence he or she will never know “what is word and how to pronounce it”. The prerequisite for uninterrupted transmission of these senses is to have the healthy state of the nerves and also they should be properly lubricated. The myelin sheath of nerves is made of about 80% lipid and about 20% protein. Therefore it is essential to maintain the lubrication by way of providing adequate unctuous vehicle. Proper lubrication to the sense organs help to improve the oxygenated blood supply and thereby help to establish the physiological functioning of specific sense organ. Applying a drop of oil or any other lubricant to finger facilitates inserting the odd-sized ring easily. This is an easy example to understand the importance in relation to the grasping ability of the sense organs. Oil and ghee are the main natural lubricants available since time immemorial. Ayurveda has described the properties of cow-ghee as follows:

It means that cow ghee improves grasping, storing and recall, the three aspects of brain function. It also stimulates appetite, improves quality of life, physical endurance, vigour and eyesight. Nose is the gateway of brain and any product introduced through the nostril has immediate access to the brain tissue. Even modern medicine has identified the potential of this path which bypasses the blood brain barrier and without much efforts, the valuable drug can be made bio-available in plasma and CSF in just 1.5 minutes. Use of nasal insulin is a well-known example to understand this phenomenon. Recently there is also nasal spray for calcium supplementation. Here is the first step towards improving the grasping capacity of the brain which mentions administration of ghee based product through nostrils. Ayurveda has described this mode of administration 5000 years ago by the name of ‘Nasya’ treatment. Besides cow-ghee, some valuable herbs like saffron help to impart phenomenal antioxidant effects on brain cells. It is scientifically proved and possesses a strong supporting reference. Nose is directly connected to the brain through olfactory apparatus; it is connected to ears through Eustachian tube, to eyes through lachrymal ducts. Therefore nasal treatment helps to restore the physiological functions of all these organs and nourish the brain’s grasping capacity. Ayurveda recommends 4-4 drops in each nostril daily to achieve the said therapeutic benefit. Despite improvement in intellectual competence, unknowingly this treatment imparts lots of other advantages like prevention of recurrent attacks of common cold, arrests hair fall, overcomes fatigue of eyes due to excess-reading, combats burning of eyes, protects occasional blocking of ears, protects vision defects etc. The ideal time to administer these nasal drops is early morning or late evening after the sun-set. One should lie-down for 5 minutes afterwards. Rarely the feeling of the drops coming into throat is noticed which may be ignored or one can have a sip of warm water. This nasal medication helps to speed up the grasping process of knowledge without any difficulty. A readymade preparation by the name of Cleverin nasal drops has been recently developed and approved by the Food and Drug administration which possess multiple therapeutic benefits attributed to grasping of knowledge by empowering the neurotransmission by cleansing and lubricating the sense organs.
Second Step: After grasping, the second step of improving the intellectual process is of increasing the storage capacity. The knowledge acquired has to be stored properly which can be utilised later as and when required. It is scientifically proved that the active constituents from herbs like Brahmi, Shankhapushpi, Shatavari, Ashwagandha helps in improving the intellectual performance by different mode of action. Some help by way of enhancement of protein kinase activity, Increase in protein in hippocampus, alleviate stress and help to minimize the release of stress hormone, some have neuro-regenerative activity, some help by improving the oxygenated blood supply to the brain and some prevent oxidative damage by imparting anti-oxidant activity. In short these herbs play a major role to improve the storage capacity of the brain. It is as simple to understand that if more books are ordered in the library, it becomes essential to make additional arrangement of accommodating them by adding number of shelves. Most of the marketed Ayurvedic and herbal formulations work on this principle. The activity starts in about 2 weeks. Nobody can deny the fact that memory related functions can’t be measured like body temperature. Even then their efficacy remains unquestionable as huge amount of data is available across the world and also the safety parameters are well established. The important aspect is to know the quantity of each item in the formulation. If inadequate quantities are consumed, one can not expect the therapeutic benefits in desired time. Besides improvement in intellectual abilities, these herbs also possess several other benefits like improvement in physical endurance, improves hemoglobin level, keep RBC, WBC in right shape, improves the immunity, hair melanin, prevent calcium depletion, and delay ageing process. Besides dosage, it is also important to check the taste of the product as children are very fussy about taste. The herbs are basically bitter in taste but many brands are available which mask the bitterness perfectly and make the product not only palatable but worth loving. Cleverol is one of such approved brands which possess chocolate flavour and acceptable palatability.
The third step: The 3rd and most important step of memory enhancement is the “recall process”. Many factors are responsible for affecting this process. Stress, fear, loud noise, lack of interest, inadequate exercise, wrong diet, weak concentration etc. are some major factors, which should be taken care of during the course of studies. Recently German researchers found they could use specific perfume at night to re-activate new memories in the brains of students during sleep and the volunteers remembered better on the next day. The test conducted showed the 97 % result and the control group performed only 84 %. During the studies, fMRI scan showed that the activity of Hippocampus was stimulated during inhalation of particular odour. Based on this research, a novel product in the form of Dhoop stick is prepared. This Cleveroma stick does not contain strong perfumes but it is composed by Ayurvedic aromatic herbs like Tulsi, Jatamansi etc. which improve the recall function of the brain. Students should light this stick in the bed room where they intend to sleep because the activity of hippocampus is at its best during sleep.
Prayers have scientific base: Prayers towards God and offering respect to seniors helps to strengthen the brain’s overall performance. This statement can be scientifically proved here. To understand this, we must match up few things together. It is an established fact that cortisol hormone is released due to stress or fear. This is therefore called stress hormone. Cortisol causes serious damage to the brain. Hence in acute and serious situations an individual becomes insane. He or she could not make any logical decision. Second situation when a child is thrown up, he laughs as he enjoys it. The confidence level of the child is to the extent that he is 100% sure about his security. Therefore in a situation where he should be afraid, he rather takes pleasure out of it. The hormone cortisol is not released and the brain remains away from its ill effects. A prayer towards God and offering respect to the seniors gradually builds the confidence level that a person feels enormous support. In olden days, it was a tradition but has a scientific base to offer respect to seniors and pray God before leaving for long journey. As there were no vehicles and even roads, people used to travel in either bullock-cart or ride on horses. Getting food during travel, climatic conditions, and possibility of attack from wild animals were major hurdles and only blessings used to be the moral support. The customs were simply followed but the hidden treasure is now understood by the modern world.
The purpose of lighting candle or oiled light during prayer also has a scientific implication as it plays a role of Tratak (a yogic practice for improving concentration). Lighting of Agarbatti and the aroma helps to improve the blood circulation to hippocampus which plays key role in recall process of the acquired knowledge. There are lots of Mantras to perform during prayers and the aroma helps to rehearse them in proper order and manner.
Importance of regular exercise: How much exercise you do is not important but how regular you perform it is rather more important. A 76 years old man reached the wedding hall slightly late for his own wedding is a fact known to the author. This was because he did not want to compromise with his exercise schedule. No doubt those taking rigorous exercise look well-built but, most of the times, their immunity is not up to mark. Their bones are also brittle and get fracture even with a small trauma. It is also found that such well-built individuals do not have an issue. This is because the optimum nutrition is utilized by the muscular portion and other systems remain under-nourished. Therefore is good to perform little but regular exercise. Apparently such people would not look as attractive in physical built, but their overall physical and intellectual abilities will be far better than a robust individual.
Intellectual exercise: As regular exercise can build good muscle power, same is the case with brain tissue. The more you keep them functioning, their performance will improve to the top. In the course of exercise, the muscular action is repeated in the same sequence many times which tones-up the muscle fibers. The brain also achieves improved ability by repetitively doing the same task. Forgetting is a natural process in living creatures. Man forgets more because his mind is diverted to too many subjects throughout the day. Intellectual performance can be further improved by meditation as it tones up the brain to stick to one subject and not to get diverted. Very few people remember the dreams on the next day. The only reason for this is the moment you get up, you see the watch, then think of the studies, then think of the bank balance, then the medicine to be consumed on empty stomach and so on. There are hundreds of such things that vanish off the experience of dream. Same is the case with studies. Try to focus more and more on the task and nothing other than your commitments. This is nothing but an intellectual exercise.
Some important things about diet: Human digestive system is fabricated by the creator of the universe for consuming vegetables only. If non-veg diet is cherished; make sure that it should not be more than once a week. There is a special recipe described in Ayurveda by the name “Pancha Khadya” which contains following 5 items. Dry dates, Raw dates, Coconut, Poppy seeds and cane sugar. This recipe helps to improve various brain functions and is extremely delicious too. Instead of fast-food, wafers, wada-pav, biscuits etc, this can be a best alternative to schooling children as recess time breakfast.
Tatak: Focusing vision at a particular point like a flame of candle or agarbatti light for 2-3 minutes can help to improve concentration.
Many people ask as how long should the treatment be continued. It is essential to understand that these recommendations should not be considered as treatments. The recommendations are for improving intellectual performance. For better understanding, I always quote one example. Regular exercise is good for health. There are many people who do not perform any exercise at all even then they survive. But ultimately an overall health profile of both such individuals will differ in long term. These recommendations improve mental well being and also physical fitness. It is up to the consumer as how long they wish to be fit and fine.


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Sep30
Fatness To Fitness
From Fatness to Fitness; Ayurvedic approach

In clinical practice few patients ask treatment for putting on weight and many come for reducing the weight. Very few are happy with their own physical condition. No doubt that very slim or very obese, both conditions are not healthy. Even then if you look health wise, it is good to be slim than being obese. It is very difficult to trim down when you become obese. Not only it looks ugly but also such people are predisposed to number of diseases like High blood pressure, High cholesterol, Type 2 diabetes, Stroke, Gallbladder disease, Osteoarthritis, Heartburn, Snoring, Shortness of breath, some category of cancer, Depression and also infertility. The lifespan of obese is obviously less than slim people. Therefore it is good to be slim than dreaming to put on weight. Overweight makes an individual less active which again tends to increase weight and finally leading to unhealthy situation. The consequences of obesity are well-known to even laymen and hence the obesity clinics have huge number of cases all over the world. It is essential to understand the causes, various treatment modalities, know the effects and side-effects of treatments, diet management, exercise importance and lifestyle modulation for obesity.

Two types of obese personalities: In the society we find people with insatiable appetite and because of over-eating; they tend to put on weight. Another group habitually consumes very less amount of food even then they become obese. Therefore it is essential to understand the constitution before initiating the treatment. Ayurveda has described different approach considering such constitutional variation. The usual anti-obesity herbal formulations have thermogenic effect which naturally tends to stimulate appetite. Adipose tissue (Fats) is like wax which melts on heating and becomes hard when cooled down. The thermogenic (heat generating) herbs are essential while considering obesity regime. In classical textbooks of Ayurveda, out of 29 herbs mentioned for obesity treatment, 20 of them are found in appetite stimulating formulations. It simply proves that anti-obesity formulations may affect appetite in different way. When considering the treatment modality of obesity, it is therefore more logical to consider two factors. The first composition should low down appetite and second to burn the deposited calories in the body. Long-term fasting reduces body weight because the digestive enzymes catabolize the tissues starting with mucous membrane, then muscles and adipose tissue. When such enzymes are stimulated, they will naturally trigger the activity and in turn help to trim down the body weight.

Three way approach: Appetite suppressing herbs are not much known except for Garciania and Hoodia. There are many research papers having controversial views about the efficacy of these herbs. Looking deep into Ayurvedic literature, there are many herbs mentioned for appetite stimulation and “Pitta shaman” group have very activity to reduce the appetite. Various globally acclaimed research journals have also published supportive data to validate the actions of these herbs. The two way approach to overcome obesity problem is therefore very scientific and has also clinically proven benefits. The appetite lowering herbs reduce the enzyme flow, strengthen the mucous membrane of digestive system to tolerate the thermogenic effect of anti-obesity herbs. The appetite lowering herbs also possess the property to lower the serum cholesterol levels in the blood which is an added advantage. The appetite lowering composition works best when consumed within 30 minutes before meals and the calorie burning composition does wonders when consumed within 2 hours after meals. The calorie burning composition otherwise may create some side effects like heart-burn, headache and regurgitation of food but the appetite lowering formula guards the possible unwanted effects. Thus a two way anti-obesity treatment has no side effects but added side benefits while treating obesity.

Why such formulations cause weight gain when the treatment is discontinued? Most of the anti-obesity products possess only thermogenic properties to achieve lipolytic results. As seen earlier, they also stimulate the enzyme secretions. While the treatment is in progress, they inhibit the absorption of fats and effective eliminate it from the body. The effect on the physiological function remains constant. When an individual discontinues the treatment, the accelerated enzyme flow remains constant and thereby the appetite increases. It naturally affects the food intake and weight gain restarts.


How can you tackle obesity?
It is observed that many people advise obese individuals to reduce the food intake and perform physical exercise rather than taking medicines. Here we need to understand 2 aspects:
1. The obese individual possesses more area in the physiological body where oxygen is needed for tissue survival. It is as simple to understand that a bigger joint family requires more grains and grocery. Hence an obese individual can not enjoy a healthy life without adequate intake. Therefore it is near to impossible for the obese individuals to cut down the intake drastically.
2. About physical exercise: Just imagine a healthy man of 40 years whose height is ideal for his body weight is asked to carry 30 kg of weight and walk for 40 minutes on a plain road or climb stairs on 5th floor. It will be extremely tiring and exhausting for him. Same thing happens with an obese individual. Expecting him to walk for 40 minutes daily or climbing is therefore too strenuous for him. Therefore he needs an assistance of medicinal inputs for physiological balancing of caloric intake and caloric expenditure.
3. Another aspect of obesity is hereditary which is linked to genetics. It is true to some extent but it is also important to understand that specific diet habits and lifestyle remains unchanged in families from generations to generations. Therefore blaming genetics only will not solve the problem.

Scientific perspective of CHR’s Slimming Kit
A set of 3 products formulated scientifically for achieving these benefits in short time span and lead quality life.
a) The first one, LIMIN tablets, helps to limit the intake moderately.
b) The second, CALEX tablets, increases caloric expenditure by enhancing the flow of digestive enzymes.
c) Third, GUDLAX powder, which stimulates the intestinal purging and thereby helps proper emptying of the bowel.
Adipose tissue is like wax which melts on heating and solidifies on cooling. Most of the single formulations used for obesity treatment are thermogenic (heat producing). Therefore they help to melt the fat and thereby help to take care for obesity. Ironically, thermogenic ingredients also possess the property of stimulating digestive enzymes and hence simultaneously increase appetite.
The effect of calorie burning and appetite spur work together. Therefore there are following therapeutic actions in the physiological activity:
* Increase the enzymatic flow in the digestive tract
* Burn some extra calories ingested
* Stimulate appetite
* Cause hyperacidity and heart burn
* Increase in appetite may further boost up food intake and in turn again add some calories.
In order to break this vicious sequence, it is judicious to have a better composition to balance the process appropriately. To understand this phenomenon correctly, one should recall the physiology of digestion and then the correlation of therapeutic activity of LIMIN, CALEX and GUDLAX.
The digestive glands that act first are in the mouth; the salivary glands. Saliva produced by these glands contains an enzyme that begins to digest the starch from food into smaller molecules. An enzyme is a substance that speeds up chemical reactions in the body.
The next set of digestive glands is in the stomach lining. They produce stomach acid and an enzyme that digests protein. A thick mucus layer coats the mucosa and helps keep the acidic digestive juice from dissolving the tissue of the stomach itself. In most people, the stomach mucosa is able to resist the juice, although food and other tissues of the body cannot.
After the stomach empties, the food and juice mixture passes to the small intestine, the juices of two other digestive organs mix with the food. One of these organs, the pancreas, produces a juice that contains a wide array of enzymes to break down the carbohydrate, fat, and protein in food. Other enzymes that are active in the process come from glands in the wall of the intestine.
The second organ, the liver, produces yet another digestive juice—bile. Bile is stored between meals in the gallbladder. At mealtime, it is squeezed out of the gallbladder, through the bile ducts, and into the intestine to mix with the fat in food. The bile acids dissolve fat into the watery contents of the intestine, much like detergents that dissolve grease from a frying pan. After fat is dissolved, it is digested by enzymes from the pancreas and the lining of the intestine.
Herbs rich in fiber bind with the cholesterol and thereby help to eliminate the cholesterol from the alimentary tract. The contents of LIMIN act by this way and help not only to minimize the appetite but also regulate the lipid contents in the blood.
Movement of Food through the System
Several factors affect emptying of the stomach, including the kind of food and the degree of muscle action of the emptying stomach and the small intestine. Carbohydrates, for example, spend the least amount of time in the stomach, while protein stays in the stomach longer, and fats stay for the longest. As the food dissolves into the juices from the pancreas, liver, and intestine, the contents of the intestine are mixed and pushed forward to allow further digestion. Since Fats remain in undigested form for longest time, the possibility of re-absorption is higher. Here comes the role of GUDLAX, which helps to eliminate the bowel contents promptly and thereby successfully achieves the 3rd step of weight management.



Importance of diet and lifestyle: It is needles to emphasize the importance of diet and lifestyle while considering successful conquer in obesity. I am purposely avoiding mentioning things like “stay away from sweets, fried food, chocolates etc.” as these are very common and a schooling child would also know about such suggestions. There are small things making exceptional outcome as far as obesity is concerned.
1. Never consume sweets at the end of meals even if it is routine to have desserts at the end. Principally obesity arises due to extra intake and less expenditure of calories. To understand the idea behind this phenomenon, you can perform an exercise. Consume your usual food and then end with a calculated quantity of sweet. Next day, start your meal with same quantity of sweet and then begin your usual food. You will notice that the food intake will be almost half than your normal intake. This is how you can reduce the caloric intake and immediately start feeling lightness of body.
2. Fruits contain good amount of sugar. The peel of the fruit contains astringent properties which balances the sugar. This arrangement is made by Mother Nature to combat the unwanted effects sugar. Hence, as and when possible, it is recommended to consume fruits along with the outer skin for added health benefits. It is easy to have apple, chickoo, mangoes and some grains with the skin. The concept of consuming brown bread (whole wheat bread) is supportive to this statement. The reason of adding saffron or nutmeg to sweets is to compensate the sugar with little amount of bitter or astringent taste which resists the unwanted effect of sugar.
3. Water is essential component for maintaining the electrolyte balance in the body. It also helps for accelerating the digestive process and proper assimilation of food. Cold water obstructs the flow of digestive enzymes and hence leads to digestive disorders leading to obesity. Therefore if you are serious about slimming, avoid consuming cold water intake or even other chilled beverages unless very essential. Some countries in East serve only warm water to household guests or even in restaurants, which is really a good practice for health conscious individuals.
4. Consuming water at the end of meals also leads to more heaviness in the abdomen. It weakens the concentration of digestive enzymes which slows down the digestive process leading to more accumulation of adipose (fat) tissue. If you are serious about slimming, you may drink little amount of water at the beginning of meals.
5. Tea and coffee is offered several times for any walk-in visitor in office or at home. While offering, we also have a tendency to share little amount each time. The sugar intake with such numerous times may lead to high caloric intake unknowingly which may become major health issue in long-term.
6. Avoid sleeping immediately after meals. The calories consumed need mild physical exercise when the stomach is full. Taking rest after meals leads to weight gain.
7. Early to bed and early to rise, that’s the way to be healthy, wealthy and wise. Even if the proverb is pretty old, it is true and good to follow. It is observed that most of the obese people have late sleeping habit and hence they get-up quite late.
8. Milk and other dairy products have substantial amount of proteins, fats and carbohydrates. These nutrients get converted to fats easily if the body has excess of storage. In short, better to be vegan for slimming.
9. Human body is created by the creator of nature for consuming vegetarian food only. After in-depth study of human physiology, it is evident that man is born to be herbivorous. If at all you are fond of Non-vegetarian food, consume it in moderation, once or maximum twice in a week and that too only during lunch.
10. Sedentary lifestyle is yet another cause of obesity. Keep working, be active, avoid laziness in life which will keep you healthy and fit.
11. Sleeping during day time is extremely unhealthy. It is not only bad for obesity but can lead to many other health complications.
12. The sense of fullness of stomach is signaled by the brain and hence the brain gives the instructions to the body to stop taking food. This sensation is passed on by the hypothalamus of the brain after about 10 to 15 minutes of the capacity of the stomach. Therefore it is good to wait for some time after certain quantity of food intake. The brain will then direct the sense of satiety and prohibit you to accept more food.
13. Form a habit of limited intake. This is especially for those who have the habit for eating huge amount of food. If you gradually reduce your intake, your body will get used to it and then without feeling of weakness, you will succeed in achieving the sense of lightness of the body.
14. There are many controversies about number of intakes in a day. It is a sincere attempt to explain you the right way for better health. Do not keep starving more than a time span of 8 hours and avoid repeat food intake within 4 hours after initial intake.
15. Little but regular exercise is most important rather than performing rigorous exercise for body building. It is observed that apparently healthy and muscular people (those who are keen on body building) have low immunity. They have weak bones and even minor accidents can cause fractures very soon in them. Their intellectual excellence is also seldom seen. They suffer from frequent digestive upsets with negligible changes in food habits. The reason is that the nutritional constituents are utilized by the muscular tissue and other systems in the body remain unattended and remain undernourished. Whereas, individuals performing little but regular exercise have better health profile.
Last but not the least, one should understand that medicines contribute only 5% to health but good diet and regular exercise contributes 95%. Hence it is irrational to depend on medication for health concerns, whether synthetic modern medicines, homoeopathic, Ayurvedic or any other branch of medicine in the world. Ayurveda has identified many such formulations and the summary of the studies is mentioned in the original texts of Ayurveda. Modern research is simply trying to find the mode of action of the herbs and then get a satisfaction of a step of achievement. It is rather impossible for the most sophisticated research laboratories in the world to recognize that how Ayurvedic scientists of the then time would have conducted research activities and gathered such a treasury of knowledge for mankind.

Author
Dr. Santosh Jalukar


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Sep30
Hip resurfacing- a viable alternative to hip replacement
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Hip Resurfacing is Viable Alternative to Hip Replacement
Patients who had hip resurfacing surgery, such as the Birmingham Hip Resurfacing technique, reported a better quality of life, less pain and greater satisfaction a year after surgery.

Patients who had hip resurfacing surgery, such as the Birmingham Hip Resurfacing technique, reported a better quality of life, less pain and greater satisfaction a year after surgery than those who had a total hip replacement, according to a study presented at the American Academy of Orthopedic Surgeons (AAOS) 2009 Annual Meeting.

The study was based on data on the outcomes of 214 total hip replacement patients and 132 hip resurfacing patients that was recorded in a joint registry maintained at a single surgeon’s practice from 2003-2006. Orthopedic surgeon Dr. Elizabeth Anne Lingard of Freeman Hospital in Newcastle Upon Tyne, England, was the study’s lead researcher.

Each patient enrolled in the study completed a questionnaire preoperatively and one year after surgery. The questionnaire included the Western Ontario and MacMaster Universities Osteoarthritis Index (referred to as WOMAC, it is a 24-item questionnaire that is completed by the patient and focuses on joint pain, stiffness and loss of function related to osteoarthritis of the knee and hip) and the SF-36, a self-report questionnaire completed by the patient that measures health-related quality of life (and generates 8 subscales: physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role-limitations due to emotional problems, and mental health; and 2 summary scores: physical component and mental component). The patients also completed a questionnaire regarding satisfaction with their procedures and outcomes one year after surgery.

The study showed that one year after surgery both groups of patients experienced significant improvements in WOMAC and SF-36. Hip-resurfacing patients, however, posted significantly higher WOMAC scores for decreased pain symptoms. When asked about patient satisfaction with the surgery, a greater number of hip-resurfacing patients said they were satisfied with their ability to perform functional activities after surgery.

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For more information:
Keywords: hip resurfacing, hip replacement, joint replacement, orthopedic surgery, minimally invasive surgery
Dr.A.K.Venkatachalam, Consultant Orthopedic surgeon at the Madras Joint Replacement center opines that hip resurfacing allows excellent range of movements with least incidence of dislocation in males younger than 60 years. While choosing female patients who demand hip resurfacing, one has to be more selective says the surgeon. Females with small femoral head circumference less than 44 mm had a higher risk of complications like femoral neck fracture. Therefore female patients with large bone size in the appropriate age group with good bone density are also suitable candidates for Hip resurfacing.

Dr.A.K.Venkatachalam, consultant Orthopedic suregeon
Madras Joint Replacement center
Chennai, India
http://www.hipsurgery.in


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Sep30
New knee for Young patients introduced in India.
A new knee implant that promises longevity and functional movements just like a normal knee is now the trend. The JOURNEY Knee in Oxinium was introduced in India by Dr. A.K.Venkatachalam, consultant orthopedic surgeon in Chennai recently. The first patient to receive bilateral Oxinium Journey replacements was a 38 year old lady suffering from crippling Rheumatoid arthritis.
The innovative JOURNEY anatomical knee system is designed to move and feel like a normal knee, and addresses problems still found in conventional systems such as instability and limited flexion. The JOURNEY System offers the additional durability of Smith & Nephew's proprietary alternate-bearing surface, OXINIUM* oxidized zirconium.

The system is described as "bi-cruciate stabilized" because unlike conventional knee systems, this implant design replicates the functions of both the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). These ligaments provide stability and support for the knee, but are frequently removed during knee replacement surgery.

The surgical technique is similar to other knee procedures but is much more exacting and the JOURNEY system's newly designed instruments allow for both minimally invasive surgery (MIS) and computer assisted surgery (CAS). Dr.Venkatachalam received special training for this abroad.

This knee was developed after Smith & Nephew conducted in-depth analyses of natural knee kinematics and the inherent limitations in knee replacement systems. The JOURNEY knee system offers more sizing options for better fit and minimal bone resections. Smaller sizing choices that are more amenable to female anatomy make the JOURNEY system the obvious choice to achieve the best fit for all patients. Surgeons believe the JOURNEY knee will offer patients a more natural feeling knee implant and greater satisfaction.

"The JOURNEY Knee System is well suited for high demand, or young & active patients. One finds that many patients seeking a knee replacement are in their forties and fifties. This knee implant is highly recommended for this group of patients. Also more elderly patients in need of a knee replacement will also experience a near normal feeling with this knee in activities like coming downstairs. They will not feel the slight instability which is common with other knee systems.
Journey knee is the only knee replacement on the market that offers patients more natural movement and function, and provides surgeons with an answer to the challenges of current total knee systems." says Dr.A.K.Venkatachalam.

About OXINIUM* Oxidized Zirconium

OXINIUM material is a unique and advanced bearing product technology created through a proprietary manufacturing process that transforms the surface to a ceramic, resulting in a material that incorporates the best features of ceramic and metal while avoiding the limitations associated with either material. OXINIUM material is a revolutionary technology used in the production of components of knee and hip implants that exhibits superior performance characteristics due to its hardness, low-friction and resistance to roughening and abrasion.

The author Dr.Venkatachalam is a consultant Orthopedic surgeon in India and has introduced the Journey knee in India.
Visit http://www.kneeindia.com


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Sep30
Knee surgery in India
Medical tourism has been growing in popularity as medical costs in America soar without an accordant rise in income or insurance benefits. Many who don’t have insurance or who have conditions that won’t be covered by their insurance are left with few options when a procedure becomes necessary: go into debt or seek treatment elsewhere. More and more people are choosing the second option, as facilities around the world are offering high quality health care at reasonable prices. For those who need a knee replacement, having surgery in India can be a way to get the operation needed to restore mobility while not draining savings and putting patients in debt. Here are just a few of the top reasons why having the procedure done in an Indian hospital can be a smart choice.

• Lower cost. The average cost of a knee replacement surgery in the U.S. is a staggering $53,000—much more than most families have on hand. In India, the same surgery would only cost around $9,200. That’s a huge difference in price, one that many families struggling to pay medical costs can appreciate.
• You can go through a larger company. Going to have surgery in a foreign country doesn’t have to be an ordeal. There are a wide range of companies out there that will make all the flight, operation, and housing arrangements for you and even schedule tours, get you interpreters and all the other necessities.
• It can be a vacation as well. Depending on your health, you may be able to do a little sightseeing while you’re overseas as well, letting you not only tend to your health but to see another part of the world and experience a whole different culture.
• High quality care. Many people worry that when going abroad that they won’t receive the same quality of care as at home. India has some of the premier medical facilities in the world, great surgeons and a hand in creating some of the newest technologies used in the medical field today. The standard of care is just as high as that in the U.S., so patients can rest assured that they will be well take care of.
• Even American doctors go for it. It’s not just normal people who are heading overseas to get new knees. Even some American doctors have made the journey to get their knee replacements done, citing lower costs and quality of care as their main reasons for doing so.
• Follow up afterwards. You won’t just be left out in the cold after your surgery. Most medical tours arrange for a sufficient recovery period and for check ups with a doctor back home once you return.

The author is a consultant Orthopedic surgeon in Chennai and offers affordable Joint replacements for Indian and overseas patients.
Visit http://www.kneeindia.com


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Sep23
Low grade astrocytomas- brain tumour
Background

Astrocytomas are CNS neoplasms in which the predominant cell type is derived from an immortalized astrocyte. Two classes of astrocytic tumors are recognized—those with narrow zones of infiltration (eg, pilocytic astrocytoma, subependymal giant cell astrocytoma, pleomorphic xanthoastrocytoma) and those with diffuse zones of infiltration (eg, low-grade astrocytoma, anaplastic astrocytoma, glioblastoma). Members of the latter group share various features, including the ability to arise at any site in the CNS, with a preference for the cerebral hemispheres; clinical presentation usually in adults; heterogeneous histopathological properties and biological behavior; diffuse infiltration of contiguous and distant CNS structures, regardless of histological stage; and an intrinsic tendency to progress to more advanced grades.

Numerous grading schemes based on histopathologic characteristics have been devised, including the Bailey and Cushing grading system, Kernohan grades I-IV, World Health Organization (WHO) grades I-IV, and St. Anne/Mayo grades 1-4. Regions of a tumor demonstrating the greatest degree of anaplasia are used to determine the histologic grade of the tumor. This practice is based on the assumption that the areas of greatest anaplasia determine disease progression.

This chapter focuses on the widely accepted WHO grading scheme that relies on assessments of nuclear atypia, mitotic activity, cellularity, vascular proliferation, and necrosis. WHO grade I corresponds to pilocytic astrocytoma, WHO grade II corresponds to low-grade (diffuse) astrocytoma, WHO grade III corresponds to anaplastic astrocytoma, and WHO grade IV corresponds to glioblastoma multiforme (GBM). This article is confined to low-grade and anaplastic astrocytomas. GBM and pilocytic astrocytoma are not discussed in this article
Pathophysiology

Regional effects of astrocytomas include compression, invasion, and destruction of brain parenchyma. Arterial and venous hypoxia, competition for nutrients, release of metabolic end products (eg, free radicals, altered electrolytes, neurotransmitters), and release and recruitment of cellular mediators (eg, cytokines) disrupt normal parenchymal function. Elevated intracranial pressure (ICP) attributable to direct mass effect, increased blood volume, or increased cerebrospinal fluid (CSF) volume may mediate secondary clinical sequelae. Neurological signs and symptoms attributable to astrocytomas result from perturbation of CNS function. Focal neurological deficits (eg, weakness, paralysis, sensory deficits, cranial nerve palsies) and seizures of various characteristics may permit localization of lesions.

Infiltrating low-grade astrocytomas grow slowly compared to their malignant counterparts. Doubling time for low-grade astrocytomas is estimated at 4 times that of anaplastic astrocytomas. Several years often intervene between the initial symptoms and the establishment of a diagnosis of low-grade astrocytoma. One recent series estimated the interval to be approximately 3.5 years. The clinical course is marked by a gradual deterioration in one half of cases, a stepwise decline in one third of cases, and a sudden deterioration in 15% of cases. Seizures, often generalized, are the initial presenting symptom in about one half of patients with low-grade astrocytoma.

For patients with anaplastic astrocytomas, the growth rate and interval between onset of symptoms and diagnosis is intermediate between low-grade astrocytomas and glioblastomas. Although highly variable, a mean interval of approximately 1.5-2 years between onset of symptoms and diagnosis frequently is reported. Compared to low-grade lesions, seizures are less common among patients with anaplastic astrocytomas. Initial presenting symptoms most commonly are headache, depressed mental status, and focal neurological deficits..
Mortality/Morbidity

Morbidity and mortality, as defined by the length of a patient's history and the odds of recurrence-free survival, are correlated most highly with the intrinsic properties of the astrocytoma in question. Typical ranges of survival are approximately 10 years from the time of diagnosis for pilocytic astrocytomas (WHO grade I), more than 5 years for patients with low-grade diffuse astrocytomas (WHO grade II), 2-5 years for those with anaplastic astrocytomas (WHO grade III), and less than 1 year for patients with glioblastoma (WHO grade IV).
Race

Although genetic determinants are recognized in astrocytoma development and progression, astrocytomas do not differ intrinsically in incidence or behavior among racial groups. Demographic and sociological factors, such as population, age, ethnic attitude toward disease, and access to care, have been reported to influence measured distributions.
Sex

No clear sex predominance has been identified in the development of pilocytic astrocytomas. A slight male predominance, with a male-to-female ratio of 1.18:1 for development of low-grade astrocytomas, has been reported. A more significant male predominance, with a male-to-female ratio of 1.87:1 for the development of anaplastic astrocytomas, has been identified.
Age

Most cases of pilocytic astrocytoma present in the first 2 decades of life. In contrast, the peak incidence of low-grade astrocytomas, representing 25% of all cases in adults, occurs in people aged 30-40 years. Ten percent of low-grade astrocytomas occur in people younger than 20 years; 60% of low-grade astrocytomas occur in people aged 20-45 years; and 30% of low-grade astrocytomas occur in people older than 45 years. The mean age of patients undergoing a biopsy of anaplastic astrocytoma is 41 years.
History

The type of neurological symptoms that result from astrocytoma development depends foremost on the site and extent of tumor growth in the CNS. Reports of altered mental status, cognitive impairment, headaches, visual disturbances, motor impairment, seizures, sensory anomalies, or ataxia in the patient's history should alert the clinician to the presence of a neurological disorder and should indicate a requirement for further studies. In this event, radiographic imaging, such as CT scan and MRI (with and without contrast), is indicated. Astrocytomas of the spinal cord or brainstem are less common and present with motor/sensory or cranial nerve deficits referable to the tumor's location.
Physical

* A detailed neurological examination is required for the proper evaluation of any patient with an astrocytoma. Because these tumors may affect any part of the CNS, including the spinal cord, and may spread to distant regions of the CNS, a thorough physical examination referable to the entire neuraxis is necessary to define the location and extent of disease.
* Special attention should be paid to signs of increased ICP, such as headache, nausea and vomiting, decreased alertness, cognitive impairment, papilledema, or ataxia, to determine the likelihood of mass effect, hydrocephalus, and herniation risk. Localizing and lateralizing signs, including cranial nerve palsies, hemiparesis, sensory levels, alteration of deep tendon reflexes (DTRs), and the presence of pathological reflexes (eg, Hoffman and Babinski signs), should be noted. Once neurological abnormalities are identified, imaging studies should be sought for further evaluation.
Causes

* The etiology of diffuse astrocytomas has been the subject of analytic epidemiological studies that have yielded associations with various disorders and exposures. With the exception of therapeutic irradiation and, perhaps, nitroso compounds (eg, nitrosourea), the identification of specific causal environmental exposures or agents has been unsuccessful.
* Children receiving prophylactic irradiation for acute lymphatic leukemia (ALL), for example, have a 22-fold increased risk of developing CNS neoplasms in WHO grade II, III, and IV astrocytomas, with an interval for onset of 5-10 years. Furthermore, irradiation of pituitary adenomas has been demonstrated to carry a 16-fold increased risk of glioma formation.
* Evidence exists for genetic susceptibility to glioma development. For example, familial clustering of astrocytomas is well described in inherited neoplastic syndromes, such as Turcot syndrome, neurofibromatosis type 1 (NF1) syndrome, and p53 germ line mutations (eg, Li-Fraumeni syndrome).
* Biological investigation has implicated that mutations in specific molecular pathways, such as the p53-MDM2-p21 and p16-p15-CDK4-CDK6-RB pathways, are associated with astrocytoma development and progression. In addition, inherited elements of the immune response known as human leukocyte antigens (HLA) have been both positively and negatively associated with an increased risk for the development of glioblastoma multiforme.
* Recently, attempts have been made to determine prognosis and response to various treatment modalities based on the individual pattern of genetic changes in a particular patient. For example, patients with oligodendrogliomas that exhibit chromosomal changes at band 1p19q are known to have improved responses to the procarbazine, CCNU, vincristine (PCV) regimen of chemotherapy. Efforts are underway to identify similar unique susceptibilities associated with other commonly altered genes and proteins in astrocytomas. Other groups are working on developing models that will
Lab Studies

* No laboratory studies diagnostic of astrocytoma currently exist. Baseline laboratory studies, including Chem 7, CBC, prothrombin time (PT), and activated partial thromboplastin time (aPTT), may be obtained for general metabolic surveillance and preoperative assessment.

Imaging Studies

* CT scans and MRI (with and without contrast) are helpful in the diagnosis, grading, and pathophysiological evaluation of astrocytomas. MRI is considered the criterion standard, but a CT scan may be useful in the acute setting or when MRI is contraindicated.
* On a CT scan, low-grade astrocytomas appear as poorly defined, homogeneous, low-density masses without contrast enhancement. However, slight enhancement, calcification, and cystic changes may be evident early in the course of the disease. In cases where a cortically based enhancing mass is discovered, particularly in cases where multiple lesions are identified, the possibility of metastatic disease must be considered. Systemic imaging, generally consisting of a contrast-enhanced CT scan of the chest, abdomen, and pelvis, may be warranted to evaluate for the possibility of an alternate primary lesion.
* Similarly, anaplastic astrocytomas may appear as low-density lesions or inhomogeneous lesions, with areas of both high and low density within the same lesion. Unlike low-grade lesions, partial contrast enhancement is common.
* Astrocytomas generally are isointense on T1-weighted images and hyperintense on T2-weighted images. While low-grade astrocytomas uncommonly enhance on MRI, most anaplastic astrocytomas enhance with paramagnetic contrast agents. New methods are being developed to assess tumor vascularity by MRI, including techniques such as arterial-spin labeling (ASL) and dynamic contrast-enhanced MRI.
* Angiography may be used to rule out vascular malformations and to evaluate tumor blood supply. A normal angiographic pattern or a pattern consistent with an avascular mass that displaces normal vessels usually is observed
Other Tests

* Because seizure activity often is associated with astrocytomas, EEG may be employed to evaluate and monitor epileptiform activity.
* Radionuclide scans, such as positron emission tomography (PET), single-photon emission tomography (SPECT), and technetium-based imaging, can permit study of tumor metabolism and brain function. PET and SPECT may be used to distinguish a solid tumor from edema, to differentiate tumor recurrence from radiation necrosis, and to localize structures.
* Metabolic activity determined by radionuclide scans can be used to determine the grade of a lesion. Hypermetabolic lesions often correspond to higher-grade tumors.
* ECG and chest radiographs are indicated to evaluate operative risk.

Procedures

* A lumbar puncture (LP) in patients with cerebral astrocytomas should be approached with extreme caution because of the risk of downward cerebral herniation secondary to elevated ICP. Although CSF studies are not employed in the diagnosis of astrocytomas, they may be employed to rule out other possible diagnoses, such as metastasis, lymphoma, or medulloblastoma.

Histologic Findings

Four histological variants of low-grade astrocytomas are recognized—protoplasmic, gemistocytic, fibrillary, and mixed.

1. Protoplasmic astrocytomas generally are cortically based, with cells containing prominent cytoplasm. Protoplasmic astrocytomas constitute approximately 28% of infiltrating astrocytomas.
2. Gemistocytic astrocytomas generally are found in the cerebral hemispheres in adults and are composed of large round cells with eosinophilic cytoplasm and eccentric cytoplasm. Gemistocytic astrocytomas constitute 5-10% of hemispheric gliomas.
3. Fibrillary astrocytomas, the most frequent histological variant, resemble cells from the cerebral white matter and are composed of small, oval, well-differentiated cells. The tumors are identified by a mild increase in cellularity and fibrillary background. Markers for glial fibrillary acidic protein (GFAP) are
Staging

Staging is not performed or described for patients with astrocytoma. The histologic grade of the tumor is of primary importance when determining prognosis. Unlike other systemic tumors, distant or extracranial metastasis of astrocytomas is exceedingly rare. Clinical decline and tumor-associated morbidity and mortality are almost always associated with local mass effects on the brain by a locally recurrent intracranial tumor.
Surgical Care

The roles of surgery in the patient with astrocytoma are to (1) remove or debulk the tumor and (2) provide tissue for histological diagnosis, permitting tailoring of adjuvant therapy and assessment of prognosis. A stereotactic biopsy is a safe and simple method for establishing a tissue diagnosis. The use of stereotactic biopsy can be limited by sampling error and the risk of biopsy-induced intracerebral hemorrhage. Diversion of CSF by external ventricular drain (EVD) or ventriculoperitoneal shunt (VPS) may be required to decrease ICP as part of nonoperative management or prior to definitive surgical therapy if hydrocephalus is present.

Total resection of astrocytoma is often impossible because the tumors often invade into eloquent regions of the brain and exhibit tumor infiltration that is only detectable on a microscopic scale. Therefore, surgical resection only provides for improved survival advantage and histological diagnosis of the tumor rather than offering a cure. However, craniotomy for tumor resection can be performed safely and is generally undertaken with the intent to cause the least possible neurological injury to the patient.
Consultations

* A neurologist should be consulted to document a patient's detailed neurological examination. This establishes a baseline and partly assesses the possibility of occult disease. Employing multiple modalities, the neurologist must correlate symptomatology with anatomic and functional imaging. This physician also may manage antiepileptic medication for patients manifesting seizures.
A neurooncologist may be consulted to help coordinate a comprehensive therapeutic plan. Once a histological diagnosis is determined, the neurooncologist should be consulted to provide comprehensive adjunctive therapy, including the use of chemotherapy and radiation.

Activity

* No broad restrictions on activity are prescribed, other than those dictated by the nature and the extent of neurological symptoms and disability.
* Seizures, if uncontrolled, may preclude driving.
* Physical and occupational therapy may be required for recovery of full or partial function.
Further Inpatient Care

* Management of low-grade astrocytomas is controversial. The tumors may be radiographically stable and clinically quiescent for long periods after the initial presentation.
* Therapeutic options include observation, radiation, and resection with and without radiation. Unless an astrocytoma is resected completely, radiation therapy should be considered.
* In higher-grade lesions, even if gross total resection is confirmed radiographically, postoperative radiation is indicated because microscopic disease remains.
* If no resection is undertaken and radiation is contemplated, a stereotactic biopsy is recommended to establish the histological grade of the tumor definitively.

Further Outpatient Care

* Patients should consult a neurologist to observe the progression of neurological signs and symptoms and to manage steroid and anticonvulsant regimens.
* Outpatient neurosurgery observation is necessary for tumor monitoring and management of hydrocephalus if a shunt has been placed.
* Postoperative and postirradiation chemotherapy trials using nitrosourea and other agents are likely to benefit patients with malignant astrocytomas, but the benefit for patients with well-differentiated astrocytomas is questionable.
* Frequency of postoperative MRI is determined by both the neurosurgeon and other physicians involved in the ongoing care of the patient, including the neurooncologist and radiation oncologist.
In/Out Patient Meds

* Corticosteroids, antiepileptic agents, and GI prophylaxis should be employed.

Transfer

* If surgery is anticipated, patients should be transferred to institutions with an appropriately equipped and adequately staffed neurosurgical intensive care unit for postoperative monitoring.
* Patients may require extensive or focused postoperative rehabilitation that may necessitate transfer to specialized institutions dedicated to physical and occupational therapy.

Complications

* Although neurological injury (potentially devastating) and death must be mentioned, neurosurgery for astrocytomas is generally intended to decrease tumor bulk while avoiding permanent neurological injury. Transient deficits due to local swelling or injury may occur, but they often improve after a course of physical therapy and rehabilitation.

Prognosis

* Prognosis for survival after operative intervention and radiation therapy can be favorable for low-grade astrocytomas.
* For those patients who undergo surgical resection, the prognosis depends on whether the neoplasm progresses to a higher-grade lesion.
* For low-grade lesions, the mean survival time after surgical intervention has been reported as 6-8 years.
* In the case of anaplastic astrocytoma, symptomatic improvement or stabilization is the rule after surgical resection and irradiation. High-quality survival is observed in 60-80% of these patients. Factors such as youth, functional status, extent of resection, and adequate irradiation affect the duration of postoperative survival.
* Recent reports indicated that irradiation of incompletely resected tumors increased 5-year postoperative survival rates from 0-25% for low-grade astrocytomas and from 2-16% for anaplastic astrocytomas. Furthermore, the median survival rate of patients with anaplastic astrocytoma who undergo both resection and irradiation has been reported to be twice that of patients receiving only operative therapy (5 y vs 2.2 y)..
* Failure to make an appropriate diagnosis of astrocytoma is a pitfall that should be avoided by adhering to a systematic diagnostic approach, including imaging studies and obtaining adequate tissue for analysis.
* Timing of diagnosis is particularly important when lesions abut crucial brain nuclei or eloquent cortex. The extent of lesion resectability may be affected by delay.
* Clear explanation of all therapeutic options and prognosis once a diagnosis is established is essential.


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Sep23
Comprehensive cancer care
In addition to helping patients and their families adjust to and cope with cancer, psychologists act as liaisons to facilitate better commu-nication between patients and doctors, thereby leading to increased involvement in treatment and treatment compliance. Ultimately, this leads to better outcomes. Also, physicians say that psychologists offer assistance to them by providing pharmacotherapy recommen-dations, which emphasizes the need for psychologists to have a background in psychopharmacology. Consultants in Medical Oncology and Hematology report high pa-tient satisfaction, as patients recognize the quality of care they are receiving. Although physicians in the practice value and are committed to financially supporting the inte-grated model, the article notes that not all insurance companies support the psychological component of oncology care. Their hope is to demonstrate value to insurance companies by collecting and presenting data, which will convince insurers to support the practice’s efforts. For more information visit their website: http://www.cmoh.org/Article from APA Monitor on Psychology, “The integrative approach to cancer care,” Volume 32, No. 4, April 2001.
Page 3
Page 3 Spotlight: Obesity Kendra Beitz, Ph.D. This issue features obesity tools. The number of obese adults and children in the United States is on the rise. According to the Center or Disease Control, 64.5 percent of U.S. adults, age 20 years and older, are overweight and 30.5 percent are obese. Given that obesity is such a high prevalence problem associated with a number of health risks (e.g., Type 2 diabetes, coronary artery dis-ease, hypertension, and dyslipidemia, to name a few), it is key health problem to target as part of an overall effort to improve patients’ life-styles. Below are several resources for providers and healthcare consum-ers: • American Obesity Association http://www.obesity.org/s new advances in medicine, treatment, care, and support extend the quality of life and life expectancy of cancer patients, more patients have an equally extended (and mostly unmet) psychological need. At Consultants in Medical Oncology and Hematology, a hospital-based cancer treatment center, patient’semotional and mental health needs were found to be difficult for John Sprandio, MD and his staff to meet, while still maintaining a high level of physical care. Sprandio and his colleagues tried outside resources, such as community support groups, but soon realized the need to integrate psychologists within the medical practice. Therefore, the decision was made to integrate three psychologists into the facility. The benefits of integrated cancer care were soon made apparent. According to John Sprandio, M.D., chief medical oncology and hematology at Delaware County Memorial Hospital, a third to one half of patients intheir practice exhibit emotional problems, including depression and anxiety. The psychologists are able to provide a broad range of ser-vices, including individual, group, and family therapy, within the medical setting. One psychologist noted differences between tradi-tional outpatient mental health and providing services in this setting, for instance seeing patients in the chemotherapy suite instead of in a private office. However, the new providers have learned to adapt tothe ecology of a hospital-based practice, including becoming medi-cally literate to help bridge the gap between patients and providers.


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Sep22
Patellar Secondaries a case report
Patellar Secondaries – A Case Report.
Dr. Hydar Kunnummal, Relief Hospital, Kondotty, Kerala, India.


The skeleton is one of the commonest sites for metastasis. The incidence is probably higher than that recorded. Skeletal metastasis may present with pain localized tenderness or pathological fracture.

The present case, a 55 year old male patient presented with complaints of pain and swelling (Rt) knee following a trivial trauma. Clinically it was diagnosed as haemarthrosis.

As symptoms was not subsided patient again came with same complaints with increase effusion around the knee after 10 days. X-ray was repeated and that shows a lytic area on the anterior aspect of the patella.

On general examination detected a small soft tissue swelling over the left leg. FNAC was done; result came as spindle cell neoplasm, with advice for excision biopsy. HPR results came as Alveolar soft part sarcoma. FNAC from the lesion of the patella is suggestive of secondaries. Patient was send for nuclear study, which also shows secondaries in the patella.

Alveolar soft part sarcoma is highly malignant even though it is a slow growing tumor. Metastasis may be the first manifestation of the disease. Patient usually presented as painless mass, may misdiagnose as haematoma or pulled muscle.

Patellar metastasis is a rare presentation. There have been approximately 20 cases reported in the literature. This may present clinically as septic arthritis or meniscal injuries. Low blood flow to the patella may be the explanation why patellar secondaries are rare.

The aim of this presentation, patellar secondaries may also keep as a differential diagnosis of the knee pain.


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Sep22
Homeopathy For Freckles
Freckles are flat, irregular spots that develop randomly on the skin,
particularly on the cheeks. They vary in color but are always darker than
the normal skin around them. They are more prominent in persons of fair
complexion.
Causes of development
There are many different causes of freckles but one main cause is repeated
and prolonged exposure to sunlight. The exposure increases the production
of pigment melanin that gets deposited in certain areas of the skin making
them look darker but this does not happen to everyone because every person
is not equally sensitive to sunlight. Generally, persons with fair
complexion are more sensitive to sunlight than dark-skinned persons but
this does not mean that all fair-skinned persons are very sensitive or all
dark-skinned persons are completely immune to the effects of sunlight.
Anyone can develop freckles depending on personal sensitivity whatever be
the complexion. Nutritional imbalance and genetic factors may also cause
uneven distribution of pigment melanin resulting in freckles.

Risk factors
Freckles have a great cosmetic value particularly when they are on the
cheeks otherwise they are harmless and pose no danger to general health.
At times, however, they might be mistaken for another skin disease.
Therefore, one should have them checked and evaluated by the dermatologist
to be sure of what the spots are.
Prevention
Freckles are a fair indication of sensitivity of skin to sunburn and other
skin diseases of more serious nature. Those with hereditary tendency
should avoid prolonged and/or repeated exposure to direct sunrays. For
those whose nature of job does not permit this precaution should use
protective sunscreens to reduce the risk.
Treatment
There are plenty of products available in the market for external use,
which can reduce the pigmentation and lighten or even eliminate the
freckles.
There are products that can hide them temporarily but hiding the
freckles is not the answer. They must be treated properly.
Freckles can also be effectively and conveniently treated by internal use
of homeopathic medicines. This is one of those conditions that can be
easily treated in a few weeks.
Some of the commonly used homeopathic
medicines to treat freckles are graphite, kali-carb, lycopodium,
muric-acid, natrum-carb, phosphorus, sepia, sulphur etc.
but you must
consult your homeopath to choose correct medicine, its dose and potency
for you.
for more details do visit at www.skinrenew.in


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Sep19
Elections & Health: Dr. Shriniwas Kashalikar
As a result of deification of democracy, the voters and the candidates, have apparently developed an illusory feeling that elections and democracy are panacea for the cure of all evils. If not, at least we tend to pretend so.

Elections and democracy are actually the means (amongst many others such as study, analysis, experimentation, research, industry, agriculture, craft, business, art, literature, sports, rituals, festivals, conventions, prayers, various techniques of meditation etc); evolved during the development of human civilization. They are meant for ushering in the ambience that would be conducive to individual and global blossoming. They are not the end in themselves.

In as much as it is true that elections and democracy are important means, it is truer that assuming elections and the democracy as the end in themselves and neglecting the other means of global blossoming such as those mentioned above, would be naive and counterproductive.

From immediate practical point of view, isn’t it true and important that we get empowered to vote selflessly and bravely and elect benevolent candidates? Conversely isn’t it true that those who get elected evolve into able and noble individuals (if they are not at present)?

The visionaries have reiterated time and again that; NAMASMARAN i.e. remembrance of; and connection with; the true self; is the source of universally benevolent and empowering inner light. They have insisted and affirmed that it is the basis, essence and culmination of all the means; conducive to individual and global blossoming! Shouldn’t NAMASMARAN be our topmost priority before, during and after elections and irrespective of the stage of evolution of democracy?


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